South African Healthcare Sector

Healthcare varies from the most basic primary healthcare, offered free by the state, to highly specialised hi-tech health services available in both the public and private sector.  The private sector, run largely on commercial lines, caters to middle- and high-income earners who tend to be members of medical schemes (18% of the population). The private sector also attracts most of the country's health professionals. The Department of Health has an overall responsibility for healthcare in the country, with a specific responsibility for public-sector healthcare. The country has around 400 public hospitals and 211 private hospitals. South Africa aims to introduce a system of National Health Insurance (NHI) over a period of 10 years.

The health sector in South Africa is experiencing fast paced change – from an increasing infectious disease burden driven by HIV / AIDS and tuberculosis to chronic diseases related to high blood pressure and obesity, the so-called double burden of disease. Central to these changes is the National Drug Policy (NDP) which aims to increase access and affordability of essential drugs to all South Africans. To this aim transparent pricing regulations were introduced which provided for the single exit price of medicines. Other recent legislative changes introduced include mandatory generic substitution, dispensing fees for doctors and prescribed minimum benefits for medical schemes.

South Africa has the largest and most well-developed pharmaceutical market in Africa due to a progressive business infrastructure and regulatory environment. Domestic production meets around 60% of pharmaceutical demand. The bulk of domestic production involves the finishing of imported raw materials and semi-finished drugs. Local producers are used as a base for distribution to most of Sub-Saharan Africa. The multinational companies either import their products or they sign agreements with manufacturers within South Africa using their relatively modern manufacturing facilities to formulate and package products for them. South Africa has around 522 public pharmacies and 2206 retail & courier pharmacies. The top six pharma companies (Aspen, Ascock Ingram, SANOFI, Pfizer, Novartis, Cipla Medpro) control more than 50% of the total market.