In recognition of World Health Day, the Board of Healthcare Funders (BHF) has requested President Cyril Ramaphosa to urgently address a serious legislative flaw in the National Health Insurance (NHI) Act concerning maternal healthcare.
The 2025 World Health Day theme, “Healthy Beginnings, Hopeful Futures,” highlights the critical need to improve maternal and newborn health outcomes across the world. However, this goal is at risk in South Africa due to a provision in the NHI Act (Section 58) that stipulates that the Medical Schemes Act must, with immediate effect, be amended to remove maternity and pregnancy-related services from the cover offered by medical schemes. This change is required to take effect before the NHI is operational, creating a dangerous coverage gap for pregnant medical scheme beneficiaries, of which more than two-thirds come from previously disadvantaged groups.
This is particularly concerning given the existing provision in the National Health Act (NHA), which currently disqualifies medical scheme members from receiving free maternal healthcare services in the public sector. This means that, if the President proclaims the relevant Schedule in the NHI Act operational while the NHA clause remains in place, pregnant women who are members of medical schemes will have to pay out-of-pocket for maternity care (whether they use private or public hospitals).
In 1994, one of the first steps former President Nelson Mandela took when coming into office was announcing free access to healthcare for all pregnant women and children under six years old. This was enshrined in the Bill of Rights three years later in Sections 27 and 28. Yet, the NHI Act will do away with free access to healthcare for millions of pregnant women, many of whom come from lower-income groups.
The BHF raised this issue repeatedly during the public participation process on the NHI Bill including in its formal written submissions. It is deeply concerning that repeated attempts by the BHF to flag what is believed to be a drafting error, with far-reaching implications, were ignored when the Bill was passed in Parliament and then signed into law by the President.
This issue is not an isolated case; rather, it reflects the broader challenges of a hasty and flawed legislative process behind the passage of the NHI Bill. It underscores the BHF’s deeper concerns regarding the unconstitutionality, impracticality, and unsustainability of the NHI Act in its current form.
We have consistently cautioned that the Act, in this form, is unlikely to achieve the goal of equitable healthcare access and, instead, threatens to destabilise existing services without a viable alternative in place.
Further compounding these concerns is the Minister of Health’s recent publication of draft regulations under the NHI Act, despite it not having been fully promulgated and being the subject of ongoing constitutional challenges.
This includes the BHF’s court challenge, which requests the court to review and set aside President Ramaphosa’s decision to sign the Bill into law. We maintain that the President was obligated by section 79(1) of the Constitution to refer the Bill back to the National Assembly for reconsideration due to the clear reservations expressed regarding the constitutionality of the Bill.
There is a possibility that the NHI Act will never be rolled out should current court challenges against it be successful. However, in light of government forging ahead with the implementation of the Act, we believe it is important that the President addresses the current and urgent flaw in Section 58. The BHF has therefore written to the President asking that he does not proclaim an effective date for the amendment to the Medical Schemes Act, ensuring that maternity and pregnancy-related services remain accessible to women until the NHI Act is fully implemented. It is critical that he intervenes decisively to delay this harmful amendment before irreversible damage is done.
The BHF reaffirms its commitment to the vision of universal health coverage and working in partnership with government to progress towards this goal. However, we maintain that collaboration between the private and public healthcare sectors is the only way to achieve equitable access for all South Africans.
About the Board of Healthcare Funders:
The Board of Healthcare Funders (BHF) is a non-profit company that works in the best interest of an effective and sustainable healthcare for all. It represents members in seven countries across Africa. For more information on the BHF and its members, please visit: https://bhfglobal.com
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Bianca Capazorio
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Tracè Venter