President Cyril Ramaphosa has reaffirmed the government’s commitment to ensuring equitable access to quality healthcare, saying excellence in medical care must be available to all South Africans, regardless of their income or location.

In his weekly newsletter on Monday, Ramaphosa pointed to the successful separation of conjoined twins at Mankweng Hospital as an example of the capabilities within the country’s public health system.

The president described the complex operation as a remarkable achievement that reflects the skill, dedication and resilience of healthcare professionals in South Africa.

“This achievement is more than a medical milestone. It is proof of what our public health system is capable of. It is a reminder that South Africa possesses world-class medical expertise, not only in the private hospitals in our cities, but also in public facilities serving communities that have historically been neglected and underserved,” he said.

Ramaphosa noted that the success at Mankweng demonstrates the impact of sustained investment in medical training and development, including subsidised education, bursaries and practical training programmes for healthcare workers.

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However, he cautioned that many South Africans still face challenges in accessing quality healthcare, despite the constitutional guarantee of this right.

“Our Constitution guarantees every person the right of access to healthcare services. That right cannot depend on where you were born, how much you earn or where you live,” the president said.

He said bridging the gap between the constitutional promise and the lived reality of many citizens is the driving force behind the implementation of the National Health Insurance (NHI).

According to Ramaphosa, the NHI is not merely a funding mechanism, but a transformative instrument aimed at ensuring that all South Africans can access quality healthcare services without financial hardship.

The NHI Act, signed into law in May 2024, aims to create a single, state-run fund that will provide universal healthcare free at the point of delivery. The legislation seeks to replace South Africa’s current two-tier health system, which sees wealthier citizens accessing private healthcare whilst the majority rely on underfunded public facilities.

However, implementation of the Act has been delayed following multiple legal challenges. Ramaphosa agreed to postpone the proclamation of any sections of the Act pending Constitutional Court hearings scheduled for 5 to 7 May. The undertaking to delay proclamation will remain in place until the court delivers its judgments.

ALSO READ: Government progressing with NHI implementation despite legal challenges

At least five formal legal challenges have been lodged by organisations including the South African Medical Association, the Health Funders Association, the Free Market Foundation, the Board of Health Care Funders and the Democratic Alliance.

Opponents argue the Act is constitutionally flawed, financially unsustainable and would eliminate private medical schemes. The Health Funders Association has described the NHI model as “unaffordable, unworkable and unconstitutional”, claiming it would require tax increases far beyond South Africa’s fiscal capacity.

The Presidency said the delay will not affect the broader timetable for implementing the NHI, and that preparatory work to strengthen and improve health services is ongoing.

ALSO READ: Ramaphosa delays NHI implementation pending court challenges

The president highlighted the inequality between the public and private healthcare sectors, noting that while only about 16% of the population relies on private healthcare, significantly more resources are spent per patient in that system compared to the public sector, which serves the majority.

“These two parts of our healthcare system cannot continue to operate in parallel, as if serving two separate nations. They must work together in service of one nation,” he said.

Ramaphosa called for stronger collaboration between public and private healthcare providers, academic institutions, pharmaceutical companies and communities to improve service delivery and share expertise.

He further outlined ongoing efforts to strengthen the public health system in preparation for the NHI, including upgrading facilities, expanding the community health worker programme, improving access to medicines and introducing digital systems.

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The president said healthcare workers remain central to these efforts and stressed the need to support and retain skilled professionals within the public sector.

“The great achievement at Mankweng Hospital has shown us what is possible. It has also reminded us of what is necessary: a health system that serves every South African with excellence, compassion and dedication. Equal access to quality healthcare must be the standard we set and the constitutional promise that we keep,” he said.