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.
From tracking steps and calories to getting the gains at the gym and taking care of mental and emotional wellness, South Africans have never been more health conscious. At the same time, there is a growing disconnect in how we perceive the systems that protect that health.
As we step further into 2026, it’s important to debunk the myths around medical aid that often cloud our judgement when it comes to looking after our own health and that of our families. Cover without interruption should be high up on our list of resolutions this year, and to achieve this, it’s important that South Africans get the facts straight.
Myth 1: Medical aid is a luxury
The most pervasive myth is that medical aid is a luxury. The data, in fact, suggests otherwise. According to the Council for Medical Schemes (CMS) 2024 Industry Report, hospital expenditure remains the dominant cost driver in South Africa, accounting for nearly 36% of total benefits paid.
‘Medical aid acts as a bridge to immediate, specialised intervention,’ says Lee Callakoppen, Principal Officer of Bonitas Medical Fund. ‘For a scheme like Bonitas, being a member is a guarantee of access to a network of private facilities when time is the most critical variable.’
Myth 2: Plan adjustments mean lower quality
There is a common fear that moving to a different plan within a scheme is a step backwards. In reality, the healthcare market is defined by customisation, allowing you to choose a plan that fits your specific lifestyle and healthcare needs without paying for bells and whistles you don’t use.
This is best seen in the rise of options that make strict use of networks and digital-first plans like Bonitas’ BonCore that was unveiled in September last year. Network options offer reduced monthly premiums by requiring members to use a specific group of healthcare providers with whom preferential rates have been negotiated. BonCore takes this further by offering a digitally enabled hospital plan that combines unlimited hospital cover with virtual-first primary care. This means that simple GP consultations happen via video link, which lowers costs and increases convenience while still providing a Benefit Booster for physical visits and specialised tests.
Myth 3: Secondary products can stand alone
A dangerous trend has seen some people viewing gap cover or health insurance as a replacement for full medical aid membership. While these tools have their place, they are designed as supplements and not replacements.
Gap cover, for instance, is a vital tool for managing specialist shortfalls, but it relies on the foundation of a medical aid to function. Without that foundation, the protection is incomplete. Real security comes from a holistic ecosystem, with Prescribed Minimum Benefits (PMBs) ensuring that a pre-determined list of chronic conditions and emergency procedures are covered by law, regardless of the plan you choose.
Myth 4: Public-private hybrids are a universal quick fix
While the integration of public and private care is a key pillar of national health policy, the immediate reality for many in 2026 comes down to capacity. Public facilities are under significant strain, and while insurance products linked to public care provide a basic entry point, they often lack the elective agility that private medical aid provides.
In simple terms, this means that while you might be covered for a life-threatening emergency, you could face a very long wait for elective procedures like hip replacements, cataract surgery or specialised scans.
Securing private care through a scheme with a broad national footprint allows for proactive health management and the ability to treat a condition before it becomes a surgical emergency.
Myth 5: Medical schemes prioritise the young and healthy
South African medical schemes operate on a principle of social solidarity. This means that all contributions go into a collective pool of funds to be used by all members, as and when needed.
As per the Medical Scheme’s Act 131 of 1998, open schemes are legally required to accept all applicants. In fact, Bonitas’ 2026 strategy emphasises preventative care for all life stages, which includes a series of health screenings, vaccinations and wellness assessments. This ensures that the Scheme’s R9 billion in reserves is used to keep all members healthy for longer, regardless of age.
‘Ultimately, being a member of a medical aid is about having a partner that bridges the gap between health consciousness and health security. We must move beyond viewing healthcare as a grudge purchase to seeing it as a vital tool for long-term resilience,’ concludes Callakoppen.
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.”
Cipla Medpro South Africa reaffirmed its commitment to ensuring the uninterrupted supply of critical antiretroviral (ARV) medicines to the Department of Health. It is essential that people living with HIV have uninterrupted access to these life-saving medicines. Any disruption of supply puts patients at risk of developing resistance to the drugs or adversely affecting health outcomes. According to Statistics South Africa, the number of people living with HIV in the country is estimated to be approximately 8 million (12,7% of the population)[1].
Recently, two suppliers who were awarded the current antiretroviral (ARV) tender, Barrs Pharmaceuticals Industries (Pty) Ltd and Innovata Pharmaceuticals (Pty) Ltd (subsidiaries of Avacare Health), have entered business rescue.
Cipla acknowledges the uncertainty this may create within the ARV supply chain and underscores its readiness to assist in maintaining stability and continuity.
Cipla has been manufacturing tenofovir/lamivudine/dolutegravir (TLD) for the government for the past 7 years, and has been one of the main suppliers of ARVs to the government for more than 12 years. Cipla has made significant investments in its local manufacturing facility, upgrading the capacity of the ARV production line with the installation of a new Countec bottle line and have increased its tablet filing capacity by 190%. The company is able to locally produce 475 million tablets annually and has upscaled its manufacturing capabilities to ensure sufficient capacity to meet current demand and support near‑term growth, while reinforcing Cipla’s commitment to secure and reliable ARV supply.
“We have mobilised resources to help maintain equitable access to quality, affordable critical medication. Cipla confirms its willingness to support national requirements under the current tender agreement and, if needed, contribute meaningfully to any supplementary procurement processes to safeguard patient access to essential treatment. We want people to live a long and healthy life as part of our commitment to caring for life,” said Paul Miller, CEO of Cipla Africa.
“In addition, we believe this tender presents an opportunity to further advance government’s commitment to strengthening local manufacturing capacity. By ensuring greater support for locally produced medicines, future allocations could meaningfully contribute to South Africa’s industrial development agenda while maintaining continuity of supply,” said Miller.
The total ARV tender is for a period of three years, and is worth an estimated R15.5bn, of which the TLD component comprises R12.6bn.
The healthcare industry has evolved significantly in the past decade with innovation, improved servicing and consolidation of medical schemes emerging. Bonitas Medical Fund has taken a strategic step in responding to the needs of its members and the Health Citizens of South Africa, by appointing Momentum Health as its new administrator from 1 June 2026.
With a considerable history spanning over 4 decades, Bonitas Medical Fund has emerged as one of the leaders in the medical scheme market. Covering over 750 000 lives, the Scheme is known as the medical aid for South Africa with a range of options – strategically designed to meet the needs of South Africans from all walks of life.
The change in administration is in line with the guidelines of the Health Market Inquiry and the industry Regulator, the Council for Medical Schemes (CMS). In 2024, the CMS stated that, “one of the main issues driving market stagnation is the prevalence of ‘evergreen’ contracts”. This alludes to long-term agreements between medical schemes and suppliers spanning decades without being subject to regular competitive procurement processes.
Principal Officer, Lee Callakoppen, explains, “One of our key strategic objectives is to ensure we create value for our members and key stakeholders. This can take the form of benefit optimisation, favourable tariff negotiations, amalgamations to obtain critical mass or optimised service. The healthcare industry has evolved considerably over the past decade, and it was critical for the Scheme to evolve in line with this. Over the past 48 months, the Board have extensively debated the steps needed to be taken to place Bonitas in a competitive position and ensure that it remains sustainable in the best interest of our members. In doing so we have continuously evaluated the value provided by our service providers with consideration to our strategic objectives and the capabilities of our service providers as well as the expectations of our members corporate clients, healthcare professionals, and brokers. We have seen medical schemes placed under financial strain with sustainability challenges emerging and we remain committed to remaining relevant to our members and must therefore be vigilant in our approach.”
This was followed by rigorous ongoing benchmarking exercises and a subsequent Request for Proposal process for administrative services and managed care – with Momentum Health appointed as the successful entity for the provision of administration services and Private Health Administrators appointed to provide managed care services.
“We are delighted to cement this relationship with Momentum Health, who have demonstrated that they have the necessary capabilities to exceed expectations and support us in our strategic growth objectives” Callakoppen said. “Bonitas’ performance in the past 18 months, has exceeded all previous benchmarks with over 80 000 new families successfully enrolled on the Scheme and financial sustainability stronger than previous years. We see these appointments as strategic enablers to challenge the status quo – and drive value optimisation to continue leading the healthcare industry. Our aim is to optimise efficiencies, achieve mass enrolment, and meaningfully contribute to the shaping of private healthcare in South Africa.”
Hannes Viljoen, Chief Executive Officer of Momentum Health welcomed the appointment, citing it as a key strategic opportunity in the dynamic open market for Momentum Health. “We are excited about positively impacting the health of more people. The group currently service over 3,3 million beneficiaries in Africa and more than 25 million world-wide and are strategically and operationally positioned to deliver value in a meaningful and impactful way,” he said.
Dr Ayanda Mbuli, Chief Executive Officer of PHA, was pleased with the outcome, “We are deeply honoured by Bonitas’ decision to entrust PHA with its managed healthcare function, a historic milestone for the Scheme. This partnership presents a unique opportunity to further optimise the care received by Bonitas members and to meaningfully contribute to both the Bonitas healthcare agenda and the broader South African health landscape.”
Bonitas has been a leading open scheme in South Africa for several decades and these changes will open opportunities to build a more significant and influential open scheme that caters for more South African’s health care needs.
As HIV, TB and other treatments are updated in our public healthcare system, it is critical that healthcare workers and counsellors stay on top of the latest developments. One innovative programme makes use of short lessons delivered over WhatsApp to provide such training.
Over her years working as an information pharmacist at the University of Cape Town’s Medicines Information Centre (MIC), Briony Chisholm noted that many health workers in rural clinics face difficulties accessing training in crucial aspects of their work.
“The lack of easy access to training was in areas where it was really needed, such as the HIV (treatment) guidelines that are constantly being updated,” says Chisholm. “It’s not enough to have training sessions when new guidelines come out; you ideally should be training all the time.”
Drug-drug interactions
At the end of 2019, government introduced new standard first-line HIV treatment that includes an antiretroviral medicine called dolutegravir. As we previously reported, by 2023 around 4.7 million people in South Africa were taking dolutegravir-based treatment.
But the introduction of a new medicine in the public healthcare system, especially at this scale, is rarely straight-forward.
“Dolutegravir is considered as a ‘wonder child’ in ARV treatment, because it provides a high barrier to resistance, is easier to take, and has far fewer side effects than older ARVs. However, it also has interactions with other key drugs, particularly those used for the treatment of TB, diabetes and some anti-epileptic medications,” she says.
Through numerous queries received on the MIC’s National HIV and TB Healthcare Worker Hotline, Chisholm and her colleagues became aware that some healthcare workers were struggling with managing drug interactions. “Some healthcare workers didn’t know about these interactions; others knew about them but not how to deal with them. For example, if a patient is on the TB drug rifampicin, but also needs to take dolutegravir, there’s a need to adjust the dose of dolutegravir. Similarly, adjustments are needed with the diabetes medicine, metformin.”
Chisholm now lives in the Eastern Cape village of Nieu Bethesda. When dolutegravir was introduced, she had just completed her part-time post-graduate Diploma in HIV and TB management through UCT and signed up for her Masters. She and a colleague had, in 2016, done a road trip to about 200 clinics in seven provinces to promote the MIC’s Hotline.
“We saw that most South African healthcare workers are dedicated and keen to learn. You hear all this terrible news about health and corruption, and then you go to these clinics which are ticking along under sometimes difficult conditions, doing amazing work. It’s inspiring!”
A key realisation was the challenges experienced by health workers at these rural clinics to access much-needed training.
“Getting nurses to a central point for training and the need for transport, accommodation and food, as well as having them absent from the clinic for anything between one and five days, is challenging. It’s expensive and involves a great deal of organising,” says Chisholm.
Doing the research
Chisholm then started conducting research on what healthcare workers know about dolutegravir-related drug interactions. Her study, published in 2022, found that about 70 percent of respondents understood that dolutegravir interacts with other drugs, but there were gaps in people’s knowledge of specific interactions and the dosing changes needed to manage those interactions.
The study found that access to guidelines and training were positively associated with knowledge of drug-drug interactions. “There was a clear indication that we needed more accessible training,” Chisholm says.
“The Department of Health offers online training through live webinars, and recordings of these, but they are often one or two hours long. Nurses in busy clinics don’t necessarily have this time to sit through training sessions.”
Testing the efficacy of short training sessions
Chisholm then designed a project to test the efficacy of short training sessions focusing on teaching one or two learning points from the national guidelines in ten to fifteen-minute live lessons using WhatsApp.
“I thought, ‘we’re in a country where not everyone has access to big computer screens, but they all have a cell phone and use WhatsApp – so let’s go as simple as we can’,” she says. “The idea was not to teach the entire set of guidelines but to pick out important parts of them and ensure that if something changes in the guidelines, you get it out to people, quickly.”
Chisholm tested the feasibility of WhatsApp-based microlearning with health workers and counsellors at 50 clinics around Nieu Bethesda. “I ran a range of short case-based lessons on WhatsApp groups and then measured the changes in knowledge and patient care, as well as other factors like uptake, feasibility and accessibility,” she explains.
She found that WhatsApp-based microlearning for healthcare workers is “effective, feasible and well received” and 98 percent of those who participated said they would take part if training sessions were held weekly throughout the year.
While using WhatsApp for medical interactions is not new, Chisholm says a structured syllabus using microlearning for short, punchy sessions is a first.
“This type of learning is equally accessible to a rural clinic as to one in central Hillbrow. We can access people wherever they are. Nobody has to spend money getting anywhere and clinical services are not disrupted. And it doesn’t matter if they’re not in the live session: when they have a moment, they can go into their WhatsApp and read back on the lesson,” she says.
Working with the department of health on 6MMD
Chisholm has been working with the National Department of Health on their Six-Month Multi-Month Dispensing (6MMD) programme. The programme allows people living with HIV who are doing well on treatment and have suppressed viral loads to get a six-month supply of ARVs in one go. This makes life considerably easier for people, since they only need to go to the clinic twice a year; whilst also reducing workloads in the clinics. The programme started in August 2025 and is still being phased in across the country.
“In the pilot phase, the Department of Health did some really good online training and they used our WhatsApp training as an add-on to the longer form training,” says Chisholm.
“We started with one group and ran an eight-week course of 15-minute lessons once a week on WhatsApp. Sessions were case-based and included which patients are eligible for 6MMD, and which patients are not,” she explains. By the end of 2025, around 2 000 healthcare workers had been reached through these sessions.
Lynne Wilkinson, a technical expert with the International AIDS Society which supports the Department of Health on 6MMD, says the microlearning is “a great way to ensure we get to all the clinicians in the country and explain how the 6MMD programme works”.
She adds: “When a new policy comes out, it takes a long time for implementation to be scaled because ground level clinicians aren’t always aware of the changes or don’t have an opportunity to engage with how to implement the changes.”
Daniel Canham, a professional nurse and facility team lead for the NGO, TB HIV Care, at Idutywa Village Community Health Centre in the Eastern Cape, says they’ve found the microlearning sessions for 6MMD very useful. “It’s no secret that the waiting times in clinics are quite extensive, so we are trying to enrol all those qualified for 6MMD as quickly as possible to ease the burden on the clinic,” he says.
“The microlearning on 6MMD has been very helpful. Our staff don’t have to be out of the facility to attend it. They can run their normal activities and attend sessions of ten minutes maximum,” says Canham.
“Our professional nurses joined the WhatsApp microlearning sessions in September last year,” says Faith Maseko, a nurse lead based at Phola Park Clinic in Thokoza in Gauteng who works for the WITS Research Health Institute (RHI). The RHI supports the health department in the management of HIV and employs more than 30 nurses.
“When nurses are trained virtually, some of the information is forgotten, but when you’re on WhatsApp, you can go back and access the information that was shared. The scenarios provided are very useful. If you see a patient, with a similar scenario you can go back and see what was discussed and apply it to your own situation,” she says.
Department of Health backing
Foster Mohale, spokesperson for the National Department of Health, says the WhatsApp-based microlearning has been “an effective low-cost, high-reach supplement to formal 6MMD training”.
He adds: “Training gaps translate directly into service gaps, affecting quality, retention, and progress toward epidemic control. Microlearning addresses this risk by enabling continuous, bite-sized reinforcement of policy and implementation guidance, rather than relying solely on once-off training events. This approach supports frontline healthcare workers in applying 6MMD consistently under real-world service pressures.”
Mohale says evidence from the department’s broader capacitation strategy shows that lifelong, continuous learning, rather than episodic training, is essential for resilient health systems.
“WhatsApp microlearning aligns with this principle by supporting rapid dissemination of updates, peer learning, and sustained mentorship. When integrated with structured models and aligned to national guidelines, it can be effectively applied across HIV, TB, maternal and child health, non-communicable diseases, and health systems strengthening more broadly,” he says.
In a small mining town in South Africa’s Limpopo province, young people are showing worrying signs of diseases that were once thought to affect only older adults.
These include type 2 diabetes, high blood pressure, high cholesterol, obesity and insulin resistance. This is not unique to Limpopo or South Africa. It reflects a global trend, where young adults in many low- and middle-income countries are increasingly experiencing early-onset metabolic diseases due to rapid urbanisation, lifestyle changes, unhealthy diets and reduced physical activity.
The World Health Organization says non-communicable diseases now account for 75% of all non-pandemic-related deaths globally. Also, 82% of premature deaths before age 70 occur in low- and middle-income countries.
I’m a public health researcher specialising in epidemiology, metabolic health, infectious diseases and environmental health. My colleagues and I conducted a study in the town of Lephalale and found that many young adults there have abnormal cholesterol levels. They also have reduced sensitivity to insulin, a condition known as insulin resistance.
Both are key risk factors for type 2 diabetes and heart disease.
Our findings suggest that these health problems are appearing much earlier in life than expected. This is particularly concerning in communities undergoing rapid social and economic change, where access to health services and screening programmes remains limited.
New jobs, new lifestyles
Lephalale, formerly known as Ellisras, offers a window into these transitions. Once a quiet rural area in the north of South Africa, it has changed rapidly over the past two decades. It is now the site of expanding mining and industrial activities, driven by the expansion of coal mining operations and the development of power stations.
This industrial growth has attracted thousands of workers from surrounding provinces and neighbouring countries, bringing new economic opportunities. It is also reshaping daily life. Increasingly, residents are doing sedentary work and eating energy-dense diets, including fast food. These lifestyle transitions make Lephalale an important setting for studying emerging health risks in young adults.
Long hours sitting at work and reduced physical activity create fertile ground for metabolic disorders. When people eat more processed, high-fat, high-sugar foods and move less, the body begins storing excess energy as fat.
Over time, this can lead to weight gain, elevated blood glucose and abnormal cholesterol levels. These changes make it harder for the body to regulate insulin, causing insulin resistance, the first step towards type 2 diabetes. Also, inactivity and poor diet increase unhealthy cholesterol and triglycerides (types of fat in the blood), raising the risk of heart disease. In rapidly transitioning communities, these health shifts can happen quickly.
Non-communicable diseases such as diabetes, hypertension and heart disease are now among the leading causes of death in South Africa. In 2020, diabetes was reported to be the second biggest underlying cause of death in South Africa, accounting for 6.6% of all deaths.
Our research
We examined 781 young adults aged 18 to 29 years living in Lephalale as part of a long-running study. We have been tracking health patterns in this community since 1992.
Participants provided fasting blood samples that were analysed for glucose, insulin and cholesterol levels. We grouped them into diabetic and non-diabetic categories based on clinical definitions used by the American Diabetes Association.
The results were striking:
Diabetic participants had significantly higher total cholesterol, low-density lipoprotein (the “bad” cholesterol) and triglycerides, and lower levels of high-density lipoprotein (the “good” cholesterol) than their non-diabetic peers.
Over half (52.7%) of the diabetic group had high total cholesterol, compared with 23% of non-diabetic participants.
Insulin resistance, when the body needs more insulin to manage blood sugar, was also much higher among diabetics.
Even some non-diabetic participants showed early signs of these metabolic changes.
Unhealthy cholesterol patterns and poor insulin sensitivity tend to occur together, each making the other worse. This combination sets the stage for early heart disease, stroke and diabetes.
Why young adults?
Most public-health strategies focus on older adults because that’s when chronic diseases usually become visible.
But our research adds to growing evidence that the seeds of non-communicable diseases are planted early, often in young adulthood or even adolescence.
Young adults in rural or semi-urban areas may seem healthy, yet many are already developing risks due to diet changes, stress and limited exercise opportunities. The modernisation of small towns, while positive economically, brings hidden health costs.
Without early detection, these individuals may enter middle age already carrying high risk of health problems. This will put pressure on health systems that are already stretched.
What makes this community unique?
Lephalale may be changing, but it still lacks many of the urban services, infrastructure and health resources found in South Africa’s big cities.
Health resources are scarce, and screening for cholesterol or insulin resistance is rare. Public clinics focus on infectious diseases such as HIV or tuberculosis. Silent metabolic disorders go unnoticed until symptoms appear.
Our study shows that rapid industrialisation without parallel investment in public-health education and preventive services risks creating a generation of young adults who are chronically unwell by their thirties.
What can be done?
Three priorities stand out:
Early screening and prevention
Regular cholesterol and glucose testing should be part of routine primary-care visits, especially for adults under 30. Mobile health campaigns, school outreach and workplace screenings could help identify those at risk.
Community-based education
Local awareness campaigns must make the link between diet, physical activity and metabolic health easy to understand. They should show, for example, how frequent consumption of fried or sugary foods contributes to cholesterol build-up and insulin resistance.
Healthy-environment policies
Urban planners and municipalities can support healthy lifestyles by ensuring there are safe spaces for exercise. They must also limit marketing of unhealthy foods, and encourage availability of affordable, nutritious options. Similar “health-in-all-policies” approaches have shown success in other countries. such as Finland’s long-running HiAP strategy, which reduced cardiovascular disease rates and improved population health outcomes.
Young people should be in peak health. Without intervention, today’s young adults risk becoming tomorrow’s chronic-disease patients, burdening families, workplaces and health systems.
