Opposition parties and trade unions overwhelmingly welcomed the recent Constitutional Court ruling, which they viewed as a crucial defence against State control and professional coercion.

The government’s Certificate of Need (CoN) scheme was widely considered a foundational mechanism for implementing the centralised control required by the National Health Insurance (NHI).

On Monday, the Constitutional Court struck down key sections of the NHI Act governing the CoN, delivering a major blow to the government's NHI plans.

The Constitutional Court invalidated Sections 36 to 40 of the NHI Act, which required doctors and healthcare facilities to apply to the State for a CoN to operate, effectively determining where they can practice.

The court found the scheme irrational and unconstitutional, noting there was no proof that denying certificates in certain areas would force professionals to relocate to underserved communities.

The CoN was viewed by the government as a cornerstone of the NHI, meaning its removal critically undermined the State's capacity to control and redistribute health sector resources.

Democratic Alliance (DA) spokesperson on Health Michéle Clarke argued that by requiring government-issued permits and allowing the State to impose strict conditions on a practitioner's services and equipment, these provisions were widely criticised as an infringement on property and occupational rights.

The Constitutional Court's confirmation that these clauses were invalid ensured that health practitioners retained their right to practice freely, she said.

She pointed out that while the NHI Act did not explicitly detail CoNs, they have long been regarded as a fundamental mechanism for implementing the NHI's centralised control.

She explained that the court’s ruling established a major legal precedent that opposed this centralisation, protecting healthcare providers from government dictation on where they were permitted to work.

“This ruling underscore the necessity of balancing constitutional rights with government policy,” she said.

The DA maintains a strong commitment to achieving universal quality healthcare for all South Africans. However, the party said it remained fiercely opposed to the NHI in its current form.

The DA argued that the NHI served as a vehicle for the severe centralisation of healthcare control, an approach it said risked undermining the private and public healthcare systems rather than improving them.

ActionSA described the ruling as a vital constitutional check against State overreach.

“By invalidating the CoN, the judiciary has safeguarded the autonomy of doctors, dentists, nurses, and other medical professionals from unnecessary and excessive government interference,” said ActionSA Member of Parliament Kgosi Letlape.

Medical practitioners are already bound by rigorous oversight and registration through existing statutory bodies, he said and added that the court's decision provided a “timely victory” as further legal challenges against the NHI Act proceed.

ActionSA said quality healthcare could not be achieved through bureaucracy, coercion, and centralised control. It blamed South Africa’s healthcare crisis on government failure, poor infrastructure, and corruption, and not because of a lack of willingness by medical professionals to serve their communities.

“Attempting to restrict the autonomy of healthcare practitioners would only exacerbate the strain on the national medical system and deter skilled workers from remaining in the country. ActionSA views this judgment as a crucial constitutional precedent that reaffirms fundamental rights,” said Letlape.

Following this judgment, the party was calling for a broad rethink of the government’s approach to healthcare reform. Meaningful reform must be constitutional, patient-centered, and focused on tangible health outcomes rather than the expansion of political control, the party said.

Lobby group Solidarity hailed the decision as a victory for professional freedom and a barrier against State control.

Solidarity argued the certificate acted as a mechanism to shift healthcare professionals to cover up public sector failures.

The group views the collapse of this mechanism as a significant triumph against the overarching centralisation and bureaucratic coercion of the NHI.

Solidarity deputy CE Anton van der Bijl stated that the ruling proved South Africans and medical professionals were not "State property".