Western Cape Cabinet approves cmments rejecting NHI Draft Governance Regulations
The Western Cape Cabinet has approved comments from the Provincial Department of Health and Wellness expressing strong objections to the draft governance regulations relating to the implementation of the National Health Insurance (NHI) Fund, published for public comment by the National Minister of Health, Dr Aaron Motsoaledi.
The draft regulations represent the attempted first formal step towards establishing the NHI Fund, effectively centralising all healthcare funding under the national government.
While the Western Cape Government supports the constitutional imperative to realise the provision of universal healthcare, it remains concerned that the NHI model in its current form - will weaken existing healthcare systems and reduce the ability of provinces to deliver responsive and accountable services to residents.
The draft governance regulations provide for detailed matters pertaining to, amongst other things, the appointment of a board and CEO for the NHI fund.
In terms of Section 55(1) of the NHI Act, the National Minister may only make regulations after consulting both the National Health Council—which includes all nine provincial health departments and the national department—and the NHI Fund. Should the Minister make regulations without consulting the fund, the Regulations will be invalid. Should the Minister wish to proceed to issue the draft regulations without consulting the fund, it will first be necessary to amend the act to remove the requirement for consultation with the fund.
The act specifies the matters on which the Minister is empowered to make regulations, however these do not specifically include “Governance” and hence could be ultra vires to the act and invalid.
Inadequate safeguards: the draft regulations grant the national Minister of Health vast powers with regard to the appointment and removal of key role players, without sufficient checks and balances to prevent maladministration with potentially severe consequences for the South African healthcare system and fiscus.
“It is deeply concerning that, despite the far-reaching implications of the NHI for every South African, the very first set of regulations has been published without following the clear procedural requirements outlined in the act itself,” said Mireille Wenger, Western Cape Minister of Health and Wellness. “The draft regulations also serve to confirm our worst fears about the NHI, that it will be a centralised fund lacking sufficient accountability mechanisms which will make it vulnerable to interference and lacking the necessary safeguards.” The Western Cape Government has consistently raised concerns about the implications of the NHI. “A rigid, one-size-fits-all system risks undermining already functional healthcare structures. In contrast, a more flexible model that actually addresses deficiencies in our healthcare system will deliver better outcomes.”
Despite ongoing procedural flaws, substantial objections, and several pending court challenges, the national Department of Health appears intent on proceeding with the implementation of the NHI.
The Western Cape Government will submit its formal written comments on the draft regulations in due course. Members of the public and stakeholders who wish to comment on the draft regulations may do so until 16:00 on 6 June 2025.
Listen to Western Cape Minister of Health and Wellness Mireille Wenger's statement: