In his 2025 State of the Nation address the president promised improved healthcare access and infrastructure. (Photo by Guillem Sartorio/Getty Images)
President Cyril Ramaphosa used his 2025 State of the Nation address on Thursday to reaffirm the government’s commitment to rolling out the National Health Insurance (NHI) and promised improvements to healthcare access and infrastructure.
But he did not mention a reported deal between the ANC and the Democratic Alliance (DA) — the two major parties in the government of national unity formed after last year’s elections — to ensure that private medical schemes remain in place once the NHI is implemented.
Ramaphosa said preparatory work for the NHI would continue this year, including developing a single electronic health record system, establishing ministerial advisory committees on health technologies and benefits, and an accreditation framework for healthcare service providers.
“The NHI will reduce inequalities in healthcare by ensuring everyone gets fair treatment,” he said.
“It will save many lives by providing a package of services that includes maternal and newborn care and treatment for people living with HIV, tuberculosis and non-communicable diseases such as heart disease, cancer and diabetes.”
Parliament approved the National Health Bill in December 2023 and Ramaphosa signed it into law last year, just before May national and provincial elections. The ANC government argued that the law was intended to ensure equal access to good healthcare, not just those with private medical aid..
But opponents of the programme, including the DA and business, said it would effectively render South Africa’s entire health system — not just the public health system — dysfunctional.
On Thursday Ramaphosa said improving the quality of care in the public health sector remained an immediate priority, including modernising, maintaining and constructing hospitals and clinics.
Hospitals under construction or being refurbished include the Limpopo Central Hospital and Siloam District Hospital in Limpopo province; the Dihlabeng Regional Hospital in the Free State; the Bambisana and Zithulele hospitals in the Eastern Cape and the Bophelong Psychiatric Hospital in North West.
Other projects in the pipeline include three new central hospitals, five district hospitals, five community health centres and a new psychiatric hospital.
Ramaphosa said the government would improve patient experience and focus on reducing waiting times, cleanliness and the attitude of staff members in public health facilities.
The president lauded the progress made towards ending HIV and Aids as a public health threat.
“By the end of March 2024, 96% of people living with HIV knew their status, 79% of them were on antiretroviral treatment and 94% of those on treatment were virally suppressed,” he said. “To ensure that we reach our target of 95-95-95, we will this year launch a massive campaign to look for an additional 1.1 million people who are not on treatment.”
The United Nations Programme on HIV/Aids’ (UNAids’) 95-95-95 targets aim to ensure that by 2030, 95% of all people living with HIV know their status, 95% of all people diagnosed with the virus receive sustained antiretroviral therapy and 95% of those receiving antiretroviral therapy have viral suppression.
Ramaphosa added that work would begin to develop a system to store all patient records in one place and preparations were being made to set up expert advisory committees to guide decisions on health technologies and healthcare benefits.
He expressed concern about the US’s decision to suspend funding for HIV and tuberculosis programmes in African countries for 90 days, noting that this funding accounts for about 17% of South Africa’s spending. The government was working to ensure the continuation of essential services, Ramaphosa added.
He made no mention of the deal reportedly struck between the ANC and DA to ensure private medical schemes continue to exist once the NHI kicks in.
On Wednesday, DA leader John Steenhuisen told journalists that the party had secured assurances from the ANC that contentious provisions in the NHI Act, which would have terminated private medical schemes, had been removed from the plan.
He said the commitment from the ANC was more than just a verbal agreement. “There was a very clear target in the medium-term development plan [MTDP] stating that by the end of the five-year period, all medical schemes would be collapsed into a single fund. That provision has now been removed from the draft MTDP as a project. That is in black and white.”
Steenhuisen said a ministerial advisory committee would be tasked with assessing the NHI’s modalities and funding models over the next five years without dismantling private medical schemes.
The presidency has publicly denied any knowledge of the agreement.
In his State of the Nation address, Ramaphosa said only that the NHI would create equality for all in health provision.