In South Africa, private and public health systems exist in parallel. The public system serves the vast majority of the population. Authority and service delivery are divided between the national Department of Health, provincial health departments, and municipal health departments.
In 2017, South Africa spent 8.1% of GDP on health care, or US$499.2 per capita. Of that, approximately 42% was government expenditure. About 79% of doctors work in the private sector.Ataguba, John Ele-Ojo. "Health Care Financing in South Africa: moving toward universal coverage." Continuing Medical Education. February 2010 Vol. 28, Number 2.
For the 2024/2025 fiscal year, the South African Government allocated R277 billion for health spending in its annual budget. It also announced its intent to increase healthcare spending to R329 billion by the 2027/28 fiscal year.
As of January 2026, major private healthcare companies in South Africa include Mediclinic Group (134 locations), Netcare (124 locations), Life Healthcare Group (63 locations), Lenmed (19 locations), Clinix Health Group (8 locations), and Melomed (6 locations).
Major private pathology (medical laboratory) companies in South Africa include Ampath, PathCare, and Lancet.
History
The first hospital in South Africa, a temporary tent to care for sick sailors of the Dutch East India Company (the Company) afflicted by diseases such as typhoid and scurvy, was started at the Cape of Good Hope in 1652.
A permanent hospital was completed in 1656. Initially, convalescent soldiers provided to others whatever care they could, but around 1700 the first Binnenmoeder (Dutch for matron) and Siekenvader (male nurse/supervisor) were appointed in order to ensure cleanliness in the hospital, and to supervise bedside attendants.
The Company subsequently employed Sworn Midwives from Holland, who practiced midwifery and also trained and examined local women who wished to become midwives. Some of the early trainees at the Cape were freed Malay and coloured slaves.
From 1807, other hospitals were built in order to meet the increasing demand for healthcare. The first hospitals in the Eastern Cape were founded in Port Elizabeth, King Williamstown, Grahamstown and Queenstown.
Missionary hospitals Roman Catholic Nuns of the Assumption Order were the first members of a religious order to arrive in South Africa. In 1874, two Nightingale nurses, Anglican Sisterhoods, the Community of St Michael and All Angels arrived from England.
The discovery of diamonds in Kimberley led to an explosion of immigrants, which, coupled with the "generally squalid conditions" around mines, encouraged the spread of diseases dysentery, typhoid, and malaria.
Following negotiations with the Anglican Order of St Michael, Sister Henrietta Stockdale and other members were assigned to the Carnarvon hospital in 1877. Sister Stockdale had studied nursing and taught the nurses at Carnavorn what she knew; these nurses would move to other hospitals in Barbeton, Pretoria, Queenstown, and Cape Town, where they in turn trained others in nursing. This laid the foundation of professional nursing in South Africa.
Sister Stockdale was also responsible for the nursing clauses in the Cape of Good Hope Medical and Pharmacy Act of 1891, the world's first regulations requiring state registration of nurses.
After South Africa left the British Commonwealth of Nations, the government nationalised the missionary hospitals that had served the poor.
20th-century nursing The Anglo-Boer war and World War 1 severely strained healthcare provision in South Africa.
Formal training for black nurses began at Lovedale in 1902. In the first half of the 20th century, nursing was not considered appropriate for Indian women but some males did become registered nurses or orderlies.
In 1912, the South African military recognised the importance of military nursing in the Defence Act. In 1913, the first nursing journal, The South African Nursing Record, was published. In 1914, The South African Trained Nurses' Association, the first organisation for nurses, formed. In 1944, the first Nursing Act was promulgated.
In 1935, the first diploma courses to enable nurses to train as tutors were introduced at the University of Witwatersrand and the University of Cape Town.
The establishment of independent states and homelands in South Africa also created independent Nursing Councils, and Nursing Associations for the Transkei, Bophuthatswana, Venda, and Ciskei. Under the post-Apartheid dispensation, these were all merged to form one organisation, the Democratic Nursing Organisation of South Africa (DENOSA).
Healthcare provision in the post-war period
Following the end of the Second World War, South Africa saw a rapid growth in the coverage of private medical provision, with this development mainly benefiting the predominantly middle class white population. From 1945 to 1960, the percentage of whites covered by health insurance grew from 48% to 80% of the population. Virtually the entire white population had shifted away from the free health services provided by the government by 1960, with 95% of non-whites remaining reliant upon the public sector for treatment.
Membership of health insurance schemes became effectively compulsory for white South Africans due to membership of such schemes being a condition of employment, together with the fact that virtually all whites were formally employed. Pensioner members of many health insurance schemes received the same medical benefits as other members of these schemes, but free of costs.
Since coming to power in 1994, the African National Congress (ANC) has implemented a number of measures to combat health inequalities in South Africa. These have included the introduction of free health care in 1994 for all children under the age of six together with pregnant and breastfeeding women making use of public sector health facilities (extended to all those using primary level public sector health care services in 1996) and the extension of free hospital care (in 2003) to children older than six with moderate and severe disabilities.
Health infrastructure
Staffing In 2013, it was estimated that vacancy rates for doctors were 56% and for nurses 46%. Half the population lives in rural areas, but only 3% of newly qualified doctors take jobs there. All medical training takes place in the public sector but 70% of doctors go into the private sector. 10% of medical staff are qualified in other countries. Medical student numbers increased by 34% between 2000 and 2012. Public sector people-to-doctor and people-to-nurse ratio by province, 2015 Province People-to-doctor ratio People-to-nurse ratio priv. sec. People-to-doctor ratio priv. sec. People-to-nurse ratioEastern Cape 4,280 to 1 673 to 1Free State 5,228 to 1 1,198 to 1Gauteng 4,024 to 1 1,042 to 1KwaZulu Natal 3,195 to 1 665 to 1Limpopo 4,478 to 1 612 to 1Mpumalanga 5,124 to 1 825 to 1North West 5,500 to 1 855 to 1Northern Cape 2,738 to 1 869 to 1Western Cape 3,967 to 1 180 to 1South Africa 4,024 to 1 807 to 1330 to 1160 to 1
Online databases of healthcare providers
Health Professions Councils of South Africa (HPCSA): Official registration body for medical professionals. South African Pharmacy Council (SAPC): Official registration body for pharmacists and pharmacies. South African Nursing Council (SANC): Official registration body for nurses. (Note that their eRegister requires an SA ID number or SANC registration number.) Medpages: Healthcare providers by category and region. Search allows finding of providers by name or specialty. South African government master facility list of primary health care facilities in the public health sector
Hospitals
There are more than 400 public hospitals and more than 200 private hospitals. The provincial health departments manage the larger regional hospitals directly. Smaller hospitals and primary care clinics are managed at district level. The national Department of Health manages the 10 major teaching hospitals directly.
The Chris Hani Baragwanath Hospital in Johannesburg is the third-largest hospital in the world.
Breakdown of hospitals and clinics in South Africa in 2014 Province Public clinic Public hospital Private clinic Private hospital TotalEastern Cape 731 91 44 17 883Free State 212 34 22 13 281Gauteng 333 39 286 83 741KwaZulu-Natal 592 77 95 12 776Limpopo 456 42 14 10 522Mpumalanga 242 33 23 13 311North West 273 22 17 14 326Northern Cape 131 16 10 2 159Western Cape 212 53 170 39 474Total 3,863 407 610 203 5,083 Total number of hospital beds in South Africa in 2014 Province Public hospital beds Private hospitals beds Total hospital beds Eastern Cape 13,200 1,723 14,923 Free State 4,798 2,337 7,135 Gauteng 16,656 14,278 30,934 KwaZulu-Natal 22,048 4,514 26,562 Limpopo 7,745 600 8,345 Mpumalanga 4,745 1,252 5,997 North West 5,132 1,685 6,817 Northern Cape 1,523 293 1,816 Western Cape 12,241 4,385 16,626 South Africa 85,362 31,067 119,155
Pharmaceuticals The technology of automated teller machines has been developed into pharmacy dispensing units, which have been installed in six sites (as of November 2018) and dispense chronic medication for illnesses such as HIV, hypertension, and diabetes for patients who do not need to see a clinician.
Payment systems
Uniform Patient Fee Schedule
The public sector uses a Uniform Patient Fee Schedule (UPFS) as a guide to billing for services. This is being used in all the provinces of South Africa, although in Western Cape, Kwa-Zulu Natal, and Eastern Cape, it is being implemented on a phased schedule. Implemented in November 2000, the UPFS categorises the different fees for every type of patient and situation.User Guide-UPFS 2009. Department of Health of Republic of South Africa. June 2009
It groups patients into three categories defined in general terms, and includes a classification system for placing all patients into either one of these categories depending on the situation and any other relevant variables. The three categories include full paying patients—patients who are either being treated by a private practitioner, who are externally funded, or who are some types of non-South African citizens—, fully subsidised patients—patients who are referred to a hospital by Primary Healthcare Services—, and partially subsidised patients—patients whose costs are partially covered based on their income. There are also specified occasions in which services are free of cost.
Private health insurance
Paying for private health insurance is common in South Africa, among those who can afford it. Some companies pay for health insurance, either in part or in full, as an employment benefit. It is quite common for individuals to pay for their own health insurance, with a provider of their choice.
The private health insurance market is competitive, with numerous major corporations offering a variety of packages. Generally, a main member will join, and then add dependent members to their plan at a slightly lower cost per member (such as their spouse or children).
Major health insurance companies include Discovery (the country's largest by total membership), Momentum, GEMS, FedHealth, BestMed, and MedShield.
Public health
National Health Insurance
The current government is working to establish a national health insurance (NHI) system out of concerns for discrepancies within the national healthcare system, such as unequal access to healthcare amongst different socio-economic groups. Although the details and outline of the proposal have yet to be released, it seeks to find ways to make health care more available to those who currently cannot afford it or whose situation prevents them from attaining the services they need.