There are other dimensions to this issue. Firstly the costs of being in practice. There are all sorts of registrations and credentialling costs s, then there are malpractice insurance costs, and then there is as a consequence of a hyper litigious culture defensive practices that add enormously to cost, then there is medical device costs , sahpra effectively creates a barrier to entry to the market which drives the costs of things up ( a knock off Chinese hip replacement can be made for 10 percent of the ones we use), then there is drug pricing policy. The entire system on the guise of patient safety adds enormously and excessively to costs. We have precisely the worst model all the worst of beauracracy.
While everything the article says is valid, it does not get to the root problems:
The ANC inherited a fully functioning health system in 1994, albeit serving only a portion of the population; it should have expanded this system to provide health to all. This would have required at least trebling the existing infrastructure and providing the "warm bodies" to staff it — not only doctors, but administrators, pharmacists, nurses, radiographers, therapists, technicians and all the entire army of caregivers and support staff a fully functional health system involves.
This implies that every cohort of matrics arriving at university or college, is capable of optimum learning. It is superflous to point out the quality of state schools. Further, research has shown that education contributes to wellness in many ways, including being able to afford healthy lifestyles and to navigate the bureaucracy.
The current medical training system is complicated: the teaching hospitals are a hybrid of state (provincial) and medical schools, with senior staff being employed by one or the other or both. Rolling out more is not a simple matter.
One reform would be to amend the medical curriculum so that aspirant medics first study for a B.Sc (this can be at non-metro universities or colleges) and then transfer to medicine. (Some applicants who fail to get into medical school do use this route, hoping to transfer subsequently). (Bridging progammes at tertiary level are more expensive and less effective than preparing the student at school).
Bottom line:
All of this costs money, as will NHI or NHS in any form. The *only* way to provide this is to grow the economy. THAT is where reforms must begin.
Spot-on. I am also very interested on the deeper "why" reasons. Why is something which has been failing time and again for years by now simply repeated year after year? Can it all be traced back to the ANC-dominated government's siocialistically inclined idiology? What else; and I am not asking about the well-known symptoms which were well recorded in the article and response...
Allowing private investment in medical colleges would alleviate much of the costs from public coffers. And the private sector has long proven that it does not only do an adequate job, but often out performs the quality of the public sector.
There is also an all or none kind of mindset in training. I can teach you how to do a carpal tunnel release very well in a few hours. That’s a useful skill, but the doctor who does this fairly simple operation has to build the cost of the time he spent learning about the krebbs cycle, or the compliment cascade or super obscure clotting disorders into the price of his operation.i have over twelve years of after school education and realistically I use less than one percent of what I learnt in actual practice.
Just to add that there's nothing about the Zuma year that's actually community service. The whole ComServ name implies that you are doing community service when working a paid job for the state, but not when working in the private sector (even while ComServ salaries are often higher than young doctors in private sector). It's just a compulsory year of government employment.
Regulatory approval is assumed to mean safety and efficacy—but in reality, SAHPRA's box-ticking often substitutes for real judgment, producing harm while creating an illusion of protection.
Delays kill access: Medicine approvals still take 12–24 months (or longer for new drugs), even with reliance pathways shortening some to 12–18 months. Patients wait years longer than in the US/Europe for better treatments—e.g., breakthrough cancer drugs like pembrolizumab (Keytruda) faced major lags, reducing survival chances.
Devices slip through gaps: Most medical devices (including diagnostics like glucose monitors) aren't fully registered or independently assessed for performance yet—registration is still in phased development (as of 2025/26), with reliance on foreign approvals starting but huge gaps allowing substandard tools to persist.
Innovation suffers: High costs/complexity block small innovators and favor big incumbents. Market competition is muted—approval = access, so little incentive to exceed minimums. Clinicians use what's approved, not what's best; patients get suboptimal care.
Bureaucracy rewards mediocrity, shields poor quality, delays life-saving advances, and normalizes invisible harm under "due diligence." SAHPRA has improved (backlog clearance, reliance, digital tools), but procedural focus over outcomes keeps stifling progress.
Reform needs real-world results prioritized over paperwork, lower barriers for innovators, and restored feedback loops. Until then, compliance masquerades as competence—and patients pay the price.
There are other dimensions to this issue. Firstly the costs of being in practice. There are all sorts of registrations and credentialling costs s, then there are malpractice insurance costs, and then there is as a consequence of a hyper litigious culture defensive practices that add enormously to cost, then there is medical device costs , sahpra effectively creates a barrier to entry to the market which drives the costs of things up ( a knock off Chinese hip replacement can be made for 10 percent of the ones we use), then there is drug pricing policy. The entire system on the guise of patient safety adds enormously and excessively to costs. We have precisely the worst model all the worst of beauracracy.
While everything the article says is valid, it does not get to the root problems:
The ANC inherited a fully functioning health system in 1994, albeit serving only a portion of the population; it should have expanded this system to provide health to all. This would have required at least trebling the existing infrastructure and providing the "warm bodies" to staff it — not only doctors, but administrators, pharmacists, nurses, radiographers, therapists, technicians and all the entire army of caregivers and support staff a fully functional health system involves.
This implies that every cohort of matrics arriving at university or college, is capable of optimum learning. It is superflous to point out the quality of state schools. Further, research has shown that education contributes to wellness in many ways, including being able to afford healthy lifestyles and to navigate the bureaucracy.
The current medical training system is complicated: the teaching hospitals are a hybrid of state (provincial) and medical schools, with senior staff being employed by one or the other or both. Rolling out more is not a simple matter.
One reform would be to amend the medical curriculum so that aspirant medics first study for a B.Sc (this can be at non-metro universities or colleges) and then transfer to medicine. (Some applicants who fail to get into medical school do use this route, hoping to transfer subsequently). (Bridging progammes at tertiary level are more expensive and less effective than preparing the student at school).
Bottom line:
All of this costs money, as will NHI or NHS in any form. The *only* way to provide this is to grow the economy. THAT is where reforms must begin.
Spot-on. I am also very interested on the deeper "why" reasons. Why is something which has been failing time and again for years by now simply repeated year after year? Can it all be traced back to the ANC-dominated government's siocialistically inclined idiology? What else; and I am not asking about the well-known symptoms which were well recorded in the article and response...
Allowing private investment in medical colleges would alleviate much of the costs from public coffers. And the private sector has long proven that it does not only do an adequate job, but often out performs the quality of the public sector.
There is also an all or none kind of mindset in training. I can teach you how to do a carpal tunnel release very well in a few hours. That’s a useful skill, but the doctor who does this fairly simple operation has to build the cost of the time he spent learning about the krebbs cycle, or the compliment cascade or super obscure clotting disorders into the price of his operation.i have over twelve years of after school education and realistically I use less than one percent of what I learnt in actual practice.
Just to add that there's nothing about the Zuma year that's actually community service. The whole ComServ name implies that you are doing community service when working a paid job for the state, but not when working in the private sector (even while ComServ salaries are often higher than young doctors in private sector). It's just a compulsory year of government employment.
Exorbitant salaries, bottle-necked by inefficient bureaucracy, at the expense of the tax payer and the health system. All in all, a horrible system.
Regulatory approval is assumed to mean safety and efficacy—but in reality, SAHPRA's box-ticking often substitutes for real judgment, producing harm while creating an illusion of protection.
Delays kill access: Medicine approvals still take 12–24 months (or longer for new drugs), even with reliance pathways shortening some to 12–18 months. Patients wait years longer than in the US/Europe for better treatments—e.g., breakthrough cancer drugs like pembrolizumab (Keytruda) faced major lags, reducing survival chances.
Devices slip through gaps: Most medical devices (including diagnostics like glucose monitors) aren't fully registered or independently assessed for performance yet—registration is still in phased development (as of 2025/26), with reliance on foreign approvals starting but huge gaps allowing substandard tools to persist.
Innovation suffers: High costs/complexity block small innovators and favor big incumbents. Market competition is muted—approval = access, so little incentive to exceed minimums. Clinicians use what's approved, not what's best; patients get suboptimal care.
Bureaucracy rewards mediocrity, shields poor quality, delays life-saving advances, and normalizes invisible harm under "due diligence." SAHPRA has improved (backlog clearance, reliance, digital tools), but procedural focus over outcomes keeps stifling progress.
Reform needs real-world results prioritized over paperwork, lower barriers for innovators, and restored feedback loops. Until then, compliance masquerades as competence—and patients pay the price.