Navigating patient confidentiality, social media and professional boundaries
Photo by National Cancer Institute on Unsplash
Date: Thursday 13th August 2026
Time: 18:00 – 19:45
Earn 2 ethics CPD points
During this webinar, the HPCSA Booklet 5: Confidentiality – Protecting and Providing Information and HPCSA Booklet 16: Ethical Guidelines on social media will be explored from a South African legal and ethical practice perspective. The webinar will offer insights into the complexities of digital communication, including WhatsApp and social media use, consent, online reviews and cybersecurity, while focusing on protecting patient confidentiality and public trust across all forms of communication.
The audience will have an opportunity to listen and engage with clinical, legal and medicolegal subject matter experts. During the webinar, a range of learning opportunities will be offered including short lectures, interactive case studies, audience polling and Q&A.
This webinar will focus on healthcare practitioners engaging in digital communication with patients and colleagues. Administrative staff working in these practices are welcome to join the discussion.
Joining us as panellists will be Emma Sadleir, South Africa’s leading expert on social media law, and Dr Isabel do Vale, a practising medical practitioner and President-elect of APRASSA. Attendance will qualify for 2 Ethics CPD points and EthiQal Recognition Programme points.
Human kidneys sell for up to £150 000 on the black market, but donors receive as little as £1000. Dr Saradamoyee Chatterjee exposes the criminal syndicates exploiting the desperate on both sides of the illegal organ trade, and asks how we can stop them.
Slums are a goldmine for organ traders. The brokers exploit people who are trapped in poverty and debt, and lure them into selling their kidneys.
Dr Saradamoyee Chatterjee
How much does a human kidney cost on the black market? It depends on who you are in the transaction.
Buyers can pay between £60 000 and £150 000. But donors only receive between £1000 and £7500, if they are lucky.
Where does the rest of the money go? The lion’s share goes to the organ brokers: criminal organisations who act as middlemen between donors and buyers.
These syndicates are sophisticated, exploitative, and international.
“One racket, operating from Israel, brought together Brazilian donors with American buyers, with the transplant taking place in South Africa.” So says Dr Saradamoyee Chatterjee, Bye-Fellow and Director of Studies in Land Economy at Lucy Cavendish College.
Chatterjee unpicks the illegal trade of human organs. She gives voice to the desperate players trapped inside its transactions, and suggests ways to stamp it out.
The organ bazaars
Beginning in the 1950s, science radically improved the success rate of human organ transplantation. Researchers found ways to suppress the immune response of the recipient, so that new organs are not rejected. Transplants now have a high degree of success between strangers, provided that donors and recipients match in blood and tissue type.
Kidneys are by far the most commonly transplanted organ, but transplants of heart, lungs, liver lobes and corneas are also possible.
In countries like India, Pakistan and the Philippines, these advancements initially led to completely unregulated human organ markets. Whichever country had the fewest regulations attracted international patients.
“In the 1980s, these countries were like an organ bazaar,” Chatterjee says. “Patients from the Middle East, UK and USA flocked to get their transplants done.”
Currently, only Iran has a legalised system for paying donors for their organs. Everywhere else relies on legal means, like organ donor lists, or illegal ones, which are still rampant in some countries. The persistence of organ trafficking reflects the desperation on all sides of the transaction.
The need for healthy organs is ever-increasing. Modern ‘lifestyle’ diseases such as diabetes and hypertension lead to kidney failure. Among the 2 current treatments – dialysis and organ transplantation – the latter significantly enhances the quality of life. Many people wait decades on donor lists and will do anything for a healthy organ.
Among slum-dwellers and asylum seekers, there is both a supply of valuable organs and the desperation required to part with them.
Here is where the middlemen come in, servicing an unsavoury gap in the market.
The sellers
Chatterjee travelled to Mumbai, Delhi, Chennai and Kolkata to seek out people with first-hand knowledge of the organ trade. In these cities she found a network of medical professionals, transplant coordinators, buyers and donors willing to share their views.
“Slums are a goldmine for organ traders,” Chatterjee says. “The brokers exploit people who are trapped in poverty and debt, and lure them into selling their kidneys.”
Many people are in need of a lump sum to escape dire circumstances – the organ traders supposedly offer that.
Once a broker gets a kidney, the sellers seldom receive the promised compensation and the vital post-operative care. Even the nominal fee would not provide any relief from poverty.
“One woman I spoke to was a cleaner for weddings,” recalls Chatterjee. “She sold her kidney to save the life of her husband. He’d fallen into debt after buying a tuktuk via a money lender, and couldn’t afford the interest payments. In the end, she only received half the offered price for her kidney.
“She was left weakened, deeply disappointed, and regretful of the whole organ-selling experience.”
In matching sellers with buyers, the syndicates respond to pleas for organ transplants on social media.
To dodge India’s prohibitions, the syndicates exploit loopholes in the law, including the forging of fake backstories. They generate false documents and testimonies to convince doctors and clinicians that 2 strangers know each other.
The transplant can then take place as if it were happening legally – as an agreement between friends or family, without money changing hands. These tactics make it difficult for doctors to detect potential exploitation.
The buyers
Organ trades are a bad deal for buyers too. Both the buying patients Chatterjee interviewed died shortly after their operations.
“In one case, the broker took payment before providing a mis-matched donor,” Chatterjee says. “In the second case, a female doctor saw that her new husband’s kidneys were failing. She placed an advertisement in the local newspaper, and a broker responded. But on the day of the planned transplant, the donor ran away.”
Operating with no regulation, the middlemen don’t uphold medical standards. They often don’t screen donors for existing conditions, exposing recipients to blood diseases like HIV or hepatitis.
The proliferation of lifestyle diseases in massive populations means that the organ trade isn’t only for the super rich: buyers only need to be rich relative to the poverty-stricken sellers.
Both of the buyers Chatterjee spoke to came from the middle class. They were compelled to borrow money from their relatives to pay the broker.
How can we make things better?
Meaningfully reducing the illegal trade of human organs requires action on many fronts.
Reducing the gap in supply means encouraging more legal donations. Other countries have focused on deceased donations, where people donate their organs after death. In Spain, everyone is an organ donor by default, meaning they have the world’s highest deceased donors rate (49 per million people; by comparison, India has only 0.77).
India claims to be tackling the black market with increased regulations and harsher sentences for perpetrators. Information campaigns targeting potential sellers should warn people about the dangerous middlemen. Further exposure of the black market by researchers like Chatterjee and Dr Sean Columb may also prevent people from being dragged into it.
On the demand side, societies need to properly fund their citizens’ healthcare. More successful countries focus on the prevention of lifestyle diseases that are leading causes of renal failure.
Encouraging people into healthier lifestyles – with fewer carbohydrates and more exercise – would decrease the prevalence of conditions like diabetes. Better screening programmes would also encourage patients to adjust before their condition deteriorates, reducing the demand for new organs.
“Organ traffickers exploit the vulnerabilities of both the donors and buyers,” says Chatterjee. To wipe out the middlemen, we need to make people on all sides of organ transplantation less vulnerable and more resilient.
The surge in demand for GLP-1 and GIP medicines—particularly those containing semaglutide and tirzepatide—has created significant commercial opportunity. It has also exposed a growing problem: the manufacture and sale of unregistered and potentially unlawful alternatives.
Recent enforcement action by the South African Health Products Regulatory Authority (SAHPRA) highlights the scale of the issue, particularly in relation to products marketed for weight loss (see SAHPRA and the SAPC Crack Down on Unlawful Manufacturing of Unregistered GLP-1/ GIP Medicines). While this is often viewed as a regulatory concern, it raises equally important questions for trade mark law.
Trade marks are traditionally seen as tools for distinguishing one trader’s goods from another’s. In the pharmaceutical sector, however, they do far more. They signal quality, safety, efficacy and regulatory legitimacy.
When those signals are misused, the consequences extend beyond commercial harm—they can directly affect public health.
More Than Molecules: Reputation as the Real Asset
The success of products such as OZEMPIC®, Wegovy® and MOUNJARO® is not driven by their active ingredients alone.
Through years of clinical research, regulatory scrutiny and market presence, these brands have accumulated significant reputational capital. Consumers are not simply looking for semaglutide or tirzepatide—they are looking for certainty.
Consumers want products backed by known standards of safety, tested efficacy and regulatory oversight.
In this context, the goodwill attached to a pharmaceutical trade mark reflects far more than brand recognition. It represents confidence in the entire lifecycle of the product—from development and approval to manufacture and distribution.
Reputation Laundering: Trading on Trust Without Earning It
In the current GLP-1 market, misuse of reputation does not always take the form of direct counterfeiting or even traditional trade mark infringement.
More often, products are marketed as alternatives, equivalents or substitutes for well-known medicines. Advertising often references established brands to attract consumer attention and to confer an aura of legitimacy on products that may not have undergone the same level of regulatory scrutiny.
This is where a more subtle form of exploitation emerges.
Even without reproducing a trade mark, these practices appropriate the trust associated with it. The result is what can aptly be described as reputation laundering, being the transfer of credibility from a trusted product to one that has not independently earned it.
From a trade mark perspective, the damage goes far beyond lost sales. It weakens the link between the brand and the qualities consumers expect from it.
The Consequences for Consumer Trust
The risks become most apparent when products fail to meet expectations- or worse, raise safety concerns.
If a consumer experiences harm after using a product marketed with reference to a well-known brand, the reputational fallout rarely remains confined to the seller. It can spill over to the genuine product.
This is what makes pharmaceutical trade marks unique. The goodwill they embody is inseparable from consumer trust in the safety and reliability of medicines.
Once that trust is compromised, the consequences extend beyond individual brand owners. They can influence patient behaviour, clinical decision and confidence in an entire class of treatments.
The Growing Union Between Regulatory Enforcement and Trade Mark Protection
Historically, regulatory compliance and trade mark enforcement have been treated as distinct legal disciplines. Increasingly, however, the two are becoming interconnected.
Regulatory authorities seek to protect consumers from unsafe or unapproved products. Trade mark owners seek to protect the reputation and goodwill associated with their brands. In many cases, these objectives are aligned.
SAHPRA’s recent focus on unregistered GLP-1 products illustrates this convergence. Both regulators and trade mark proprietors share an interest in ensuring that consumers are not misled regarding the nature, origin or reliability of pharmaceutical products.
As pharmaceutical brands continue to acquire substantial reputational capital, the distinction between consumer protection and brand protection becomes increasingly difficult to draw.
It is clear that pharmaceutical trade marks are no longer simply badges of origin. They have become proxies for trust. As the current GLP-1 market demonstrates, protecting that trust is not only a commercial imperative- it is increasingly a matter of public health.
Fake and substandard medicines, along with bogus healthcare practitioners, pose a growing threat to patient safety in South Africa.
The sale of fake and substandard medicines is a significant threat to patient safety around the world. In South Africa, the main affected products are painkillers, antibiotics, weight-loss and sexual enhancement products, skin-lightening products, and some chronic medicines.
In pealing back the different layers of this problem, it is essential to get the definitions right.
Substandard products are those that do not meet quality standards and specifications.
Falsified products deliberately misrepresent their identity, composition or source.
Neither of these should be confused with generic medicines, which have the medicines regulator’s green light for being safe, effective, and of good quality.
People are often duped into purchasing substandard and falsified products, especially when the real thing is not available or too expensive. But, as Elna Schütz this week reports for Spotlight, there are also people who buy these medicines fully aware of the risks.
These unregulated medicines are mostly distributed through informal channels, unregulated outlets, online platforms, and cross-border smuggling networks. It is also possible that some substandard and falsified medicines have been infiltrated into otherwise reputable medicines distribution channels.
Data on the scale of the problem is scant, but there is agreement that the problem is substantial. The WHO estimates that around 1 in 10 medicines in low- and middle-income countries are substandard or falsified.
The South African Health Products Regulatory Authority (SAHPRA) is the main body responsible for regulating substandard and falsified medicines. It does this through post-market surveillance and inspections, a whistleblower reporting system, product recalls, and monitoring illegal advertising and online sales. A new National Action Plan and comments from the Minister of Health suggests there is some intent to step up these efforts.
The good news is that we can generally trust that the medicines we buy at pharmacies contain what they are supposed to and that they were manufactured according to good quality standards. As regulatory entities go in South Africa, SAHPRA is generally one of the better-functioning ones.
But, outdated legislation means that SAHPRA doesn’t have all the tools it needs to stamp out the sale of unauthorised medicines. For instance, it has limited powers in relation to advertising and marketing, cannot block a web site, and cannot issue infringement notices, or impose sanctions on entities or individuals whose actions potentially place the public at risk of harm.
The misrepresentation may include using fraudulent certificates, using another practitioner’s registration, or still offering healthcare services while being suspended or erased from the register.
From early 2024 through late 2025, 66 bogus practitioners were caught and arrested, with the majority operating in the economic hubs of the Western Cape, Gauteng, and KwaZulu-Natal.
You can help curb these problems. Suspicious practitioners can be reported to the HPCSA, and suspicious products or sellers can be reported to SAHPRA. People are also advised to buy only from licensed and authorised pharmacies and checking if healthcare providers are registered.
And then there is fake news
In some areas, as with bogus health professionals and falsified medicines, the solution to misrepresentation is clearly to have legally empowered regulators with enough muscle to consistently enforce the law.
But when it comes to misinformation and disinformation – call it fake news if you will – the way forward is much less obvious. In recent years, we’ve seen a toxic mix of political polarisation, conspiracy theories, disinformation campaigns, and twisted social media algorithms – often fuelling a rejection of science and evidence-based policy-making. Beyond just our screens, these trends have unfortunately started to distort the real world, as we’ve seen at various critical health institutions in the United States.
In our view, regulators should have a role in preventing misinformation and disinformation about medicines. But how exactly to make such regulation work in an age of largely unaccountable social media networks is not at all clear.
What we think is clear, is that much of the solution to the problem of health misinformation and disinformation, is simply to keep creating its opposite, high-quality, rigorous, and evidence-based journalism.
This is the core of what we try to do at Spotlight. It is also why we have made our journalism subject to the South African Press Code, work hard to stick to our Editorial Policy and Style Guide, and why we urge you to hold us accountable when we get things wrong, as we will inevitably do from time to time.
From unregulated weight loss injections to unsafe pain tablets, substandard and falsified medical products pose a threat to the health of people. Spotlight reports on how regulators are fighting the problem in South Africa.
“I know that there is a risk, but at this point I feel that the benefits outweigh everything else,” says Anna*, who buys unregulated medicine on the black market.
She was prescribed GLP-1 RA medicines by a doctor after being tested for insulin resistance. She has lost around 30kg and says the positive impact on her body, life, and self-esteem has been massive. GLP1 RAs (Glucagon-Like Peptide-1 Receptor Agonists) medicines, sold under brand names like Ozempic and Mounjaro, are increasingly used for weight loss and to prevent and/or treat diabetes.
When global shortages affected GLP-1 RA stocks in local pharmacies, Anna started buying similar drugs directly from unregistered sellers. For around R1 650, a fancy-looking box with a three-month supply of injections is delivered to her in a small cooler box. “I knew then already that what I was buying was unregulated and potentially inferior or even dangerous,” she says, adding, “but I was finally starting to feel good about myself.”
Apart from being aware that the unregulated drugs could potentially harm her, Anna says she found that the regulated products were often out of stock, expensive, and came with stigma from pharmacists who quizzed her on whether she deserved the products. “If I could have kept doing it the proper way, I would have, but there were just too many obstacles,” she says.
Defining the problem
Weight-loss medicines are only one of several types of health products that are frequently purchased outside of formal channels, according to the South African Health Products Regulatory Authority (SAHPRA).
“Commonly affected products include painkillers, antibiotics, weight-loss and sexual enhancement products, skin-lightening products, and some chronic medicines,” Mokgadi Fafudi, SAHPRA’s manager of regulatory compliance, tells Spotlight.
“Combating the threat of substandard and falsified medical products is one of the urgent global challenges of this decade,” says Faridun Nazriev, the external relations and communications officer at the World Health Organization (WHO) Country Office in South Africa.
“Substandard products are those that do not meet quality standards and specifications, often due to poor manufacturing practices or inadequate quality control. Falsified medical products deliberately misrepresent their identity, composition or source”, according to the WHO. These products, it adds, are often created and distributed with the intent to deceive consumers for financial gain.
Two other definitions should not be confused with these, cautions Dr Andy Gray, a senior lecturer in Pharmacology at UKZN and co-director of the WHO Collaborating Centre for Pharmaceutical Policy and Evidence-Based Practice.
Compounded medicines are custom formulations that may be specific to a patient, but are generally not registered by SAHPRA.
Generic medicines are those that have been tested and found to be as safe and effective as originator medicines, but are generally cheaper. Generic medicines on the market have been approved by SAHPRA and are not in any way substandard.
Gray says the term counterfeit is no longer used by the WHO, because it refers specifically to breaches of intellectual property, like trademarks.
Lack of data
While the WHO estimates that 1 in 10 medicines in low-and middle-income countries are substandard or falsified, all regions are affected and have been seeing an increase, according to a 2024 report from the WHO’s Global Surveillance and Monitoring System.
South Africa also appears to have rising rates. SAHPRA’s 2021/2022 annual report notes that 101 health product quality complaint reports were filed. In 2022/23, that figure nearly tripled to 297.
Fafudi says that the organisation received 588 reports of possible non-compliance in the 2024/2025 year. She says that for the 2025/26 year, this number exceeds 570 cases, though this has not yet been published by SAHPRA.
But such reports are likely only the tip of the iceberg. Gray laments that we don’t have the full picture of how big the problem of substandard and falsified medical products really is.
This is partly because, by its very nature, the sale of substandard and falsified medicines is usually hidden. Fafudi says that these medicines are often sold through informal markets, unregulated outlets, online platforms, and cross-border smuggling networks.
Gray adds that these medications aren’t necessarily always sold through informal means. “They may be infiltrated into wholesalers or state medicine depots, and then distributed,” he says, “Or they may be sold directly to pharmacies or prescribers and then sold to patients.”
A threat to patients
As in Anna’s experience with GLP-1 RAs, there is often a demand for unregulated products because the properly regulated products can’t meet the public demand.
Fentse Maseko, who works in the Department of Pharmacology and Pharmacy at Wits University, researched this issue in her Master’s thesis and advocates in the space. She notes that in many low- and middle-income countries, particularly in remote and underserved areas, limited access to medicines may force patients to seek treatment from informal markets. She adds that in South Africa, porous borders and rising costs also play a role.
Whatever the reasons behind their proliferation, the risks to the healthcare system and individuals are multi-faceted.
“Substandard and falsified medicines are a serious threat to patient safety and public trust,” says Refiloe Mogale, the executive director for the Pharmaceutical Society of South Africa (PSSA). “These products can lead to treatment failure, harm, or even death.”
Maseko warns that it can also add to the growing problem of antibiotic resistance if antibiotics are substandard. It can also strain the healthcare system when second or third-line treatments are needed for issues initially addressed with unregulated products, or caused by them.
The role of the regulator
The main body in South Africa responsible for regulating substandard and falsified medicines is SAHPRA. Fafudi explains that they conduct post-market surveillance and inspections, run a whistleblower reporting system, manage product recalls, and monitor illegal advertising and online sales.
SAHPRA also works with specialised units in the South African Police Service as well as other stakeholders such as customs to enforce joint operations. Fafudi says such joint operations have been conducted on at least a monthly basis.
There are also legal actions, including issuing warnings, seizing or destroying products and criminal prosecution. According to the Medicines and Related Substances Act 101 of 1965, fines or prison sentences not exceeding 10 years may be prescribed.
The PSSA however charges that not enough is being done. “Key gaps are visible in insufficient regulatory capacity, weak border control, limited enforcement scale and the under-resourced National Action Plan,” Mogale says. “The system is overwhelmed by the speed and sophistication of the problem.”
Reporting unregulated products
The public can help address the problem of substandard and falsified medicines. SAHPRA advises buying only from licensed and authorised pharmacies and healthcare providers.
“Be cautious of unusually low prices, miracle cure claims, and poor packaging,” Fafudi warns. “Always check packaging, expiry dates, and consult healthcare professionals before use.”
Suspicious products or sellers can be reported on the SAHPRA website.
Jas Bhana, Chief Executive Officer of the Innovative Pharmaceutical Association of South Africa, adds that the public can also report suspicious products to the National Department of Health or their nearest pharmacy. “Combating this threat requires collective vigilance to safeguard every patient’s right to safe, quality, and effective medicines,” she says.
This goes hand-in-hand with the need for consumers to know the dangers, Maseko explains. “While public education plays an important role in mitigating this risk, effective risk communication remains a challenge, particularly in communities with limited health literacy,” says Maseko.
On a bigger scale, Nazriev explains that the WHO prioritises prevention, detection, and response as the main pillars of action. This includes local regulation as well as collaboration between countries.
“Given the transnational nature of globalised medical product supply chains as well as criminal networks, collaborating across borders and sectors is essential to national, regional and global responses,” he says.
Better regulation
Gray acknowledges that there is a challenge in budgets and laboratory capacity, but even so he calls for more to be done. “SAHPRA needs to move from a largely reactive stance to a more proactive one, sampling medicines from the distribution chain and submitting them for checking, and then report to the public on their findings,” he suggests.
The PSSA recommends implementing a national medicine registry with a track-and-trace system and stricter control of online medicine sales, including mandatory certification and monitoring.
SAHPRA is already planning along some of these lines. “Future plans include strengthening supply chain traceability, enhancing detection systems, regulating online medicine sales, and increasing public awareness campaigns,” says Fafudi.
Part of this direction comes from a National Action Plan (NAP), launched late last year by SAHPRA, with support from the National Department of Health and the WHO.
“All actors within the supply chain, particularly at key pinch points in both the public and private sectors, must be equipped with the knowledge, skills, and equipment to identify and report suspicious products to SAHPRA,” Health Minister Dr Aaron Motsoaledi is reported to have said at the launch of the NAP. “All activities should mitigate the risk of substandard and falsified medical products. This includes increased vigilance at ports of entry, through to post-market surveillance of high-risk products, inspection of manufacturers, distributors and wholesalers.”
Whether all this will be done, and what it will mean for people like Anna who knowingly choose to use unregulated medicines, remains to be seen.
Time to restore kindness and compassion in healthcare to improve patient and staff well-being
Source: Pixabay CC0
Healthcare has lost its human, moral, and relational foundations and must reconnect with its core values to improve both patient and staff well-being, argue experts in The BMJ today.
Despite unprecedented advances in diagnostic precision, therapeutic capability, and computational power, a deep paradox exists, say authors Don Berwick, Maureen Bisognano and Bob Klaber. Patients increasingly feel processed rather than cared for, staff report moral distress and loss of meaning, and the workforce is haemorrhaging people at an unsustainable rate.
The core problem, they write, is that we have accumulated extraordinary technical power while quietly losing the human, moral, and relational foundations of care on which its effectiveness ultimately depends.
Several powerful forces have helped create this imbalance, they explain. For instance, in some countries the pursuit of profit has choked healthcare’s moral purpose, while across the globe modern healthcare has become an industrialised system that processes patients through standardised protocols in ways that risk disregarding the unique texture of individual lives.
This has happened through an imbalanced emphasis on a “rational” lexicon (focused on measurement, targets and efficiency) over a “relational” one (concerned with feelings, kindness and human connection).
Yet re-establishing the relational balance is not a sentimental or “soft” approach; it is vital for quality and safety, they argue.
They point to research on NHS culture and behaviour that found organisations where staff felt supported and valued had consistently lower patient death rates, while the Institute for Healthcare Improvement (IHI) framework shows that the conditions for increasing joy in work – clarity of purpose, psychological safety, and feeling that what matters to you is actually valued – are both achievable and measurable.
Kindness – linked empirically to better staff retention, higher teamworking scores, and improved patient outcomes – should also be repositioned at the business end of delivering high quality care, they add.
The “What matters to you?” movement, inspired by an article in the New England Journal of Medicine, exemplifies this shift, changing the clinical encounter from a diagnostic focus to a partnership based on the patient’s lived reality.
While the forces pulling healthcare away from its human dimension are structural and powerful, they are not irreversible, they say. Every ward round, clinical consultation, and leadership conversation is a small but powerful opportunity for all of us working in healthcare to balance relational practice with rational systems and processes.
The evidence is clear: patients do better and staff thrive when healthcare systems invest in joy, kindness, and compassionate leadership, they write. “We do not need to wait for system reform. We can begin now on our collective leadership challenge to reconnect healthcare with its mission and purpose.”
On May 18, 2026 (yesterday), South Africa’s Constitutional Court unanimously upheld a 2024 ruling from the Pretoria High Court, declaring Sections 36 to 40 of the National Health Act 61 of 2003 (NHA) unconstitutional and invalid.
QuickNews previously reported on the High Court judgement, which you can read about here. The Certificate of Need (CON) was part of 2003’s NHA, which was never implemented. Despite it not being a part of the 2023 NHI Act, the removal of the Sections was seen as undermining a core pillar of NHI – centralised management.
The case was brought by Solidarity Trade Union, the Hospital Association of South Africa (HASA).
It was argued that the CON unfairly constrained the rights of doctors to practise where they chose, and hospitals and other healthcare facilities would not be able to operate without one, nor for new facilities to open or even expansions to be made. The provisions, which aimed to promote equitable distribution of healthcare services, had not yet been implemented.
The Director-General of Health, who issued the CON, would have had exercised a “blunt instrument” to control private healthcare in the country, noted Judge Anthony Millar of the Pretoria High Court in his judgement.
The sections were found to be irrational and an unjustifiable limitation on the constitutional right (Section 22) to freely choose a trade, occupation, or profession. They granted overly broad discretionary powers without adequate safeguards. Finally, the court ruled that severing (removing) these sections entirely from the NHA was appropriate, with no need to refer them back to Parliament for fixing. The Health Minister and Director-General were ordered to pay costs.
Anton van der Bijl, Deputy Chief Executive of Solidarity, said: “The Certificate of Need was far more than merely an administrative instrument. It was an instrument of centralisation and state control.”
EthiQal cordially invites you to an ethics webinar on Thursday, 16th April.
During this webinar, the HPCSA Booklet 7: Guidelines for the Withholding and Withdrawing of Treatment and HPCSA Booklet 17: Ethical Guidelines on Palliative Care will be explored from a South African legal and ethical practice perspective. The webinar will offer insights into the complexities of withholding, treating, withdrawing and palliating patients while focusing on offering ethical and compassionate care and support to both patients and their loved ones.
The audience will have an opportunity to listen and engage with clinical, legal and medical malpractice insurance subject matter experts. During the webinar, a range of learning opportunities will be offered, including short lectures, interactive case studies with a series of multiple choice questions, panel discussions, and audience Q&A.
Date: Thursday 16th April 2026
Time: 18h00 – 19h45
2 CPD Ethics Points
Speakers
Dr Shetil Nana
Dr Shetil Nana is a Paediatrician and Paediatric Critical Care Consultant with experience across the South African state and private healthcare sectors. Currently based at Mowbray Maternity Hospital, she works as a sessional consultant in the neonatal intensive care unit – where her clinical expertise is matched by a deep commitment to patient-centred advocacy.
Dr Hlombe Makuluma
Hlombe is a general medical practitioner with a Masters in Medical Law and Ethics. He is currently a PhD Candidate in Medical Law with the University of Pretoria.
Assoc Prof Zainab Mohamed
Associate Professor Zainab Mohamed is a Clinical and Radiation Oncologist in the Department of Radiation Oncology, Groote Schuur Hospital, and the University of Cape Town. She is the head of the clinical unit, runs the Lymphoma, Kaposi’s sarcoma and Thyroid cancer clinics and provides radiotherapy services to Clinical Haematology.
Dr Luyanda Mtukushe
Luyanda is a practicing advocate and a member of the Johannesburg Society of Advocates. He has 10 years’ experience as an Advocate and his areas of practice being medical related litigation, and general commercial litigation.
Amy Wolfe
Amy is a healthcare continuing professional development (CPD) professional with more than 15 years’ experience of building, delivering and evaluation programmes for South African healthcare professionals.
This webinar will focus on specialist practices. Administrative staff working in these practices are welcome to join the discussion.
The newly launched, first of its kind, EthiQal Recognition Programme strives to acknowledge professional conduct that reflects a commitment to the delivery of excellent patient care and the reduction of medicolegal risk.
It is aimed at specialist clinicians in private practice and is based on a point system where defined activities qualify for set points that over time convert to premium refunds.
The Programme underpins EthiQal’s pledge to promoting high-quality healthcare, supporting practitioners in building successful, safe practices and managing their medicolegal risk, and aligning individual practitioners’ professional indemnity premiums with their unique insurance risk.
How the Programme works and which activities qualify for point collection are outlined in the Recognition Programme Benefit Guide, with the formal details of the Programme defined in the Terms and Conditions and Benefit Rules documents, which can all be viewed on the EthiQal website: https://ethiqal.co.za/
For more information about EthiQal, click here [https://ethiqal.co.za/contact/] complete the form, and an Advisor will call you back.
The South African Medical Technology Industry Association (SAMED) is raising the alarm over the Gauteng Department of Health’s ongoing failure to meet its financial obligations to medical technology suppliers – a crisis that now threatens business survival, jobs, and the stability of healthcare delivery across the province.
The Gauteng Health Department currently owes SAMED member companies more than R700 million. Despite fulfilling their contractual commitments and continuing to supply essential medical products and services, many companies have been forced to carry this debt burden for months without payment. To remain operational, suppliers are relying on costly loans and overdrafts simply to sustain cash flow and pay their employees.
SAMED Chairperson, Scott de Oliveira, notes that a recent member survey revealed several companies are on the brink of closure, with job losses imminent – even as South Africa prepares to host the G20 Summit, a global event intended to showcase Johannesburg and the country’s economic potential.
“As the upcoming G20 Summit demonstrates, our government is capable of decisive action and resource mobilisation when it chooses to,” says de Oliveira. “What is deeply concerning in the medtech payment crisis is the Gauteng Department’s lack of urgency to engage with us.”
Despite repeated formal requests from SAMED to meet with senior Gauteng Department of Health officials – including the Chief Financial Officer, Head of Department, and hospital Chief Executive Officers – no meaningful engagement has taken place. Meetings are frequently missed, and correspondence has gone unanswered.
“This reflects a worrying lack of accountability, urgency, and leadership from decision-makers,” de Oliveira emphasises.
The consequences of this inaction are far-reaching. The mounting financial strain on suppliers threatens not only the sustainability of small- and medium-sized enterprises but also the continuity of international subsidiaries that have invested in South Africa and are vital to the delivery of healthcare services.
“Disruptions in the medical supply chain place patients and healthcare professionals at risk,” warns de Oliveira. “Delays or interruptions in the supply of essential equipment, consumables, and support services could have devastating effects on hospitals across Gauteng.”
Several SAMED members have indicated that, unless the issue is urgently resolved, they will be forced to suspend supply to the Department, a decision that would further endanger patient care.
SAMED calls on provincial and national leadership to take immediate, decisive action to clear the payment backlog and to implement a transparent, sustainable payment framework that ensures future compliance and stability.
“It is irrational for government to champion economic growth and job creation through initiatives such as the MEDTECH Master Plan and the G20 Summit, while simultaneously eroding existing businesses and employment through maladministration,” concludes de Oliveira. “This crisis must be addressed urgently – to protect patients, preserve healthcare delivery, and rebuild trust between the public sector and its suppliers.”
SAMED urges the media, public, and stakeholders to bring attention to this issue and hold the Gauteng Department of Health accountable. Public awareness and pressure are essential to compel action and safeguard the integrity of South Africa’s healthcare system.
