South Africa healthcare law providing free coverage to all dismissed as vote-grabbing stunt

Legal challenges loom as general election set for end of month in country with two-tier healthcare system, a legacy of apartheid era

Medical experts and critics of the ruling African National Congress have labelled a healthcare Bill signed into law by South Africa’s president Cyril Ramaphosa as an electioneering stunt.

Mr Ramaphosa signed the National Health Insurance (NHI) Bill on Wednesday afternoon after a surprise announcement on Monday that it would become law this week.

Numerous medical bodies, political parties and business associations have indicated they will take legal challenges against the Bill, which means it could take years for it to have any impact.

Speaking at the signing event, Mr Ramaphosa said the new law, which will bring the public and private healthcare sectors under a state umbrella, is designed to provide free universal health coverage to all South Africans.


South Africa has a two-tier healthcare system that is a legacy of the apartheid era. According to the government, about 16 per cent of the country’s 60 million citizens avail of private medical care while the rest rely on the public system.

Under the new law, hospitals, doctors, nurses and all health professionals will be paid directly by the state.

Public healthcare is vastly inferior to the private alternative in South Africa, due to inadequate government funding, corruption, mismanagement, poor infrastructure and a lack of medical professionals in the system.

Questions have been raised about how the government will secure the resources needed to adequately fund, roll out, manage and maintain the new system, with many analysts saying it will be extremely difficult to implement.

Mr Ramaphosa insisted his government was “not mad” to sign the Bill into law, saying the financial responsibilities of the new system could be navigated to achieve healthcare equity for all South Africans.

“For those who would like to see those [private medical aid] privileges continuing, sorry, you are on the wrong boat. The boat we are on is about equality,” he told reporters at Union Buildings in Pretoria.

Mr Ramaphosa said the new legislation will be implemented in phases, with the first to be completed by 2026.

South Africa’s medical aid representative body, the Board of Healthcare Funders, has called aspects of the new law “unconstitutional and unlawful”.

Medical workers’ unions have welcomed the move towards universal health coverage, but have raised many concerns about whether the legislation is fit for purpose.

The main opposition party, the Democratic Alliance, called Wednesday’s signing event “a cheap election ploy” designed to prop up voter support for the ANC ahead of general elections on May 29th.

South Africans go to the polls to vote in a new government at national and provincial level, and most surveys indicate the ANC will fall well below the 50 per cent plus one vote threshold it needs to continue its 30 years of rule in the country.

Bill Corcoran

Bill Corcoran

Bill Corcoran is a contributor to The Irish Times based in South Africa