The implementation of NHI faces growing criticism over concerns that excluding undocumented migrants and many asylum seekers from comprehensive healthcare could undermine public health goals. - Streamline (29 June 2026)
At the centre of the debate is Section 33 of the NHI Act, which limits private medical schemes to offering only top-up cover while creating a single state-funded healthcare system.
Eligibility is tied to the Department of Home Affairs database, leaving undocumented migrants and asylum seekers with pending applications largely excluded from full benefits.
Critics, including National Treasury, warn this could restrict access to essential healthcare, particularly for vulnerable children. Public health experts fear interruptions to HIV and tuberculosis treatment could threaten SA’s globally significant antiretroviral programme and increase disease transmission.
Although Health Minister Dr Aaron Motsoaledi has defended Section 33 as fundamental to achieving universal healthcare, he has suggested regulations may protect access to essential services such as HIV treatment, maternal care and emergency healthcare, despite no proposed legislative amendments.