High Court on South African National Health Insurance Bill

By Danélia Botes

March 1, 2024


In an intriguing case that unfolded on 29 February 2024 in the High Court of South Africa, Gauteng Division, Pretoria, Solidarity, a trade union, brought forward a challenge against the Minister of Health and other government respondents. The case, presided over by Judge Unterhalter, revolved around the South African National Health Insurance Bill (the Bill) and the proposed National Health Insurance Fund (NHI Fund), a key element of the Bill.

The Controversy Surrounding the South African National Health Insurance Bill

Solidarity contested five decisions, which, they asserted, were prematurely taken to operationalise the NHI Fund before the Bill was enacted into law. They argued that such actions were unlawful, irrational, and infringed upon the constitutional principle of separation of powers.

The Ultra Vires Challenge

Solidarity’s primary contention was that the decisions to create organisational capacity for the NHI Fund were tantamount to implementing the Bill before its legal enactment, thus exceeding the executive’s legal powers (ultra vires). The court, however, held a different view. It ruled that the decisions were part of prudent planning for anticipated legislative changes, not an implementation of the Bill. 

The Misrepresentation Challenge

Solidarity claimed that the Health Minister misrepresented facts to secure approval from the Minister of Public Service and Administration (PSA Minister). They alleged that the Minister falsely stated the Treasury had already allocated funds for establishing the NHI Fund. However, the court decided this representation was not false, but premature. This conclusion came because the Treasury did approve the fund transfer shortly after the PSA Minister agreed.

The Court’s Decision

Upon thorough examination, the court concluded that Solidarity’s application lacked merit and dismissed it without an order of costs. The court confirmed the government’s preparatory actions for the NHI Fund as legal, based on the expectation of the Bill becoming law. They differentiated these actions from the early implementation of the Bill itself.


The High Court’s decision to dismiss Solidarity’s application strengthens the executive’s right to plan for legislative changes, but within the Constitution’s limits. The judgement highlights a sophisticated understanding of the separation of powers. It makes sure that while the executive can plan for future policies, it shouldn’t cross into legislative enactment. This decision establishes a precedent for balancing government efficiency and constitutional compliance. It allows the executive to responsibly plan for the changes in national healthcare policy.

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