South Africa’s largest doctors’ organisation, the South African Medical Association (SAMA), is preparing for fresh talks with Health Minister Aaron Motsoaledi on the future shape of National Health Insurance (NHI). The move follows a public push by Finance Minister Enoch Godongwana for organisations challenging the NHI Act to consider negotiating a settlement, rather than prolonging court battles.
SAMA is one of multiple groups that have taken the NHI Act to court. President Cyril Ramaphosa signed the law in May 2024, but it has not yet been implemented.
National Health Insurance Negotiations Return to The Table
SAMA said it most recently met Motsoaledi on 15 January 2026, on other issues, and both sides agreed to schedule a dedicated engagement focused on NHI.
In its statement, SAMA argued that progress on NHI depends on “meaningful engagement” with government and stakeholders across the health system. It stressed that litigation was a last resort. SAMA said it had tried to influence the policy through parliamentary submissions, petitions to the National Council of Provinces, and direct correspondence with the President, without getting what it considers a meaningful response.
Why SAMA Says Court Action was a Last Resort
The association is positioning its court case as leverage to reopen dialogue, rather than a final attempt to block reform. In its wording, the goal is a “reconfigured NHI” that still delivers universal health coverage but in a way that is financially sustainable and equitable.
That stance matters for healthcare businesses. It signals potential room for negotiation on contested design features, including purchasing arrangements, accreditation rules, and the role of the private sector.
What National Health Insurance Negotiations Mean for Medical Schemes
Godongwana’s intervention has put settlement talks firmly on the agenda. In Parliament, he urged the state and litigants to “meet and craft a settlement”, arguing that drawn-out litigation risks delaying shared goals around universal coverage.
Motsoaledi’s spokesperson, Foster Mohale, said the Minister had noted Godongwana’s comments as a proposal to stakeholders. If necessary, the Minister would engage the Finance Minister through normal government channels, including on funding issues.
However, SAMA’s openness appears to differ from several other challengers. Recent reports indicate that other litigants are sceptical about the state’s willingness to negotiate and show a limited appetite to drop their cases.
At the heart of the dispute is the NHI model itself. The act proposes a central NHI Fund that would purchase services from accredited public and private providers. It also limits medical schemes from covering services that NHI would offer. These provisions are central to industry concern because they affect benefit design, contracting, and the long-term role of schemes and private hospitals.
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