G20's roadmap for better healthcare in SA

South Africa’s public healthcare system supports more than 80% of the population, but faces underfunding, operational inefficiencies, and stark inequities.

With the G20 Health Working Group championing universal health coverage (UHC) through primary healthcare (PHC), and the B20 Health Task Force advocating for public-private partnerships (PPPs), South Africa has a unique opportunity to transform its primary healthcare system.

By strengthening and digitalising PHC, the nation can deliver equitable, cost-effective care, particularly to underserved communities.

The private sector, armed with innovative models and digital tools, must lead the charge to bridge systemic gaps and build a resilient future for healthcare. And RMB is committed to being a leader in this space through the creation of innovative blended financing models and connecting our clients and investors to the tech innovators paving the way.  

The challenges are undeniable.

South Africa’s PHC system is underfunded, overburdened and fragmented

Only 56% of clinics meet the Ideal Clinic standards, according to a 2023 report by the Human Sciences Research Council. Meanwhile, a two-tiered system exacerbates inequities. Eight-four percent of the population relies on public care, yet over 70% of doctors work in the private sector. This leaves public clinics understaffed and ill-equipped to manage rising cases of non-communicable diseases (NCDs) such as diabetes and cardiovascular disease, or to improve maternal and child health outcomes.

The World Health Organization (WHO) and G20 affirm that PHC is the cornerstone of equitable, resilient health systems, yet South Africa’s current model falls short of this ideal.

Innovative PHC models, however, offer hope.

In KwaZulu-Natal, BroadReach Health utilises data analytics to enhance HIV care, resulting in a 32% increase in viral suppression rates. Platforms like Vodacom’s mHealth show how private investment can scale remote care and reduce travel burdens for rural patients. Discovery’s Healthy Company programme provides accessible PHC through mobile apps, offering remote consultations and health tracking. These align with the global rise of mHealth, where mobile technologies enhance service delivery in low-resource settings.

Kenya’s Equity Afia, a bank-funded PHC network, provides a compelling blueprint: its clinics combine affordable care with workforce training for community health workers, ensuring sustainability. This model offers South Africa a blueprint for sustainable, entrepreneurial, community-based care.

In South Africa, pharmacies like Dis-Chem are actively expanding PHC delivery through its stores, and more regionally, similar trends like CFAO’s acquisition of Goodlife Pharmacies in Kenya are being adopted. These models demonstrate how digital tools and alternative delivery channels can extend care to underserved areas.

According to the WHO and G20, effective PHC is essential for tackling NCDs and improving maternal-child health outcomes. Robust PHC systems reduce hospital strain by prioritising prevention and early intervention. For instance, digital triage tools can identify high-risk patients, while telehealth connects rural clinics to specialists.

South Africa’s high maternal mortality rate (119 per 100 000 live births, per WHO) and NCD burden (51% of deaths, per 2023 stats) underscore the urgency of scaling such solutions. Digitalised PHC also ensures continuity of care for mobile populations, a critical need in South Africa’s transient communities.

The private sector’s role is crucial in scaling PHC

Public-private partnerships can extend PHC reach, as seen in BroadReach’s collaboration with public clinics. Investment in digital infrastructure – AI-driven triage, telehealth platforms, and electronic health records (EHRs) – can modernise clinics.

For example, AI tools can cut diagnostic errors by 30-40% (per McKinsey), enabling early NCD detection. Vodacom’s mHealth platform illustrates how private investment can scale telehealth, reducing travel costs for rural patients. Workforce development is equally critical: training community health workers, as Equity Afia does, builds local capacity. Discovery’s Healthy Company programme further shows how private firms can incentivise healthier behaviours, lowering long-term costs.

Barriers persist, including data, regulation, and trust

Fewer than 30% of clinics comply with South Africa’s Health Normative Standards Framework, stalling EHR integration. Regulatory gaps and inadequate digital training for healthcare workers are slowing progress. Public mistrust, fueled by concerns around data privacy or job losses, complicates adoption. The G20’s call for interoperable, ethical digital frameworks offers guidance, but South Africa must localise these standards. For instance, transparent data governance can rebuild trust, while upskilling programmes can equip nurses to use AI tools effectively.

To achieve health equity, South Africa must take decisive action.

First, prioritise PPPs to fund digital infrastructure, drawing on models like Equity Afia’s bank-backed clinics. Second, enforce EHR interoperability to enable data-driven care, aligning with the goals of the NHI. Third, invest in workforce training, with a focus on community health workers to serve rural areas. Finally, engage communities to demystify digital tools, emphasising their role in empowering patients. These steps align with the B20’s push for inclusive PHC and the G20’s UHC vision. These steps align with the B20’s push for inclusive PHC and the G20’s UHC vision.

The stakes are high.

South Africa’s PHC system is the backbone of its healthcare future; yet, inequities threaten to undermine the NHI and the achievement of sustainable development goals. By strengthening and digitalising PHC, South Africa can deliver affordable, quality care to all. Private sector innovators, such as BroadReach, Vodacom, and Dis-Chem, are leading the way, but success hinges on public sector alignment and systemic reform.

As the G20 and B20 advocate, primary healthcare is not just a strategy; it’s a moral obligation. With the right partnerships and investment, South Africa can lead by example, building a fairer, more resilient healthcare system for all.

South Africa has the tools and talent to lead. It must seize this moment to build a healthier, fairer nation.

Liza Eustace is sector head for healthcare, hospitality and services at RMB.