Two decades into its democracy, the remnants of apartheid still affect the lives and health of the South African people. Social inequality among racial groupings remains a strong determinant for access to healthcare and opportunities. The South African government has taken great strides towards addressing access and equity in the healthcare sector through policies such as the National Department of Health Strategic Plan 2010/11–2012/13 and the National Development Plan that show firm commitment to improving outcomes in the country. However, many challenges remain; the three most significant of these is the shortage of health workers, the prevalence of HIV, and poor infrastructure.
South Africa’s health care system may be viewed, to a large extent, as a reflection of the issues facing other Southern African countries who struggle with a similar disease burden, lack of systemic infrastructure and cohesiveness, and societal inequities. Both the public and private sector coexist in South Africa. However, the private sector accounts for the largest share of the money spent in healthcare, and this includes out-of-pocket payments and medical schemes. The evolving health landscape in South Africa and the reforms being undertaken to prepare for a National Healthcare Insurance, presents the opportunity to understand effective models of care provision as developed in other African contexts and translate the applicability of these models as appropriate to the South African environment. A main focus of the South African Ministry of Health in regards to the National Health Insurance is the delivery of high-quality accessible primary care to all citizens and, thus, research on translational models of primary care would hold value for local policy makers.
The landscape for innovation in healthcare in the country has focused primarily on technology, product innovations, and vaccines. Other innovations have been focused on addressing the energy crisis and environmental challenges such as pollution. The National Development Plan is one of the more recent documents that have made innovation synonymous with technology; thus, government funding and support have been focused in this arena with the belief that this form of innovation can contribute towards improving the country’s economy. The Technology Innovation Agency is an example of a government-initiated agency that focuses on developing devices and vaccines, and which is supported by the Department of Science and technology. There are also a growing number of innovation incubators and funding mechanisms, such as crowd funding emerging that have created an appetite for innovation.
In addition, there have been developments within the South African innovation landscape in the areas of technology, new applications and capitalization of the growing use of mobile phones has created a new and competitive market. There has been a shift towards improved and context appropriate technologies that present immediate solutions. One example is Power Free Education Technologies, which has produced a fetal heart monitor that does not require electricity and can be used with water. Such technology is life saving and needed in rural areas where infrastructure still remains poor. Lastly, grassroots innovations are underexplored as a way of alleviating the burden on public health facilities. There have been examples of these namely the MSF Adherence Clubs in Khayelitsha, Cape Town and Iyeza Express that are kept running by individuals from under resourced community and have achieved good outcomes. Below are several other opportunities for innovative entrepreneurs to contribute to healthcare in South Africa:
OPPORTUNITY 1: AN ACUTE SHORTAGE AND MISDISTRIBUTION OF HEALTHCARE WORKERS
In the public sector there is a substantial shortage of health workers especially in rural areas. The ratio of physicians per 10 000 population is 8 and there are 5.1 nurses per 10 000 populations. The first obstacle that has been identified is the issue of retention of health professionals in poor, rural areas. This shortage of healthcare professionals is providing South Africa the opportunity to explore other cadres of health workers and the greater involvement of lay people in the delivery of care.
OPPORTUNITY 2: HIGH DEMAND FOR HEALTH SERVICES AND PUBLIC SERVICES FAILING TO MEET THE DEMAND
As described above, public health facilities are very congested because the ratio of patients to health workers is disproportional, thus they have long waiting times and oftentimes people miss work while waiting to be attended to and health workers are stretched. Private health facilities do not face these challenges but are not affordable for those who are in low socio-economic settings. There exists, therefore, the opportunity to capitalize on the growing middle-income market population in South Africa, who are able to pay out-of-pocket for healthcare but do not necessarily wish to purchase health insurance.