Legal Setback for NHI Act as Court Stops Implementation Amid Public Participation Challenges

In a significant ruling, the Pretoria High Court has prohibited the Minister of Health and the President from implementing or proclaiming any provisions of the National Health Insurance (NHI) Act until the ongoing challenges to the Act's public participation process are resolved. This court order, which stems from an agreement between the parties, marks a major milestone in the legal battle against the controversial legislation.

The order is a result of a counter-application brought by Sakeliga in October 2025. Sakeliga had argued that the state’s request for a delay in the constitutional challenges to the NHI should not be granted unless the state also committed to not implementing any aspects of the NHI Act during the period of delay. The state, in turn, conceded to this request, resulting in a court-ordered prohibition on the proclamation and implementation of the Act’s provisions.

The court's order enforces three crucial undertakings by the state, aimed at preserving the status quo while the procedural challenges are heard. These undertakings are:

1. Minister’s Pledge: The Minister of Health has committed not to request the President to proclaim any section of the NHI Act until the Constitutional Court rules on the public participation challenges.
2. President’s Pledge: The President has undertaken to refrain from proclaiming any part of the NHI Act pending the Constitutional Court’s judgment on the procedural matters.
3. Non-implementation: The Minister of Health has also committed to not implementing any provisions of the NHI Act or exercising any powers under the Act until the Constitutional Court delivers its verdict.

These commitments effectively halt any further steps towards the operationalisation of the NHI Act for the time being, leaving the law in a state of legal limbo.

This ruling is part of an ongoing, multi-faceted litigation process involving several parties, including healthcare stakeholders, who have expressed concerns about the NHI’s potential implications for the country’s healthcare system. Sakeliga’s counter-application is one of several substantive constitutional challenges currently being litigated. While these challenges are stayed for the time being, they remain a significant part of the legal landscape and will be heard once the Constitutional Court addresses the procedural issues related to public participation.

The court’s ruling follows a broader pattern of legal resistance against the NHI Act, highlighting concerns about the Act's potential to disrupt the healthcare sector, particularly with regard to its implementation process and its costly impact on taxpayers. The court has ensured that the public will not be subject to an “irrational, costly, and harmful policy” while the legal challenges unfold, which could take an unpredictable amount of time.

The next major step in the case comes in May 2026 when the Constitutional Court is set to hear the procedural challenges raised by the Premier of the Western Cape and the Board of Healthcare Funders, which will likely be a key moment in determining the fate of the NHI Act.

For now, the public is protected from any immediate actions by the state to move forward with the NHI Act. However, the legal battle is far from over. Should there be any breach of the state’s commitments, Sakeliga and other parties have the right to approach the court, and further legal proceedings, including contempt charges, could follow.

For healthcare businesses, the ruling represents both a legal victory and a valuable opportunity. With the NHI’s implementation halted, healthcare companies are advised to avoid unnecessary pre-compliance with the Act, instead focusing on value-added operations that contribute to the stability and growth of the sector. This ruling underscores the importance of strategic public-interest litigation in challenging state policies that may have detrimental consequences for industries and the public alike.

Sakeliga’s role in this case highlights the vital function of well-resourced, strategic litigation in safeguarding the public interest, ensuring that policies are thoroughly scrutinised before being enacted. The court’s intervention is a significant check on the executive’s power to impose sweeping policy changes without fully resolving key legal and procedural issues first.

As the legal process continues, all eyes will be on the Constitutional Court’s upcoming hearings in May and the potential for further delays or setbacks for the NHI Act’s implementation.