The Western Cape government has been criticised for spending money on fighting the National Health Insurance (NHI) bill in the Constitutional Court, while its own health system is sick and struggling — running on a tight budget and having lost more than 1,500 staff in the previous financial year.

On Tuesday, the Western Cape Government said it filed papers with the Constitutional Court to challenge the validity of the NHI.

Health and wellness MEC Mireille Wenger said: “The NHI is likely one of the most significant and controversial statutes in South African democratic history, which was rushed through the NCOP without considering, debating or deliberating on any substantive input arising from the public participation processes in the provinces.

“We bring this challenge in the interests and on behalf of the people of the Western Cape, given our role in the provision of public health care in the province.”

Premier Alan Winde said: “We are standing up for the right of every South African to have a meaningful voice in how laws are made.

During Wednesday’s health portfolio committee meeting, the department presented statistics showing that 1,573 staff members left between March 2024 and March 2025.

It said Treasury’s austerity measures were to blame and that this was a national issue.

“The health sector across the country has been under enormous pressure,” a representative said.

“Post-Covid, it has been under enormous pressure. And the impact of the austerity measures has been felt absolutely everywhere. It has been brutal. It has been very hard. And it has been an emotional journey for all involved to be reduced like this.”

Asked to explain the reduction in staff, Wenger said: “Due to the national fiscal emergency, provincial budgets were cut.

“For the Western Cape, R6bn was removed from the Provincial Equitable Share over the 2024 medium-term expenditure framework.”

She added: “We are very encouraged that the Western Cape is now appointing more healthcare workers than are leaving the system – one of only two provinces in South Africa to have reached this important turnaround.

Regarding the costs of the NHI court case, Wenger’s spokesperson Robyn Thomson said: “Please note that we are unable to comment on the cost of the legal proceedings as it is an ongoing legal matter.”

At Groote Schuur, a hospital with one of the highest trauma burdens in the world, thousands of emergency cases are managed each year.

Road traffic accidents alone account for between 20 and 30 percent of admissions, and in 2023, over 4,500 emergency surgeries were conducted.

The hospital treats more than 50,000 inpatients and 500,000 outpatients annually.

Despite the crumbling infrastructure and mounting pressure on overstretched staff, the department, in partnership with Groote Schuur and the Groote Schuur Hospital Trust, said it was preparing to launch what it called a “world-class emergency centre” by 2026.

The department said the new facility was set to transform emergency care in the province, offering rapid, life-saving treatment to thousands each year.

At the Khayelitsha District Hospital, patients were being forced to sleep on cold floors, sit on chairs for days, and even buy their own medication due to severe overcrowding, staff shortages, and a chronic lack of resources.

The situation at the hospital was also raised in the provincial legislature this week.

“The house calls on the provincial government to immediately intervene by increasing funding, staff, and capacity at Khayelitsha Hospital, and to present an urgent turnaround plan to ensure that no patient in the Western Cape is again forced to sleep on the floor in a so-called world-class province,” ANC MPL Rachel Windvogel said.

“Anything less is a betrayal of the people.”

Union Hospersa said its members were facing ongoing staff shortages across hospitals, clinics, and EMS services.

“This has led to increased workloads, high levels of burnout, and a decline in the quality of patient care, particularly in rural areas where service delivery is severely affected,” it said.

Leader of the opposition in the Legislature, Khalid Sayed, said the funds used for the court case should be redirected to the delivery of healthcare.

“NHI is a progressive reform aimed at ensuring access to quality healthcare for all South Africans and that resources being spent on lawyers and litigation could instead be directed toward clinics, hospitals, medical staff, and service delivery in communities most in need,” Sayed, of the ANC, said.

“Premier Winde’s legal challenge clearly shows that the DA is not concerned about the health of the people, but only that they remain healthy enough to work.

MPL Brett Herron, of GOOD, said the provincial government was using “procedural concerns” as a smokescreen to obstruct long overdue reforms to South Africa’s “deeply unequal healthcare system”.

The Progressive Health Forum said they agree that the 1,500 health workers who left the health service in the current reporting period is disturbingly high, but added that “in addition to normal attrition, the number likely includes many who were in joint assignment with the DoH and Pepfar -, CDC – and USAID – funded projects, which were closed because of those agencies unilaterally withdrawing funding”.

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