Innovation in the health system is not a luxury, it is a necessity in the South African context. Photo: Denvor de Wee/Gallo Images/Foto24)
South Africa’s National Health Insurance (NHI) policy promises a future where healthcare access is no longer determined by income or geography. It’s an ambitious step toward equity and dignity in healthcare. But, for many of us working in health innovation, one fundamental concern persists — can the NHI succeed without a simultaneous investment in technologies that improve delivery, access and sustainability, particularly in under-resourced areas?
On paper, NHI is a powerful vision. In practice, it is being built on the crumbling scaffolding of an overburdened public system. Public healthcare workers are already stretched to breaking point. Clinics and hospitals in underserved communities operate beyond capacity, face critical shortages in staffing and equipment and frequently lack the infrastructure to manage growing patient volumes.
South Africa spends over 8.1% of GDP on healthcare, yet public outcomes remain dismal, and the gap between private and public services continues to widen. According to Statistics South Africa, fewer than 20% of rural South Africans have regular access to doctors. Compounding this is the financial fragility of the system. With only 3 million taxpayers supporting more than 60 million people, the sustainability of NHI remains a looming question mark.
South Africa is not the first country to attempt universal coverage under strained circumstances. The US’s Medicaid programme, which covers more than 90 million low-income individuals, also faces longstanding issues of underfunding, provider shortages and delayed access — particularly in rural and underserved regions. And this in one of the world’s wealthiest nations.
Medicaid shows us that even large-scale healthcare reform can fail to deliver on its promises without robust support systems, innovation and decentralised access strategies. If the US struggles with healthcare equity under Medicaid, South Africa — without the fiscal cushion — must be even more intentional about how it designs and sustains its reforms.
Far too often, innovation is painted as a luxury. But in South Africa’s context, it’s a necessity. If we want to build a healthcare system that serves all South Africans — not just the urban, well-connected few — we must invest in the tools that can decentralise care, cut costs and extend reach.
Additive manufacturing (3D printing) and artificial intelligence (AI) are two of the most powerful tools available today. In countries around the world, these technologies are already being used to expand diagnostic capacity, produce custom-fit medical devices and deliver faster, more accurate care — even in remote areas.
In cardiovascular care, 3D-printed anatomical models reduce surgical time by up to 30% and cut diagnostic errors by 15%. Custom prosthetics, surgical instruments and patient-specific implants can now be produced on-site, at a fraction of the traditional cost. These are not hypothetical scenarios — they are already in use in countries like India, Brazil and China.
South Africa imports over 90% of its medical devices, many of which are overpriced, ill-suited to local realities and/or delayed due to global supply-chain bottlenecks. The result? Clinics are left waiting for tools that never arrive. Patients go untreated. And opportunities to empower local innovation are lost.
More concerning is the environmental toll. Long-distance shipping of bulky medical goods contributes significantly to healthcare’s carbon footprint. With the right investment, point-of-care manufacturing could allow South Africa to make what it needs, where it’s needed, cutting costs and emissions.
The African Continental Free Trade Agreement and Harmonization of Medicines Act offer frameworks through which regional collaboration and regulation can support the growth of localised, ethical and quality-controlled manufacturing hubs.
Globally, AI is transforming how healthcare is delivered. In India, AI tools have improved early cancer detection rates by 40% by analysing imaging scans in low-resource hospitals. In Kenya, mobile AI tools have reduced maternal mortality by 20%, reaching patients who would otherwise go undiagnosed or untreated.
AI could support nurses and community health workers in South Africa by helping triage patients, prioritise care and assist in early detection of chronic conditions like hypertension and diabetes. These technologies can be adapted to local languages, health profiles and epidemiological realities. But without training datasets reflective of African populations, AI tools risk being inaccurate or irrelevant. Investment in African-led, context-specific AI systems is not only ethical — it’s essential.
Some will argue that South Africa is not ready for these technologies. But the truth is, we cannot afford not to be. The cost of not investing in innovation is already evident in overburdened hospitals, long wait times and the endless cycle of donor dependency and imported solutions.
NHI could be a historic leveller — but only if it is accompanied by the foresight to integrate innovation into every layer of the health system.
For the NHI to succeed — and for it to truly serve South Africans in all corners of the country — the department of health must invest in decentralised innovation infrastructure, such as 3D-printing hubs in regional hospitals; support AI diagnostic tools tailored to South African data and disease burdens; incentivise public-private partnerships that bring innovation to frontline clinics; integrate sustainability metrics into the procurement of medical devices, rewarding local, ethical manufacturing and train and upskill the healthcare workforce in using these new tools effectively.
Innovation is not just about gadgets. It’s about resilience. It’s about dignity. And it’s about justice.
Healthcare reform is never easy. But we stand at a crossroads — continue with a bureaucratic version of equity or invest in a system that truly changes people’s lives.
We don’t need more promises. We need policy backed by science, budgets backed by courage and innovation backed by inclusion.
South Africa has the talent, the youth and the policy frameworks to lead Africa in healthcare innovation. The only question that remains is whether we have the will to act.
Dr Cherise Dunn is an entrepreneur and a Harvard South Africa fellow pursuing an MPH at the Harvard TH Chan School of Public Health. She has presented a TEDx talk on healthcare innovation in Africa, has represented South Africa at global forums including the G20 and Brics, and among other awards, was one of the Mail & Guardian’s Top 200 Young South Africans in 2019.
