Health legislation that would require doctors and health practitioners to obtain a 'certificate of need' before being allowed to practise in a particular area has been declared unconstitutional by the high court. The requirement has been described as a cornerstone of the proposed National Health Insurance.

The Gauteng Division of the High Court in Pretoria on Wednesday ruled that legislation that would allow the government to determine where doctors and other health professionals could practise was unconstitutional.

The application was brought by the trade union Solidarity, the Alliance of South African Independent Practitioners Associations, the South African Private Practitioner Forum, the Hospital Association of South Africa and a group of doctors in private practice.

Solidarity's chief executive, Dr Dirk Hermann, said, "This judgment is a major blow to the total NHI [National Health Insurance] idea, as the principle of central management is a core pillar of the NHI Act itself. A more extensive consequence of this ruling with regard to the certificate of need is that parts of the NHI Act are now probably also illegal in principle.

"The NHI in its current format cannot be implemented as the essence of the NHI is central planning -- and this has now been found unconstitutional."

While this case targeted relevant sections of the National Health Act, he said Solidarity would also fight the National Health Insurance Act in court and specifically provisions that allow for the centralisation of funds for healthcare.

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