South Africa Healthcare Market Overview

South Africa is the largest economy on the African continent with a population of 56.4mn in the emerging world markets. However, economic growth has slowed in recent times due to low global commodity prices and the wavering mining sector. Nevertheless, the economy is showing some signs of regaining traction and this will improve the outlook for the healthcare sector.

Achieving universal health coverage remains a government priority. The implementation of the National Health Insurance will be gradual and will boost the public sector’s contribution. Delivery challenges will necessitate effective private sector engagement and the establishment of PPPs for healthcare.

Healthcare Sector

South Africa currently runs a two-tiered healthcare system, comprising of the public and the smaller, rapidly -growing private sector. The country spent 9% of its GDP on healthcare in 2017, which is 4% higher than the WHO’s recommended spending for a country of its socioeconomic status.

Despite this high expenditure, health outcomes are still trailing in comparison with similar middle-income countries, mostly due to the inequities between the public and private sectors. To eliminate this inequality, the government is in the process of implementing National Health Insurance (NHI) to establish universal healthcare. This coverage will provide the population with required healthcare and financial protection to all citizens.

The NHI seeks to establish a fund – the National Health Insurance Fund – to act as a public entity governed by the Public Finance Management Act. The fund will be a single public purchaser and financier of health services in the country, to ensure “equitable and fair distribution” and will be a mandatory pre-payment health services system.

Government Healthcare Provision

Provision of healthcare infrastructure and services by the state is largely skewed towards provinces with weak economies and the lesser gross state product per capita - such as those of the Eastern Cape, Limpopo, KwaZulu-Natal and Mpumalanga. The national health insurance project remains a priority. The NHI is being reformed to establish a compulsory medical scheme for the nation that will be rolled out in three phases by 2025 across each district.

The Department of Health (DoH) will oversee the distribution of healthcare resources and personnel. The public sector’s contribution is expected to increase from 44% of total health spending at ZAR175bn (USD13.1bn) in 2017 to 52% at ZAR418.2bn (USD24.4bn) by 2027. There are concerns over the private healthcare sector.

Allocations for implementing South Africa’s NHIS are set to rise from ZAR700mn (USD60.3mn) in FY2018- 19 to ZAR1.4bn (USD0.1bn) inFY2019-20. These will be funded through an amendment to the medical tax credit. The extra funding will finance increased personnel costs, including contracting with GPs and providing school optometry and audiology services, as well as an expansion of the chronic disease medication distribution programme.

Healthcare Resources
(South Africa 2012-2016)		 2012 2013 2014 2015 2016
Total Hospitals 687 694 701 708 715
Public Hospitals 418 422 426 430 435
Private Hospitals 269 272 274 277 280
Hospitals beds 131,929 133,246 134,575 135,918 137,274
Healthcare Personnel
(South Africa 2012-2016)		 2012 2013 2014 2015 2016
Total Physicians 38,444 39,445 41,132 42,323 43,425
Total Dentists 5,613 5,667 5,824 5,998 6,147
Total Pharmacists 12,998 13,401 13,364 13,479 13,878
Total Nurses 248,736 260,698 270,437 278,617 287,458
Healthcare Activity
(South Africa 2012-2016)		 2012 2013 2014 2015 2016
Public inpatient admissions, ‘000 4,861.40 4,987.70 5,117.28 5,250.23 5,386.63
Hospitals, average length of stay, days 4.0 4.0 4.0 4.0 4.0
Surgical procedures, ‘000 1,458.42 1,496.31 1,535.18 1,575.07 1,615.99
Outpatient visits, ‘000 162,046.74 166,256.72 170,576.07 175,007.63 179,554.33