Statistics South Africa (Stats SA) recently released its report on deaths that occurred in 2024. The headline findings contain a sobering, recurring truth: diabetes was once again the country’s leading underlying natural cause of death.
In 2024 alone, 28 767 people died from complications caused by diabetes, accounting for 6.1% of all deaths nationwide. That is an average of nearly 79 deaths every day.
Diabetes also claimed the top spot in 2022 and 2023. These numbers cannot be accepted as South Africa’s new normal. Behind every data point is a human life, a grieving family and, all too often, years of encounters with a health system that missed opportunities to diagnose, treat and support people in time.
As a public health specialist and chairperson of the non-profit organisation Diabetes Alliance, I view this three-year trend as an unacceptable tragedy. Diabetes is manageable. With timely support, people can lead long, healthy lives free from preventable complications. Acknowledging this crisis is the start, but recognition must give way to political action. The Department of Health must establish a national diabetes strategy with clear targets for prevention and care. The finance minister must resource it. And the Presidency must lead a coordinated, whole-of-government response.
The broader health landscape is equally stark. Noncommunicable diseases accounted for 60.7% of all recorded deaths in 2024. The top three causes of natural death – diabetes, hypertensive diseases and cerebrovascular diseases – frequently overlap in the same individuals. Managing these interconnected conditions through isolated disease programmes makes little sense for primary care clinics or the patients navigating them.
Reading beyond the numbers
At first glance, the 2024 total is 800 deaths higher than the revised 2023 figure of 27,967 (5.8% of recorded deaths). Stats SA compiles these mortality figures from death notification forms filed through the Department of Home Affairs. Medical practitioners record the cause of death, which Stats SA then classifies using international coding standards. Late death registrations and administrative backlogs are processed retroactively; this leads to revision or updating of prior years’ totals.
The updated count for 2022 stood at 33,126, higher than diabetes deaths recorded in 2023 and 2024. Diabetes has remained South Africa’s single largest natural killer for three consecutive years.
The diabetes burden is also deeply unequal:
Women bear the heaviest loss: diabetes was the leading recorded natural cause among women, claiming 17,429 lives (7.9% of all female deaths) and 11,334 or 4.5% of all male deaths.
Working-age adults are hard hit: it ranked first among people aged 45-64, accounting for 9,364 deaths (7.9% of deaths in this group).
Geographic split: diabetes ranked as the top natural cause in five provinces, Western Cape, KwaZulu-Natal, Limpopo, Eastern Cape and Gauteng, while hypertensive diseases led in the remaining four provinces. These provincial rankings are not a measure of individual care quality or residency. They are a starting point for region-specific questions about access and system performance.
The geographic split shows the need to investigate whether access to diagnosis, treatment and good quality care differs between and within provinces.
A death certificate is only the final chapter
Mortality statistics record the primary cause listed on a death notification, but remain blind to what happened along the way.
They cannot tell us how many South Africans live with undiagnosed diabetes. They cannot show whether a patient had consistent access to insulin and testing supplies, whether their blood sugar was adequately controlled, or whether a simple follow-up could have prevented a fatal complication. Nor do they capture the full toll of diabetes when another condition is listed as the underlying cause.
Those are the questions we must answer while patients are still alive.
In my work on strengthening diabetes care, including the Tshwane Insulin Project – a nurse-led programme that helped people with type 2 diabetes start and adjust insulin treatment in primary care, with follow-up support at home – I have seen where care pathways break down, and where they succeed. Survival rarely hinges on high-tech interventions. It depends on the links in primary healthcare:
a trained clinic nurse with the time to act
a reliable supply chain for medicines and diagnostics
routine follow-up mechanisms when a patient misses an appointment
regular screening for kidney, eye and vascular (blood vessel) complications
support systems that respect the economic reality of a person’s daily life.
We need real-time clinical data that helps a facility respond today, not a national death tally published two years later.
Turning policy into frontline care
South Africa already has a framework: the National Strategic Plan for Non-Communicable Diseases and its 90-60-50 targets. This cascade aims to ensure that 90% of adults know their blood pressure and blood glucose status, 60% of those with elevated levels receive treatment, and 50% of those receiving care achieve clinical control.
The challenge is making policy work in practice.
Tools like the National Health Laboratory Service diabetes dashboard offer valuable insights into blood sugar levels control across districts. But to close the loop, South Africa urgently needs a national diabetes registry and integrated digital tracking to understand who enters care, who remains in care, and who is being left behind.
From declaration to delivery
After the 2025 Diabetes Summit, the Diabetes Alliance launched the Johannesburg Declaration for Accelerated Action on Diabetes. The declaration calls for coordinated national leadership, sustainable financing, decentralised primary care, and direct participation by people living with diabetes. It asks the Presidency to lead a multisectoral response and calls on the National Treasury and health sector to match policy commitments with financial resources.
The latest mortality report gives this agenda even more urgency. There are three practical priorities:
Connect early diagnosis to sustained care. Screening is only useful if a positive result leads to uninterrupted treatment, reliable medicines, blood glucose monitoring and clinical review.
Measure quality of care: publish a picture of diagnosis, treatment, retention and complication rates by district and province.
Address the conditions in which health choices are made. Food prices, transport barriers and economic hardship shape health outcomes.
People living with diabetes must help define what quality care looks like. Their experience should guide national policy and daily clinic operations alike.
Vocal tracts and the sounds they produce vary, resulting in distinct sounds in speaking groups
Vocal tract outlines for the five vowels [i], [e], [a], [o] and [u] in the midsagittal plane producing a vowel sound. Each colour represents a different vowel and speaker, showcasing markedly different vocal tract and tongue configurations across speakers and vowels. Image credit: Tiena Danner and Christoph Zollikofer (CC-BY 4.0)
The anatomical differences in our vocal tracts could be one of the sources of our Tower of Babel – the vast difference in languages spoken around the world, according to a study published October 13th in the open access journal PLOS Biology by Steven Moran and Tiena Danner from the University of Neuchâtel, Switzerland, and colleagues.
Many variations exist in the human voice. People vary in the size and shape of the tissues in the head and neck and also shape that anatomy differently to produce similar sounds. Developmental and cultural factors will shape the way people speak. To better understand how anatomical and articulatory variation might affect how a speaker sounds, the authors of this study analysed data from 32 speakers (16 male and 16 female) from the USC 75-Speaker Speech MRI Database, an open-source collection of real-time Magnetic Resonance Imaging (rtMRI) conducted during speech tasks, focusing on American English vowels (i, e, a, o and u).
The authors found that the subjects had widely different vocal tracts and used very different ranges of motion in those tracts to produce the same sound. Those ranges of motion, or articulatory differences, were a result of each person’s specific vocal anatomy, and produced both the correct sound and an individual acoustic difference. Finally, by combining the rtMRI results with multilingual speech data, they showed that the amount of variation within other languages such as Basque or Hindi was similar to the variation present in American English, suggesting that within each language, there’s a basic level of speaker variation as a result of vocal tract anatomy.
While the sample size of vocal tracts was small, and the authors compared variations in only a few language families, the authors propose a biocultural model of how spoken sounds might vary and diversity between peoples, where variation of pronunciation within a group feeds into the development of a language difference between groups, eventually producing two groups that can’t understand each other.
The authors add, “We often think of differences in pronunciation between speakers of a language as noise to be normalized away in linguistic analysis. However, the results of our study suggest the opposite: that the variation between individuals may be an important source of information in understanding the evolution of spoken languages.
“An exciting aspect of our study is that it provides researchers with a null model for studying the phonetic evolution of spoken languages. If the differences between the world’s 7000 or so languages reflect variation already present in the anatomical differences between speakers, we now have a baseline against which we can identify sociocultural or historical factors that have driven language diversification.
“Every person has a slightly different vocal tract and speakers compensate for these differences to remain mutually intelligible. Nevertheless, our anatomical differences leave systematic acoustic signatures in the sounds we produce. Remarkably, we find that the same patterns of phonetic variation between individuals are also reflected in the difference between languages.
“Our results suggest that the seeds of phonetic differences between languages are already present in the variation between individual speakers. Spoken language evolution is driven by the biological diversity within populations and the sociocultural forces that shape how languages change.”
A longitudinal study of more than 13 000 children in the UK found that higher childhood body mass index and fat mass were associated with greater body dissatisfaction at age 14 in both sexes
Photo by Patrick Fore on Unsplash
Children who follow higher trajectories of body mass index (BMI) and fat mass index across childhood report greater body dissatisfaction at age 14, in both boys and girls, according to a new study published October 14, 2026, in the open access journal PLOS One by Dr Madelaine Davies Kellock, a Research Fellow at University College London, UK, and colleagues.
Body dissatisfaction has been rising among young people over recent decades and is linked to later depression and eating disorders. Prior research using BMI has suggested weight relates to body dissatisfaction differently in girls and boys, but BMI cannot distinguish fat mass from fat-free mass, which includes muscle, bone and other tissues. Fat mass and fat-free mass may relate to dissatisfaction differently than BMI, particularly given the social desirability of muscularity in boys.
Researchers used data from 13 025 participants in the UK Millennium Cohort Study, which provided measurements of height and weight from age 3, and body composition from ages 7 to 14. For the new analysis, children were grouped into low, moderate and high trajectories of BMI, fat mass index, and fat-free mass index based on that data. At age 14, body dissatisfaction was measured using a self-reported questionnaire.
Children with moderate or high BMI trajectories had higher dissatisfaction scores than those with low trajectories (adjusted mean difference 0.32 and 0.71, on a 0-6 scale), with similar results for fat mass index (0.33 and 0.73), and no evidence these associations differed by sex. The researchers expected higher fat-free mass index, which includes muscle as well as other non-fat tissue, to relate to lower dissatisfaction in boys; instead, boys with high fat-free mass had greater dissatisfaction than those with low fat-free mass (adjusted mean difference 0.31), and the association was larger in girls (0.36 moderate, 0.79 high).
Because the study was observational, it could not establish that body composition causes body dissatisfaction. It was also limited by the single question measurement of body dissatisfaction and the fact that children from more disadvantaged families were more likely to have missing data.
The authors conclude that both girls and boys with higher childhood adiposity are at risk of body dissatisfaction in adolescence and say the findings could help shape ways to target body dissatisfaction.
The authors add: “Body dissatisfaction is often thought of as something that mainly affects girls, but our findings suggest that both girls and boys with higher BMI or fat mass index trajectories in childhood have higher levels of body dissatisfaction in adolescence.
Our findings for fat-free mass index were quite surprising. We did not find that higher fat-free mass index was associated with lower body dissatisfaction in boys, but as we found a smaller association compared to girls, this might suggest that some aspects of fat-free mass are less of a risk factor for body dissatisfaction in boys. There are lots of reasons why someone might have high fat-free mass, so it’s likely that this group includes people with quite different physical characteristics, including high levels of lean muscle mass, as well as those with increased bone and muscle mass partly as a consequence of having high fat mass. This could mask the role that aspects such as muscle mass might play in how young people experience their bodies.
There is now good evidence that body dissatisfaction in adolescence is associated with subsequent poorer mental health. The association between adiposity and body dissatisfaction might emerge because young people with higher weight experience more negative events, such as stigmatising comments and bullying. Therefore, it is important that we think carefully about how we talk about weight and body size with young people, including in schools.”
For years, rising rates of myopia have been widely attributed to increased screen time, especially among children and young adults. But new research from scientists at the SUNY College of Optometry suggests the story may be more complicated – and more human.
In a new study published in Cell Reports, researchers propose that myopia may be driven less by screens themselves and more by a common indoor visual habit: prolonged close-up focus in low-light environments, which limits how much light reaches the retina.
The research offers a new hypothesis that could help explain a long-standing puzzle in vision science – why so many seemingly different factors, from near work and dim indoor lighting to treatments like atropine drops, multifocal lenses, and time spent outdoors, all appear to influence myopia progression.
“Myopia has reached near-epidemic levels worldwide, yet we still don’t fully understand why,” said Jose-Manuel Alonso, MD, PhD, SUNY Distinguished Professor and senior author of the study. “Our findings suggest that a common underlying factor may be how much light reaches the retina during sustained near work – particularly indoors.”
A different way of thinking about near work
Myopia affects nearly 50 percent of young adults in the United States and Europe and close to 90 percent in parts of East Asia. While genetics play an important role, rapid increases over just a few generations suggest environmental factors are also critical.
Scientists have long known that:
Spending more time outdoors appears to protect against myopia
Extended near work is associated with increased risk
Treatments as different as atropine eye drops, multifocal lenses, and contrast-reducing optics can slow progression
What has been unclear is why these diverse approaches work.
SUNY Optometry researchers propose a unifying explanation centred on the pupil – the eye’s natural “aperture,” similar to a camera diaphragm.
“In bright outdoor light, the pupil constricts to protect the eye while still allowing ample light to reach the retina,” explains Urusha Maharjan, SUNY Optometry doctoral student who conducted the study. “When people focus on close objects indoors, such as phones, tablets, or books, the pupil can also constrict, not because of brightness, but to sharpen the image. In dim lighting, this combination may significantly reduce retinal illumination.”
According to the researchers’ hypothesis, reduced retinal stimulation over long periods may weaken specific neural pathways involved in visual processing, contributing to myopia development and progression.
Explaining what we already observe
The proposed mechanism may help explain several well-known observations:
Why outdoor time is protective: bright light keeps retinal stimulation high
Why atropine may slow myopia: it limits pupil constriction, allowing more light into the eye
Why certain lenses help: they reduce the need for strong close-up focusing
Why prolonged indoor near work under low light may be particularly problematic
Importantly, the study does not claim that screens directly cause myopia, that light alone explains the condition, or that genetics are unimportant. Rather, it offers a testable hypothesis that reframes how visual habits, lighting, and eye focusing interact.
“This is not a final answer,” Alonso emphasised. “It’s a hypothesis grounded in measurable physiology that brings together many pieces of existing evidence. More research is needed, but it gives us a new way to think about prevention and treatment.”
Implications for families and clinicians
While the findings do not change clinical guidelines overnight, they may help inform future research, public health strategies, and conversations around children’s visual habits – especially as digital devices become a constant part of daily life.
The study was conducted by Urusha Maharjan in the laboratories of Jose-Manuel Alonso at SUNY College of Optometry.
Millions of South Africans still struggle to access consistent, quality primary healthcare. Language barriers, distance from facilities and a shortage of trained health workers are just a few of the factors impacting the standard of care. Tshikululu Social Investments and Dr Sophia AI are addressing this gap through a new partnership to advance health equity across South Africa.
Dr Sophia AI is an Australian-developed, clinically governed decision support platform that helps clinics deliver consistent, high-quality care at the point of consultation. Through this partnership, small and medium healthcare practices in South Africa will gain access to AI-assisted clinical support that strengthens the care they provide. As these practices grow, more communities gain reliable access to primary healthcare.
The technology is intended to support — not replace — healthcare professionals. It guides structured assessments, helps identify potential risks and drug interactions, and supports clinical documentation, while clinicians remain responsible for reviewing and approving recommendations. The platform is built around explainability, traceability and clinician oversight, with an audit trail designed to support clinical governance and accountability.
A pilot is already under way with nurses working in community-based primary healthcare settings in the Western Cape. This is this first phase in testing how Dr Sophia AI can strengthen healthcare systems, and small businesses, in under-resourced communities.
The pilot will focus on localising Dr Sophia AI for South African community healthcare settings. This includes embedding South Africa’s Essential Medicines Lists and relevant clinical guidelines, refining the platform for local care pathways and testing its language capabilities in the context of how patients and healthcare professionals communicate in practice. The pilot will also gauge how the platform can grow revenue streams in small businesses by streamlining operations. Insights from the pilot will be used to continually refine the platform for the local context and inform its potential wider deployment.
Alongside the pilot, Tshikululu and Dr Sophia AI are designing a funding model that could complement traditional grant funding by linking commercial growth to social impact. The concept would see a percentage of future revenue generated through Dr Sophia AI’s commercial deployment directed towards a grant fund. This fund will be channelled towards initiatives that expand access to quality healthcare and support SMME growth, with Tshikululu bringing its experience in social investment and fund management to the model.
Dr Sophia AI complies with American FDA Clinical Decision Support Software requirements and is registered in Australia as Software as a Medical Device, Class I, Clinical Decision Support Software; providing an internationally recognised regulatory foundation for its use as clinical decision-support technology. Its South African deployment will equally align with applicable POPIA, SAHPRA and HPCSA requirements.
“Where you live, the language you speak or the availability of healthcare professionals in your community should not determine the quality of healthcare you can access,” says Leanne Emery-Hunter, CEO of Tshikululu Social Investments. “This pilot is about taking an established AI-assisted clinical platform and embedding it in the South African context — our clinical guidelines, our languages and the realities of frontline healthcare delivery.”
The partners are looking to engage funders, healthcare organisations, corporates and other potential partners interested in helping to shape and participate in the model. The ambition is to explore whether commercial adoption of the technology can create an ongoing source of funding that, in turn, supports grant-funded healthcare initiatives in underserved communities.
“Healthcare is deeply local, but the challenge of delivering consistent, high-quality care is global,” says Julia McCann, GM, Dr Sophia AI. “Our ambition is to build technology that can support healthcare professionals across very different health systems, languages and communities. South Africa is an important opportunity to demonstrate how a global platform can be meaningfully localised — combining international clinical capability with the guidelines, languages and realities of care on the ground.”
The partnership reflects a broader approach to social investment. It brings together technology, commercial and social-sector partners to develop new approaches to persistent social challenges and explore funding mechanisms that can complement traditional grant-making.
“This is the kind of social innovation we want to enable,” says Emery-Hunter. “It brings together technology, frontline expertise and a new approach to funding around a very practical question: how do we get better healthcare closer to people who have historically had the least access to it? We believe that will require collaboration, continuous learning and new ways of thinking about how social impact is funded.”
Tshikululu and Dr Sophia AI welcome conversations with organisations interested in partnering on the next phase of the initiative and helping to shape how the model could contribute to more equitable access to quality healthcare.
Africa is home to more human genetic diversity than anywhere else on Earth. The average African genome shows nearly a million more genetic variants than the average non-African genome. But this wealth of data remains largely unexplored, with African populations historically underrepresented in research. Less than 3% of global genomic datasets and genome-wide association studies include participants of African descent.
Renowned African researchers have released a new book to explain what we know about the continent’s remarkable genetic diversity, showcase on-the-ground research being carried out today and set out a roadmap for future discoveries.
Genomics in Africa is designed to support the next generation of African scientists, providing vital information for researchers, funders and policymakers working to advance genomics and precision medicine in the continent.
It is co-edited by Professor Segun Fatumo of Queen Mary University of London, and Dr Tinashe Chikowore of Harvard Medical School, who believe there is an urgent need to invest in African genomics research.
Professor Fatumo says: “Genetic research on the African continent could create more effective precision medicine, improve global drug development, and help scientists understand everything from our evolutionary history to why some people develop particular diseases.”
While there is a lot we don’t know about human evolution and background, it is accepted that early Homo sapiens evolved in Africa approximately 300 000 years ago. Over millennia, we spread across the continent and settled all over it.
At some point between 50 000 and 70 000 years ago, a small band of people left Africa. This might have been a single tribe or group of tribes, and it likely had only a few thousand people of childbearing age.
There have been other migrations, but this particular one – known as the Southern Route or Southern Dispersal – is believed to be the founder population which colonised the rest of the world and interbred with archaic humans such as Neanderthals and Denisovans.
The small size of this founder population means all modern humans with ancestry outside Africa share a high degree of genetic similarity.
While we can’t know exactly how many people in total were living on the African continent at that time, we do know that the population the group left was much larger and much more genetically diverse. This means many gene variants not present in the handful of people who left Africa have been passed down and are thriving in people of African genetic heritage.
Ambroise Wonkam (Professor of Medical Genetics at Johns Hopkins School of Medicine and current President of the African Society of Human Genetics) said of the work: “Increasing the number of sequenced African genomes will refine tools for predicting disease-related variants, improve diagnoses, and enhance precision medicine.
“Ultimately, investing in African genomics promotes both scientific innovation and health equity worldwide.”
Professor Segun Fatumo and Dr Tinashe Chikowore suggest that further research into African genomics could also develop and improve treatments of inherited diseases which predominantly affect African populations, such as sickle cell disease.
African researchers are currently exploring research into infectious diseases, cardiometabolic traits, cancer, mental health traits and medicine sensitivities – but the authors argue more investment both in research and infrastructure is needed to unlock the potential of these studies.
They propose a ten-year strategic roadmap for research leaders, funders, and governments planning future genomic initiatives on the continent.
“Research into these areas is essential to ensure that people with African genetic heritage can experience the full benefit of precision medicine and gene therapies,” Professor Fatumo explains. “Genetic variation could mean they react differently to treatments or medicines developed for the population outside Africa, so for true health equity there is an urgent case to expand on current scientific knowledge.”
A new study at The University of Texas at Arlington could help substantially reduce the amount of radiation heart patients receive during imaging procedures without sacrificing diagnostic accuracy.
The study, led by Mingwu Jin (professor of physics), will focus on computed tomography angiography (CTA), an advanced imaging test that noninvasively assesses coronary artery disease. CTA combines a CT scan with iodine contrast dye injected into a patient’s vein to create 3D images of blood vessels and surrounding tissues. Doctors can use CTA to detect aneurysms, narrowed or damaged blood vessels, blood clots, tumours and other conditions.
The project is funded by a three-year, $579 745 grant from the National Heart, Lung, and Blood Institute. The project is titled “Deep leaRning-bAsed reConstruction (DRAC) for Multi-Phase Cardiac CT Angiography.”
Multi-phase coronary CTA (MP-CCTA) captures images at multiple points during the heartbeat, providing doctors with more information and helping reduce blurring caused by the heart’s movement. The drawback is that collecting images across multiple phases exposes patients to more radiation than a single-phase scan. Dr Jin’s research aims to substantially reduce that radiation exposure while preserving the quality and diagnostic value of the images.
“Lowering the radiation dose in medical imaging has been vigorously pursued due to imaging prevalence and potential cancer risk of ionising radiation,” Jin said. “Although notable progress has been made by developing advanced reconstruction methods, the dose reduction potential is far from its limit.”
CT scans use reconstruction methods to turn raw data collected during a scan into images doctors can interpret. One advanced approach is model-based iterative reconstruction (MBIR). Another is 4D reconstruction, which adds the dimension of time to standard 3D imaging. In cardiac imaging, this technique can capture clear views of fast-moving heart valves and coronary arteries while reducing motion artefacts.
Jin said that recent breakthroughs in deep learning provide an unprecedented opportunity to substantially lower radiation doses by combining MBIR with information learned from a large database of high-quality MP-CCTA images. The resulting 4D DRAC method would reconstruct a patient’s images using not only data from that individual scan, but also information learned from a much larger collection of images.
Jin said the project could substantially lower the radiation dose needed for MP-CCTA, potentially improving its use in detecting the narrowing of coronary arteries and monitoring the progression of high-risk plaque. He said the 4D DRAC methods could also be applied to other dynamic CT scans.
To test the hypothesis, Jin and his team will:
Build a synthetic patient library using computational human models based on retrospectively collected MP-CCTA data from real patients.
Develop 3D and 4D deep-learning methods that combine CT imaging physics with features learned from the high-quality patient data.
Determine the lowest radiation dose that can be used without compromising diagnostic accuracy. The team will evaluate diagnostic accuracy using a computer model designed to mimic how a radiologist assesses an image, then validate the results through a small-scale study involving human observers.
The Mayo Clinic in Rochester, Minnesota, will provide MP-CCTA patient data for the study.
“This award reflects the high quality of Dr Jin’s research and the strength of his proposed ideas,” said Alex Weiss (professor of physics and former department chair). “I know a great deal of work goes into preparing a successful proposal of this kind. This is a significant achievement for Dr Jin and a major benefit to our department.”
Graduate students Noor Rasel and Darnisha Langlais will work with Jin on the project. The grant will also allow Jin to hire undergraduate students in the summers, providing them with research opportunities to apply AI techniques to medical imaging.
Tuberculosis is mainly diagnosed and treated in the public healthcare system, but the private sector should also be able to deal with it.
Tuberculosis (TB) remains one of the leading causes of death in the country, claiming around 50 000 lives a year. Caused by a tenacious bug called Mycobacterium tuberculosis, it has plagued mankind for centuries.
In response, South Africa’s public healthcare system has devoted a lot of resources to TB and many public sector doctors, nurses, pharmacists, and community healthcare workers have years of experience with the illness. The country was ahead of the rest of the world in rolling out new molecular TB tests in the early 2010s. In the last decade South Africa introduced new treatments for drug-resistant forms of TB, before most other countries did so. Much important TB research has also been conducted at clinical sites in the country, like the recent BEAT-TB study published in the New England Journal of Medicine.
But what about the private healthcare sector? Indications are that it has not become similarly expert at combatting the age-old bug, even though people who use mainly private sector healthcare services also get TB. Spotlight recently reported on a PhD student who became ill with TB and was diagnosed in the private sector but received treatment in the public sector. That was not an isolated case. Up to 29% of TB patients across 13 high TB burden countries, which included South Africa, engaged with the private healthcare system when their symptoms first started, according to a 2017 study. In South Africa’s first TB prevalence survey, of the 1 726 participants surveyed who had TB symptoms and sought out care, 139 (8.1%) first sought care in the private sector.
However, finding information on TB care in the private sector has proven to be a challenge, and what Spotlight was able to find is at times contradictory and confusing.
Most cases of TB could be treated in the private sector
Let’s start with the basics. Does the private sector diagnose and treat TB at all?
Here a distinction between types of TB is important. Well over 90% of people who develop TB in South Africa have “normal” drug-susceptible TB, that is to say TB that can be successfully treated with the standard set of antibiotics. A much smaller group, fewer than one in 10, have drug-resistant forms of TB. Drug-susceptible TB can be treated in the private sector, while drug-resistant TB appears to be exclusively treated in the public sector.
“[T]here is a common misconception that tuberculosis (TB) can only be treated in the public healthcare sector,” Dr Noluthando Nematswerani, Chief Clinical Officer at Discovery Health, tells Spotlight. She says that there are many healthcare providers that can diagnose and treat TB in the private sector, since TB is part of the standard training medical doctors receive in South Africa. “Discovery Health does not maintain a dedicated network of healthcare professionals who exclusively treat TB, as TB care falls within the scope of practice of suitably trained medical practitioners across multiple disciplines,” she says.
Treating TB is covered under the prescribed minimum benefits – a list of benefits medical aid schemes is required by law to provide to their members, regardless of what plan they are on. According to the Council for Medical Aid Schemes, TB treatment can be made available to members of medical aid schemes through public sector clinics, but they should be given the option of getting their treatment through the private sector.
Medical aid schemes are prohibited by the Medical Schemes Act from saying that “they do not cover the costs of diagnosing, treating and/or the care of TB and that you can only get this cover in the public sector”. A member of a medical aid scheme may only be referred to a public sector facility if that scheme has a designated service providers arrangement with that facility. And a medical aid scheme cannot refuse to cover TB treatment.
“In line with these regulations, members across all Discovery Health Medical Scheme plans have access to comprehensive evidence-based TB care which includes consultations with the relevant healthcare professionals, the necessary diagnostic and follow-up laboratory and radiology investigations, and clinically appropriate medications for the effective management and care of TB,” says Nematswerani.
However, while the option is there for doctors in the private healthcare sector to diagnose and treat drug-susceptible TB, the majority of TB cases in the country are tested for and treated in the public healthcare sector, says Dr Francesca Conradie, a leading TB researcher. At the moment, drug susceptible TB in adults is treated with a six-month treatment course – consisting of four drugs for two months and then two drugs for the remaining four months.
Drug-resistant TB is likely only treated in the public sector
The picture for drug-resistant TB looks quite different. Conradie points out that some of the medications used to treat drug-resistant TB are only available in the public sector. This means patients with drug-resistant TB need to be referred to a public sector facility to get treatment.
While there does not appear to be any outright legal or regulatory prohibition on private sector pharmacies supplying these drugs (in fact, they have listed single exit prices), by all appearances these medicines are not available in the private sector.
The Council for Medical Aid Schemes does not plainly say that drug-resistant TB (sometimes subdivided into MDR-TB, pre-XDR-TB, or XDR-TB) cannot be treated in the private sector at all. It does however state: “Complex cases such as MDR-TB are often referred to specialised public TB hospitals or clinics, as the required drugs and monitoring may be unavailable or too expensive in private settings”.
“Discovery Health Medical Scheme members have cover for MDR-TB, including consultations, diagnostics and hospitalisations. However, there are limits in access to certain MDR-TB medicines in the private sector as they are only available in the public health sector. These medications would be funded as per the Scheme’s policy if they were made available in the private sector,” says Nematswerani.
How this works for Discovery members, Nematswerani explains, is those who have been diagnosed with drug-resistant TB will be referred by their private sector doctor to a designated public healthcare facility that offers the treatment under the National Department of Health’s MDR-TB programme.
“When designated facilities submit claims for MDR-TB services, Discovery Health assesses and Discovery Health Medical Scheme funds eligible claims in line with applicable Prescribed Minimum Benefit (PMB) requirements,” she says. “For example, members have received MDR-TB treatment at Nkqubela TB Hospital, a specialised facility near East London. All eligible claims submitted by the facility since 2025 have been funded in full by Discovery Health Medical Scheme under PMB requirements.”
Drug-resistant forms of TB are treated with anything from three to seven drugs and treatment can last anything from six to 24 months. Two of the drugs bedaquiline and pretomanid, which form the backbone of the drug-resistant treatment regimen, are monitored closely and can only be accessed through the National Department of Health in public sector facilities. This is according to Professor Keertan Dheda, Head of Pulmonology at Groote Schuur Hospital and the University of Cape Town. The reason for this, Dheda says is to “ensure antibiotic stewardship and so that we do not get acceleration of antimicrobial resistance to specific drugs through inappropriate prescription of such drugs used for DR-TB”.
“It’s because they [the drugs in the current DR-TB regimen] are pearls of great price,” explains Conradie, adding the restriction is to try and safeguard some of the drugs in the current drug-resistant TB regimen, particularly bedaquiline, against the development of resistance for as long as possible. Another reason is that drug-resistant TB patients need to be monitored quite closely for potential side effects, something Conradie says the public sector is well-equipped for.
Finding confirmation on the degree to which the private sector can or cannot access bedaquiline and pretomanid directly has proven challenging. When Spotlight asked about this, spokesperson for the National Department of Health Foster Mohale indicated that the department does not have information on these issues and that our questions could be better handled or addressed by the pharmaceutical industry and the private sector.
Spotlight contacted all the pharmaceutical companies that were listed on the South African Health Regulatory Authority’s website as having registered the DR-TB drugs bedaquiline, pretomanid, and delamanid.
“Viatris in South Africa is the Marketing Authorisation Holder (MAH) for pretomanid and delamanid, both registered for drug-resistant TB, available to the public sector through the national tender and to the private sector upon request,” says a spokesperson for the pharmaceutical company Viatris. “Drug-resistant TB treatment is predominantly coordinated through the public health system, where patient follow-up, pharmacovigilance and reporting mechanisms are established.”
Bedaquiline, from the pharmaceutical company Johnson & Johnson, is available in South Africa, including through the country’s private healthcare sector, a spokesperson for the company told Spotlight.
Two other companies responded that they are not directly involved in supplying the drugs and were only involved in the registration process.
Private sector prices for bedaquiline and pretomanid are listed in South Africa’s single Exit Price database, something that usually indicates at least some intent from the manufacturers to supply it to the private sector. UKZN pharmaceutical sciences expert, Dr Andy Gray, tells Spotlight that there is no legal reason for not making these medicines available in the private sector, but access is often constrained. “That the manufacturers have taken the trouble to submit a launch Single Exit Price to the National Department of Health Pharmaceutical Economic Evaluations unit is important, and indicates a willingness to supply a private market, even if availability is limited because demand is almost non-existent,” he adds.
Gaps in knowledge of TB in the private sector
Putting aside the complexities of drug-resistant TB, the option for testing and treatment of drug-susceptible TB in the private sector clearly exists on paper. Yet it is not clear how widely such care is actually available, and when it is, whether it is always up to scratch. Our impression is that it is a bit of a lottery as to whether or not your private sector GP has knowledge of TB.
“There are many gaps in knowledge amongst general practitioners, not only for TB,” says Dheda. “Unlike other countries where there are regular licensing exams that are undertaken, we have decided to use a different approach in South Africa and updating one’s knowledge in a particular field is achieved through their own reading and conference attendance, and through the CPD system where they need to accrue a certain number of points showing that they have attended continuing medical education meetings.”
From the limited information available, it appears that the private sector’s approach to testing for and treating TB is underdeveloped. A likely reason for this is because most TB cases are treated in the public sector, so there is little opportunity or need to develop these skills. A few recent studies on TB care in the private sector have shown that there are significant gaps in and among general practitioners in the private sector. “South Africa’s leading role in prioritising TB in policy and practice possibly contributes to its strong public sector performance,” notes a commentary in the South African Medical Journal. “However, it is unclear to what degree recent advancements in TB screening and care recommendations have permeated the private sector.”
One 2022 study looked at the quality of TB and HIV care in the private sector. The researchers used specially trained staff who would go to a general practitioner with one of three sets of symptoms and histories – all indicating possible or confirmed TB. Case one had typical TB symptoms and was HIV-positive; case two had a TB-specified laboratory report and was HIV-negative; and the third case had a history of incomplete TB treatment and was HIV-positive.
Among the 511 interactions the trained staff had with 212 general practitioners in KwaZulu-Natal and the Western Cape, TB was more likely to be ideally managed as per the study framework – meaning the patient was referred to the public sector or given the relevant tests – if the patient had a diagnosis of TB already or a history of TB. The researchers also found that the private sector GPs in their study did not perform as well as public sector doctors in South Africa.
Some of the public health experts we interviewed were sceptical about the private sector’s ability to provide TB care.
Some patients think they’ll get better TB care in the private sector but in reality, it’s been shown that quality of care is actually far poorer when compared to the public sector, Professor Renier Coetzee tells Spotlight. Coetzee is an associate professor at the School of Public Health at the University of the Western Cape.
Conradie has a similar view. Because of personal experience with family members not getting timely TB diagnosis or appropriate treatment, and anecdotes from other doctors and researchers stating similar scenarios, she tells Spotlight that she is not convinced that TB should be treated in the private sector at all.
Dheda disagrees with the idea that drug-susceptible TB shouldn’t be treated in the private sector. “Both the public and the private sectors prioritises patient care and wellbeing and improving outcomes in patients no matter what the disease. The same should apply for TB,” he says.
Strengthening TB care in the private sector
Strengthening these gaps in TB testing and treatment in the private sector is possible in theory, but according to Conradie will require significant investment by medical aid schemes to better equip general practitioners and private sector clinics. She advocates for strengthening referral pathways for the private sector to get TB patients linked to care in the public system. As well as strengthening education on TB for the private sector by improving awareness of how TB presents and how it should be diagnosed.
One way to potentially strengthen the TB response in the private sector is through stronger partnerships with the public sector, particularly around testing for TB. This 2025 pilot study conducted in KwaZulu-Natal linked 158 General Practitioners to free public sector TB testing using an existing medical referral application (Vula). 61 of the doctors (38.6%) submitted at least one sputum sample collected at their practise to be tested for TB. As a result, 107 people who had TB were identified and almost all were linked to care in the public sector. This showed, according to the researchers, a workable public-private mix model for TB management in a high TB burden setting, but more research is needed in this area.
But how this is playing out in reality, is not clear.
The role of pharmacists
A reoccurring theme in our research for this article is the notion that TB treatment in general could be improved by leveraging pharmacies – both private and public – to make it easier for people to get their medicines.
“More pharmacies in each locality should be designated to carry TB treatment,” says Dheda. “From my experience, often TB treatment is only available at certain designated private pharmacies, and it is not easy to find.”
This experience is echoed by private sector pharmacists interviewed for a recently completed master’s thesis. The thesis has not yet been published, but the author, Brenda Knipe, a pharmacist and master’s student at the University of the Western Cape’s School of Pharmacy shared some general findings with Spotlight.
Her observations are based on interviews with 14 pharmacists from seven provinces (KwaZulu-Natal and the Northern Cape were not included), working in private hospitals or community pharmacies. She says how often pharmacists reported TB patients varied. Some saw many TB patients who come to them to get their treatment, while others never or rarely did.
For those pharmacists interviewed by Knipe who needed to refer patients to the public sector for treatment, some relied on informal networks based on contacts they’ve made in the public sector. This was due to a reported lack of clear guidelines on how or where to refer patients. Knipe says these networks were essentially based on “who you know”. The pharmacists who didn’t have these contacts or informal networks expressed uncertainty about what to do to assist their patients.
The pharmacists, according to Knipe, were eager for more consistent training and continuing professional development on TB so they can assist patients better.
The pharmacists in the study who had to provide TB patients with treatment, according to Knipe, reported sometimes having difficulties in finding stock of drug-susceptible TB treatment. Most community pharmacies don’t normally keep a supply of TB drugs. If a patient does come to the pharmacy with a doctor’s script for TB medicines, the drugs have to be ordered from suppliers. If the drugs are in stock, the pharmacists would then order the full course for that patient, dispense one month’s supply and keep the rest at the pharmacy specifically for that patient.
However, not all the suppliers keep a lot of stock of the drugs on hand, likely due to low demand for TB medicines in the private sector, resulting in some pharmacists in the study reporting that at times they had to phone several suppliers before finding stock. The pharmacists interviewed who were working in private hospitals also had some difficulties sourcing stock of TB medicines, according to Knipe.
Nematswerani points out that Discovery has had similar challenges.
“Discovery Health continues to see a decline in the availability of TB medicines within the private healthcare sector. This is largely attributable to the relatively small number of TB cases managed privately,” she says. “South Africa has a well-established public-sector TB treatment and monitoring programme, and many private healthcare practitioners refer patients to public healthcare facilities for ongoing treatment and follow-up. As a result, demand for TB medicines in the private sector has progressively decreased, contributing to their limited availability through private healthcare channels.”
Thousands of heart patients could be treated without having a metal stent permanently implanted in their arteries – according to research from the University of East Anglia (UEA).
A major analysis of more than 7800 patients found that a newer treatment using drug-coated balloons performed just as well as conventional stents at preventing heart attacks and cardiovascular deaths.
These balloons are removed after treatment, and the findings suggest this approach could offer a safe alternative to permanent stents.
But the team warned that some patients treated with drug-coated balloons may be more likely to need a repeat procedure in the future.
The findings are published in The Lancet’s eClinicalMedicine.
Researchers reviewed data from 10 randomised clinical trials involving 7,832 patients with coronary artery disease.
Lead researcher Dr Natasha Corballis, from UEA’s Norwich Medical School, said: “Drug-releasing stents are tiny mesh tubes inserted into blocked arteries. They are currently the standard treatment for many patients undergoing a common operation to open blocked heart arteries, known as angioplasty.
“But drug-coated balloons offer an alternative approach. Unlike a stent, which remains in the artery permanently, the drug-coated balloon is removed after treatment. As it is inflated, it releases medicine into the artery wall to help prevent the vessel becoming narrowed again.
“Our work shows that there is no meaningful difference between these two treatments when it came to the most serious outcomes.
“Patients treated with drug-coated balloons were no more likely to die from cardiovascular causes than those receiving stents. Rates of heart attack were also virtually identical between the two groups.”
The findings remained unchanged even when researchers excluded studies focusing only on small coronary arteries, where drug-coated balloons already have an established evidence base.
But the study also revealed a potential drawback.
Dr Corballis said: “When we looked at larger arteries, patients treated with drug-coated balloons were more likely to require a repeat procedure to reopen the artery – a measure known as revascularisation.”
Even so, the researchers urged caution over that result, noting there was considerable variation between studies and that the finding appeared heavily influenced by a single clinical trial.
The findings add to growing interest in the so-called “leave nothing behind” strategy, which aims to restore blood flow without implanting a permanent device inside the artery.
Senior author, Prof Vassilios Vassiliou, also from UEA’s Norwich Medical School, said: “This approach could reduce some longer-term complications associated with stents, while preserving future treatment options if patients develop further disease.”
The researchers concluded that larger clinical trials with longer follow-up periods are needed to determine whether drug-coated balloon treatment is equally effective in larger vessels and more complicated coronary lesions.
This research was led by UEA in collaboration with the Norfolk and Norwich University Hospital NHS Foundation Trust.
For patients battling neurodegenerative diseases like ALS, Parkinson’s, Alzheimer’s and other dementias, delivering disease-fighting antibody drugs directly to the brain has proven to be a difficult task. The blood–brain barrier prevents infection crossing into the brain, with fatal outcomes. Unfortunately, this protective feature also prevents us from getting drugs into the brain. Only about 1 in 10 000 antibodies injected into patients actually make it to the brain, with these cellular fighters trapped in the blood rather than escaping through cracks in the blood vessels into the brain.
Now, researchers have mapped out a new transit process to enable drugs to reach the brain which uses extracellular vesicles – which are like tiny bubbles naturally produced by cells in our bodies. Researchers at the University of Ottawa showed that extracellular vesicles find a way to squeeze through blood vessels into the brain, allowing them to deliver drugs there. As a next step, they wanted to find ways to improve the ability of antibodies in the brain to eliminate the pathological proteins that cause neurodegenerative diseases.
“Normal antibodies can attach themselves to the disease-causing proteins in these diseases, but they can’t eliminate them and so aren’t as potent as they could be,” explains Dr Derrick Gibbings (Professor, Department of Cellular and Molecular Medicine, University of Ottawa).
Autophagy is the body’s natural recycling plant, collecting waste from the cell and breaking it up into the small pieces that can be re-used to build other things useful to cells. This allows the body to break them down and reuse things. Dr Gibbings’ team engineered antibodies which attach themselves to disease-causing proteins with a baggage tag that directs these disease-causing proteins into the autophagy garbage disposal system to eliminate whatever the antibodies bind.
“It’s a natural cleaning out process that is normally activated when your cells are stressed or deprived of nutrients. In cells and mouse models we showed that using autophagy improved elimination of the proteins which cause Alzheimer’s, Dementia and Amyotrophic Lateral Sclerosis greatly and mice showed improvements in their symptoms of disease,” says Gibbings. This research, led by a research associate in Dr Gibbings’ lab, Huishan Guo, is published in the journal Nature Biomedical Engineering.
While this discovery is cause for optimism, Dr Gibbings reminds us this is a first step. Treating mice is one step, but an important one, on the road toward clinical trials and showing benefits in patients.
“There is a lot of enthusiasm for antibodies like these in industry, with many of the major pharma and biotech companies having invested billions of dollars in this space,” says Dr Gibbings, a member of the Eric Poulin Centre for Neuromuscular Disease. “Many of these antibodies have been tried in patients in clinical trials but have shown minimal benefits to patients so far. We hope our new strategy to get these antibodies into the brain and eliminate their targets may be a key to making these drugs work for patients.”
