South African President Cyril Ramaphosa signed the National Health Insurance (NHI) Act into law on Wednesday, marking a significant step toward universal health coverage just two weeks before a highly competitive election. The NHI Act aims to address the disparities in South Africa's two-tier health system, where a publicly funded sector serves 84% of the population but remains overburdened and under-resourced, while private insurance offers superior treatment to a minority.

The legislation will gradually reduce the role of private insurance, establish a public fund to provide free healthcare access to all South African citizens, and regulate the fees private healthcare providers can charge for NHI-covered services. Ramaphosa emphasized that the current healthcare system is fragmented, unsustainable, and rooted in apartheid-era inequalities.

Opponents of the bill have vowed to challenge it in court, accusing the government of using it as a vote-winning tactic—a claim the presidency denies.The ruling African National Congress (ANC) faces a tough battle to maintain its parliamentary majority after 30 years in power.

"For those who would like to see their privileges continuing, sorry, you are on the wrong boat. The boat we are on is about equality," Ramaphosa stated at the signing ceremony at the Union Buildings in Pretoria.