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Motsoaledi sticks to his guns on NHI while Steenhuisen confident of redraft

Motsoaledi sticks to his guns on NHI while Steenhuisen confident of redraft
The NHI Act is central to the ANC’s goal of universal health coverage. However, it is proving to be a sticking point among members of the Government of National Unity. (Photo: Rosetta Msimango / Spotlight)
Nonkululeko Njilo
By Nonkululeko Njilo
7 Feb 2025
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While President Cyril Ramaphosa says preparatory work to roll out the NHI will begin this year, a number of stakeholders appear confused over whether a deal has been reached to protect medical aid schemes.

A compromise appears to have been reached between the ANC and DA, the two largest parties in the 10-party Government of National Unity (GNU), to amend a section of the National Health Insurance Act to protect medical aid schemes.

With the preparatory work for the rollout of the NHI expected to begin this year, as announced by President Cyril Ramaphosa in his State of the Nation Address (Sona) on Thursday, 6 February, some government officials seem unaware of the apparent compromise or are simply dissatisfied with it. Business Leadership SA, meanwhile, remains sceptical and Cosatu demands full implementation. 

While delivering the crucial address for the seventh administration on Thursday, Ramaphosa reaffirmed the government’s commitment to improvements to healthcare access and infrastructure. 

“The NHI will reduce inequalities in healthcare by ensuring everyone gets fair treatment,” he said. 

“It will save many lives by providing a package of services that includes maternal and newborn care and treatment for people living with HIV, tuberculosis and non-communicable diseases such as heart disease, cancer and diabetes.”  

The remarks followed a News24 report in which Planning, Monitoring and Evaluation Minister Maropene Ramokgopa said that the ANC and DA had come to an informal agreement that the government would not collapse medical aid schemes and that a ministerial advisory council would be established.

Ramokgopa told the publication that the agreement was reached during last week’s Cabinet lekgotla after she and Minister of Health Aaron Motsoaledi met with DA leader John Steenhuisen, who also holds the position of agriculture minister.

GNU confusion


On the sidelines of Sona, meanwhile, Motsoaledi came out guns blazing, saying he was not aware of such an agreement.

“The only thing I am aware of is what is in the Act, not what any other person has said.  

“The Act clearly says when NHI is in full operation, medical aids will be complementary and to be honest, they are already playing a complementary role, meaning that whatever the NHI is able to pay for, they cannot duplicate it because if you duplicate healthcare services and expenditure, the country will spend much more on health than any other country on earth,” Motsoaledi said.  

Meanwhile, Steenhuisen confidently confirmed a deal had been struck. 

“I expect that the NHI Act will have to have some of its provisions redrafted. This is a compromise that has been reached,” Steenhuisen told journalists on the sidelines of Sona, threatening once again to walk out of the GNU should this not be the case. 

“We will not be part of the destruction of the private medical aids. If that does happen then we cannot be part” of the unity government, he said.  

Read more: Everything you ever wanted to know about the NHI but were afraid to ask

Unions want NHI as is 


NHI scenarios The NHI Act is central to the ANC’s goal of universal health coverage. However, it is proving to be a sticking point among members of the Government of National Unity. (Photo: Rosetta Msimango / Spotlight)



It is not only Motsoaledi who appears to be in the dark about the deal, but also the ANC’s alliance partner Cosatu, which is calling for the full implementation of the Act in its current form.

Cosatu president Zingiswa Losi rallied behind Ramaphosa’s announcement on the rollout of the legislation, adding it was important now more than ever. 

Asked about the deal between the ANC and DA, Losi could not be drawn to speculate.

“What I know is what is in the Act. What other people are discussing outside, I am not privy to that, but as Cosatu, we want to see the implementation as is.

“We understand that we are not going to wake up tomorrow with a full National Health Insurance being implemented, so we understand that, but what we are happy about in this Sona is that he has been able to make that emphasis that it is not going to go away. 

“We cannot continue in this trajectory, where millions of South Africans, the poorest, must be subjected to long queues as early as 4am with some still leaving the facilities without being attended to,” Losi said.

Read more: NHI, housing, employment and education — What Ramaphosa got right and where he fell short

The ANC’s first deputy secretary-general, Nomvula Mokonyane, admitted differences over sections of NHI persisted between her party and some GNU partners, such as the DA. She was, however, optimistic they would soon be ironed out.  

“I think we are going to find each other in the process.”

Quizzed about the issue of medical aids and whether or not a deal had been struck, she said: “People must be given options, we can’t be prescriptive.” Her statement seems to support remarks reportedly made by Ramokgopa, a former adviser and close ally of Ramaphosa. 

Meanwhile, Zola Saphetha, the secretary-general of the National Education, Health and Allied Workers’ Union, condemned what he said was “recent misinformation” about the NHI, urging the government to immediately forge ahead with its full implementation. 

“We no longer want to hear about preparatory steps, while over 56,000 people die of tuberculosis annually. We want to see the President act decisively in promulgating the Act into law and ensuring full implementation of NHI, as guided by Section 57 of the NHI Act.

“We once again reiterate that the state’s current macroeconomic and fiscal policy continues to directly undermine the implementation of NHI,” Sapetha said.

Presidency spokesperson, Vincent Magwenya, said Ramaphosa was committed to ironing out differences within his administration over the NHI and suggested he would be “entirely surprised” if an agreement was to be reached in that regard.

Concerns and challenges


Several industry bodies representing healthcare workers and the business sector have expressed their intention to challenge the legislation once it is implemented.

Business Leadership SA CEO Busi Mavuso has highlighted the lack of clarity on how the NHI, the government’s plan for universal health coverage, will be funded, saying that the organisation cannot support it without this critical information.  

Mavuso also expressed concern about the potential permanent withdrawal of Pepfar by former US President Donald Trump, warning that South Africa would likely face increased fiscal pressures as a result. 

Asked about the impact of the withdrawal of Pepfar and whether SA has a plan should indeed the funding for HIV/Aids treatment be permanently withdrawn, Motsoaledi told Daily Maverick: “Of course we are concerned, but we are working on a plan.”

The government’s most immediate priority is to strengthen the health system and improve its quality, Ramaphosa said. 

“A vital part of this is the modernisation, improvement and maintenance of existing health facilities and construction of new hospitals and clinics. A number of hospitals are under construction or undergoing revitalisation.”  

He mentioned the Limpopo Central Hospital and the Siloam District Hospital in Limpopo, the Dihlabeng Regional Hospital in Free State, the Bambisana District Hospital and Zithulele District Hospital in Eastern Cape, and the Bophelong Psychiatric Hospital in North West.  

The implementation and possible success of the NHI in South Africa remains uncertain. There are many reasons for scepticism, including the risks of corruption and mismanagement, as well as the ongoing challenges within the public healthcare system. DM

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