South Africa’s health system at a crossroads as experts call for health taxes, prevention and stronger district care
South Africa’s health system is under growing pressure and civil society says the country must rethink how it funds and delivers care before the cracks deepen.
This was the central message at a Health Tax Alliance symposium held in Rosebank, Johannesburg on 04 March 2026.
Titled ‘Navigating transition and building an integrated health care system in South Africa: can health taxes be part of the solution?’ the event aimed to unpack how to strengthen and integrate disease priorities, focus on prevention and early management in SA’s health care system and rethink service delivery.
Discussions highlighted the financial pressures facing the public health system. Economist Rashaad Amra explained that South Africa’s fiscal space has been narrowing for more than a decade as the gap between government revenue and expenditure has widened. Rising borrowing and growing debt service costs mean a larger share of public resources is now used to repay debt, leaving less available for essential services such as health.
National Treasury’s Jonatan Daven focused on how these pressures are playing out at district level, where most people access public health services. District health services account for the largest share of provincial health spending, covering primary health care, community health services and district hospitals.
However, recent trends show that spending per person on these services has begun to decline in real terms following the peak during the COVID 19 period. Daven also pointed to large variations in primary health care spending between districts, highlighting persistent inequalities in how health resources are distributed across the country.
Prevention and early intervention featured strongly throughout the symposium. Health economist Dr Darshini Govindasamy from Priceless SA emphasised that investing earlier in prevention and primary health care can reduce costly hospital admissions, prevent complications and protect households from financial hardship.
Speakers also highlighted the importance of stronger community health systems. Research presented by Mohamed Motala from NACOSA showed that many households still face barriers to accessing care, including difficulties reaching clinics, interruptions in treatment and unmet social support needs. Strengthening community networks and frontline health workers can help connect people to services earlier and improve continuity of care.
Cancer Alliance’s Salomé Meyer also warned that cancer outcomes remain deeply unequal in South Africa, with many patients in the public sector diagnosed at late stages. Strengthening screening and referral systems at district level could improve survival and access to care.
The symposium also explored the role of health taxes on products such as alcohol, tobacco and sugary drinks. Advocates argue that these taxes can both reduce harmful consumption and generate revenue that can be reinvested into prevention and public health programmes.
Participants agreed that addressing South Africa’s health challenges will require stronger investment in prevention, better use of existing resources and policies that place equity and primary health care at the centre of the system.