President Cyril Ramaphosa has formally undertaken not to promulgate any provisions of the National Health Insurance Act until the Constitutional Court has handed down judgment in two pending “public participation challenges”.
In a letter dated 20 February 2026, the Office of the State Attorney, acting for the President, confirmed that “in order to ensure the orderly procedural conduct of the pending challenges and to avoid parallel proceedings overlapping”, the President undertakes not to promulgate any provisions of the Act before judgment is delivered in those matters.
The undertaking is expressly linked to:
- An application brought by the Board of Healthcare Funders (BHF), in which the President is cited as the fourth respondent.
- A matter brought by the Western Cape Government, in which the President is not cited as a party.
The Constitutional Court has set the public participation challenges down for hearing from 5 to 7 May and has issued directions regarding further pleadings and written submissions.
In the first case, Ramaphosa is appealing a High Court ruling issued last May that ordered him to provide the full record of the decision to the BHF. In the second, the Western Cape Government argues that the public participation process to pass the NHI was flawed, because it was rushed through the National Council of Provinces.
The President’s letter was addressed to the attorneys representing seven applicants challenging aspects of the NHI process: BHF, Health Funders Association, Hospital Association of South Africa, Sakeliga, Solidarity, South African Medical Association, and South African Private Practitioners Forum.
The letter records that Health Minister Aaron Motsoaledi had, on 19 February, undertaken not to request the President to promulgate any sections of the Act pending the Constitutional Court’s determination of the two matters.
The State Attorney reiterated this was consistent with the President’s previously stated position that he would not bring the Act into operation unless requested to do so by the Minister. It added that the President “does not act in isolation” in determining whether to bring legislation into effect, and that such a decision is influenced by the readiness of the responsible department – “with particular force in respect of legislation with the scope of the NHI Act”.
The letter concludes by stating that the President’s rights remain reserved.
The NHI Act was signed into law in May 2024 but has not yet been promulgated. Promulgation would bring specific provisions into operation.
The undertaking does not suspend or repeal the Act, nor does it concede any defect in the legislative process. It is framed as a procedural measure pending the Constitutional Court’s ruling in the identified public participation challenges.
Separately, the letter notes that on 9 February the Constitutional Court removed the President’s and Minister’s applications for leave to appeal and direct access – referred to as “Presidential assent challenges” – from the roll and postponed them sine die until the public participation challenges are determined.
