Category: Expert Opinion

Salim Abdool Karim | Transforming Adversity Into Opportunity for the AIDS Response

Epidemiologist Professor Salim Abdool Karim is internationally recognised for his significant contributions to research on HIV treatment and prevention. (Photo: Supplied)

By Salim Abdool Karim

As World AIDS Day 2025 swings by, CAPRISA Director Professor Salim Abdool Karim reflects on the frantic days following this year’s unprecedented cuts to health aid and research funding from the US, arguing that the deliberate disruptiveness was designed to be cruel. Nonetheless, he argues, our HIV response must now forge ahead on a path that is more affordable, sustainable and independent.

STOP WORK!

A “STOP WORK” order is immediate.

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) received its first US government “STOP WORK” order from the US Agency for International Development (USAID) on 27 January 2025, imposing a 90-day suspension on a major HIV prevention research project.

A week earlier, on 20 January 2025, incoming US President Donald Trump signed an Executive Order imposing a 90-day freeze on USAID funding. Shortly thereafter, Elon Musk and his Department of Government Efficiency arrived at the USAID headquarters to systematically dismantle it and terminate most of its projects. Within 7 days, the full effect of Trump’s decision was reverberating across the world. The acute US funding cuts disrupted its foreign aid programmes that had for years worked to improve the lives of the most vulnerable communities across the globe.

The impact was instantaneous. Several US-funded projects ground to a halt. Feeding programmes for the hungry, shelter projects for those displaced by war and conflict, daycare for abandoned children and many other programmes in dozens of countries around the world were stopped. The swiftness of the implementation of the USAID dismantling caught the world off-guard.

On 3 February, Secretary of State, Marco Rubio, declared himself to be the new head of USAID, giving Musk carte blanche to destroy it. That day, I was contacted by journalists from The New York Times and from the prestigious magazine Science for information on the impact of US funding cuts on our HIV research.

On 7 February, the New York Times front page headline, “Clinical Trials Left in Lurch By Aid Freeze” informed the world of the impact of the US funding cuts on AIDS research in Africa. It described in graphic detail the impact of the funding cuts on research Dr Leila Mansoor and Dr Disebo Potloane of CAPRISA were undertaking in partnership with world-leading US scientist Dr Sharon Hillier, in developing new HIV prevention technologies for women.

Exactly a month after the initial 90-day “STOP WORK” order, we were notified that this US government funded project had been officially terminated for good. Several other large US-funded projects in South Africa, such as an HIV-vaccine development project led by Professor Glenda Gray, also received termination notices.

While the US government is perfectly entitled – as it sees fit – to stop funding for any of its projects, the deliberate disruptiveness of its implementation was sadly designed to be cruel. Musk relished his destruction of USAID with a chainsaw performance on stage at the Conservative Political Action Conference on 21 February. Ironically, the chainsaw, which he had just received as a gift from Argentine President Javier Milei, was engraved with the phrase “Viva la libertad, carajo”, which is Spanish for “Long live liberty, damn it.”

‘Disownment of science’

The Trump administration effectively dislocated the highly effective partnerships forged by the US and South African scientific communities over the past three decades. It was not simply a withdrawal of funding, but the disownment of science that rocked these research collaborations. A devaluing of science and an era of disinformation set in.

False information from the Trump administration is now rife, from debunked theories regarding autism from vaccines to the supposed dangers of paracetamol during pregnancy to the fictitious “white genocide” in South Africa or “Christian genocide” in Nigeria. This is a threat to democracy and to the decades of progress made in the AIDS pandemic.

Science, in its search for the truth, is under attack, as disinformation-based policies become official.

No time to wallow

Following the initial shock, we realised that we had zero time to wallow in this grief of sorts. CAPRISA went to work mobilising our own resources, reaching out to participants in terminated studies to offer them medical and emotional support. In March and April, our scientists routinely worked late into the night on new grant applications to research funders besides the US government. That hard work is now beginning to bear fruit as new grants begin to fill the gaps in our research funding.

These unprecedented disruptive funding cuts have been a stark reminder to never take donor funding for granted. And certainly, never to be as heavily reliant on a single donor again. While overseas development aid is intended to be altruistic, it has often come with strings attached. Those strings were a rude awakening in 2025 and has left several governments and non-governmental organisations, who were dependent on US foreign aid, in the lurch.

Scientific breakthroughs in HIV, including those by South Africa’s many highly accomplished AIDS researchers, have had widespread global impact benefitting vulnerable groups from all walks of life. Ironically, the funding cuts comes at a time when even greater resources are needed for research to successfully navigate the “last mile” on the way to the Sustainable Development Goal of ending AIDS by 2030.

As this year’s World AIDS Day theme, “Overcoming disruption, transforming the AIDS response” reminds us, this is the time to forge ahead on a path that transforms the response to one that is more affordable, sustainable and independent. As African scientists, we have already begun to take bold steps on the path to greater independence, thereby shifting our focus away from the disruption towards charting a determined path to a world without AIDS.

*Abdool Karim is the Director of CAPRISA and Pro Vice-Chancellor (Research) at the University of KwaZulu-Natal in Durban.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

#InsideTheBox with Dr Andy Gray | Where Are We on the Road to More Coherent Cannabis Regulation?

#InsideTheBox is a column by Dr Andy Gray, a pharmaceutical sciences expert at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice. (Photo: Supplied)

By Andy Gray

There has been much confusion and misunderstandings about how cannabis and associated products are regulated in South Africa, with government’s own missteps adding to the uncertainty. In his last #InsideTheBox column for the year, Dr Andy Gray clearly sets out the current legal and regulatory situation and where we’re heading.

There is a fundamental assumption that underpins much of the legislation relating to pharmacologically active substances, especially those that have neuropsychiatric effects. Some are recognised as having legitimate medicinal uses, in humans and/or animals, and so are regulated as medicines. Others are deemed to have no legitimate medicinal uses, and so their possession and use is prohibited or even criminalised. Some of these substances are obtained from natural sources, such as plants or fungi, and some have been recognised and used since antiquity, precisely for their effects, both for pleasure and ritual.

Cannabis is a prime example, which grows on all continents other than Antarctica and has been used for a wide variety of purposes, both for its pharmacological actions and for its physical attributes, as a source of fibre and nutrition.

South Africa has a long and complex history with regard to cannabis. It was the South African government which proposed to the League of Nations Dangerous Drugs Committee in 1923 that cannabis be subjected to international regulation. That status remains in place, in terms of the Single Convention on Narcotic Drugs, 1961, to which South Africa is a signatory. Schedule I to the Convention, which is maintained by the International Narcotics Control Board, includes “the flowering or fruiting tops of the cannabis plant”, as well as “the separated resin, crude or purified, obtained from the cannabis plant”. Parties to the Convention are required to “adopt such measures as may be necessary to prevent the misuse of, and illicit traffic in, the leaves of the cannabis plant”. Cultivation of cannabis is to be regulated in the same manner as that applied to opium poppies, but with an important caveat: “This Convention shall not apply to the cultivation of the cannabis plant exclusively for industrial purposes (fibre and seed) or horticultural purposes.”

As a result, cannabis was for many years listed as a Schedule 7 substance in terms of South Africa’s Medicines and Related Substances Act, 1965, and also included in the “Undesirable Dependence-Producing Substances” in terms of the Drugs and Drug Trafficking Act, 1992. While exceptional access was allowed for research, analysis or use by a particular patient, substances in those categories could not ordinarily be possessed or sold.

That entire legal construct was overturned by a 2018 Constitutional Court judgment which declared the relevant sections of both laws unconstitutional “to the extent that they criminalise the use or possession in private or cultivation in a private place of cannabis by an adult for his or her own personal consumption in private”. The court allowed legislators a period of 24 months to remedy the situation.

THC and CBD

Although the cannabis plant contains over 100 identifiable chemical components, two are of particular importance. Tetrahydrocannabinol (THC) is the psychoactive component, whereas cannabidiol (CBD) is not psychoactive. At higher doses, cannabidiol has been shown to be effective in the management of some paediatric epilepsy syndromes.

The first change made to comply with the Constitutional Court judgment involved moving THC to Schedule 6 (alongside morphine, for example) and CBD to Schedule 4 (as a prescription medicine). The Schedule 6 inscription also included an exception to allow adult use, echoing the wording in the court judgment. The control measures applicable to a Schedule 6 substance (such as the need for a prescription) do not apply when “raw cannabis plant material is cultivated, possessed and consumed by an adult, in private for personal consumption”. The Schedule 4 inscription also allowed for low-dose CBD products (containing a maximum of 20mg per day and 600mg per pack) to be regulated as a complementary medicine, provided the labelling made only a low-risk claim (a general health enhancement or health maintenance claim or a claim of relief from minor symptoms).

The South African Health Products Regulatory Authority (SAHPRA) has issued just over a hundred licences for the cultivation and export of cannabis for medicinal purposes. These licences are for the preparation of the raw material from which medicines could be made, but no THC-containing products have yet been registered in South Africa. SAHPRA does not report on the number of section 21 permits issued to individual patients seeking access to THC-containing medicines, nor on the sources of unregistered medicines approved in that manner (section 21 permits allows for access to medicines not registered by SAHPRA).

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SAHPRA’s cannabis cultivation permits do not allow the sale of cannabis products directly to the public. SAHPRA has not issued licences to any retail outlets for cannabis or cannabis-containing products. Retail outlets claiming to be licensed “dispensaries” are therefore operating illegally.

In 2024, the Schedules were again updated, with this exception inserted: “in raw cannabis plant material cultivated and possessed in accordance with a permit issued in terms of the Plant Improvement Act (Act 11 of 2018) and processed products manufactured from such material, intended for agricultural or industrial purposes, including the manufacture of consumer items or products which have no pharmacological action or medicinal purpose”.

The Plant Improvement Act, 2018, is intended to regulate the propagation and sale of particular plants, setting quality standards for economically important varieties, such as wheat. In November 2025, the Minister of Agriculture, Land Reform and Rural Development issued regulations in terms of this Act, setting a THC limit of 2% for the leaves and flowering heads of cannabis plants considered to be “hemp” (low-THC cannabis). That action provides the clarity required to interpret the Schedules to the Medicines Act and creates a process for the issuing of “hemp” permits for the cultivation and sale of low-THC cannabis for industrial applications.

‘A work in progress’

Bringing the Drugs and Drug Trafficking Act into alignment with the Constitutional Court judgment has been far more complex than the Medicines Act and is still a work in progress. The section of the Drugs Act which enabled the Minister of Justice to make schedules listing substances in different categories was found to be unconstitutional in 2020. Future changes to the schedules will require an Act of Parliament. Distinct from the Schedules to the Medicines Act, these lists designate which substances, for example are considered “Undesirable Dependence-Producing Substances”, the possession of which may be a criminal offence.

Instead, the Minister of Justice and Correctional Services tabled a separate Bill in 2019, which was finally passed as the Cannabis for Private Purposes Act, 2024. While that Act has been assented to by the President, it has not yet been promulgated and no regulations have been issued. The legislation is therefore not yet in operation. Regulations are needed, for example, to specify the amounts of cannabis that can be cultivated, possessed or transported. Most importantly, though enabling the possession or cultivation of cannabis in a private place, and therefore personal consumption by an adult, the Act does not enable the commercialisation of cannabis for “recreational” or “adult use”, as is the case with alcoholic beverages or tobacco products.

South Africa’s Cannabis Master Plan, which envisages three separate value chains, covering medicinal cannabis, hemp, and adult use, is now being driven by the Department of Trade, Industry and Competition (DTIC). The DTIC plans to submit a Hemp and Cannabis Commercialisation Policy to Cabinet by April 2026 and to table an Overarching Cannabis Bill by mid-2027.

The 2018 Constitutional Court judgment overturned almost a century of established practice. While the evidence for the medicinal value of cannabis and specific cannabinoids is still scanty, the assumption that such products have no medicinal value at all is no longer tenable. As with all pharmaceutical products, this is a highly regulated market with high barriers to entry.

An industrial market for low-THC cannabis is already well established and the necessary steps to enable its growth are now in place. However, the ill-informed ban on the inclusion of any cannabis components in foodstuffs, which was issued and then rapidly repealed in 2025, is indicative of the lack of coherence in government policy. The challenge remains the commercialisation of an adult use market, and whether that will enable the involvement of the small-scale rural growers who have traditionally met demand for the product.

Cannabis policy therefore remains in flux, and the entire legislative process has been marked by missteps, missed steps, reverses, ambivalence and confusion. Some pieces of the picture are in place, but others remain uncertain or incomplete.

*Dr Gray is a Senior Lecturer at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice. This is part of a series of #InsideTheBox columns he is writing for Spotlight.

Disclosure: Gray serves on three technical advisory committees at the South African Health Products Regulatory Authority and previously chaired the Cannabis Working Group.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

Opinion Piece: Turning Data into Wellbeing: Why Health Insights Are the Missing Link in Employee Benefits

By Lushan Sundram, Senior Sales & Business Development Manager at Essential Employee Benefits

Despite making significant investments in employee benefits, many organisations continue to struggle with low employee engagement, growing healthcare expenses, and diminishing productivity.  A lack of insight, not a lack of investment, seems to be the problem. 

Even the most extensive medical coverage may fall short if the true health needs of the workforce are not thoroughly understood. Employers must first understand the individuals they are attempting to assist in order to make health benefits genuinely meaningful.

The business case for healthier workforces

It is now indisputable that employee well-being and company performance are related. Investing in the physical, mental, and social well-being of employees yields quantifiable benefits, according to numerous studies. According to research, a single unit improvement in staff health can result in an 80% boost in productivity, and well-run wellness programmes can yield a Return on Investment (ROI) of up to 6:1. Healthy workers are more engaged, more productive, and less likely to quit, demonstrating that promoting health, benefits businesses as well as individuals.

Moving from guesswork to insight

Understanding that health encompasses more than just physical well-being is the first step in creating pertinent and efficient medical coverage. Four important aspects are taken into account in a holistic approach: social, financial, mental and emotional, and physical welfare. The difficulty, though, is in understanding worker health without violating personal privacy. Data-driven platforms that provide aggregated insights while maintaining privacy hold the key to the solution. Digital nurse checks, for example, can evaluate vital signs including Body Mass Index (BMI) , blood pressure, body composition and more. Analysis of this anonymised data can then reveal patterns across age groups, genders, and departments. Employers can use these data to identify areas where their employees most need help, such as managing stress, preventing chronic diseases, or improving nutrition, all while maintaining complete compliance with privacy laws.  Essentially, it gives leaders the insight they need to allocate resources strategically.

From one-size-fits-all to tailored support

Once health insights are gathered, employers can move beyond generic benefit structures. Tailored medical cover ensures that plans address the most pressing needs of specific employee groups. For example, one division might prioritise diabetes prevention, while another invests in weight management or mental health programmes.

Barriers to access are also addressed by meaningful medical cover.  Employees may be deterred from obtaining private medical care by expensive premiums or difficult claims procedures. Instead, offering basic yet comprehensive cover promotes prompt treatment and keeps small problems from becoming more serious and expensive. Rather than concentrating only on reactive treatment, integrating preventative care contributes to the development of a sustainable culture of wellbeing.

Building loyalty through wellbeing

A targeted, data-driven benefits strategy does more than optimise healthcare spending, it strengthens trust and retention. Employee loyalty and engagement increase when they see that their employer truly cares about their well-being. Businesses with wellness programmes that are very successful report voluntary attrition rates of only 9%, whereas those with programmes that are less successful report rates of 15%.

This exemplifies the principles of Social Exchange Theory: when employees perceive that the organisation values them and supports their health, they reciprocate with loyalty and effort. In this way, wellbeing becomes a performance strategy, not merely a perk.

Partnering for precision and impact

To move from assumption to precision, many organisations are partnering with experts who use innovative, privacy-preserving tools to provide data-backed insights into workforce health. These insights enable executives to create inclusive and appropriate benefits that yield quantifiable increases in retention and productivity.

The capacity to act on data-driven health insights is a strategic imperative in a setting where healthcare expenditures and talent competitiveness are both on the rise. The healthiest, most resilient, and most dedicated workforces of tomorrow will be created by employers who make the investment to understand their employees today.

Opinion Piece: The Ethical Pulse of Progress – AI’s Promise and Peril in Healthcare

By Vishal Barapatre, Group Chief Technology Officer at In2IT Technologies

Artificial Intelligence (AI) is revolutionising healthcare as profoundly as the discovery of antibiotics or the invention of the stethoscope. From analysing X-rays in seconds to predicting disease outbreaks and tailoring treatment plans to individual patients, AI has opened new possibilities for precision medicine and increased efficiency. In emergency rooms, AI-driven diagnostic tools are already helping doctors detect heart attacks or strokes faster than human eyes alone.

However, as AI systems become increasingly embedded in the patient journey, from diagnosis to aftercare, they raise critical ethical questions. Who is accountable when an algorithm gets it wrong? How can we ensure that patient data remains confidential in the era of cloud computing? And how can healthcare institutions, often stretched thin on resources, balance innovation with responsibility?

When algorithms diagnose: the promise and the problem

AI’s strength lies in its ability to process massive amounts of data, such as medical histories, imaging scans, and lab results, and detect patterns that human clinicians might miss. This can dramatically improve diagnostic accuracy and treatment outcomes. For instance, AI models trained on thousands of mammogram images can help identify subtle indicators of breast cancer earlier than traditional methods.

However, the same data that powers AI can also introduce bias. If the datasets used to train an algorithm are skewed, say, over-representing one demographic group, the results may unfairly disadvantage others. A diagnostic model trained primarily on data from urban hospitals, for example, might misinterpret symptoms in patients from rural areas or underrepresented ethnic groups. Bias in healthcare AI isn’t just a technical flaw; it’s an ethical hazard with real-world consequences for patient trust and equity.

The privacy paradox

The integration of AI in healthcare requires access to vast quantities of sensitive data. This creates a privacy paradox: the more data AI consumes, the smarter it becomes, but the greater the risk to patient confidentiality. The digitisation of health records, combined with AI’s hunger for data, exposes systems to new vulnerabilities. A single breach can compromise thousands of medical histories, potentially leading to identity theft or misuse of personal health information. The paradox underscores the need for robust data protection measures in AI-driven healthcare systems.

Striking a balance between data utility and privacy protection has become one of the healthcare industry’s most pressing ethical dilemmas. Encryption, anonymisation, and strict access controls are essential, but technology alone isn’t enough. Patients need transparency: clear explanations of how their data is used, who has access to it, and what safeguards are in place. Ethical AI requires not only compliance with regulations but also the cultivation of trust through open communication.

Accountability in the age of automation

When an AI system makes a medical recommendation, who is ultimately responsible for the outcome – the algorithm’s developer, the healthcare provider, or the institution that deployed it? The opacity of AI decision-making, often referred to as the “black box” problem, complicates accountability and transparency. Clinicians may rely on algorithmic outputs without fully understanding how conclusions were reached. This can blur the line between human and machine judgment.

Accountability must therefore be clearly defined. Human oversight should remain central to any AI-powered decision, ensuring that technology supports rather than replaces clinical expertise. Ethical frameworks that mandate explainability, where AI systems must provide understandable reasoning for their outputs, are key to maintaining trust. Moreover, continuous auditing of AI models, which involves regularly reviewing and testing the system performance, can help detect and correct biases or errors before they lead to harm, thereby ensuring the ongoing ethical use of AI in healthcare.

Behind the code: who keeps AI ethical

While hospitals and clinics focus on patient care, many lack the internal capacity to manage the complex ethical, security, and technical demands of AI adoption. This is where third-party IT providers play a pivotal role. These partners act as the backbone of responsible innovation, ensuring that AI systems are implemented securely and ethically.

By embedding ethical principles into system design, such as fairness, transparency, and accountability, IT providers help healthcare institutions mitigate risks before they become crises. They also play a crucial role in securing sensitive data through advanced encryption protocols, cybersecurity monitoring, and compliance management. In many ways, they serve as both architects and custodians of ethical AI, ensuring that the pursuit of innovation does not compromise patient welfare.

Building a culture of ethical innovation

Ultimately, the ethics of AI in healthcare extend beyond technology; they are about culture and leadership. Hospitals and healthcare networks must foster environments where ethical reflection is as integral as technical innovation. This involves establishing multidisciplinary ethics committees, conducting bias audits, and training clinicians to critically evaluate and question AI outputs rather than accepting them without examination.

The future of AI in healthcare depends not on how advanced our algorithms become, but on how wisely we use them. Ethical frameworks, transparent governance, and responsible partnerships with IT providers can transform AI from a potential risk into a powerful ally. As the healthcare sector continues to evolve, the institutions that will thrive are those that remember that technology should serve humanity, not the other way around.

Using AI to Empower Care Physicians

Photo by National Cancer Institute on Unsplash

By Henry Adams, Country Manager, InterSystems South Africa

When people think about artificial intelligence (AI) in healthcare, they often picture complex machines in high-tech hospitals. But some of the most exciting uses of AI are happening in primary care, right at the first point of contact between doctor and patient.

Globally, AI is helping general practitioners, nurses, and clinicians make faster, more accurate decisions by giving them access to clean, connected data. It helps detect early signs of disease, spot patterns across patient populations, and ensure the right people get the right care sooner.

South Africa is not there yet, but that is exactly why we should be paying attention.

Learning from what is working elsewhere

In countries where healthcare data is already digitised and connected, AI-assisted tools are starting to prove their worth. In parts of Europe, AI systems are helping GPs analyse symptoms, lab results and patient histories to identify possible conditions much earlier. In the US, data platforms are used to surface insights from millions of patient records, helping clinicians identify patterns that might otherwise go unnoticed.

At InterSystems, we have seen firsthand how this combination of reliable data and intelligent technology is changing the way care is delivered. In the UK, our data platform helps care providers securely connect across places of care to patient information across multiple systems, making it easier for AI tools to interpret symptoms in context. In France, AI-assisted prescriptions through partners like Posos are helping doctors reduce errors and improve treatment safety.

These examples show what is possible when data, people and technology come together in the right way.

Why data comes first

AI is only as powerful as the data it works with. If a clinician’s system lacks complete or up-to-date patient information, the AI cannot provide reliable support. That is why data quality and interoperability are so important; they form the foundation for everything else.

Many countries that are seeing success with AI in primary care started by getting their data in order, building connected health records, standardising information, and ensuring privacy and compliance at every step. Once those pieces were in place, they could start introducing AI tools that help doctors and nurses make better decisions without adding extra admin or complexity.

Again, in South Africa, we are not quite there yet, but we are heading in the right direction. There are ongoing efforts to digitise health records and bring together fragmented systems. As that process continues, it will open the door for more advanced AI-driven support tools, from diagnosis assistance to population health management.

What this could mean for South Africa

Imagine a community clinic in Limpopo or the Eastern Cape, where a doctor sees dozens of patients a day. With AI support, they could instantly access each patient’s medical history, flag high-risk symptoms, or receive early alerts about potential complications like diabetes or hypertension.

AI will not replace the doctor’s or their judgment. It simply gives them more context and better information. It is like having a quiet assistant in the background, helping spot what is easy to miss when you are under pressure.

This kind of technology could also help identify broader health trends, guiding public health decisions and making sure resources are sent where they are needed most. It is not about high-end tech for big hospitals, it is about making everyday healthcare smarter, safer and more efficient for everyone.

Building the foundations

Before we can get there, we need to focus on the basics: connected systems, reliable data, and trust. AI tools cannot function properly in silos. They need access to consistent, secure information, the kind that interoperable platforms like InterSystems IRIS for Health are designed to manage.

Once we have that in place, the rest becomes achievable. Doctors can use AI to compare patient data against proven medical knowledge bases. Clinics can share insights securely across regions. And the healthcare system becomes more proactive instead of reactive.

It is easy to look at what is happening overseas and feel that South Africa is far behind. But I see it differently. Every success story abroad gives us a roadmap, lessons we can adapt to our own realities. We do not have to reinvent the wheel; we just have to make sure it is fit for our local terrain.

Digital Tools Can Transform Africa’s Healthcare Outcomes – And Save the Continent Billions

AI image created with Gencraft

By Thom Renwick, General Manager, Roche Pharma South Africa

Early screening and treatment. Much higher survival rates. And savings in the billions of dollars. From AI-powered medicine development to teleconsultations, technology can boost Africans’ health and livelihoods while growing economic and social impact across the continent.

Access to quality healthcare is fundamental to leading a fruitful, economically active life. Yet, breast cancer is still the number one cancer killer of women in Africa – in most cases, while they’re still in their prime. Tragically, most are diagnosed too late for curative treatment.

Across the continent, non-communicable diseases – such as treatable breast cancer – cause hundreds of thousands of preventable deaths every year[1], devastating families and hampering economic growth.

Global projections indicate a worrying 38% rise in incidence of breast cancer and a 68% increase in deaths by 2050 without urgent intervention, with the least developed countries being the most affected, according to a new white paper[2] by independent German economic think tank the WifOR Institute.

The Value of Investing in Innovative Medicines report outlines the economic burden from not treating the aggressive HER2-positive type of breast cancer over five years in seven African countries – South Africa, Kenya, Nigeria, Algeria, Tunisia, Côte d’Ivoire and Morocco. The findings are staggering, indicating a $10.3-billion loss in productivity from 2017 to 2023.[3]

The data also shows that, in Africa, 89% of the economic burden of HER2-positive breast cancer – representing 15% to 20% of all breast cancer cases around the world – falls on women of working age.[4]

It goes beyond economics. Mothers hold households together and when they die that has huge ramifications for entire families and communities.

In sub-Saharan Africa, every 100 deaths among women under 50 leave around 210 children without their mothers[5], resulting in unstable, vulnerable households and long-term developmental challenges.

These figures are a wake-up call, but in challenge lies scope for innovation. I believe we can – and must – turn the burden into opportunity.

Closing the gap through health-tech partnerships

Every woman diagnosed and treated early is not only more likely to survive but also able to remain active in her family and community[6], contributing to shared prosperity.

Through healthcare and technology partnerships, we can leapfrog traditional healthcare models and turn the tide towards survival.

Excitingly, this process has already started. Governments are increasingly setting strategies and allocating funding for digital health. Start-ups and companies are driving the uptake of digital health tools that could revolutionise care delivery.

Artificial intelligence stands out as the breakthrough technology. Pharmaceutical and biotech companies such as Roche are already using AI throughout their value chains, both in the early stage of drug development and also to correctly interpret the enormous amounts of data generated to deliver effective health solutions.

In most sub-Saharan countries, more than 20% of the population lives more than two hours from essential health services.[7] Tech’s role in Africa’s future is about much more than connectivity or commerce. It’s about lives and well-being – AI, apps, telemedicine and other digital solutions can close the gap to bring care closer to people.

But without individuals and organisations working together, innovation can’t come to life.

And since the journey for a patient experiencing a health crisis such as breast cancer involves many stakeholders, we must urgently identify opportunities for partners to come together and spur real action.

This week, Roche sponsored the 28th annual Africa Tech Festival’s first-ever health track. Policymakers, innovators, professionals and experts met to thrash out actionable solutions to the continent’s biggest health challenges.

This was part of an ambitious broader strategy to transform healthcare in Africa – investment in early intervention strategies can generate returns that far outstrip their cost.

Research by McKinsey & Company shows that the African digital health space is already seeing unprecedented growth, with $123-million in investment secured by 55 start-ups in 2021.[8]

The consultancy’s analysis showed that digital health tools – such as virtual platforms for consultations; electronic health records; mobile apps to help patients self-manage their diseases; and patient e-booking platforms – could help South Africa, Kenya and Nigeria capture efficiencies of up to 15% in total healthcare expenditure by 2030.[9]

Widespread adoption could free up an astounding $1.9-billion to $11-billion in South Africa alone.[10]

Speaking with one voice for a better future

Innovation has been the backbone of progress across any major public health disease – whether it’s HIV, cancer or ophthalmology. It takes a combination of passionate people and expert innovation to make a difference.

One existing solution and real-life example of African innovation and partnership is EMPOWER, a groundbreaking digital health platform developed to improve coordinated breast and cervical cancer care in Kenya.[11]

The initiative has grown from a single clinic in 2019 to a 76-site national platform and is integrated into Kenya’s National Cancer Registry.[12]

Empower ensures that the entire patient journey, from screening to treatment and follow-up, is digitally powered.

The current average five-year survival rate for breast cancer across Africa is roughly five out of 10 patients that are diagnosed (48%).[13] My vision is that this will increase to 80% within the next 5 years.

Realising this audacious goal will take commitment from stakeholders to drive action for the tens of thousands of African women who desperately need it.

There is no reason why someone in a Western society should have a better health outcome than here in Africa. The health of our people is the wealth of our nations. We must speak with one voice and act now.

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Thom Renwick is general manager of Roche South Africa and the sub-region. He began his journey with the company in 2012 on its United Kingdom graduate programme, following his studies at King’s College London, Cranfield School of Management and the University of Oxford.

During his career at Roche, he has worked in global product strategy in Basel, Switzerland, as head of ophthalmology in the UK and as chief of staff for Pharma International. He won the PharmaTimes New Marketer of the Year Award in 2015 and was featured in the publication’s Smart People series in 2021.


[1] World Health Organisation African region. https://www.afro.who.int/health-topics/noncommunicable-diseases. Accessed: Nov. 12, 2025. [Online]. Available: https://www.afro.who.int/health-topics/noncommunicable-diseases.

[2] WifOR Institute, ‘The Value of Investing in Innovative Medicines: Socioeconomic Burden of HER2+ Breast Cancer and Annual Social Impact of Roche’s Treatments for the Disease in Africa’. Accessed: Nov. 7, 2025 [Online]. Available: https://africa.roche.com/stories/what-s-it-worth-the-value-of-innovation

[3] WifOR Institute, ‘The Value of Investing in Innovative Medicines: Socioeconomic Burden of HER2+ Breast Cancer and Annual Social Impact of Roche’s Treatments for the Disease in Africa’. Accessed: Nov. 7, 2025 [Online]. Available: https://africa.roche.com/stories/what-s-it-worth-the-value-of-innovation

[4] WifOR Institute, ‘The Value of Investing in Innovative Medicines: Socioeconomic Burden of HER2+ Breast Cancer and Annual Social Impact of Roche’s Treatments for the Disease in Africa’. Accessed: Nov. 7, 2025 [Online]. Available: https://africa.roche.com/stories/what-s-it-worth-the-value-of-innovation

[5] WifOR Institute, ‘The Value of Investing in Innovative Medicines: Socioeconomic Burden of HER2+ Breast Cancer and Annual Social Impact of Roche’s Treatments for the Disease in Africa’. Accessed: Nov. 7, 2025 [Online]. Available: https://africa.roche.com/stories/what-s-it-worth-the-value-of-innovation

[6] WifOR Institute, ‘The Value of Investing in Innovative Medicines: Socioeconomic Burden of HER2+ Breast Cancer and Annual Social Impact of Roche’s Treatments for the Disease in Africa’. Accessed: Nov. 7, 2025 [Online]. Available: https://africa.roche.com/stories/what-s-it-worth-the-value-of-innovation

[7] Mckinsey, ‘How digital tools could boost efficiency in African health systems.’ Accessed: Nov. 7, 2025 [Online]. Available: https://www.mckinsey.com/industries/healthcare/our-insights/how-digital-tools-could-boost-efficiency-in-african-health-systems

[8] Mckinsey, ‘How digital tools could boost efficiency in African health systems.’ Accessed: Nov. 7, 2025 [Online]. Available: https://www.mckinsey.com/industries/healthcare/our-insights/how-digital-tools-could-boost-efficiency-in-african-health-systems

[9] Mckinsey, ‘How digital tools could boost efficiency in African health systems’. Accessed: Nov. 7, 2025 [Online]. Available: https://www.mckinsey.com/industries/healthcare/our-insights/how-digital-tools-could-boost-efficiency-in-african-health-systems

[10] Mckinsey, ‘How digital tools could boost efficiency in African health systems’. Accessed: Nov. 7, 2025 [Online]. Available: https://www.mckinsey.com/industries/healthcare/our-insights/how-digital-tools-could-boost-efficiency-in-african-health-systems

[11] Roche Africa, ‘From vision to national platform: EMPOWER scales through Kenya’s National Cancer Institute’. Accessed: Nov. 7, 2025 [Online]. Available: https://africa.roche.com/stories/empower-scales-through-kenya-national-cancer-institute

[12] Roche Africa, ‘From vision to national platform: EMPOWER scales through Kenya’s National Cancer Institute’. Accessed: Nov. 7, 2025 [Online]. Available: https://africa.roche.com/stories/empower-scales-through-kenya-national-cancer-institute

[13] A. Padu-Pebrah, et al., ‘Five-Year Survival Outcomes for Breast Cancer Patients Across Continental Africa: A Contemporary Review of Literature with Meta Analysis’, eLife. Accessed: Nov. 7, 2025 [Online]. Available: https://elifesciences.org/reviewed-preprints/105488#mainMenu

Gauteng Department of Health’s Non-payment Crisis Threatens Suppliers and Healthcare Stability

Photo by Towfiqu barbhuiya on Unsplash

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.

#InsideTheBox with Dr Andy Gray | Public Participation in Medicines Selection and Regulation – Lacking?

#InsideTheBox is a column by Dr Andy Gray, a pharmaceutical sciences expert at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice. (Photo: Supplied)

By Andy Gray

In several countries, the public is given an opportunity to share their views with regulators before new medicines are registered or to engage with those choosing essential medicines. In South Africa, however, opportunities for such public participation remains limited. In his latest #InsideTheBox column, Dr Andy Gray takes a look at how public participation is handled elsewhere and how it could be improved here.

One of the rallying cries of patient and community-based organisations has long been “nothing about us, without us”. The “patient voice” is, however, not always heard in medicines selection or medicines regulation.

How it works in the US and Europe

Recent highly contested medicines regulatory decisions in the United States, such as the warnings about paracetamol use in pregnancy, have highlighted the role of advisory committees to the Food and Drug Administration (FDA). The FDA relies on a number of such committees to provide advice on regulatory questions, such as whether to approve a new medicine or how to manage emergent safety signals. The FDA usually follows the advice provided by these independent structures, but is not bound to do so.

The fact that advisory committees meet in open session, and that their recommendations are transparent to the public, means that the final decision by the FDA can be contrasted with the scientific advice. The curricula vitae of advisory committee members are posted on the FDA website and updated annually. Critically, when an advisory committee meeting is scheduled, the date and time is announced at least 15 days in advance of the meeting, and this serves as an invitation to interested parties to register to make oral submissions during the Open Public Hearing portion of the meeting.

In addition to providing opportunities for public engagement in this manner, the FDA has also operated a Patient Representative Program since 2024. FDA Patient Representatives are appointed, provided with training, and may then engage with the scientific and other expert members of the advisory committees. Among the criteria applied in their selection are personal experience with a particular disease as a patient or primary caregiver, knowledge about the treatment options and research in that area, and the willingness and ability to communicate in public, as well as being objective while representing the concerns of others affected by the disease.

Similar mechanisms have been put in place in Europe. The European Medicines Agency (EMA) has enabled the appointment of patients as members of its management board and scientific committees. In addition, the EMA Patients’ and Consumers’ Working Party provides a venue for ongoing engagement. The EMA engagement framework explicitly aims to ensure “access to patients’ real-life experiences of living with a condition, its management and the current use of medicines, complementing the scientific evidence provided during the evaluation process” and “the generation, collection and use of evidence-based patient experience data for benefit-risk decision-making”.

How it works in South Africa

Section 3(9) of the Medicines and Related Substances Act, 1965, instructs the chief executive officer of the South African Health Products Regulatory Authority (SAHPRA) to appoint advisory committees. The wording is peremptory, but also broadly enabling: “The Chief Executive Officer shall, in consultation with the Board, appoint committees, as he or she may deem necessary, to investigate and report to the Authority on any matter within its purview in terms of this Act.” Provided there is consultation with the Board of the Authority, the number of committees and their membership is left to the CEO to decide.

To date, however, there has been no deliberate effort to include patient or consumer representatives on any of the advisory committees.

More importantly, meetings of the committees are not open to the public, nor are their recommendations to the regulatory authority placed in the public domain. The “patient voice” is therefore potentially missed, and stakeholders are unable to determine when or how final decisions taken by the Authority may differ from the recommendations made by the technical advisory committees. In that sense, SAHPRA is no more transparent than its predecessor the Medicines Control Council, which also laboured under the same antiquated secrecy provision in the Act. Section 34 of the Act is actually labelled “Preservation of secrecy”.

Similar concerns with medicines selection

Medicines regulators determine whether medicines should be allowed onto the market and how those should be controlled. Similar dynamics are at play in determining which medicines are “essential” and should be procured or reimbursed by health systems.

At a global level, the World Health Organization (WHO) updates its Model List of Essential Medicines every two years. The Model List is a starting point for many countries’ efforts to develop national essential medicines lists, guiding procurement in their public sectors. Although the expert committee responsible for this work does not explicitly include patient representatives, all proposals submitted are placed in the public domain, as are the reviews conducted, and an account of the final decisions. On the first day of the meeting, an open session is held at which stakeholders are invited to apply to present.

One of the most trusted medicine selection bodies is the UK National Institute for Health and Care Excellence (NICE), which also has a deliberate process for stakeholder engagement at multiple steps in its guideline development. For example, right at the outset, this invitation is issued: “NICE invites all stakeholder organisations to attend a scoping workshop. You will be sent a first draft of the scope, which will be discussed at the meeting. We encourage you to send someone who knows about and can represent patients and carers’ interests.”

Medicines selection in the South African public sector is evolving, embracing the challenge of health technology assessment. While there are as yet no patient representatives on either the Expert Review Committee or the National Essential Medicines List Committee, there are opportunities for stakeholder engagement with draft guidelines and increasing transparency, with medicines evaluation reports posted on the Department of Health website.

Full medicine reviews follow an evidence-to-decision framework that was first piloted during the height of the COVID-19 pandemic. One of the questions posed reads: “Is there important uncertainty or variability about how much people value the options?” This question is aligned with what the WHO Handbook for Guideline Development refers to as “values and preferences”. For example, the WHO guidance calls for evidence of the “values and preferences of the people receiving the intervention or experiencing the outcomes the intervention can affect”. While that evidence may sometimes be reported in the scientific literature, all too often it is lacking.

Ultimately, “nothing about us, without us” should not only be a demand made by patients, but also by those who care about the quality, reliability and acceptability of medicines selection and regulatory decisions. Improving the transparency of decision-making processes is critical, but so is creating, promoting and protecting the spaces for an effective “patient voice”. Doing so is a critical investment in building trust, which is so easily eroded.

*Dr Gray is a Senior Lecturer at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice. This is part of a series of #InsideTheBox columns he is writing for Spotlight.

Disclosure: Gray is a member of South Africa’s National Essential Medicines List Committee and co-chairs its Expert Review Committee.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

No More Sugarcoating It: GLP-1s Are a Powerful Weapon in the War Against Sugar

Photo by Patrick Fore on Unsplash

A new movement in weight management is taking hold in South Africa as the country confronts weight-related illnesses. A powerful class of medication known as GLP-1 therapies is proving highly effective in cutting obesity rates, lowering cancer risk, and improving overall metabolic health. Their growing popularity marks a new frontline in the fight against sugar-driven disease.

A landmark study published in JAMA Oncology has revealed that patients using GLP-1 medications – a class of therapies originally developed for type 2 diabetes – experienced a 17% lower overall risk of cancer.

The data, drawn from over 86 000 patients, showed striking reductions in specific cancers: ovarian cancer risk nearly halved, meningioma cases fell by 31%, and endometrial cancer dropped by 25%.

Dr Tommie Smook, medical practitioner at Dr Smook & Partners (managed by RXME Group), says these findings reinforce the urgent need to fight back against sugar-related disease:

“We are witnessing the medical consequences of unchecked sugar consumption every day in practice. Obesity has become one of the greatest epidemics of our time. If we are serious about safeguarding public health, we must declare a national war on sugar – and GLP-1s are among the most powerful tools we now have to help people reclaim their health.”

What GLP-1s actually do

The body naturally produces GLP-1 – a hormone that regulates blood sugar, appetite, and digestion. GLP-1 medications mimic this process:

            •           They slow stomach emptying,

            •           Reduce hunger and cravings,

            •           Help patients feel satisfied with smaller portions, and

            •           Stabilise blood sugar levels.

The result is sustained weight loss. Clinical trials consistently show patients losing 10-15% of body weight, particularly when therapy is combined with nutrition, exercise, and professional support. In South Africa, several GLP-1s are now formally registered for obesity and chronic weight management.

But the benefits don’t end at weight loss. International studies have demonstrated improvements in cardiovascular health – lowering blood pressure, reducing inflammation, and decreasing the risk of heart attacks and strokes. Emerging evidence also suggests neuroprotective effects, with potential to reduce risks of dementia and Alzheimer’s disease.

From diabetes treatment to disease prevention

“GLP-1s are no longer just diabetes drugs,” says Dr Smook. “They are transforming the way we think about weight, chronic disease, and prevention. When used responsibly under medical guidance, these therapies can change not only waistlines, but lifespans.”

At Dr Smook & Partners, patients gain access to GLP-1 therapy under the supervision of qualified medical doctors. Medications are prepared only through SAHPRA-approved compounding pharmacies, ensuring quality and safety. This is supported by a multidisciplinary team – dietitians, biokineticists, nurses, and sports physicians, providing holistic care.

Here are the five essentials you should consider before starting GLP-1 therapy:

  1. See a doctor first – these medications require proper screening and monitoring.
  2. Think beyond injections – lifestyle, diet, and exercise remain vital.
  3. Expect an adjustment phase – side effects like nausea are usually temporary.
  4. Protect lean muscle – resistance training and adequate protein intake are essential.
  5. Avoid shortcuts – unregulated, black-market products are unsafe and unpredictable.

A turning point for public health

Obesity is a modern epidemic, and sugar is at the heart of it. GLP-1 medications are not a “quick fix,” but they represent one of the most promising advances in decades – a way to tackle both the causes and consequences of excess weight.

Dr Smook concludes: “The stigma around GLP-1s must end. These therapies are not about vanity – they are about survival. Every patient who regains control of their health is one step closer to breaking sugar’s grip on our society.”

The Future of Pharmacies in South Africa Lies in Sustainable Expansion

Photo by National Cancer Institute on Unsplash

By Christina Mooki, Head of Acquisition Operations at Merchant Capital

Pharmacies, especially ones in rural areas, are often the cornerstone of their communities. Beyond filling prescriptions, they provide medication, medical equipment, and counselling, sometimes serving as multi-service clinics in small towns and outlying areas. When people cannot wait weeks for a doctor’s appointment or need trusted advice, the local pharmacy is their first stop.

In many outlying areas, it is not just the most practical option, but often the only one. With the country’s high and rising burden of chronic disease, this role will only grow in importance.

The sector is indeed expanding. In just two years, 2020 and 2021, about 648 new community pharmacies opened across South Africa. By 2021, the total number stood at roughly 3580 outlets, and nearly 70% of these were independent rather than corporate-owned. That is over 2000 small businesses carrying community healthcare.

Christina Mooki, Head of Acquisition Operations at Merchant Capital

But every pharmacy is also a business. Behind the scenes, owners are juggling supplier deliveries, unpredictable supply chain issues, negotiating credit terms, paying staff, and trying to keep overheads under control. Balancing that with the responsibility of keeping communities healthy makes pharmacy ownership uniquely challenging and uniquely important.

Why more pharmacies are needed

A growing number of South Africans are living with chronic illness such as diabetes, hypertension, and HIV. These patients cannot miss their repeat medications and local pharmacy access becomes essential. Independent outlets do more than only dispense medicine, they also cut travel time, keep treatment within reach, and help build local economies.

Around the world, the role of a pharmacy is expanding. They are no longer limited to handing out prescriptions. According to Deloitte, many pharmacies are transforming into community health hubs by adding point-of-care testing, preventative health screening, and digital services to meet the changing expectations of modern consumers. Locally, they are also incorporating retail services to diversify their offerings further.

Running a pharmacy like a retailer

Passion for helping people will take you far as a pharmacist, but on its own, it will not keep the doors open. Independent pharmacies need to be run with the same discipline as any other retailer. Cash flow must be watched so staff are paid and suppliers are not left waiting. Shelves must carry the medicines that matter most without tying up money in products that sit for months. Costs like rent and electricity creep up quickly, and if unchecked, margins vanish.

Strong supplier relationships also make a difference. Paying on time, negotiating fairly, and keeping that trust intact can protect a business when times are tough. And like any other retailer, pharmacy owners have to be careful about how much debt they take on. Too much, too soon, can put even a busy store under pressure.

When these basics are in place, a pharmacy is not just a trusted point of care. It is also a resilient business that can think about growing, instead of simply surviving.

Where funding helps

Growth always asks for money before it offers returns. Anyone who has opened a second branch, hired staff, or added delivery knows this reality. The bills arrive first, and only later does the revenue follow. For a small independent owner working on thin margins, that can feel like a brick wall.

This is also the point where funding can be an enabler rather than a burden. At Merchant Capital, we treat pharmacies like retail businesses because that is what they are. They need capital that moves quickly, without red tape, and repayment models that flex with real turnover rather than with a rigid schedule. That flexibility gives owners breathing space, the confidence to back their instinct, invest in a new outlet, upgrade systems, or respond to their community.

Looking ahead

Independent pharmacies have already shown how vital they are to South Africa’s healthcare system. The next step is ensuring more of them open in the areas where they are most needed. With sound business management and access to the right kind of funding, these enterprises can grow their footprint, create jobs, and continue to provide reliable access to healthcare.