Background <p>South Africa’s healthcare system is characterized by an overburdened public and well-resourced private sector, fuelling healthcare inequality. The National Health Insurance seeks to achieve universal health coverage but faces delays due to understaffing, resource shortages, and infrastructure gaps. Despite reforms like Primary Health Care re-engineering, healthcare practitioners fear National Health Insurance implementation may worsen workloads and care quality, yet their voices are overlooked. This study aimed to determine the perceptions of healthcare practitioners on the implementation of National Health Insurance in the public sector in the Sedibeng district.</p> Materials and methods <p>A quantitative approach, with a cross-sectional descriptive design, was used among 352 healthcare practitioners in the public health sector in Sedibeng district, Gauteng Province. The researcher uses questionnaires with closed-ended questions to obtain information about the perceptions of healthcare practitioners on the implementation of National Health Insurance. The Microsoft Excel spreadsheet was imported to STATA 17 software for data analysis.</p> Results <p>The level of confidence in the country’s ability (24%), adequacy of resources (15%), and infrastructure (15%) to implement NHI, was very low among respondents and most of them (86%) felt that lack of adequate healthcare personnel is a challenge in NHI implementation.</p> Conclusion <p>The study concluded that challenges related to the healthcare system and the success of National Health Insurance amongst others are poor infrastructure, shortage of the health workforce, medical products, and vaccines. Most respondents (74%) indicated that poor implementation of policies is the biggest challenge in the implementation of NHI. The successful implementation of National Health Insurance will depend on addressing these varied challenges.</p>