South Africa's Healthcare Puzzle: Why Spending More Delivers Worse Results

South Africa spends roughly double what most African nations invest in healthcare, yet produces worse health outcomes than many neighbors who spend far less. That gap between resources and results has become the central challenge driving a new wave of research and innovation aimed at transforming how the system works.

The Medical Research Council (SAMRC) and University of Cape Town (UCT) have launched the AI for African Population Health Unit to tackle this inefficiency directly. The initiative brings researchers and clinicians together to develop artificial intelligence and machine learning tools designed specifically for African health contexts, moving away from generic solutions built elsewhere.

Professor Nicola Mulder, who heads the unit, describes the scope plainly: the tools will be trained on comprehensive African biomedical and clinical datasets to improve early detection of common diseases like cancer, diabetes and cardiovascular disease. The same AI systems will strengthen diagnosis and management of infectious diseases including tuberculosis, HIV and malaria. The framework aims to discover precise biomarkers, sharpen diagnostic accuracy and enable personalized treatment choices across diverse African patient populations and healthcare settings.

The unit is one of 30 Extramural Research Units operated by the SAMRC, each focused on strategic health research. South Africa’s research reputation on the global stage is well-established, yet the country’s investment in research and development tells a different story. In 2022 and 2023, R&D spending stood at just 0.61 percent of GDP, according to the 2025 South African Science, Technology and Innovation Indicators Report. The government has set a target of 1.5 percent by 2030, signaling an ambition to nearly triple current spending.

The gap between resources and outcomes reflects deeper systemic problems, according to SAMRC President and CEO Professor Ntobeko Ntusi. In an interview in early July, he outlined what moving from reactive to proactive healthcare actually requires. “We need to have much stronger leadership from government and a better financing for health from the national fiscus, understanding that the investment in healthcare is probably the single most important investment in developing human capital, but also in building a knowledge economy, and so a healthy society is actually a wealthy society,” he said.

Integration across the healthcare system matters equally. Ntusi pointed to the artificial divide between public and private sectors, noting that many patients move between both without friction. Better coordination between levels of care could improve efficiency and create economies of scale.

Yet even with stronger financing and integration, the core issue remains optimization. “If you look at South Africa’s health expenditure, it’s double that of most African countries, and yet our outcomes are poorer than that of many African countries, who spend far less as a proportion of their GDP than South Africa does,” Ntusi explained. “Resourcing is important, but it’s also about our systems and processes, and how we are able to optimize the use of these resources in health, which at the moment is something we’re not doing well.”

He identified a substantial obstacle. Corruption in the health sector has resulted in significant misappropriation of funding and redirection of resources. Addressing that problem sits alongside the technical and organizational challenges, and cannot be separated from them.

Innovation holds particular weight in Ntusi’s vision for the sector’s future. “Health innovation is absolutely critical, and it plays a really important role, in driving a knowledge economy in this country but, ultimately, in providing products that can improve the health of our people,” he said. The South African health innovation market (relatively mature by regional standards) still generates only a fraction of the annual revenue that comparable high-income countries extract from similar platforms. Substantial room for growth remains.

The AI for African Population Health Unit sits within this broader context. It represents an attempt to use technology and research collaboration to address the efficiency gap, creating tools and frameworks tailored to local conditions rather than importing solutions designed elsewhere. Whether such innovation can help redirect South Africa’s healthcare system toward better outcomes for the resources it already commands is a question the unit’s researchers are now racing to answer.