The State concedes to suspending NHI implementation
This concession by the state is the result of a raft of comprehensive litigation against the NHI Act
In a significant development in Sakeliga's case against the National Health Insurance Act (NHI Act), the Pretoria High Court has ordered that the Minister of Health and the President are prohibited from proclaiming or implementing any provision of the NHI Act until the pending public participation challenges against the Act are resolved.
This order emanated from an agreement between the parties and incorporates key provisions of a conditional counter-application that Sakeliga brought in October 2025.
Background
The state applied for a stay (delay) in the substantive constitutional challenges to the NHI while the procedural challenges were heard. Sakeliga’s counter-application argued that a stay in proceedings was not justified, but that if it were to be granted, then for the period of the stay, the state should be prohibited from implementing any aspect of the NHI Act.
This concession by the state and order of the court is the result of a raft of comprehensive litigation against the NHI Act by several parties representing key healthcare stakeholders and constituencies.
The state's commitments
The court order records three important binding undertakings by the state:
The Minister of Health undertakes not to request the President to proclaim any sections of the NHI Act prior to a Constitutional Court judgment in the public participation cases.
The President undertakes not to proclaim any provision of the NHI Act pending those same judgments.
The Minister of Health undertakes not to implement the NHI Act or exercise any powers under that Act pending the Constitutional Court's judgments.
All constitutional challenges to the NHI Act currently before the Pretoria High Court — including Sakeliga's case — are stayed on terms that protect the applicants. Should there be any alleged non-compliance with the undertakings made by the state, any party may approach the court on 48 hours' notice.
Next steps
The Constitutional Court is now scheduled to hear the procedural public participation challenges by the Premier of the Western Cape and the Board of Healthcare Funders from 5 to 7 May 2026.
The length of time required to resolve legal proceedings of this nature is unpredictable. In the event that the procedural cases are drawn out, the public is protected by the prohibition on the state implementing an irrational, costly, and harmful policy.
Sakeliga's and other parties’ substantive constitutional challenges remain alive in full and will be heard once the Constitutional Court has ruled on the procedural matters.
In the meantime, Sakeliga will actively and closely monitor the state's compliance with the court order.
Should either the Minister of Health or the President take any further steps to proclaim or implement any provision of the NHI Act in breach of those commitments and the court order, contempt or other proceedings will ensue.
These developments demonstrate the importance of well-resourced, strategic public-interest litigation in resisting harmful policy and achieving meaningful concessions from the state.
Healthcare businesses should avoid unnecessary pre-compliance with the NHI and take full advantage of further delays and setbacks to the NHI to continue focusing on value-adding healthcare operations.
