The healthcare system in South Africa

South Africa boasts the highest standard of healthcare in Africa. There are over 200 private hospitals across the country; expats who take out private health insurance can expect the standard of care to be on par with their home country.

This helpful guide to healthcare in South Africa includes information on:

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Overview of healthcare in South Africa

The healthcare system in South Africa

There is a two-tier healthcare system in South Africa with a large subsidized public sector and a small, but very high quality, private sector. With significant funding and the best specialists going to the private sector, there is a major gap between public and private healthcare facilities in much of the country. This means that while reduced price healthcare is on offer to the lowest earners in the public sector, it is still highly advisable for expats to take out a private plan.

Healthcare in South Africa is administrated by the Department of Health. Around 80% of the population uses public healthcare, with the wealthiest 20% opting for private healthcare.

South Africa ranks 49th out of 89 countries on the 2019 Global Healthcare Index. It is the highest-ranked African country, although it ranked below countries such as India, Sri Lanka, and the Philippines. According to 2018 figures, life expectancy is 61.1 years for men and 67.3 years for women (below the global averages of 67 years and 71.1 years respectively). Its infant mortality rate has declined to 36.4 per 1,000 live births; this is above the World Health Organization (WHO) global average of 29 per 1,000 births.

Who can access healthcare in South Africa?

Everyone can access public healthcare in South Africa, regardless of nationality or immigration status. However, it primarily serves those who cannot afford to take out private health insurance in South Africa. The majority of expat residents take out a private insurance policy so they can receive the best healthcare available in the country.

Healthcare costs in South Africa

Public healthcare in South Africa is subsidized up to 40% of total costs; charges are based on your income and number of children. Visits to the doctor can cost around R55. However, waiting lists can be long, especially when it comes to seeing a specialist. Hospital stays can cost up to €50 a night if you are in the top income bracket.

Funding for public healthcare in South Africa currently comes from government spending through taxation and point-of-care spending from those using services. There are plans to implement a National Health Insurance (NHI) scheme to provide more free services for all and improve the quality of public healthcare. However, estimates for funding this range from R165bn to R450bn.

South Africa’s total healthcare spending in 2014 was 8.8% of GDP, which amounts to R16,957 per capita.

Health insurance in South Africa

Unless the NHI scheme gets underway, there is no official public health insurance scheme in South Africa. Residents and expats who want 100% of their healthcare costs covered can take out private health insurance. This will also allow them to choose from the best available healthcare providers.

Visitors to South Africa will need to provide proof that they have taken out private health insurance to cover them during their stay. If you are going to study in South Africa, you will need to show proof that you have medical insurance when you apply for your study visa. Universities in South Africa will usually accept insurance with any private provider, as long as it covers the whole duration you anticipate being in the country.

In South Africa, you have to pay for healthcare up-front. As a result, you’ll need to make sure your insurance covers the fees you will have to pay and recoup them from your insurer (if applicable) after your treatment or consultation.

There are many different health insurance providers in South Africa, including a number of expat-friendly international companies that offer tailored packages. These companies include:

• Allianz Care
• Cigna Global

See our guide to health insurance in South Africa for more information.

How to register for healthcare in South Africa as an expat

Registering for healthcare in South Africa involves less paperwork than in many western countries. If you are a resident, you can sign up at a local doctor’s surgery by filling out a form and providing your address, personal ID such as a passport, and proof of South African residency.

If you want to access private healthcare services, or are not entitled to the state health system, you can register with a private doctor and use private facilities such as hospitals and specialist services if you can show proof of private health insurance coverage.

Private healthcare in South Africa

South Africa has an extensive network of private doctors, specialists, hospitals, and clinics. These are used by the majority of expats relocating to the country, however, only around 18% of the local population regularly use private providers.

Despite being smaller than the public healthcare sector, private healthcare in South Africa accounts for around half of annual expenditure. Whereas public services are heavily subsidized by the government and cheap, private healthcare costs in South Africa can be comparable to countries such as the UK, France, and Germany.

Around 79% of doctors in South Africa work privately. There are also around 200 private hospitals across the country. Two of the biggest private providers are Netcare and Mediclinic, which run many hospitals.

Private services can be accessed through private health insurance in South Africa. You can choose your own coverage plan and will typically have to pay for services upfront and then claim for reimbursement.

While being of superior quality to the public system, the private sector has come under recent criticism for over-pricing and being monopolized by a small number of large providers. If the government succeeds in introducing the NHI system, it’s likely that the private sector will be overhauled and more tightly regulated.

When choosing a healthcare provider in South Africa, you will need to think about your personal requirements and ensure you read reviews of the various suppliers; some come more highly recommended than others. For more information on choosing a provider, check out our full guide to health insurance in South Africa.

Doctors and specialists in South Africa

Doctors and specialists work both publicly and privately in South Africa. Private doctors work out of individual or group practices, clinics, day centers, and hospitals. Private consultation costs are around R350-400, compared to around R55 through state healthcare.

If you have private health insurance, you will be able to choose your own doctor. You will also likely have a shorter waiting time for an appointment and should be able to access specialist healthcare without a referral.

Major cities in South Africa boast many private healthcare facilities; from day clinics to large medical centers, which are affiliated with the private hospitals. As a fee-paying customer, you should be able to see your doctor or a specialist quickly rather than waiting a number of weeks.

For more information and advice, read our full guide to doctors in South Africa.

Women’s healthcare in South Africa

In private clinics, women’s healthcare in South Africa is very good, and you will be able to access a range of services through gynecologists. As with other things in South Africa, public provision lags behind what is available privately, therefore most female expats choose to take out a private insurance package. You can find private insurance packages that cover maternity costs including prenatal care, birth costs, and antenatal services.

Contraception is readily available in South Africa, however, you will need a prescription for the pill. Emergency contraception, on the other hand, does not require a prescription. Abortions are legal up until 12 weeks of pregnancy, and even later in certain medical cases, however, you need to have approval from a physician. Abortion is free to perform through the state healthcare system, but many people choose to have private treatment.

Because South Africa has been experiencing an HIV epidemic, testing for sexual health infections (STIs) are widely available across the country. In the private sector, Marie Stopes provides a range of sexual health services including contraception and abortion.

Read more in our guides on women’s healthcare in South Africa and having a baby in South Africa.

Children’s healthcare in South Africa

As a result of the problems with children’s healthcare, South Africa has a higher than average child mortality rate. However, those insured for private treatment which covers care for their children won’t have a problem accessing services. Private GPs can provide pediatric care and private providers such as Netcare and Mediclinic have many pediatricians and childcare experts listed among their specialists.

South Africa has an extensive program of vaccinations that are provided for free through public health. You can also get your child vaccinated at a private clinic if your insurance covers this. Although no vaccinations are mandatory in South Africa, doctors recommend the following for children:

• Polio
• Tuberculosis
• Tetanus
• Whooping cough

Find out more in our guide to vaccinations in South Africa.

Dental care in South Africa

Under the public healthcare system, co-payments which are on offer to the lowest-earning people also apply to dental care. However, these only cover basic visits and don’t include more complicated procedures. Some private health insurance plans also don’t include dental care as standard.

Two associations, the Dental Therapy Association of South Africa and the South African Dental Association, ensure dental services remain on par with other countries and oversee dental treatment.

Check our guide to dental care in South Africa for an overview of dentistry in the country.

Hospitals in South Africa

South Africa boasts some of the best hospital care on the African continent. However, most of this comes at a cost through private providers. There is low-cost treatment available through state hospitals in all provinces, charged at the standard 40% subsidized rate. However, local residents who cannot afford private healthcare mostly use this.

Private hospital care in South Africa is of a similar standard and price to many western countries. If you are covered for hospital treatment through a private insurance plan, you will usually have to pay for treatment upfront and claim back the costs through your insurance provider.

Our guide to hospitals in South Africa has more information on both public and private hospital care.

Visiting the pharmacy in South Africa

Pharmacies in South Africa are accessible in most places and medicines are generally relatively affordable; this is because the government fixes the prices. You can search the Medicine Price Registry to find out information about what different forms of medication should cost.

Pharmacies are run by large chains including Dis-Chem, Clicks, and MediRite. They can be in shorter supply in rural areas, however mail-order and delivery services are generally available. You can find details of pharmacies in your area by searching the individual company websites or looking on a directory website such as the Yellow Pages.

Mental healthcare in South Africa

South Africa suffers from an underdeveloped mental healthcare system at the state level. Around one in six South African residents experience mental health problems. However, despite the fact that 85% of those suffering from mental illness are reliant on public sector services, only around 27% receive treatment for their conditions.

The country has only 18 beds per 100,000 residents in psychiatric hospitals (below the global average). It also has a low number of professional psychiatrists. Community mental health facilities are also poor and, in some parts of the country, practically non-existent.

As with other forms of healthcare in South Africa, the level of provision is a different story when it comes to private healthcare. The main private providers and hospitals in South Africa have access to a range of specialists; these include psychiatrists, psychologists, and neurologists. Depending on your healthcare provider and insurance plan, you might be able to access services without the need of a referral and have treatment costs covered through your plan.

The South African Depression and Anxiety Group (SADAG) is a non-profit organization providing information, advice, and resources to all residents on a range of mental health issues including bipolar disorder, obsessive compulsive disorder (OCD), and substance abuse.

Other forms of healthcare in South Africa

Traditional medicine still plays a large part in South African healthcare. In fact, around 80% of the local population report using a traditional healer for some form of health issue; usage rates are even higher in rural areas.

Healers, as well as other alternative and complementary therapists in South Africa, are regulated by the 1982 Associated Health Service Professions Act. All healers and therapists must be licensed and registered, holding the relevant qualifications.

As well as traditional South African healers, you can find various different forms of alternative medicine in South Africa including:

• Homeopathy
• Osteopathy
• Chiropractic
• Naturopathy

Most private insurance packages don’t include alternative and complementary medicine as part of their standard package. If you want coverage for this, you will need to shop around and find a provider who is willing to offer it as an add-on.

What to do in an emergency in South Africa

If you need to contact the emergency services in South Africa, you can call 112 from any mobile phone. Some private healthcare providers also have their own emergency phone numbers.

Other useful emergency numbers include:

• 10111 – Nationwide emergency response
• 10177 – Ambulance response

Useful resources

• National Department of Health
• South African Dental Therapy Association
• South African Dental Association