Health-care systems across Southern Africa are grappling with the dual challenge of growing demand and limited resources. As populations grow, age and urbanise, the pressure on both public and private health-care providers intensifies. At the same time, rising costs, staff shortages, corruption and shrinking budgets threaten the provision of quality health care.
If we are to succeed in our global quest for universal health coverage (UHC), partnerships across sectors, borders and disciplines are no longer a choice — they are essential. Collaborative models of care, strategic co-investment and knowledge-sharing that cut across institutional divides represent the future of health care in Africa.
During the Covid-19 pandemic, African countries defied the direst projections, thanks in part to co-ordinated partnerships. Governments shared critical information and resources, private sector players stepped in to procure personal protective equipment and logistics, donor funding was rapidly mobilised, and civil society organisations helped ensure vaccine equity. It was an extraordinary illustration of what is possible when we join hands to solve problems that affect us all.
Similarly, South Africa’s response to HIV/Aids is the result of decades of collaboration across government departments, international donors, research institutions, civil society organisations and health-care providers. Activist pressure, scientific research and donor funding coalesced to drive down new infections, expand access to antiretrovirals and nearly eliminate mother-to-child transmissions. The result is that South Africa now runs the largest HIV treatment programme in the world, with nearly 6-million people receiving life-saving antiretroviral treatment.
However, this programme is currently under threat due to donor funding shifts, including the funding freeze for the US’s President’s Emergency Plan for Aids Relief (Pepfar) The focus must now be on how African health systems can respond with resilience, diversify funding streams and build stronger locally anchored partnerships to safeguard progress in the face of shifting donor landscapes.
While the goals of the NHI Act (equitable access, universal coverage and improved efficiency) are noble, the act in its current form risks displacing the private health-care sector almost entirely. Instead of integrating medical schemes as part of the solution, it will do away with them in their entirety
Another flagship South African public-private initiative is MomConnect, which has registered nearly 5-million pregnant women in the public health system since 2014. Through SMS-based messaging, it provides stage-based health advice and encourages clinic attendance. It is a shining example of how mobile technology and public health can converge to support maternal and child outcomes.
The need for a collaborative approach to health care is not in dispute. And yet, by proposing to centralise health-care funding and service delivery under a single state-controlled entity, the National Health Insurance (NHI) Act threatens to dismantle critical partnerships, which will result in the regression of South Africa’s health-care system over time.
While the goals of the NHI Act (equitable access, universal coverage and improved efficiency) are noble, the act in its current form risks displacing the private health-care sector almost entirely. Instead of integrating medical schemes as part of the solution, it will do away with them in their entirety.
Rather than building on the complementary strengths of the public and private sectors, the act, as it stands, will lead to reduced patient choice, a loss of skilled private professionals and decreased health system capacity. This is a threat not only to private providers and medical schemes but to all South Africans. What the country and the broader region need is not a zero-sum approach that sidelines key stakeholders, but a synergistic model that leverages all available resources to close gaps, drive innovation and accelerate progress towards UHC.
That’s why the theme of the upcoming Board of Healthcare Funders Conference 2025, “Collaborating for value: partnerships transforming the future of health care — uniting parallels”, could not be more timely.
This is an opportunity to grapple with the challenges we face and to replicate the partnership models that have served us so well. This means embedding collaboration into health policy, contracting, financing and service delivery. It means reimagining how health care is delivered, from workforce training to benefit design to infrastructure planning, with partnerships at the centre.
As countries in Southern Africa, including South Africa, continue to grapple with how best to achieve UHC, the BHF conference will bring together experts from across the continent and the world to interrogate current reforms, share proven models and build alliances that prioritise sustainability, inclusivity and value.
The future of health care in Southern Africa depends not on sweeping overhauls that sideline key players but on strategic partnerships that leverage everyone’s strengths. Building a stronger, more equitable health system will require collaboration, trust and a shared commitment to solutions that prioritise people over politics, and partnerships over exclusion.
• Mothudi is MD of the Board of Healthcare Funders. The BHF Conference 2025 takes place in Cape Town from May 11-14
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