Point of view: understanding South Africa's healthcare system

South Africa’s healthcare system stands at a crossroads, where ensuring quality of care is not just a goal—it’s a necessity for long-term sustainability. The way patients are treated, screened, and monitored impacts everything from health outcomes to service efficiency. If we want a system that truly serves its people, we need to pay attention to the data. Fortunately, HQA, a non-profit organisation, provides an annual review of how well medical schemes are performing in clinical quality of care.

This latest report, which assesses over 84% of insured beneficiaries, paints a picture of how primary care, maternity services, chronic disease management, and hospital-based care stack up. What makes HQA’s review particularly valuable is its independent nature—now in its 21st year, it offers unbiased insights into where healthcare is improving and where it’s falling short.

“These indicators give us a snapshot of how well we are doing—not just in treating illness, but in preventing it,” says Louis Botha, CEO of HQA. “They also highlight where healthcare providers, funders, and patients alike can take more proactive steps.”

This year, four key areas have been highlighted: diabetes care, flu vaccination for older adults, colorectal cancer screening, and breast cancer screening. Let’s unpack what the numbers reveal.

According to the report, diabetes is one of South Africa’s fastest-growing health challenges, fuelled by poor diets and increasingly sedentary lifestyles. A 2025 health report estimated that nearly two-thirds of South African women are overweight or obese, putting them at high risk of developing diabetes.

One of the most important tests for diabetes management is HbA1c testing, which tracks blood sugar levels over three months. Good control of blood sugar can prevent serious complications like vision loss, kidney failure, and amputations.

Encouragingly, 72% of beneficiaries living with diabetes had at least one HbA1c test in 2023—a huge jump from 46% in 2010. Among those enrolled in a diabetes management programme, 34% received two or more tests, in line with clinical guidelines. But the numbers vary across schemes—some report only 20% of diabetes patients getting two tests, while others reach as high as 53%. These gaps matter because access to routine testing is key to preventing complications.

Every year, influenza poses a serious risk to older adults, especially those aged 65 and above. Complications like pneumonia, heart attacks, and strokes can often follow flu infections, and research shows the risk of heart attack increases up to fivefold during the first two weeks of flu.

Despite this, vaccination rates remain low. In 2023, only 19% of older adults in medical schemes received their flu jab. While this is better than the 8% recorded in 2010, it’s still far below ideal levels. Some schemes see uptake as low as 3%, while the best performers reach 26%. One issue is that many flu jabs are given outside traditional claims processes, during wellness days and company-sponsored vaccinations, so actual coverage may be higher than the numbers suggest.

Still, with flu season approaching, getting vaccinated is an easy, effective step to protect vulnerable populations. It’s not just about your own health—it helps shield family members, colleagues, and the elderly in our communities.

Colorectal cancer is one of the most treatable cancers, but only if caught early. That’s why regular screening is critical, particularly for people aged 50 and older. HQA’s latest data tracks two forms of screening:

1. Annual Faecal Occult Blood Test (FOBT)
2. Colonoscopy or sigmoidoscopy every five years

Although colonoscopy rates have improved, rising from 7% in 2014 to 12% in 2023, FOBT screening remains stagnant. Only 1% of beneficiaries underwent the test last year, with the highest-performing schemes reaching just 3%.

This is concerning, considering the risk factors for colorectal cancer, which include being over 50, family history, poor diet, smoking, excessive alcohol consumption, and physical inactivity. Improved awareness and access to easier screening tools, such as FIT (Faecal Immunochemical Test), which can be done at home, could significantly improve detection rates.

Breast cancer is one of the most common cancers among South African women, yet early detection remains the best chance of survival.

HQA tracks mammography screening in women aged 50 to 74, measuring those who have had a mammogram in the past two years versus those who haven’t had one in five years. The latest numbers show 24% of women in this group had a mammogram in 2023, compared to 22% in 2010. Encouragingly, the number of women who hadn’t had a mammogram in five years dropped from 88% in 2016 to 65% in 2023.

However, there’s still a gap between the highest-performing schemes (42%) and the lowest (7%). Since most medical schemes include benefits for breast cancer screening, greater education and outreach efforts could drive better participation.

The data from HQA’s annual review makes one thing clear: South Africa has made progress in healthcare quality, but there’s still a long road ahead. Whether it’s diabetes, flu prevention, cancer screening, or access to basic care, healthcare providers, policymakers, and medical schemes must continue to focus on proactive care, not just reactive treatment.

For the everyday South African, the takeaway is simple: know what benefits you have, ask the right questions, and take advantage of preventive care. The more informed we are, the better our healthcare system will serve everyone.

* Maleke is an editor of Personal Finance.

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