The Healthcare System in South Africa: Public Sector, Medical Schemes, Emergencies and Health Risks

The public sector, funded by tax, serves the majority of the population. Stats SA reports that 73.1% of households first consult a public facility (clinic, hospital or other establishment) when a member falls ill or is injured, and 25.3% a private doctor, clinic or hospital. Use of the public sector is least frequent in the Western Cape (54.8%) and Gauteng (67.0%), and most frequent in Limpopo (84.9%), Mpumalanga (81.4%) and the Eastern Cape (80.4%).

The private sector rests on medical schemes, health insurers regulated by the 1998 Medical Schemes Act. According to the same Stats SA survey, 15.5% of people were members in 2024, or about 9.8 million people. Coverage varies by province: 25.4% in the Western Cape, 21.3% in Gauteng, 10.2% in KwaZulu-Natal and 10.0% in Limpopo. The Council for Medical Schemes (CMS) counts 9.17 million beneficiaries in 2024, or about 14.6% of the population, and nearly 40% of them live in Gauteng.

The Constitution guarantees everyone access to healthcare services (section 27(1)) and provides that no one may be refused emergency medical treatment (section 27(3)). The Ministry of Health publishes a national fee schedule, the Uniform Patient Fee Schedule (UPFS), which reserves free care or reduced fees according to the patient’s status and means. A foreigner asks the facility which category applies to them before presenting for non-urgent care.

Public academic hospitals provide specialised care: Groote Schuur Hospital in Cape Town, Steve Biko Academic Hospital in Pretoria, Chris Hani Baragwanath Academic Hospital in Soweto, near Johannesburg, or Inkosi Albert Luthuli Central Hospital in Durban. An expat’s routine care most often goes through the private sector, funded by a medical scheme or an international contract.

The CMS regulates 71 medical schemes at the end of 2024, of which 16 open schemes available to everyone and 55 restricted schemes, reserved for members of an employer, a sector or an administration. A registered scheme in principle accepts any application for membership when it is open, with common rules:

• Prescribed minimum benefits (PMB): medical emergencies, 271 defined conditions and a list of chronic diseases, covered whichever option is chosen.
• Waiting periods: up to 3 months for a general wait and up to 12 months for a pre-existing condition, except for PMBs.
• Contribution: medical schemes apply a logic of solidarity, where a person on a lower income may pay a smaller contribution; ordinary health insurance prices by age and health status.

The CMS thus distinguishes the medical scheme, which reimburses routine costs (consultations, nursing care, surgery, dental), from health insurance, which pays only for events set out in the contract. Options are compared on benefits, ceiling and waiting periods. The guide to the medical questionnaire and prior medical history explains the effect of prior history on membership.

The insurance requirement depends on the visa (Department of Home Affairs): the study visa and the exchange visa require cover with a medical scheme registered under the Medical Schemes Act, the retired person visa proof of medical cover, and work visas a medical report signed by a practitioner. For the visitor’s visa, the DHA list mentions sufficient financial means. In all cases, the French state does not pay healthcare costs abroad: protection is arranged before departure.

Three routes exist for a French resident: membership of a medical scheme, voluntary membership of the CFE (the French social security fund for expatriates) and international health insurance. The guide to the coverage zone helps you check that an international contract does apply in South Africa. The page healthcare reimbursement details who pays what depending on the situation.

First-line care is at a private practice, funded by the medical scheme or by the patient, or at a local public clinic, which refers to the hospital if needed. A scheme may require going through its network of providers for full cover: its guide to benefits should be read before the first consultation.

• Emergencies: dial 112 from a mobile and 10177 from a landline, according to the Western Cape government, which recommends saving 112 in your phone. In Cape Town, the municipal centre answers on 107 from a landline or 021 480 7700 from a mobile; for the Eden district, which covers the Garden Route, the number is 044 805 5071.
• Right to emergency care: section 27(3) of the Constitution prohibits refusing emergency medical treatment; emergencies are also part of the minimum benefits of medical schemes.
• Assistance and repatriation: a medical evacuation or repatriation falls under an assistance contract; see repatriation and assistance.

The Single Exit Price is the maximum regulated price of medicines in the private sector: it is the only price at which a manufacturer or importer can sell to a buyer, pharmacy, dispensing doctor or hospital, which guarantees everyone the same price. The Ministry of Health announced on 30 September 2026 an increase of 2.88% applicable on 1^st October 2026 to all registered medicines, to support supply while preserving affordability for patients and medical schemes. This rule does not apply to public procurement.

For the chronic diseases on the PMB list, a medical scheme covers the medicines, consultations and tests linked to the condition. A traveller on treatment takes their prescriptions and a duplicate, and checks with their insurer and their pharmacy the conditions for renewal on site.

Malaria: it is endemic in certain areas of north-eastern KwaZulu-Natal, Mpumalanga and Limpopo. The season runs from September to May (South African government). The National Institute for Communicable Diseases (NICD) cites areas around the Kruger park, between Limpopo and Mpumalanga, and recommends seriously considering preventive medication. Protective measures include: avoiding the outdoors between dusk and dawn, wearing long, light-coloured clothing, applying repellent, sleeping under a mosquito net and using a fan or air conditioning. A fever or flu-like illness justifies a rapid blood test. The Western Cape and Gauteng are not among the provinces cited by the government.

Yellow fever: the DHA asks for a vaccination certificate for travellers who have stayed in or are going to an endemic zone, other than simple direct transit. Other vaccinations are chosen with a doctor or an international vaccination centre before departure; bringing routine vaccines up to date is part of this.

National Health Insurance (NHI) aims at universal coverage funded by a national fund. The law was signed on 15 May 2024 and is being phased in: a first phase from 2023 to 2026 devoted to strengthening the system, then a second from 2026 to 2028, depending on available financial resources (Ministry of Health). The fund will purchase services for citizens, permanent residents, refugees and certain categories of foreigners; children will be covered whatever their nationality. Medical schemes will remain voluntary and will offer only services complementary to those of the NHI.

On 24 February 2026, the Presidency announced that the president was deferring the proclamation of any provision of the law until the Constitutional Court rulings, on appeals concerning the public participation process heard from 5 to 7 May 2026, without any change to the implementation timetable. The official sources consulted mention no Court ruling on these appeals as of the date of this page: the status should be checked on the Ministry’s site. For an expat, the current functioning of the public sector and of medical schemes remains as described above.