CAPE TOWN, 7 MAY 2024: The good, the bad and the ugly of South Africa’s healthcare sector
were hotly debated on day two of the 23rd annual conference of the Board of Healthcare Funders

Kicking off proceedings for the day, Professor Nomafrench Mbombo, Provincial Minister of Health
for the Western Cape, disclosed the province’s plans to ensure healthcare for all.

Following this, Timothy O. Olweny from the Social Health Authority, Kenya, provided insights into
ongoing Universal Health Coverage (UHC) initiatives in the country, along with the challenges
encountered in achieving success. Additionally, Dr. Michael Gone, an expert in health financing
and private sector engagement, shared lessons learnt from Rwanda’s community-based health
insurance (CBHI) system.

Subsequently, Dr. Siri Wiig, Centre Director of SHARE – Centre for Resilience in Healthcare at
the University of Stavanger (UiS) in Norway, presented findings on the significance of high-quality
health systems in fostering a sustainable future.

Notably, Dr Katlego Mothudi, Managing Director at BHF, delved into the organisation’s vision for
a successful healthcare future, suggesting that healthcare organisations across southern Africa
are negotiating a multifaceted landscape, fraught with escalating challenges and promising

“The rapid surge in non-communicable diseases has placed a substantial burden on healthcare
systems worldwide. Concurrently, economic volatility continues to escalate healthcare costs,
rendering essential care less accessible to many. Furthermore, the pervasive presence of fraud,
waste, and abuse within the system exacerbates these financial strains. Compounding these
issues is the limited expansion of private health insurance or medical scheme coverage, further
hindering efforts to ensure comprehensive healthcare access for all,” he said.

Despite these obstacles, several encouraging developments have surfaced, offering avenues for
progress. These include a steadfast commitment to achieving health equity, an intensified
emphasis on primary healthcare, care coordination, preventative measures and wellness
initiatives. Additionally, the rapid advancement of digital health technologies has opened up new
possibilities, alongside notable growth in the health insurance sector.

Although progress towards value-based care has been gradual, strides are being made in this
direction. Moreover, collaborations with both local and global tech innovators, coupled with a
strategic internal focus on tech integration, are shaping promising pathways forward.

Mothudi alluded to several critical and interconnected barriers that are impeding progress towards
sustainable healthcare.

“Regulatory hurdles, exacerbated by inefficiency and politicisation, are stalling critical healthcare
reforms, including the implementation of the NHI bill and revisions to Prescribed Minimum
Benefits (PMBs),” adds Mothudi. “The healthcare sector faces a conundrum of workforce and
technological strains, including inadequate training, limited job opportunities, high emigration
rates and workforce burnout. This, together with challenges in formalising a developmental
pipeline for human resources, management capacity and enterprise development; and a lack of
integration of digital health technologies, are just a few examples of the complexity of the issue at

Furthermore, economic instability is straining healthcare affordability and the viability of public
services, compounded by workforce shortages, infrastructure decay, and rising costs for
traditional medical schemes. In South Africa, additional challenges include the absence of lowcost benefit options and restrictions on provider tariffs and collective bargaining.

Lastly, the growing corporatisation of healthcare threatens smaller, independent practices,
potentially reducing patient care diversity. The shift towards larger entities and hospital-centered
care may concentrate the market, diminishing patient choice and weakening the traditional
community-based healthcare model.

In response, healthcare organisations are taking strategic actions to mitigate these challenges.
This includes collaboration with government and business; encouraging private sector
participation; promoting the harmonisation of regulations; encouraging the strengthening of
governing agencies; shifting towards integrated healthcare models; and adopting advanced
technologies and digitalisation.

While these responses may attend to current challenges, Mothudi suggests that a more
comprehensive set of longer-term solutions are required at a systems level to be sustainable.

“To achieve Universal Health Coverage (UHC), a multi-payer system must ensure quality care for
all without financial strain. Implementing UHC principles involves aligning benefits to promote
preventative care and managing chronic diseases. Public-Private Partnerships (PPPs) can
enhance access and improve care quality, with proactive private sector engagement
complementing government responsibilities in policy implementation,” said Mothudi.

“Furthermore, policy and regulation should aim to strengthen oversight by enhancing regulatory
institutions and promoting inclusivity and knowledge sharing across the SADC region to learn
from each other’s experiences,”he added.

To enhance healthcare infrastructure and workforce development, it is imperative to invest in
facilities and technology in underserved areas, strengthen training, improve workforce planning,
and leverage digital health initiatives such as telemedicine and electronic records. Lastly, the
adoption of environmental, social and governance standards are required to promote resilience
and position Southern African healthcare systems as leaders in sustainable practice.

“As we steer beyond the transitional state of the liminal into a future ripe with potential, it becomes
clear that a resilient and inclusive healthcare system is within our reach. Through these
collaborative efforts, we are not just meeting the current needs, but laying the groundwork for
future demands,” concludes Mothudi.