In this Q&A, South Africa’s Minister of Health, Aaron Motsoaledi, responds to questions following the Constitutional Court’s ruling that declared sections of the National Health Act relating to the certificate of need unconstitutional.

The certificate of need mechanism had been widely debated in relation to the National Health Insurance (NHI) system, with critics arguing it could enable excessive state control over where healthcare professionals may practise.

Motsoaledi rejects this interpretation, insisting that the certificate of need is not about forcing doctors to work in specific areas, but rather about ensuring a fair geographical distribution of healthcare facilities across the country.

He argues that the tool is designed to improve equitable access to healthcare services, ensuring that facilities are placed where populations are most in need.According to him, doctors remain free to choose where they practise and are not compelled to work in underserviced areas.He further maintains that while the certificate of need may be a useful administrative tool, its absence does not prevent the implementation of NHI.The minister also addresses broader concerns about whether NHI implies centralised control over healthcare.

He acknowledges that the system involves a central fund and centralised procurement, but argues that this is aimed at improving efficiency, reducing corruption, and achieving economies of scale rather than exerting total control over healthcare professionals.

Motsoaledi dismisses claims that NHI is intended to control every aspect of private healthcare practice, stating that its core objective is universal health coverage based on equity, not restriction of professional freedom.