As the ANC heads to its policy conference in July, Cosatu and the ministry are reportedly on a collision course over the implementation of the National Health Insurance (NHI) scheme, with the trade union federation accusing the health department of "going rogue" on the ANC's own policy.
According to Business Day on Monday, Cosatu wants a "single payer, single fund" approach to the NHI in which there is no role for the private sector or other funding mechanisms like medical schemes.
But department of health director-general Precious Matsoso told Business Day that the public sector did not have the capacity or infrastructure to implement the NHI immediately.
"It would be sad in this country if we just look at unorthodox options and pursue those, and that ends up undermining the very basis of achieving universal health coverage," she told the paper.
A series of multi-stakeholder meetings had been held to discuss how other actors might be involved in the NHI, Matsoso reportedly said.
But Cosatu spokesman Sizwe Pamla accused the department of watering down ANC policy on the NHI.
"What we are starting to see worries us... government changing its tune. If the ANC policy conference thinks the health department is on the right path, there will be a clear break for us," Pamla told Business Day.