South Africa’s health-care spend is estimated at some US$39 billion. The health-care system comprises a large under-funded and
under-staffed public sector, which supports 80% of the population and the small private sector, financed by medical aid schemes.
The bulk of the country's health-care expenditure emanates from the public sector, with 50% of total spend.
The sector comprises about 400 public and 220 private hospitals. Private-Public Partnerships (PPP’s) are prevalent and have been highlighted as catalysts for improving, in an innovative manner, ways to fund the quality of the health-care services towards the goal of achieving a sound universal health care system.
The sector comprises hospitals, clinics, pharmacies, emergency services, specialists and medical consumables.
The SA pharmaceutical industry is well established and contributes approximately 1.5% to the national GDP with overall revenue at about
R40 billion rand and employing about 9,500 full time workers. The sector is represented by the following companies amonst others:
• Abbott Laboratories
• Boehringer Ingelheim
• Bristol-Myers Squibb
• Eli Lilly
• GE Healthcare
• Janssen Pharmaceutica
• Novo Nordisk
• Servier Laboratories
Medical technologies are described as medical devices, in vitro diagnostics, imaging equipment and e-health solutions used to diagnose,
monitor, assess predispositions and treat patients suffering from a wide range of conditions. It covers a broad range of products like
wheelchairs, hip prosthesis, cardiac stents, syringes and MRI-scanners to name a few. Medical technology helps people live healthier and
longer lives and is an indispensable necessity to any health system. Moreover continuous innovations in medical technology enhance the
effectiveness and quality of care.
The South African medical technology market has an estimated value of US $ 1.0 billion and constitutes 0.4% of the global medical technology market. The average revenue for multinational medical technology companies (R 283 million per annum, per company) is more than the revenue for local medical technology companies (R 75.2 million per annum, per company). The majority of companies import medical technology products from other parts of the world. It is therefore no surprise that the volume of imported products exceed the volume of exported products in monetary terms. In terms of exports, most products are exported to other African countries (80% of total export of medical technology products). South Africa’s health system is described as a dichotomous system with well-developed private sector and a burdened public sector. The medical technology market derives most of its revenues from clients in the private sector (70%) when compared with clients in the public sector (30%). The medical technology industry employs over 3 600 people and medical technology companies are on average BBBEE level 4 contributors. The average BBBEE rating is lower for local manufacturers when compared to multinationals. Medical technology companies spent a total of R 23.7 million on sponsorship and R 31.7 million on training healthcare professionals that use their products.
Medical technology industry respondents to the industry survey raised concerns regarding the import of substandard medical technology products. According to respondents this hampers fair competition, specifically on price for quality products, and is exacerbated by the lack of a quality regulator for medical devices in South Africa. The majority of medical technology companies would support the establishment of a quality regulator. Other matters raised by respondents include the lack of transparency in government tender processes, delayed payment from major public sector clients, the relative power of private sector healthcare funders in approving reimbursement for medical technology products or not, the limited appreciation for and availability of funds for Research & Development (R&D) of medical technology products in South Africa.
The Chemical Industry is well developed with few large plants and a diverse grouping of specialist medium sized firms.
Downstream there are many SMME chemical formulators, which play an important role in the distribution chain. Central to the
industry are the two large oil refineries that feed into the Petro-Chemical sector.
The KZN chemical and petro-chemical sub-sector, industrial chemicals comprise a third, at R1.1-billion, of the gross output, petroleum and coal products 30% at R1-billion, chemicals 21% at R0.7-billion, and rubber and plastic products the balance. Other sectors that enjoy substantial investments are paint, agricultural chemicals, plastics and synthetic resins.
South Africa's health system consists of a large public sector, a smaller but fast growing private sector and an NGO sector.
The public health sector is funded by the state. 40% of all expenditure on health comes from the National Treasury.
Public health consumes around 11% of the government's total budget and is allocated mostly to nine provincial departments.
The public sector is further hampered by a shortage of key medical personnel.
There are 4200 public health facilities in South Africa with each clinic providing on average for 13,718 persons (a figure that exceeds the WHO guidelines of 10,000 per clinic.) People averaged 2.5 visits per year to public health facilities and the bed occupancy rates were between 65% and 77% at hospitals. Since 1994, more than 1600 clinics have been built or upgraded. For 2,5 million South Africans, their nearest clinic is more than 5 kilometres away from their homes.
There are 376 public hospitals in the country; 143 in urban areas and 233 in rural areas. Diagnostic and health research services are provided by the National Health Laboratory Service (NHLS), the largest pathology service in South Africa with 265 laboratories, serving 80% of South Africans. There are 165,371 qualified health practitioners in both public and private sectors, registered with the Health Professions Council of South Africa, including 38 236 doctors and 5 560 dentists. In the public service there is one doctor for every 4,219 people, given that 73% of general practitioners work in the private sector, compared to 243 patients to a general doctor in the private sector. Each year, about 1,200 medical students graduate and provide two years of community service in understaffed hospitals and clinics.
The Public Healthcare System:
The foundation of the public health system is the primary healthcare clinics that are the first line of access for people needing healthcare services. These clinics provide their services free. Access to clinics has improved significantly since 1994 (the country’s transition to democracy) but in many instances, the quality of health care provided at this level has fallen.
The next tier of the public healthcare system in South Africa are the district hospitals to which patients are referred from primary healthcare clinics when they need more sophisticated treatment. At the tertiary level are the academic hospitals where advanced diagnostic procedures and treatments are provided. These also serve as training institutions for healthcare providers. 4 The annual expenditure of the public healthcare sector is around R122.4-billion to serve 84% of the population, or 42-million people, who are dependent on the public health care sector for services.
The Private Healthcare System:
The private healthcare system is made up of healthcare professionals who provide their services on a private basis, usually funded by the subscriptions of individuals to medial aid schemes. Private healthcare practitioners also provide services through private hospitals. The private healthcare sector spends around R120.8-billion annually to cover 16.2% of the population or 8.2-million people, many of whom have medical cover.
South Africa has more than 110 registered medical schemes, with around 3,4-million principal members (and 7,8- million beneficiaries). There are 238 private hospitals in the country, 188 in urban areas and 50 in rural areas. NGO Healthcare Provision Multiple NGOs contribute to the health sector with a focus on HIV/Aids and TB, accounts for a spend of donor money of around R5.3 billion.
Effects and consequences of the division between the private and public health sector:
The division in the healthcare delivery system was the outcome of the unjust system over the past 300 years which took responsibility for providing services primarily to the white minority. The health of black people was only a consideration if it affected the labour supply or if infection posed a risk to white public health. After the passing of the 1913 Land Act which provided a relatively limitless supply of black labour for the mines and other industries, the epidemics of silicosis, tuberculosis and sexually transmitted diseases were allowed to develop relatively unchecked. Few black people were trained and educated as doctors. More black women were trained as nurses as a result largely of the shortage of nurses during World War II. The focus of medicine and medical technology was on curative and hospital care in urban areas to meet the health needs of the white population.
During apartheid, fourteen separate health departments were set up, one for each racial group (black, coloured, Indian and white) and one for each nominally independent apartheid homeland resulting in fragmentation, duplication and differential funding of the different healthcare systems which created racial inequality in access, in the training of healthcare workers and in conditions of employment. This entire system had to be dismantled at the end of apartheid to create a unitary, comprehensive, equitable and integrated national health system as envisaged in the ANC’s 1994 National Health Plan which sought to build a system based on the provision of health and not only on medical care; on redressing the harmful effects of apartheid healthcare services; on establishing new norms, ethics and standards; on providing a voice for healthcare workers; on securing effective community participation; on delivering efficient and compassionate care; on respecting the rights of providers and beneficiaries and on reducing the burden of disease affecting the health of all South Africans.
In less than a decade there have been several global public health crises. These include: The Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Ebola, Zika virus and now the Corona Virus (otherwise known as COVID-19). In order to contain most of these contagious respiratory diseases there is a need to limit the movement of people, warranting the need for telemedicine or telehealth.
Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It is convenient and allows for long distance patient consultation, care, advice, reminders, education, intervention and monitoring.
In the case of the COVID-19 pandemic, telemedicine is a readily available solution that allows those following treatment for other conditions to continue doing so, while potential COVID-19 cases can be filtered out remotely. It entails the use of information and communication technology to provide patient care and the sharing of clinical information between different locations.
Clinical applications of telemedicine include teleconsultations, telecardiology, telegynaecology, and mental health consultations. It does, however, carry some challenges and limitations particularly with regards surgery and anaesthesiology. As the coronavirus wreaks havoc on the healthcare system, telemedicine is helping healthcare provider organisations and caregivers better respond to the needs of patients. It enables the transfer of health information across distances using email, telephony, video links and social networks. In this way, telemedicine is bridging the gap between people, physicians and health systems, allowing everyone, especially asymptomatic patients, to stay at home and communicate through virtual channels, helping to reduce the spread of the virus to populations and frontline medical staff.
Telemedicine has helped healthcare provider organisations and caregivers better respond to the needs of patients. Globally and in South Africa telemedicine is facing certain legal, regulatory and reimbursement challenges, but there is nonetheless a need to facilitate more widespread adoption thereof. In March 2020, the Health Professions Council of South Africa (HPCSA) added a relaxation clause to the telemedicine rules, allowing its use during the Covid-19 crisis. This allowed patients to be managed remotely as the country went into lockdown. We are hopeful that telemedicine will continue to be permitted after the crisis. improving access to healthcare.
The telemedicine surge during the COVID-19 pandemic is helping to provide care to patients who might need it after exhibiting potential symptoms of coronavirus infection. Telemedicine is presenting itself as the ideal solution in this regard, linking patients remotely to hospitals, primary care and consulting disciplines, thus allowing access to healthcare while curbing disease spread. Telemedicine solutions and programmes allow people suffering from other medical ailments during this time to receive care from home without entering medical facilities, minimising the risk of their contracting the virus. The Centers for Disease Control and Prevention also known as the CDC and the World Health Organisation (WHO) are urging both the general public and medical staff to use telemedicine solutions for non-urgent communications in order to reduce the pressures on emergency rooms and clinics.
During the pandemic, telemedicine has been used to ‘forward triage’ patients long before they arrive at primary care facilities. Many chronic care patients can schedule teleconsultations with their doctors hence minimising their risk of exposure to COVID-19. Chronic medication can be delivered to patients’ homes. This allows for continuity of care. This digitalisation of healthcare is streamlining the dispensing of medication, record sharing and patient-tracking. In the process, telemedicine has proven to be a crucial lifeline for some rural communities as it allows rural hospitals to outsource diagnostic and other services and thus help reduce providers’ sense of isolation. There are however a few limitations particularly if the treating practitioner is unable to obtain a full clinical picture from a remote location particularly in the absence of a physical examination. Although telemedicine is evolving fast and is a proven modality to enable access to healthcare, it is important that it is used appropriately, and its use should not compromise patient care. Telemedicine oversight is therefore essential, and this is the responsibility of the HPCSA
The sugar cane growing areas of South Africa namely; KwaZulu-Natal, Mpumalanga and the Eastern Cape, generate an
income from the sale of sugar and molasses of over R4.2 billion per anum. The sugar industry is an important provider
of jobs as well as the cornerstone of business development in rural areas in which sugar cane is grown. The quest for
increasing efficiency has reduced the number of workers per ton of sugar, but expansion in production has limited job
The social programs and the government/private sector joint projects that have been facilitated and implemented by the sugar industry bear testimony to the industry's conscious commitment to the socio-economic and welfare upliftment of its employees. The key challenge for the sugar cane industry remains the maintenance of competitiveness in relation to other world-class producers and industries.
The most important agricultural area lies along the coast, where sugarcane is the major crop. Sugar growing is now of increasing importance in the Midlands. The industry is composed of 15 sugar mills, 13 of which are scattered from the southern border of KwaZulu-Natal to its northern border, and 2 of which are in Mpumalanga. Most of the sugar cane supplied to these mills (85%) is produced by over 53 000 registered cane growers, the balance being supplied by the mill estates. The production of sugar cane on communally held land has expanded significantly in the past 25 years. Allied to the expansion in cane production in these areas has been the development of a large number of contractors who harvest and transport the cane.
Extensive trade in medicinal plant products takes place within the eThekwini Municipality (Durban, South Africa). It is estimated 1 500 tonnes of plant material is traded per annum, with a value of R21 million (the raw unprocessed products). Value-adding on this raw material takes place through prescription by traditional healers. In eThekwini it has been estimated that some four million products are dispensed through prescription per year, adding R152 million to the value of the trade (total trade value per annum is thus R173 million). It is estimated that some 13 950 income-generating opportunities are provided by the medicinal plants trade in eThekwini.
Ethekwini Municipality Interventions:
1. Promoting improved processing of medicinal plant products: eThekwini Municipality has invested in two hammer mills (heavy-duty grinders) for the Herb Market at Warwick Junction.
2. Providing Market Information
3. Promoting cultivation of medicinal plant products:
See CPWILD for more information.
Despite the fact that KwaZulu-Natal covers such a small portion of South Africa's land area, a significant percentage of the country's small-scale farmers are based here. Agriculture in KwaZulu-Natal is extremely diverse and is reflected in the patterns of its topography. Most of the world's agricultural activities can be practised here. Due to the good reliable rainfall and fertile soils, the region's agricultural sector has become very productive, and is known for its specialist capability in several types of farming. The Province has a total of 6.5 million hectares of land for farming purposes of which 82% is suitable for extensive livestock production and 18% is arable land.