Medicines, especially advanced therapies, come with high price tags. Photo: Madelene Cronje
Despite the promise of progress in the healthcare system outlined in the budget speech and the Presidential Health Compact, the reality is persistent and growing barriers to accessing innovative medicines. Economic pressures, funding constraints and infrastructure gaps undermine equitable healthcare delivery. What’s more, recent international developments such as US President Donald Trump’s cuts to funding that supported healthcare initiatives in South Africa threaten to exacerbate these problems.
The cost of advanced therapies remains out of reach, and the structural inequalities in our healthcare system persist. While top-tier medical plans still provide access to advanced medicines, we are seeing a shift. Patients are moving to lower-tier plans or into the public system, because they cannot afford more. With that shift, their access to advanced therapies disappears.
This is not a uniquely South African problem. Globally private healthcare becomes a fortress that only those who can pay the toll may enter. Everyone else is left to rely on an overburdened public system, strained by funding shortfalls, infrastructure gaps and workforce shortages.
Both private and public sectors face severe funding constraints. Innovative medicines, especially advanced therapies, come with high price tags that strain budgets and limit availability. At the same time, infrastructure and skills gaps hinder the effective delivery of these treatments. Investments in healthcare infrastructure, workforce training and data management are needed to support the growing demand for advanced therapies.
The Presidential Health Compact offers a promising framework aimed at transforming South Africa’s healthcare landscape through infrastructure development and improved data surveillance. But it stops short of directly addressing access to innovative medicines. This gap underscores the need for stronger collaboration between public and private stakeholders to ensure that patients do not bear the financial burden alone.
Another way is through a robust, transparent health technology assessment (HTA), where medicines are evaluated not only on their cost but on their ability to save lives, improve quality of life, and reduce the long-term burden on the health system. Inclusive HTAs, where payers and pharmaceutical companies work together, are essential for reimagining access to advanced therapies. If we only look at the upfront cost of innovation, we miss the bigger picture of societal value.
Globally, risk-sharing models and outcome-based pricing agreements are helping bridge the affordability gap. South Africa could benefit from more flexible legislation to enable these models, ensuring that innovation doesn’t remain locked behind prohibitive price tags.
South Africa’s healthcare future depends on what we choose to prioritise: short-term financial gains or long-term societal wellbeing. Healthcare should never be a luxury. Yet in South Africa, and across much of the world, the reality is stark: exclusion is the norm, not the exception.
If we want a future where access to life-saving medicines is a reality for all, we need to break down the barriers of affordability, infrastructure and policy inertia. And we need to do it together — governments, healthcare companies, funders and civil society — because lives are at stake.
Matimba Ngobeni is the country head of value and access at Novartis South Africa.