Despite a 63% drop in under-five deaths since 1990, more than a quarter of countries won’t reach the UN’s 2030 child mortality target on time, with sub-Saharan Africa lagging the most
Years in which the U5MR reduction target is expected to be achieved. U5MR: under-5 mortality rate. Image credit: Cao et al., 2026, PLOS One, CC-BY 4.0
A new study tracking global progress on child mortality finds that the world will miss a key United Nations (UN) health target by at least five years at current rates, with the burden falling heavily on Sub-Saharan Africa. The findings are published on April 1, 2026, in the open-access journal PLOS One by Min Liu of Peking University, Beijing, China, and colleagues.
The UN’s Sustainable Development Goal 3.2 calls for all countries to reduce the mortality rate for children under five to fewer than 25 deaths per 1000 live births by 2030. As that deadline approaches, there has been no comprehensive assessment of where countries stand.
In the new study, researchers used data from the UN to analyse annual under-five death counts and mortality rates from 1990 to 2023 across 200 countries and territories. They calculated the rate of change in mortality over time and used those trends to project when those countries still above the target threshold would be expected to reach it.
The researchers found that globally, under-five deaths fell by 63% over the study period – from nearly 13 million in 1990 to 4.78 million in 2023 – and the mortality rate dropped by an average of 3.18% per year. However, the global rate still stands at 36.72 deaths per 1000 live births, well above the SDG target, and is not projected to reach the target until 2035. 133 countries have already met the target and nine more are on track to do so by 2030. However, 58 countries will miss the deadline, including 25 that are not projected to reach the target until after 2050, and Dominica, where under-five deaths have risen. More than four-fifths of all under-five deaths worldwide are concentrated in just two regions: Sub-Saharan Africa, where the mortality rate remains at 68.82 deaths per 1000 live births and is not projected to meet the SDG target until 2055, and Central and Southern Asia.
The study is limited by the assumption that trends over the last two decades will continue unchanged. Data quality was also poor in some conflict-affected regions and low-income countries, the very places where child mortality is highest.
The authors conclude that to meet UN targets, policymakers must focus on scaling up proven interventions – including skilled birth attendance, postnatal care, vaccination, improved nutrition, and treatment for common childhood illnesses – in every community, and especially in Sub-Saharan Africa.
ANC President Cyril Ramaphosa, with Minister of Health, Dr Joe Phaahla and his deputy Dr Sibongiseni Dhlomo, during the signing into law of the National Health Insurance Bill. (Photo: @MYANC/Twitter)
By Thoneshan Naidoo
Healthcare funding is always about trade-offs, writes Thoneshan Naidoo, CEO of the Health Funders Association. The hardest question in healthcare is not what we would like to provide, he argues, but what we can provide sustainably, fairly and at scale.
South Africa’s healthcare debate is shifting and perhaps for the first time in years, it is becoming more honest.
With the National Health Insurance (NHI) Act tied up in legal processes and no credible funding pathway emerging from the 2026 Budget, the conversation is moving away from sweeping promises about the future to a more immediate and uncomfortable question. That is how do we fund healthcare today, and what trade-offs are we willing to accept?
At the centre of that reality is a part of the system that is often misunderstood and frequently criticised – medical schemes.
They are often portrayed as profit driven and exclusionary. In reality, they are not for profit, member owned entities built on a simple but powerful principle, social solidarity. Simply put, members pool their contributions so that those who are healthy today help fund the care of those who are sick.
In practice, around 80% of members claim less than they contribute in any given year. Their contributions help fund the care of the 20% who need it most. That is not exploitation. It is the very definition of risk pooling, and it is the same principle that underpins universal health coverage.
But solidarity comes with trade-offs.
Every Rand paid out in benefits in excess of a member’s monthly contributions is funded by other members. That means decisions about what is covered, how much is paid, and when limits apply are not arbitrary. They are the result of difficult choices about what the overall pool can afford.
These trade-offs become most visible in moments of tension, when a claim is limited, a treatment is excluded, or a dispute arises. To the individual, the system can feel uncaring. But at a system level, the alternative, unlimited funding for every possible intervention, is simply not sustainable.
Even prevention, often presented as an obvious solution, is not as straightforward as it seems.
Take colorectal cancer screening. An inexpensive test such as a faecal immunochemical test can help detect disease early. But many false-positive results lead to follow up procedures like colonoscopies, even when no serious condition is ultimately found. At the same time, some cases are still missed and only diagnosed later, when treatment is more complex and more expensive.
The question is not whether prevention is valuable, it is how to fund it at scale in a way that balances early detection, over treatment and cost.
These are not abstract policy debates but are real world funding decisions that affect millions of people.
And they are taking place in a system under pressure.
Medical scheme membership is voluntary, so younger and healthier individuals often delay joining until they need care. This drives up costs for those already in the system. At the same time, schemes are required to cover a comprehensive set of 270 Prescribed Minimum Benefits, which raises the baseline cost of cover.
The result is a system that works well for those inside it but remains out of reach for many.
This is South Africa’s so-called “missing middle” – millions of working people who earn too much to qualify for public support, but too little to afford private cover. They are left exposed, paying out of pocket, and navigating a fragmented system while waiting for reforms that may still be years away.
As the NHI debate continues, this gap can no longer be treated as a future problem. It is a present reality.
The risk is that the debate remains stuck in ideology. That private healthcare is painted as inherently problematic, or that structural reform alone will resolve access challenges.
Neither is true.
Healthcare funding is always about trade-offs. There are no perfect systems, only different ways of balancing access, quality and affordability within finite resources.
If South Africa is serious about expanding access to healthcare, the debate must move beyond rhetoric and toward practical solutions.
These include using spare capacity in private facilities to treat public patients, and allowing medical schemes, through targeted regulatory reform, to offer affordable primary healthcare cover for people who are currently excluded. Done properly, this could unlock access to private healthcare for more than 10 million uninsured South Africans at a cost of as little as R400 per person per month. Combined with existing tax credits, the impact on a family’s take home pay could be close to negligible. By providing access to preventive and primary care through the private sector, they would reduce pressure on overcrowded public facilities and ease waiting times. Importantly, a strong focus on prevention and early intervention would reduce the need for costly hospitalisation over time.
Medical schemes are well placed to deliver these options, given the principles of social solidarity, community rating and cross-subsidisation that underpin their design. This approach is aligned with the Sustainable Development Goals and the core principles of universal health coverage, and could serve as a practical transitional step as South Africa moves towards the full implementation of National Health Insurance.
After all, the hardest question in healthcare is not what we would like to provide. It is what we can provide sustainably, fairly, and at scale.
*Naidoo is CEO of the Health Funders Association, an industry group that represents several medical schemes and medical scheme administrators in South Africa.
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.
A University of Pretoria study has revealed troubling ethical and procedural gaps in the way medical schemes conduct forensic audits of physiotherapists, showing how practices intended to prevent billing irregularities are often leaving practitioners fearful, stigmatised and traumatised without proving guilt.
Audits of healthcare professionals are designed to detect billing irregularities and protect medical scheme funds. However, research conducted by Lesley Meyer, an extra-ordinary lecturer at University of Pretoria’s Department of Physiotherapy, explored the lived experiences of physiotherapists who have undergone such audits, and found that the audit practices conducted were experienced as punitive and harmful to practitioners rather than corrective.
Forensic audits in the healthcare sector are, in principle, supposed to protect medical scheme funds and by extension, patients’ contributions. In practice, however, Meyer’s research study, published in the latest edition of The South African Journal of Physiotherapy, found that these audits often extend beyond their legal scope and adversely affect the profession, while pocketing patient’s savings instead of returning these funds to the patients in accordance with the Medical Schemes Act.
Under Section 59(3) of the Medical Schemes Act of 1998, schemes may investigate inconsistencies in claims, but when alleged fraud, waste or abuse exceeds R100 000, the matter should be referred to the Health Professions Council of South Africa (HPCSA) or the South African Police Service. However, the study found that schemes mistrust these authorities, so they bypass that requirement by reclassifying potential fraud as administrative billing errors. This practice allows them to conduct internal investigations without external oversight, creating a loophole that has opened the door to misuse, coercive practices and a lack of accountability.“
Participants reported feeling unfairly targeted and singled out, describing the audit process as unfairly conducted. Many felt they were subjected to a witch hunt,” Meyer says, who is also a physiotherapist and runs a private outpatient practice with a special interest in chronic pain and trauma management. Participants described being treated as suspects rather than professionals and reported severe distress caused by a process that offers no transparency or recourse.
The study found that the problem is exacerbated by South Africa’s outdated billing system. The gazetted tariff codes, last updated by the Competition Commission in 2006, have remained unchanged. Due to the fact that medical aid schemes don’t accept new, unlisted codes, practitioners are forced to use outdated tariffs to describe modern, evidence-based treatments. In some instances, practitioners leave those treatments unbilled altogether.
The study found that practitioners were sometimes accused of overbilling or coding errors without being given access to the evidence used against them. Some described being pressured to sign an Admission of Debt (AOD) to avoid escalation, leading to payments that varied from R54 000 in a solo practice to R4,5 million for one group practice.
As reported in the study, the investigators’ tactics were perceived as coercive and participants were forced to either sign AODs or face continued blockages on payments, effectively turning them into cash practices. Physiotherapists operating as cash-based practices were blacklisted because scheme administrators could not use offset controls to manage claims.
Meyer explains: “For those who sign the AOD it means they’re admitting that they’re guilty, which is against the Health Professions Act, because if you are guilty, it means you’ve committed fraud, and you can lose your licence. But participants felt like they didn’t have a choice, because they weren’t getting any money from the schemes.”
The impact on clinical care
One of the key problems highlighted in the research is the lack of external oversight over medical schemes’ auditing procedures. While the Health Professions Council of South Africa regulates practitioner conduct, schemes are governed by the Council for Medical Schemes (CMS), however, a physiotherapist who participated in the study, who complained to the CMS received no response. This gap leaves practitioners vulnerable to arbitrary decisions and offers no appeal mechanism when they believe they have been treated unfairly.
Meyer says the distress caused by the audits has clear hallmarks of trauma with participants describing the trauma they experience being akin to post-traumatic stress disorder, triggering physical reactions such as going into a cold sweat when encountering reminders of the medical fund and enduring stigma from being blacklisted.
One participant said: “Seven months of watching my father die was easier than this experience.
”Meyer’s research shows that these experiences aren’t isolated incidents but systemic. Interviews revealed a pattern of practitioners who felt coerced into compliance due to their fear of professional ruin.
The study revealed that physiotherapists perceived the audit process as vindictive rather than beneficial. The physiotherapists also felt that the forensic investigators perceived them as being guilty from the start, without considering alternative reasons for irregular billing patterns.
These hostile auditing processes contradict the principle of procedural fairness, Meyer says, which requires fair treatment, transparency, impartiality and an opportunity to be heard.The way forwardThe study recommends teaching undergraduate and registered physiotherapists about forensic literacy. Therefore, Meyer created five lectures based on her findings’ which have been implemented with the fourth-year physiotherapy students as part of the IHL module at the University of Pretoria, to empower students and increase their resilience when faced with forensic audits in private practice.
Moreover, the study recommends a framework that allows practitioners to be heard and protected while ensuring that accountability remains central. Such a framework includes establishing an independent oversight body, standardising investigative procedures and ensuring audited practitioners can access evidence, respond to allegations and appeal decisions. Meyer will continue with this framework through a PhD.
A significant development since Meyer’s study was completed, is the release of the final report by an independent legal panel that reviewed how Section 59(3) of the Medical Schemes Act is applied in forensic audits of healthcare professionals. Meyer says the report confirmed many of the issues raised in her research, including retrospective audits, a lack of transparency and potential misuse of power by medical schemes.“
The release of this report is an important step toward institutional accountability and reform,” Meyer says. “However, the full implementation of its recommendations remains critical to ensure fair audit practices and to restore trust among healthcare providers.”
“The people I interviewed were not trying to avoid accountability. They wanted fairness. They wanted to be heard. If we don’t address the lack of oversight, we risk losing good practitioners and damaging trust in the healthcare system itself.”
Universal health coverage cannot succeed with fragmented systems, weak data, and largely symbolic participation. A recent court-ordered pause to NHI implementation offers a chance to build the foundations properly, argue Dr Haseena Majid and Professor Mogie Subban.
Implementation of the NHI Act has been delayed following a High Court order, by agreement between the parties, prohibiting the proclamation or implementation of its provisions until the Constitutional Court rules on challenges related to public participation.
Beyond the legalities, the pause reveals something more consequential. Universal health coverage cannot succeed on fragile administrative foundations.
If the NHI is to deliver equity, efficiency and quality care, the state must first confront the structural weaknesses that continue to shape large parts of South Africa’s health system. These include fragmented governance across national, provincial and local levels that weakens coordination and accountability; persistent shortages of health professionals that leave facilities understaffed and overburdened; and weak information systems that limit the state’s ability to track performance, allocate resources effectively and plan services based on reliable data.
The NHI Act can mandate pooled financing and new purchasing arrangements, but financing reform alone cannot fix fragmented governance, uneven data systems or inconsistent coordination between stakeholders. When reforms are layered onto unstable administrative systems, the result is not transformation but increased risk.
The eye health example
Eye health illustrates this challenge clearly. This is because it depends on coordination across many parts of the health system including clinics, skilled cadres such as optometrists and ophthalmologists, hospitals, NGOs and screening programmes. When these stakeholders do not work together effectively, patients fall through the gaps.
South Africa’s burden of chronic disease is rising, and with it preventable vision loss. The International Diabetes Federation estimates that around 2.3 million people in South Africa aged 20–79 live with diabetes, a condition that can affect the eyes and lead to vision loss and blindness if not detected early. Studies in South Africa have reported high rates of diabetic eye disease, including prevalence estimates of 39% in a tertiary diabetes clinic in Durban and around 25% in primary care settings in Tshwane.
These figures are not simply about eye disease. They reflect gaps in chronic disease coordination, screening coverage and referral systems. When diabetic eye screening is inconsistent, when referral pathways are unclear and when health data are incomplete, preventable vision loss becomes far more likely.
Cataract surgery, one of the most effective medical procedures available, is rightly prioritised. Yet provincial reporting continues to show significant surgical backlogs. While numbers fluctuate, the pattern remains consistent: demand continues to outpace coordinated capacity.
Vision challenges are also increasing as the population ages. A KwaZulu-Natal study reported presbyopia prevalence of 77% among examined adults. As the population grows older, near-vision impairment becomes not only a clinical concern but also one that affects productivity, mobility and independence.
Taken together, diabetes-related eye disease, cataracts and age-related vision decline illustrate a predictable and growing demand for eye-care services. The burden is clear, but the health system response remains uneven.
Only around 6–7% of optometrists practice in the public sector, while the majority work in private urban settings. Across the country, eye-care services are delivered through a mix of public facilities, private practitioners, NGOs, outreach surgical programmes and school screening initiatives. Yet there is no single national picture showing who is providing which services, where those services are located, and how well they are functioning. Government therefore does not consistently have a clear view of which partnerships are active, which communities are overserved or neglected, what equipment is functioning at facilities, or how the workforce is distributed relative to need. This is not a minor administrative gap, instead it is a governance failure with real consequences.
No clear view
Government cannot plan for what it cannot see. Data gaps and poor system visibility are creating blind spots that will paralyse even the best financing reforms. Without clear stakeholder mapping and infrastructure audits, planning becomes reactive. Procurement decisions become distorted and workforce deployment misaligned. Funding reform under the NHI may change how services are purchased, but if the underlying service network remains fragmented, inefficiencies will simply be redistributed.
The consequences extend beyond clinics. Children with uncorrected vision problems struggle at school. Adults with untreated diabetic eye disease risk losing income and economic stability. Older persons waiting for cataract surgery may lose mobility and independence. When health systems fail to coordinate care, the costs are first absorbed by households and later by the state through disability, preventable complications and lost productivity.
The NHI Act aims to improve equity and purchasing efficiency. But efficiency depends on knowing where services exist and where they are missing. Equitable access depends on understanding how infrastructure and human resources are distributed. Quality oversight depends on reliable data that allows performance to be monitored. What the NHI pause ultimately exposes is unfinished work in health-system governance. South Africa does not lack policy ambition. The country is widely recognised for progressive health policy. The challenge lies in fragmented implementation, limited visibility of service networks and uneven coordination across institutions.
A strategic choice
The Department of Health now faces a strategic choice. It can wait for the courts to resolve the legal process, or it can use this moment to strengthen the operational foundations needed for equitable reform.
Eye health presents a practical place to begin. It may not command the urgency of oncology, emergency medicine or infectious disease management, but that is precisely why it offers an opportunity to test workable solutions. Even under the best financing model, sustainable eye care depends on coordinated collaboration between public facilities, private practitioners, NGOs and community networks. A focused national pilot could map eye care services geographically, combining stakeholder mapping with infrastructure audits and workforce distribution analysis. This would strengthen planning in eye health while providing the system visibility that large-scale purchasing reforms like NHI depend on. The efficiency gaps are already known. What is needed now is coordinated implementation. If government can demonstrate that fragmented service environments can be mapped and coordinated within eye health, it will create a practical reform model for other strained areas of the health system.
Universal health coverage will not be secured simply by moving money differently. It will be secured by making the system visible, coordinated and accountable. The current pause has given us more time. What matters now is whether it is used to build the governance foundations that real reform requires.
*Dr Majid is a Postdoctoral Research Fellow at the College of Law and Management Studies, University of KwaZulu-Natal. Professor Subban is Academic Mentor and Public Governance Expert, at the College of Law and Management Studies, University of KwaZulu-Natal.
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.
The National Health Insurance (NHI) Act On Friday (20 February), it was reported that President Cyril Ramaphosa had put a halt on putting the NHI Act into effect, amid an array of legal challenges. Four days later, the Pretoria High Court granted an order to the same effect.
The NHI has probably been the most contentious piece of legislation passed in South Africa, and the developments since it was signed into law have been coming thick and fast. The promulgation, that is, putting the law into effect, of the NHI was long predicted to be the hardest part of getting this attempt at universal healthcare to work.
This latest court order restrains President Ramaphosa from any further work in promulgating the NHI Act – something which he had already announced he would do just a few days ago, as reported by BusinessTech. This represents something of a pause in the ongoing legal maelstrom – nothing can be decided until the court cases clear, according to an attorney’s statement on behalf of the President.
Almost as soon as the NHI was signed into law, an array of unions, hospitals, professional organisations and even the Western Cape government launched legal challenges. A ruling compelled the President to provide the records of his decision to sign the NHI into law. One key part governing where healthcare professionals could practice has already been struck down as unconstitutional by a July 2025 High Court ruling.
The lobby group AfriForum last week entered the fray with multiple challenges to the NHI’s constitutionality, aiming to force the government to scrap the NHI completely. A few days later, President Ramaphosa paused the NHI’s promulgation. This all came amidst discussion by the Department of Health into phasing out medical aid tax credits to begin the NHI Fund – which would squeeze many middle-class families out of being able to afford private healthcare. (For now at least, there is good news – just as QuickNews was typing this, it was announced that medical aid tax credits would be increased for 2026).
Experts and even the government itself have acknowledged that these legal challenges will further delay the already decades-long implementation of the NHI, and it appears that this has come to pass. Whether the NHI is modified to a workable version along the lines suggested by industry experts, or whether it is scrapped entirely and South Africa remains stuck with its deeply unequal public/private sector divide remains to be seen.
What is certain is that the NHI as originally envisioned simply isn’t affordable for South Africa – or even a wealthy developed country. The National Treasury seems to be aware of this, as suggested by its minimal allocations to the NHI Fund and medical aid tax credits being updated for this year’s budget.
The District Health Programme Grant is a mechanism for funding the country’s public health efforts, particularly relating to HIV, TB, and other communicable diseases.
By Russell Rensburg
District managers in South Africa’s public healthcare system currently have to juggle funding from multiple government budget lines, each with different strings attached. To improve district health services, we urgently need to simplify and integrate these funding flows, argues Russell Rensburg.
In his State of the Nation Address this year, for the first time in a long time, President Cyril Ramaphosa focused on the broader determinants of health, delivering the strongest message yet around the importance of prevention.
This included signalling reforms around the taxation and regulation of alcohol as well as announcing broad initiatives to improve child health through good nutrition.
And his announcement that government will be rolling out the HIV prevention injection, lenacapavir, means that South Africa stands at the cusp of a massive healthcare transition. The six-monthly injection will be a game-changer in the country’s ongoing fight against HIV.
His efforts must be applauded.
But to deliver on this, Ramaphosa will need a functioning district healthcare system. The challenge, however, is that the district healthcare system often functions in name, but not in practice. This disconnect is mostly due to how district-level services – and healthcare in general – is funded.
In short, we ask for integrated healthcare services in a system built on siloed funding streams. We task district managers with coordinating care, but the budgets they depend on are split across the provincial equitable share, multiple conditional grants, and hospital-level allocations.
Health is funded from national revenue through two streams: the national department of health and the provincial equitable share. The equitable share, which funds healthcare and education, is calculated using several factors including population size, use of services and potential unmet and future needs. The allocations are unconditional allowing provinces to determine all the allocations relative to provincial realities, cost pressures and needs. With national funding, 85% is transferred to provinces through defined use conditional grants to fund strategic priorities. The challenge is that in recent years these grants have become transfers to provinces with poorly managed conditionalities resulted in fragmented healthcare.
One way to fix these challenges is to consolidate all district health funding — including district hospitals — into a single, nationally coordinated expanded District Health Programme Grant. This reform would align the system with the National Health Act, strengthen accountability, and prepare us for the healthcare transitions ahead.
This shift is not about centralising services. It is about aligning authority with responsibility, and aligning money with the legal design of the health system. Provinces would remain responsible for service delivery. But national government — as required by the Act — would finally have a coherent instrument to guide, monitor, and support the district health system.
A fragmented system
Twenty-three years ago, the National Health Act set out a detailed framework for how healthcare should be structured in the country. Health policy norms and standards are set nationally. Provinces are responsible for coordinating and providing technical and operational support to districts. Crucially, the act locates the delivery of health services within the district health system, which is mandated to plan, coordinate and deliver comprehensive primary healthcare services closest to where people live.
Where the National Health Act falls short, is in providing guidance on how these powers and responsibilities would be financed.
Currently, district health services are funded through three streams:
The provincial equitable share, allocated nationally to each province based on population size and demand for health services. This covers most primary healthcare services and all district hospitals.
The District Health Programme Grant, which focuses on HIV, TB, community outreach, and some primary healthcare enablers.
And thirdly, a patchwork of other conditional grants for training, infrastructure, oncology, and digital systems.
The challenge with this approach is that each of these funding streams has its own rules, reporting requirements, and political histories. None of them were designed to work together.
Making the case for consolidation
Twenty odd years ago, the case for split funding streams made more sense. In the early 2000s, South Africa faced an overwhelming HIV epidemic. We needed targeted programmes, ringfenced funds, and rapid scale-up. Conditional grants was an instrument, that in a specific context, helped save millions of lives. But this instrument has now hardened into permanent architecture. And unfortunately, it is not fit for today’s health challenges.
South Africa is at a critical moment. The population is ageing, rates of non-communicable diseases like diabetes and hypertension are rising, HIV and TB require lifelong, coordinated management, and the pace of technology is rapidly reshaping healthcare.
The system that was built 20 years ago simply cannot carry us through the next 20 years.
At the same time, South Africa’s health budget is tightening. Despite a small increase in last year’s budget, the trend over the last decade or so is clearly toward having to do more with less.
We cannot expect the system to meet these growing demands while the foundational governance and funding architecture is no longer fit for purpose.
How it could work
Under an expanded District Health Programme Grant, national government – as the law mandates – would set the healthcare package, standards, indicators, and information requirements. Provinces would continue to run services, hire staff, manage facilities, and account for performance in line with the provisions of the National Health Act. And districts would finally have a budget that reflects their actual responsibilities.
In simple terms, this means that the expanded district health programme will be structured as a conditional grant. It will be informed by a nationally defined package of district health services, developed in consultation with provinces. Provincial allocations will be informed by strategic priorities and service needs such as essential health services, reproductive, maternal and child health services, as well as infectious diseases and non-communicable diseases. The National Department of Health will be responsible for managing the grant conditions with stronger accountability mechanisms to ensure alignment with strategic aims and constitutional responsibilities. Provinces will continue to control human resources, service delivery networks and district variations. This is what the National Health Act intended.
This is the model used by many countries that have successfully strengthened district health systems: national sets the rules and maintains oversight, while provinces or local governments handle delivery.
As already noted, South Africa does have the legal architecture for this. We just don’t have the financial mechanisms in place to match it.
In practical terms, such reforms will mean that for the first time, a district could budget for clinics, ward‑based outreach teams, HIV and TB services, chronic disease management, district hospitals, laboratory and pharmacy systems, emergency medical services linkages, and digital and information systems.
The artificial lines between primary healthcare and district hospitals would disappear. The system would fund itself as the Act intended, as one. District hospitals would no longer be expected to manage pressures created by primary healthcare gaps they have no control over.
There are several other benefits, such as improved accountability, an easier adaptation to demographic and epidemiological transitions, and more efficient use of limited budgets. These ultimately all develop a realistic pathway to universal health coverage.
A governance correction, not a revolution
There may be concerns that consolidating funding into a single grant means taking power away from provinces. The reality, however, is that this reform would restore coherence, not remove authority.
South Africa has spent decades speaking about equity. This is a practical way to make equity real.
When we underfund the district health system in structure, we undercut the very people who rely on it most. These are rural communities, working class households, and people managing chronic and infectious diseases who require continuity of care, not bureaucratic fragmentation.
A unified District Health Programme Grant will not solve every problem in our health system. But without it, we will continue asking a fragmented system to produce cohesive outcomes, and blaming managers and health workers when it inevitably cannot.
It is time to give the district health system the financial foundation it has always needed. Only then can we build the health system people in South Africa deserve.
*Rensburg is director of the Rural Health Advocacy Project and project director for the TB Accountability Consortium.
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.
As thousands of cancer patients wait months for diagnostic scans, senior clinicians at Charlotte Maxeke Academic Hospital have questioned a decision by the Gauteng Health Department to override their choice of MRI machine.
In a letter to Gauteng Health Department’s acting chief financial officer, the head of supply chain management at the hospital, Solly Mokgoko, expressed a concern that a recommendation by the head of radiology and the acting clinical director to buy a Philips scanner had been overridden by the Gauteng health department’s central office. The letter is dated 31 October 2025.
Mokgoko said the doctors had preferred the Philips MRI scanner – at a cost of about R27.4-million – on the grounds of “technological advancement, operational sustainability, and clinical research potential”.
However, the department had chosen a machine from Mamello Clinical Solutions at R38.5-million, they said. The room in which the machine will be installed is currently being prepared.
The letter said the Philips unit’s cost “offers reduced lifecycle expenditure due to minimal helium dependency and extended operational uptime”. The Philips scanner used low-maintenance technology, “requiring minimal or no helium top-ups, thereby reducing lifecycle costs and mitigating downtime risks”.
The Mamello-proposed model, by contrast, “relies on traditional cryogenic technology, which entails higher running costs and environmental exposure”, they said.
They said the decision is inconsistent with value-for-money principles set out in the Public Finance Management Act (PFMA) and Treasury regulations.
The purchase of a Chinese MRI scanner from Mamello is part of a R304-million roll-out of eight scanners across Gauteng public hospitals, in which roughly R190-million has been awarded to Mamello Clinical Solutions (five machines) and the remainder to Philips SA.
The Gauteng Department of Health rejected any suggestion of irregularity, saying the purchase was made under a lawful, competitively awarded contract and that both suppliers met the required technical standards.
In this case, the original procurement contract was drawn up by the Limpopo Health Department, with the Gauteng department piggybacking on it.
Clinicians at Charlotte Maxeke who spoke to GroundUp say the procurement shift occurred without adequate consultation and against explicit technical recommendations — allegations the department disputes.
Approximately 2,600 oncology patients are awaiting MRI scans at Charlotte Maxeke alone, with outpatient bookings extending to December 2026. Similar waiting lists exist at Chris Hani Baragwanath Academic Hospital.
The letter said that besides the external patient scans waiting list, there are over 50 inpatients awaiting scans.
One department head said: “How can the hospital order an MRI that’s over R10-million more expensive in an environment where it can’t even provide decent food, [and where there is] widespread cost-cutting and a dire shortage of doctors?” Late last year, the hospital made headlines for shortages of adequate patient meals.
Mamello Clinical Solutions, a private company based in Polokwane, was established in December 2014, trading as Mamello Development until 2019 when it changed its name. Robert Makhubedu, its sole director, was appointed in June 2023 after two previous directors resigned, according to official company registration records.
Makhubedu previously worked as chief radiographer at Charlotte Maxeke Hospital in the early 1990s, then spent more than two decades as director of business development at Tecmed, before joining Mamello Clinical Solutions.
A Gauteng Health Department spokesperson “categorically” denied any irregular, inflated or non-compliant procurement.
He said the MRI acquisitions had been made under a lawful, competitively advertised contract which had been evaluated in line with constitutional, PFMA and Treasury requirements.
Philips Healthcare and Mamello Clinical Solutions had both met minimum safety, functional and performance specifications, he said.
While acknowledging that Charlotte Maxeke clinicians preferred the Philips MRI, the spokesperson said procurement decisions could not be driven by “brand preference or proprietary technology.” He said over the life of the machine the price difference between the two was about R1.07-million, not R11.1-million.
Treasury rules, he said, did not permit sole-supplier selection where multiple bidders meet approved specifications. Multi-supplier models were standard public-sector practice.
Makhubedu pointed out that the tender had not called for a “helium-free” scanner. He attributed the doctors’ complaints to a combination of “brand bias” and hostility towards emerging black-owned companies, compared to multinationals.
“Some black companies awarded these contracts in the past could not relate to the business and clinical profile of the projects,” he said. “The legacy of that is that you have to prove yourself all the time.”
Makhubedu said that provinces tried to strike a procurement balance between emerging and established companies. He said his scanner was in fact R300,000 cheaper than the Philips machine over the life of the machine, and Mamello was capturing market share because of scanner quality and price.
“We believe we were fairly, legally and transparently awarded the contract. And we were cheaper.”
#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 South Africa, as in many places, pharmaceutical companies are not free to change medicine prices as they wish. In his latest Inside The Box column, Dr Andy Gray unpacks how medicines prices are regulated in the country and considers how this regulatory framework might change.
South Africa’s medicine pricing policies are recognised internationally for their commitment to transparency, but the reality may be different from what exists on paper.
Medicine pricing is a good example of the deficiencies in the National Drug Policy (NDP), which has never been revised since it was first issued in 1996. The original policy document proposed the establishment of a Pricing Committee and committed to “total transparency in the pricing structure of pharmaceutical manufacturers, wholesalers, providers of services, such as dispensers of drugs, as well as private clinics and hospitals”.
Two key proposals were that “the wholesale and retail percentage mark-up system will be replaced with a pricing system based on a fixed professional fee” and “price increases will be regulated”. There was also a commitment to monitoring prices in comparison to those charged in other countries. Finally, there was this statement: “Where the State deems that the retail prices of certain pharmaceuticals are unacceptable and that these pharmaceuticals are essential to the well being of any sector of the population, the State will make them available to the private sector at acquisition cost plus the transaction costs involved.”
Few policies survive an encounter with reality, and opposition, and this document is no exception.
Never the twain shall meet
A cardinal feature of South Africa’s medicine pricing system is the clear separation between the public and private sectors.
In the public sector, the prices paid by the provinces, military and prison services are the result of a tender process. Only medicines registered by the South African Health Products Regulatory Authority (SAHPRA) may be offered in response to a tender call. The National Department of Health makes all tenders publicly accessible and also publishes the resultant tender awards, as well as the Master Health Products List, updated whenever any listing changes. The prices paid therefore reflect the downward influence of the buying power of the state. The tenders include a quantification of anticipated demand over the tender period (usually three years). Prices are also influenced by the number of potential suppliers and therefore the extent of competition in the market.
For some critical, high-volume medicines, such as the first-line antiretrovirals, the tender is split among multiple suppliers, at slightly different prices. Split tenders are intended to ensure security of supply if a contracted supplier is unable to meet demand.
Where the state accounts for most of the quantity sold in the country, it is usually able to attract bids at lower prices than are charged in the private sector. However, in some cases, tenders attract no bids and the state is forced to purchase on quotation. Where a registered medicine is only available from a single supplier, the price paid by the state may be closer to that paid in the private sector. In November 2025, the Director-General of Health published a statement of concern about bid prices exceeding the private sector single exit price (SEP), urging manufacturers to “reflect on their pricing practices”.
Although there are some limited agreements to provide state stock, such as childhood vaccines, to private healthcare providers, the two distribution chains and their pricing remain separate. The private sector cannot access medicines at the same price as the state.
Private sector – not entirely transparent
The Medicines and Related Substances Control Amendment Act, 1997, sought to put in place at least some of what was proposed in the 1996 National Drug Policy. After the multinational pharmaceutical industry withdrew a court challenge to the Act in 2001, and after another Amendment Act, the changes came into effect in 2003, but with the pricing portion delayed until 2004. Further delay followed, with court challenges brought by community and hospital pharmacy groups, leading to an eventual Constitutional Court judgment in 2005. While the basic construct remained in place, the government had to revise the dispensing fee.
The basic construct of the pricing provision, which has been inserted into the Medicines and Related Substances Act, 1965, but is not the responsibility of SAHPRA, relies on what is called the SEP. The SEP is defined as “the only price at which manufacturers shall sell medicines and Scheduled substances to any person other than the State”. In other words, the “exit” refers to the price which is charged by the manufacturer to the final seller such as a pharmacy, hospital or healthcare provider. This is a little different from the more commonly used term of a “factory gate price”, which then allows additions to be made at each step in the distribution chain.
The SEP is the price that the final seller charges to the patient or medical scheme. Final sellers are, however, entitled to a dispensing fee, which is set as a maximum each year and differs between pharmacists and licensed dispensing practitioners. Wholesalers do not add a mark-up to the SEP charged by the manufacturer, but are paid a logistics fee by the manufacturer, as a portion of the exit price.
Crucially, the “single” component refers to the intention that the same price would be paid by all buyers, regardless of the volume of medicine procured. In other words, the private sector cannot use its buying power to exert any pressure on manufacturers’ prices. The Act is prescriptive in this regard: “No person shall supply any medicine, medical device or IVD according to a bonus system, rebate system or any other incentive scheme.” While the application of this section to Schedule 0 medicines, medical devices and in vitro diagnostics has been paused, it still applies to other medicines.
Annually, the Pricing Committee asks for input on two elements: the dispensing fees for pharmacists and dispensing practitioners, and the SEP adjustment (SEPA). The latter is a maximum percentage increase that manufacturers can apply to the SEPs on an annual basis. In some years, exceptional additional SEPAs have been allowed, but they have generally mirrored the consumer price index. The SEPA allowed for 2026 was set at a maximum of 1.47%, compared with 5.25% in 2025. The SEPA mechanism has protected South Africa against the large pharmaceutical price increases that have been seen in other countries. However, the initial launch SEP remains unregulated.
The dispensing fees include a flat amount and a percentage of the SEP, varying across 4 price bands. As the price of the medicine increases, the percentage component decreases. For example, the September 2025 version states that where the SEP of a medicine exceeds R1 530.73, the dispensing fee charged by a pharmacist shall not exceed R270.54 + 5% of the SEP.
A spreadsheet showing all declared SEPs (for registered medicines in Schedules 1 to 6) is publicly accessible on the health department’s website. That site also provides access to various SEPA documents. All final sellers are required to disclose to a buyer what the SEP for a medicine is, and then indicate the dispensing fee charged, which cannot exceed the maximum gazetted each year.
So, what’s not transparent?
The first problem lies with the logistics fee paid to wholesalers by manufacturers. Although there is a column in the SEP spreadsheet that shows a logistics fee, the actual amount paid is known to vary considerably. Importantly, where a final seller, such as a large pharmacy chain, owns its own wholesaler, it can gain additional income from the logistics fee. That component is not disclosed to buyers (patients or medical schemes) – but may influence the seller’s ability to charge less than the maximum dispensing fee.
The Act enables the Minister of Health, in consultation with the Pricing Committee, to “prescribe acceptable and prohibited acts” in relation to bonus systems, rebate systems or other incentive schemes. Despite being published for comment on two occasions, in 2014 and in 2017, no final regulations have been issued. The extent to which co-marketing fees, data fees, shelf fees, formulary listing fees, patient assistance programmes, off-invoice rebates and bonus systems have crept back into the private sector is therefore unknown, as is the quantum of such potentially perverse incentives. Certainly, such revenue streams are not transparent to patients and caregivers.
The enforcement capacity of the health department and Pricing Committee is also questionable. South Africa’s much-vaunted transparent medicine pricing system may conceal many unsavoury elements.
New concerns – failure to declare an SEP
Once SAHPRA has registered a new medicine, the online database is updated. However, SAHPRA does not concern itself with pricing. The holder of the certificate of registration (HCR) can choose to sell the medicine only to the state. However, if the HCR wishes to sell the medicine in the private sector, an SEP has to be declared. Some of the questions asked in the declaration form are interesting, but of dubious legal weight. For example, manufacturers are asked: “The methodology used to determine the SEP and factors that influence the price at which the medicine will be sold.” Even though no external reference pricing system is in place, the prices in other countries are requested. While it is reasonable to ask what the registered indications for the medicine are, as approved by SAHPRA, to demand the “prevalence of the disease or condition as established by the applicant in South Africa” is less reasonable. To date, no SEPs have been declared to be “unacceptable”, as was signalled in the NDP in 1996. Manufacturers thus have a relatively free hand to set their private sector launch prices.
However, two high-profile registrations of HIV drugs by SAHPRA, of cabotegravir by GlaxoSmithKline and of lenacapavir by Gilead, have not been followed by the declaration of an SEP. One contributory reason may be a reluctance to make a price to be charged in an upper middle-income country such as South Africa transparent to the rest of world.
Unregistered medicines imported in terms of section 21 (an application to access an unregistered medicine in circumstances where there is no suitable product registered in South Africa) are not subject to the SEP. In the case of the cystic fibrosis treatments sold by the pharmaceutical company Vertex, a refusal to apply for registration by SAHPRA, thus forcing medical schemes and patients to rely on section 21, has allowed the company to reach agreements with specific medical schemes at undisclosed prices. These medicines are not available to public sector patients.
The unknown unknown
Although the National Health Insurance Fund is expected to be an “active purchaser”, using its buying power to exert downward pressure on prices, bolstered by health technology assessment processes, the exact manner in which the prices of medicines will be determined is unclear.
In particular, how the fund will contract with public and private sector providers to serve beneficiaries in a particular geographical area, given the current clear separation in pricing, is yet to be disclosed. Once NHI is fully implemented, the current tender system will not be tenable. A tender award to a single supplier would immediately make all competitors leave the market. Instead, a reimbursement system, perhaps closer to the reference pricing applied in medical scheme formularies, will be needed. The complexity lies in the period of co-existence of the current public and private sectors and a nascent NHI.
Has the NDP 1996 been implemented?
Although a fixed dispensing fee proved impractical, some elements of the 1996 policy are discernible. Regulated price increases are in place, for instance. Other elements are less clearly implemented, and full transparency remains elusive. There is a need to revisit the entirety of the national medicines policy, not least in relation to how best to deliver access to affordable, quality-assured, essential medicines as part of universal health coverage.
*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 columns he is writing for Spotlight.
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.
Under South African law, no one may practise medicine unless they have the proper training and are officially registered. Photo by Usman Yousaf on Unsplash
By Elna Schütz
Bogus medical practitioners threaten the health of patients and undermine trust in doctors. The problem might be growing, but so is the fight against it.
“If you’re in the hands of an unqualified person, you’re as well as dead, and we think it is not fair for the country,” Dr Magome Masike tells Spotlight.
He is the Registrar of the Health Professions Council of South Africa (HPCSA), which is responsible for the registration of medical doctors and other health professionals in South Africa.
The controversy over bogus doctors gained widespread attention in late 2023 when it was discovered that ‘TikTok doctor’ Matthew Lani lied about being a medical doctor. In his videos, Lani was often seen in scrubs and wearing a stethoscope, impersonating a medical doctor. Although he was arrested at Helen Joseph Hospital in Johannesburg, the National Prosecuting Authority eventually decided not to prosecute.
The term bogus doctor has become a shorthand for any medical practitioner who is working without being properly qualified or registered by the HPCSA. In practice, being “bogus” can also apply to physiotherapists, interns, or anyone else practising medicine.
The misrepresentation may include using fraudulent certificates, using another practitioner’s registration, or being suspended or erased from the register. It can involve someone who studied but did not fully qualify, or has not kept up to date with their registration. Masike gives the example of the child of a registered practitioner who decides to take on their parent’s practice after their death without themselves being registered.
It is an ongoing problem. In the beginning of February, the HPCSA says it facilitated the arrest of a woman working at a medical facility in Midrand, north of Johannesburg, allegedly without being correctly registered to practice medicine.
Bogus qualifications are part of the larger problem of healthcare fraud. According to research in a report by risk management services firm D-Finitive, it is estimated that this fraud overall costs African countries more than USD50 billion in 2012. In the South African private sector, that comes to about R22-28 billion a year. The report explains that beyond bogus practitioners, there is a problem with similar fraud, like doctors billing more clients than is realistic, manipulating diagnostic and procedural codes, or deceased doctors billing the government for decades after their death. At times, this type of fraud is reportedly executed by syndicates.
“While the majority of practitioners are honest and committed to patient care, it takes only a small number of bad actors, whether unregistered impostors or credentialed professionals abusing the system, to inflict widespread damage,” says Dr Katlego Mothudi, Managing Director of the Board of Healthcare Funders (BHF).
A substantial problem
Masike says that from March 2024 to February 2025, 49 bogus practitioners were caught and arrested. From April to December 2025, that number was at 17. Even though these numbers do not suggest a year-on-year increase, Masike says that overall, the numbers are increasing.
The HPCSA’s annual report for 2024/2025 shows that 589 investigations into unregistered persons were concluded in the year in question. Over the past five years, 3 708 complaints were received.
The majority of bogus practitioners who have been caught were operating in economic hubs of the Western Cape, Gauteng, and KwaZulu-Natal, Masike says. “Bogus people want money, so they go where there’s money,” he explains. However, while the trend tends urban, he says rural communities also fall prey to scammers.
“A notable pattern is that many of these individuals use or forge the details of legitimately registered practitioners,” Masike says.
It is, of course, unclear how many unlicensed practitioners are not yet caught. “We can tell you the problem is bigger than we think,” Masike says. The problem, he says, is sector-wide and stretches across different health professions, with most of these illegal practices occurring in the private sector. Masike adds that bogus doctors often work with a network of others, for example, those who supply unregistered or fake medicines.
Mothudi also says that the problem is growing. “Medical schemes are seeing a rise in suspicious provider activity picked up through claims analysis and credential verification processes,” he says. This may include practitioners misrepresenting their registration status, practising outside their approved scope, or using the registration details of legitimate practitioners to submit claims.
Risk to patients
Catching and prosecuting bogus practitioners is crucial because they can pose a direct danger to unsuspecting patients. “Unregistered medical doctors, like other health professionals, pose severe risks to patients, including serious physical harm, injury, and misdiagnosis which may lead to death, due to their lack of necessary training, ethical standards and relevant qualifications,” warns Foster Mohale, the spokesperson for the National Department of Health.
Dr Zanele Bikitsha, National Vice Chairperson of the South African Medical Association, cautions that if bogus doctors are performing procedures, it will likely be in settings that are not appropriate or sterile.
“They’re not going to go to a registered facility, because they know they’ll be caught, so this puts patients in danger as well.”
While some operate on a cash basis, Mothudi says that submitting claims to medical schemes is attractive because it allows for much larger and repeatable payouts. “In some cases, bogus practitioners submit claims using stolen, borrowed or fraudulently obtained practice numbers belonging to legitimately registered healthcare professionals,” he says. “In other instances, they collude with registered providers who allow their credentials to be misused in exchange for payment.”
Knowing the signs
While the HPCSA undertakes compliance inspections, there are some clear signs that might help the public spot a bogus practitioner. Firstly, it is a legal requirement to have registration information easily visible in a practitioner’s practice and on the letterhead of documents or prescription notes.
Members of the public can also look up a doctor’s credentials. All registered practitioners should be listed in the HPCSA’s digital register online, which is publicly searchable. With as little as the practitioner’s surname, the system lets users search for registered practitioners.
Masike points out that a trained doctor tends to take an extensive medical history and make a systemic or wide-reaching inquiry. He recommends that patients look out for how doctors speak and whether they use and are able to explain medical terminology.
Complaints can be filed with the HPCSA’s Inspectorate, including anonymously. Their call centre is at 0123389300/1 and they can be e-mailed at office@hpcsa.co.za. Suspicious practitioners may also be reported to hospitals, the Department of Health, SAMA or other medical organisations.
Processing the problem
Complaints typically lead to an investigation by the HPCSA Inspectorate, which works together with other entities, such as the South African Health Products Regulatory Authority (SAHPRA), the Office of Health Standards Compliance, the Special Investigating Unit (SIU), and the South African Police Service.
Masike explains that the investigation tends to lead to a clandestine operation and involves the police arresting the suspects. He adds that police recently assigned specific staff members to focus on these cases. He says that once the case goes to court, there is a conviction rate of around 77%, although this may have changed. “Many of the cases from 2023 to 2025 remain before the courts, and therefore updated conviction statistics are not yet available.”
Practising medicine without proper training and registration is in contravention of Section 17(1) of the Health Professions Act, 56 of 1974. Typical sentences for such fraud include fines, such as R12 000, or around two years imprisonment. In one 2017 case, a man who had treated almost a thousand patients over six years was sentenced to 20 years’ imprisonment by the Mahikeng High Court in the North West.
Bikitsha says there are other systemic changes that could help catch the problem earlier on. “If you are still paper-based, you are at risk,” she says, referring to the way that hospitals and institutes tend to verify the qualifications of most interns, locums and medical practitioners. She argues that upgrading to biometrics and digital systems would decrease the risk of fraud.
Another step forward is simply to increase public awareness and education, so that patients know the risks.
Masike concurs. “We need society to stand up to this,” he says. “We need a participating community to get rid of this malaise, otherwise it will continue forever.”
South Africa’s judicial system is so clogged with Road Accident Fund (RAF) cases that a top judicial official has called for an RAF tribunal.
The RAF is a government agency that compensates people for losses resulting from vehicle accidents. It receives most of its income from the RAF levy, currently at R2.18 per litre on petrol and diesel.
The fund has been in disarray for years.
A judge of the North Gauteng High Court in Pretoria has said the RAF’s “chaotic approach to litigation” has resulted in huge losses of public money. In a ruling last June, Judge Jan Swanepoel said the RAF did not deal with its matters properly, does not send lawyers to court to oppose applications or, if it does, does not provide them with any instructions.
This resulted in “default” judgments. The fund would then apply to rescind the judgments, often on baseless grounds.
“In this manner huge sums of money, public money, it must be emphasised, are lost,” said Swanepoel.
Now Simbongile Siyali, assistant State Attorney in Johannesburg, has made the case for a special tribunal in a piece published in December 2025 by the Law Society of South Africa’s (LSSA) magazine, De Rebus. The LSSA represents South Africa’s attorneys.
Siyali said the government had intended the RAF to be efficient, but laying a claim has become a cumbersome, litigious process that has overwhelmed the judiciary and burdened claimants.
“The mounting backlog of RAF cases – often stretching into years before resolution – has eroded public confidence in the system,” he wrote.
Siyali also pointed out that high courts are ill-suited to deal efficiently with the technical and repetitive nature of RAF claims.
“Against this backdrop, the establishment of a specialised tribunal dedicated exclusively to RAF matters emerges not merely as an administrative convenience but as a constitutional necessity.”
The huge RAF case backlog had profound human consequences, he said.
“Many RAF claimants are individuals who have suffered serious bodily injuries, loss of income or the death of a breadwinner.”
He said there were other specialised courts, including the Labour Court, the Competition Tribunal, the Land Claims Court, the Tax Court and the Electoral Court.
A dedicated tribunal could develop institutional expertise and standardise approaches to damages assessment.
“In doing so, it would improve not only the speed of adjudication but also the substantive fairness of outcomes.”
A RAF tribunal would comprise adjudicators – possibly senior judges, senior magistrates, and legal practitioners – who have significant experience in personal injury and insurance law.
The tribunal would be cost-effective, he said.
“The current model is extraordinarily expensive for claimants and the Fund.”
“The time has come for bold reform. Establishing a specialised tribunal for RAF disputes would not only unclog the courts but would mark a decisive step toward a more efficient, responsive and humane justice system – one that truly delivers on the constitutional promise of access to justice for all.”
Parliament’s Standing Committee on Public Accounts (SCOPA) is currently holding an inquiry into the RAF.
SCOPA member and ActionSA MP Alan Beesley said it was painfully clear that the RAF “is completely broken”.
He said ActionSA would support the establishment of a specialised RAF tribunal.
“If urgent changes are not implemented, the RAF horror show will continue, and the clogging up of the justice system will get considerably worse,” Beesley said.
DA MP and SCOPA member Patrick Atkinson told GroundUp the DA would support any action that would help streamline the resolution of RAF claims.
“The establishment of a RAF tribunal that would deal specifically with RAF matters would go some way to alleviating the burden on both the courts, as they stand, with court rolls clogged with RAF matters, and speed up the finalisation of claims.”
But Atkinson warned that an RAF tribunal would be a partial resolution for a “completely dysfunctional process”. He said RAF court cases could be reduced by running an efficient settlement system where the RAF would make offers to claimants based on a transparent menu of payouts for a specified list of injuries and their severity.
“If run efficiently, far fewer cases would end up in court, and lawyers would have to balance the value of an immediate settlement versus a protracted court battle that may not yield much more for their clients.”
ANC MP and SCOPA member Helen Neale-May said she was unable to comment
GroundUp emailed SCOPA chairperson Songezo Zibi’s spokesperson but no response had been received at the time of publication.
Wayne Duvenage, the chief executive of Organisation Undoing Tax Abuse (OUTA) said he would support a dedicated RAF tribunal.
‘We believe that the RAF entity has been badly managed and fraught with political interference over the past decade to 15 years,” he said.
