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    The Healthcare Sector in South Africa 2024

    Carole Veitch | South Africa | 29 February 2024

    The Healthcare Sector In South Africa 2022

    Gary Phillips | South Africa | 03 June 2022

    The Healthcare Sector in South Africa 2020

    Carole Veitch | South Africa | 31 October 2020

    The Healthcare Sector in South Africa 2019

    Carole Veitch | South Africa | 29 March 2019

    The Healthcare Sector in South Africa 2017

    Carole Veitch | South Africa | 26 September 2017

    The Healthcare Sector in South Africa 2016

    Carole Veitch | South Africa | 27 June 2016

    The Healthcare Sector in South Africa 2015

    Carole and David Veitch | South Africa | 30 January 2015

    Report Info

    Report Summary Table of Contents
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    Report Coverage

    The healthcare sector in South Africa report includes hospitals and other services such as blood banks, pathology laboratories and emergency medical services. There is comprehensive information on the number and distribution of hospitals, healthcare expenditure, capacity, practitioners, notable players, regulation, the state of public and private healthcare and NHI developments. There are profiles of 50 companies including major hospital groups Mediclinic, Life Healthcare and Netcare, pathology services such as AC Mauff and Partners and Ampath, specialist hospitals such as Bay Eye Hospital and emergency services including ER24 EMS and Cape Medical Response.

    Introduction

    • South Africa spent an estimated R547bn on healthcare in the financial year to end-March 2023, compared to around R529bn in the previous fiscal year. \r\n
    • Although total healthcare spending as a percentage of GDP declined, it compares favourably with the global average for middle-income countries. \r\n
    • The performance of the private healthcare sector has largely normalised since the pandemic.\r\n
    • The public health sector is in crisis, with crippling staff shortages, funding constraints, corruption and maladministration.

    Trends

    • A shift towards wellness services and preventative healthcare.
    • Competition for the services of healthcare professionals.
    • Focus on preventative healthcare and the delivery of primary health services.
    • Greater willingness of the health department to collaborate with the private sector, notably in the distribution of chronic medication and facilities management.
    • Growing demand for mental health services and facilities.
    • Healthcare practitioners and service providers continue to be negatively affected by medical schemes that restrict their members to preferred provider networks.
    • Private Healthcare
    • Private hospitals and healthcare practitioners remain under pressure to make healthcare more affordable.
    • Public Healthcare
    • Strong demand for mental health services and facilities.
    • Strong focus on technologies that can improve efficiency.
    • Surgical procedures are increasingly being performed in day theatres.
    • Telemedicine and virtual consultations have become mainstream.
    • The medical and dental tourism market, is supported by strong demand from expatriates.
    • There are less patients due to stagnant medical scheme membership growth.

    Opportunities

    • Local and regional research and development interventions including health apps.
    • The development and training of healthcare practitioners.
    • The implementation of National Health Insurance offers opportunities for private-public collaboration.
    • The medical tourism market (including dentistry) offers high growth potential.
    • The provision of public and private mental health facilities and services.

    Challenges

    • Concerns about NHI’s affordability, the state’s ability to implement the NHI and the impact it will have on the private healthcare sector.
    • Disparities in the provision of healthcare services, particularly in rural areas.
    • Inequity in healthcare.
    • Public healthcare management is generally inefficient and corruption is pervasive. Critical staff shortages, challenging working conditions and low morale.
    • Service delivery in the public health sector is constrained by inadequate funding allocations.
    • Spiralling private healthcare costs.

    Outlook

    • With the NHI Bill on the cusp of being signed into law, the healthcare sector is facing an uncertain future. \r\n
    • The enactment of the proposed legislation will require the amendment of other legislation, which will delay the rollout of the new health system. \r\n
    • Although the private healthcare sector is unlikely to be overhauled over the short and medium term, investment in the sector is expected to be muted.\r\n
    • Human resource challenges are likely to increase. \r\n
    • Surveys on the bill suggest a high risk of an exodus of healthcare professionals from South Africa is extremely high.

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    Table of Contents

    [ Close ]
    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Industry Value Chain 5
    2.2. Geographic Position 7
    2.3. Size of the Industry 12
    3. LOCAL 19
    3.1. State of the Industry 19
    3.2. Key Trends 26
    3.3. Key Issues 27
    3.4. Notable Players 28
    3.5. Corporate Actions 30
    3.6. Regulations 31
    3.7. Enterprise Development and Social Development 32
    4. AFRICA 34
    5. INTERNATIONAL 36
    6. INFLUENCING FACTORS 38
    6.1. Unforeseen Events 38
    6.2. Economic Environment 39
    6.3. Labour 40
    6.4. Environmental Issues 42
    6.5. Technology, R&D, Innovation 43
    6.6. Government Support 46
    6.7. Input Costs 46
    7. COMPETITIVE ENVIRONMENT 47
    7.1. Competition 47
    7.2. Ownership Structure of the Industry 49
    7.3. Barriers to Entry 49
    8. INDUSTRY SUMMARY 50
    9. OUTLOOK 51
    10. INDUSTRY ASSOCIATIONS 52
    11. REFERENCES 53
    11.1. Publications 53
    11.2. Websites 55
    ANNEXURE 1 – Industry Legislation 57
    APPENDIX 1 – Summary of Notable Players 65
    Government Hospitals 65
    Private Hospitals 65
    Medical and Dental Practices 75
    Optical 76
    Pathology Practices 77
    Ambulance Services 77
    Blood Banks 79
    COMPANY PROFILES – Government and Private Hospitals 80
    Advanced Health (Pty) Ltd 80
    Ahmed Al-Kadi Private Hospital Ltd 84
    Bay Eye Hospital (Pty) Ltd 86
    Busamed (Pty) Ltd 87
    CareWell Robertson Private Hospital (Pty) Ltd 90
    Clinix Health Group (Pty) Ltd 92
    Cormed Kliniek (Pty) Ltd 98
    Cure Day Hospitals Holdings (Pty) Ltd 100
    Drs Erasmus, Vawda, Rabe and Partners 103
    Edge Day Hospital (Pty) Ltd 106
    Eyedoc (Pty) Ltd 108
    Joint Medical Holdings (Pty) Ltd 109
    Lenmed Investments Ltd 111
    Life Healthcare Group (Pty) Ltd 116
    M-Care (Pty) Ltd 125
    Mediclinic Group Ltd 127
    Melomed Hospital Holdings (Pty) Ltd 132
    Mondia Health (Pty) Ltd 134
    National Department of Health 136
    National Hospital Network NPC 154
    Netcare Ltd 164
    Nurture Care Group (Pty) Ltd 170
    RH Bophelo Ltd 172
    Spescare (Pty) Ltd 175
    Van Rensburg and Partners Southern Africa Inc 177
    COMPANY PROFILES – Medical and Dental Practises 180
    Kaelo Prime Cure (Pty) Ltd 180
    Medicross Healthcare Group (Pty) Ltd 182
    Momentum Metropolitan Holdings Ltd 188
    Novahealth (Pty) Ltd 193
    COMPANY PROFILES – Optical 196
    Benmore Optometrists CC 196
    Dynamic Vision Network (Pty) Ltd 198
    KFML Holdings (Pty) Ltd 200
    Mellins I Style Optometrists Inc 202
    Moffatt Inc 205
    Neovision Group (Pty) Ltd 207
    Torga Optical (Pty) Ltd 209
    COMPANY PROFILES – Pathology Practices 215
    AC Mauff and Partners 215
    Ampath Trust 219
    Bio Analytical Research Corporation South Africa (Pty) Ltd 223
    Dietrich Voigt Mia (Pty) Ltd 226
    Ishara Ramparsad Inc 233
    National Health Laboratory Service 235
    COMPANY PROFILES – Ambulance Services 239
    Cape Medical Response CC 239
    David\'s Medical Response CC 240
    ER24 EMS (Pty) Ltd 242
    Gardmed Ambulance Service Trust 247
    Hartmann Trading CC 249
    Netcare Ltd 251
    Relay EMS (Pty) Ltd 257
    COMPANY PROFILES – Blood Banks 258
    South African National Blood Service NPC 258
    Western Cape Blood Service NPC 263

    Report Coverage

    This report focuses on the public and private healthcare sector in South Africa, including hospitals and other medical facilities, medical practitioners, emergency services and pathology services. It includes comprehensive information on the state of the sector, statistics, the performance of notable players, corporate actions and other major developments. There are profiles of 47 companies including hospital groups such as Netcare, Mediclinic, Life Healthcare, Lenmed and RH Bophelo, pathology practices such as Ampath, ambulance services such as ER24 and optometry groups including Torga Optical and Neovision.

    Introduction

    • Healthcare expenditure in South Africa, amounting to more than R500bn a year, is roughly evenly split between public and private healthcare, despite the former providing care for 85% of South Africans. \r\n
    • Private healthcare bounced back in 2021 and 2022 to pre-COVID performance levels. \r\n
    • Public healthcare, already under strain from lack of resources and sub-quality care, struggled to cope with service provision during the pandemic. \r\n
    • Healthcare funding concerns are increasing and public healthcare budget cuts are expected.\r\n
    • Rising private healthcare costs are causing a reduction in the already small pool of medically-insured people. \r\n
    • Government expects National Health Insurance to fund over 90% of all healthcare, but there are huge concerns. \r\n

    Strengths

    • Enhancing the quality of public healthcare and improving the management of public healthcare facilities have been identified as imperatives.
    • Government is committed to the sustainable development goal of universal health coverage.
    • The healthcare system weathered the COVID-19 storms of 2020 and 2021, displaying capacity and resilience.
    • The public healthcare system has made considerable gains in the battle against HIV/AIDS reducing mortality and raising South Africa’s population lifespan.
    • The quality of healthcare in the private sector, and at some public sector academic hospitals, is of a high standard.
    • The standard of medical research is high.

    Weaknesses

    • Inadequate infrastructure, poor maintenance and a lack of basic services, such as waste removal.
    • Private healthcare costs are high and escalating ahead of inflation.
    • Progress towards universal health coverage has slowed in recent years.
    • Public healthcare management is generally inefficient, there is excessive bureaucracy and service delivery is poor.
    • South Africa’s healthcare system is characterised by extreme inequality of access. 85% of the population have no form of medical insurance and cannot afford private hospital care.
    • The private hospital market is highly concentrated and dominated by three players.
    • There are critical staff shortages across all disciplines in the public health system, where conditions are challenging, morale is low and working hours are long. The retention of healthcare practitioners is a challenge.

    Opportunities

    • Local and regional research and development interventions including the development of health apps.
    • The development and training of healthcare practitioners.
    • The implementation of National Health Insurance offers opportunities for lower healthcare costs, greater universal health coverage and more public-private collaboration.
    • The provision of public and private mental health facilities and services.

    Threats

    • Climate change and the high environmental burden of disease could result in substantial increases in the number of people requiring treatment for illnesses and injuries.
    • Economic pressures could result in funding constraints for both public and private sectors.
    • Industrial action and protests, which cripple the delivery of essential services.
    • The continued impact of waves of COVID-19 infection amidst low vaccination rates.
    • The possibility that National Health Insurance will not be able to meet the needs of the population and will impose an unsustainable tax burden on South Africans.
    • The threat of cyber security breaches is increasing with the development of digitised health systems.

    Outlook

    • South Africa’s healthcare system has not achieved the outcomes expected with the level of expenditure it receives. \r\n
    • The high costs associated with private healthcare are making it difficult for some people to continue to use it. \r\n
    • The impact of the pandemic is likely to exacerbate healthcare funding concerns. \r\n
    • National Health Insurance is its current form has come under some scrutiny, including its funding and the ability of the state to implement it. \r\n
    • The design of the solution with have a fundamental bearing on the outlook of the South African healthcare system.

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    Table of Contents

    [ Close ]
    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Industry Value Chain 4
    2.2. Geographic Position 5
    2.3. Size of the Industry 11
    2.4. Key Success Factors and Pain Points 18
    3. LOCAL 24
    3.1. Key Trends 24
    3.2. Notable Players 32
    3.3. Corporate Actions 36
    3.4. Regulations 38
    3.5. Enterprise Development and Social Economic Development 41
    4. AFRICA 42
    5. INTERNATIONAL 48
    6. INFLUENCING FACTORS 51
    6.1. COVID-19 51
    6.2. Economic Environment 54
    6.3. Labour 56
    6.4. Environmental Issues 61
    6.5. Technology, Research and Development (R&D) and Innovation 62
    6.6. Implementation of National Health Insurance 64
    6.7. Input Costs 66
    7. COMPETITIVE ENVIROMENT 67
    7.1. Competition 67
    7.2. Ownership Structure of the Industry 68
    7.3. Barriers to Entry 69
    8. SWOT ANALYSIS 69
    9. OUTLOOK 71
    10. INDUSTRY ASSOCIATIONS 71
    11. REFERENCES 73
    11.1. Publications 73
    11.2. Websites 74
    APPENDIX 1 - SUMMARY OF NOTABLE PLAYERS 76
    Government Hospitals 76
    Private Hospitals 77
    Medical and Dental Practices 86
    Optical 87
    Pathology Practices 89
    Ambulance Services 90
    Blood Banks 92
    COMPANY PROFILES – Government & Private Hospitals 93
    Advanced Health Ltd 93
    Ahmed Al-Kadi Private Hospital Ltd 97
    Busamed (Pty) Ltd 99
    CareWell Robertson Private Hospital (Pty) Ltd 102
    Clinix Health Group (Pty) Ltd 104
    Cormed Kliniek (Pty) Ltd 108
    Cure Day Hospitals Holdings (Pty) Ltd 110
    Joint Medical Holdings (Pty) Ltd 113
    Lenmed Investments Ltd 115
    Life Healthcare Group (Pty) Ltd 119
    M-Care (Pty) Ltd 129
    Mediclinic International PLC 131
    Melomed Hospital Holdings (Pty) Ltd 136
    National Department of Health 138
    National Hospital Network NPC 157
    Netcare Ltd 167
    Nurture Care Group (Pty) Ltd 173
    RH Bophelo Ltd 175
    Spescare (Pty) Ltd 178
    COMPANY PROFILES – Medical & Dental Practices 180
    Kaelo Prime Cure (Pty) Ltd 180
    Medicross Healthcare Group (Pty) Ltd 182
    Momentum Metropolitan Holdings Ltd 188
    Novahealth (Pty) Ltd 193
    COMPANY PROFILES – Optical 196
    Benmore Optometrists CC 196
    Dynamic Vision Network (Pty) Ltd 198
    KFML Holdings (Pty) Ltd 200
    Mellins IStyle Optometrists Inc 202
    Moffatt Inc 205
    Neovision Group (Pty) Ltd 207
    Torga Optical (Pty) Ltd 209
    COMPANY PROFILES – Pathology Practices 215
    AC Mauff and Partners 215
    Ampath Trust 218
    Bio Analytical Research Corporation South Africa (Pty) Ltd 222
    Dietrich Voigt Mia (Pty) Ltd 225
    Ishara Ramparsad Inc 232
    Medilab Clinical Pathology (Pty) Ltd 233
    National Health Laboratory Service 234
    Pathology Lab One (Pty) Ltd 238
    COMPANY PROFILES – Ambulance Services 239
    Cape Medical Response CC 239
    David\'s Medical Response CC 240
    ER24 EMS (Pty) Ltd 242
    Friedcorp 529 CC 247
    Gardmed Ambulance Service Trust 248
    KwaZulu Private Ambulance CC 250
    Netcare Ltd 252
    Relay EMS (Pty) Ltd 258
    COMPANY PROFILES – Blood Banks 260
    South African National Blood Service NPC 260
    Western Cape Blood Service NPC 264

    Report Coverage

    This report focuses on the healthcare sector in South Africa and examines the capacity and capabilities of the healthcare system and the impact of the coronavirus crisis on the sector. It includes information on the state and size of the sector, developments and corporate actions of notable players, and influencing factors including the coronavirus pandemic and regulation. There are profiles of 26 entities including the Department of Health and the South African National Blood Service, major private hospital groups Life Healthcare, Mediclinic and Netcare and laboratory services such as Ampath.

    Introduction

    The South African healthcare sector provides essential services to the country’s population of around 59.8 million people. Expenditure on public and private healthcare in the formal sector totalled more than R400bn in 2019, while traditional healers, the majority of whom operate in the informal sector, generated an estimated R3.5bn. On 5 March 2020, South Africa reported its first confirmed case of coronavirus and the country plunged into a health crisis. By 29 October 2020, South Africa had recorded the twelfth highest number of confirmed coronavirus cases in the world, more than 93,500 infected people had been admitted to hospital and there were 19,164 related deaths. This report examines the capacity and capabilities of South Africa’s healthcare system and the impact of the coronavirus crisis on the sector during the first wave of the pandemic.

    Strengths

    •  Enhancing the quality of public healthcare, tackling corruption and improving the management of public healthcare facilities have been identified as imperatives.
    • Government is committed to the sustainable development goal of universal health coverage.
    • The quality of healthcare in the private sector, and at some public sector academic hospitals, is of a high standard.
    • The standard of medical research is of a high standard.

    Weaknesses

    • Inadequate infrastructure, poor maintenance and a lack of basic services, such as waste removal.
    • Public healthcare management is generally inefficient, there is excessive bureaucracy, corruption is pervasive and service delivery is poor.
    • South Africa’s polarised healthcare system is characterised by extreme inequity. More than 83% of the population has no form of medical insurance and cannot afford private hospital care.
    • The private hospital market is highly concentrated and dominated by three players.
    • There are critical staff shortages across all disciplines in the public health system, where conditions are challenging, morale is low and working hours are extremely long. The retention of healthcare practitioners is a challenge.

    Opportunities

    • Local and regional research and development interventions including the development of health apps.
    • The development and training of healthcare practitioners.
    • The implementation of National Health Insurance offers opportunities for private-public collaboration.
    • The provision of public and private mental health facilities and services.

    Threats

    • A potentially more devastating second wave of coronavirus.
    • Climate change and the high environmental burden of disease could result in substantial increases in the number of people requiring treatment for illnesses and injuries.
    • Economic pressures could result in funding constraints.
    • Industrial action and protests, which cripples the delivery of essential services.
    • The possibility that National Health Insurance will not be able to meet the needs of the population.
    • The threat of cyber security breaches is increasing with the development of digitised health systems.

    Outlook

    The coronavirus pandemic has tested the capacity and capabilities of South Africa’s healthcare system to deal with a public health crisis. Within less than eight months since the declaration of a national state of disaster, South Africa had reported 721,770 confirmed cases and 19,164 deaths. While shaken, the South African health sector has proved to be relatively resilient and has delivered better outcomes than some of the world’s most well-resourced health systems. Role players say that the pandemic has catalysed much-needed remedial action and through the collaboration of the public and private sectors, solutions were swiftly implemented to mitigate the impact of the crisis. \r\n\r\nDelivering the Department of Health’s adjusted budget and policy statement on 23 July 2020, health minister Zweli Mkhize said: “The Covid-19 pandemic has motivated all of South Africa’s health institutions to rethink, re-organise and reshape their priorities and agendas. In this context many of South Africa’s leading research institutions and senior researchers have forged new national and global research collaborations aimed at urgently answering critical clinical and public health questions.” Mkhize added that to ensure a safer clinical environment, improve morale and boost confidence in the public health system, the department plans to accelerate the implementation of its national health infrastructure plan. Although public hospitals remain under pressure, role players say that they are now better resourced than prior to the pandemic and significantly more prepared to deal with the threat of a second onslaught of the virus.

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    The Healthcare Sector in South Africa 2015-01-30

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    Table of Contents

    [ Close ]
    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Industry Value Chain 4
    2.2. Geographic Position 5
    3. SIZE OF THE INDUSTRY 7
    4. STATE OF THE INDUSTRY 12
    4.1. Local 12
    4.1.1. Corporate Actions 18
    4.1.2. Regulations 19
    4.1.3. Enterprise Development and Social Economic Development 23
    4.2. Continental 24
    4.3. International 27
    5. INFLUENCING FACTORS 31
    5.1. Coronavirus 31
    5.2. Government Interventions 34
    5.3. Economic Environment 36
    5.4. Labour Resources 37
    5.5. Input Costs 41
    5.6. Technology, Research and Development (R&D) and Innovation 41
    5.7. Environmental Concerns 45
    5.8. Civil Society 46
    5.9. Cyclicality 47
    6. COMPETITION 47
    6.1. Barriers to Entry 48
    7. SWOT ANALYSIS 49
    8. OUTLOOK 50
    9. INDUSTRY ASSOCIATIONS AND OTHER ENTITIIES 51
    10. REFERENCES 53
    10.1. Publications 53
    10.2. Websites 54
    APPENDIX 1 - SUMMARY OF NOTABLE PLAYERS 56
    Government Hospitals 56
    Private Hospitals 56
    Medical and Dental Practices 60
    Optical 61
    Blood Banks 61
    Pathology Practices 62
    Ambulance Services 63
    COMPANY PROFILES - GOVERNMENT AND PRIVATE HOSPITALS 64
    ADVANCED HEALTH LTD 64
    BUSAMED (PTY) LTD 68
    CLINIX HEALTH GROUP (PTY) LTD 70
    LENMED INVESTMENTS LTD 74
    LIFE HEALTHCARE GROUP (PTY) LTD 78
    MEDICLINIC INTERNATIONAL PLC 87
    NATIONAL DEPARTMENT OF HEALTH 91
    NATIONAL HOSPITAL NETWORK NPC 108
    NETCARE LTD 117
    COMPANY PROFILES – MEDICAL AND DENTAL PRACTICES 123
    KAELO PRIMECURE (PTY) LTD 123
    MEDICROSS HEALTHCARE GROUP (PTY) LTD 125
    MOMENTUM METROPOLITAN HOLDINGS LTD 130
    NOVAHEALTH (PTY) LTD 135
    COMPANY PROFILES – OPTICAL 137
    MELLINS I STYLE OPTOMETRISTS INC 137
    MOFFATT INC 141
    SPEC SAVERS SOUTH AFRICA (PTY) LTD 143
    TORGA OPTICAL (PTY) LTD 145
    COMPANY PROFILES – BLOOD BANKS 150
    SOUTH AFRICAN NATIONAL BLOOD SERVICE NPC 150
    WESTERN CAPE BLOOD SERVICE NPC 153
    COMPANY PROFILES – PATHOLOGY PRACTICES 156
    AC MAUFF AND PARTNERS 156
    AMPATH TRUST 159
    BIO ANALYTICAL RESEARCH CORPORATION SOUTH AFRICA (PTY) LTD 162
    DIETRICH VOIGT MIA (PTY) LTD 164
    NATIONAL HEALTH LABORATORY SERVICE 168
    COMPANY PROFILES – AMBULANCE SERVICES 172
    ER24 EMS (PTY) LTD 172
    GARDMED AMBULANCE SERVICE TRUST 177
    NETCARE LTD 180

    Introduction

    South Africa’s two-tiered healthcare sector, supported by more than 252,650 registered practitioners, provides essential services to the country’s population of over 57.5 million people. During the 2017/18 financial year, combined public and private healthcare expenditure remained on an upward trajectory, breaching R400bn. However, notwithstanding the crucial role that it performs in society, the healthcare sector is at a critical juncture. In his address to delegates at the inaugural Presidential Health Summit in October 2018, president Cyril Ramaphosa stated that the country’s dysfunctional health system was in crisis and in need of urgent rehabilitation. “This does not mean that the system has completely collapsed, but that it is edging to a tipping point where it will be impossible to deliver needed services if we do not rescue it,” warned Ramaphosa. Acknowledging the magnitude of the challenges facing the sector in his recent state of the nation address, he sounded the call to action, announcing the establishment of the National Health Insurance (NHI) and quality improvement “war room” in the Presidency.

    Strengths

    •  Enhancing the quality of healthcare, tackling corruption and improving the management of public healthcare facilities have been identified as imperatives.
    • Government has affirmed its commitment to universal health coverage.
    • South Africa’s major private healthcare groups are regarded as leading players in various international markets.
    • The quality of healthcare in the private sector, as well as at certain academic hospitals is of a high standard.

    Weaknesses

    • Inadequate infrastructure, poor maintenance and a lack of basic services, such as waste removal.
    • Private healthcare is not accessible and not affordable for more than 83% of South Africa’s population.
    • Public healthcare management is generally inefficient, there is excessive bureaucracy, corruption is pervasive and service delivery is poor.
    • South Africa’s polarised healthcare system is characterised by extreme inequity.
    • There are critical staff shortages in the public sector, where conditions are challenging, morale is low and working hours are extremely long. The retention of healthcare practitioners remains a challenge.

    Opportunities

    • Local and regional research and development initiatives, including the development of health apps.
    • The burgeoning medical tourism industry.
    • The development and training of healthcare practitioners.
    • The implementation of National Health Insurance offers opportunities for private-public collaboration across all healthcare disciplines.
    • The provision of public and private mental health facilities and services.

    Threats

    • Climate change and the high environmental burden of disease could result in substantial increases in the number of people requiring treatment for illnesses and injuries.
    • Funding constraints resulting from macro-economic pressures.
    • Industrial action, which cripples the delivery of essential services.
    • The possibility that National Health Insurance will not be able to meet the needs of the population.
    • With health systems and health delivery becoming increasingly connected, the threat of cyber security breaches is increasing.

    Outlook

    President Cyril Ramaphosa’s call to action at the Presidential Health Summit marks a decisive turning point in the health of the country’s ailing healthcare sector. Despite lingering concerns about National Health Insurance, many role players suggest that a fundamental attitudinal shift appears to have taken place, with stakeholders from a broad spectrum of sectors committing their support to find inclusive solutions to the massive challenges facing the healthcare system. With the establishment of a health sector ‘war room’ in the office of the Presidency, some stakeholders say that the prognosis for the public healthcare sector has improved. Analysts predict that the uptake of digital technology will drive the restructuring of the sector, maximising efficiencies and enhancing service delivery. Meanwhile, pending the highly-anticipated publication of the Competition Commission’s final health market inquiry report, the future prospects of private healthcare providers remain uncertain.

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    Table of Contents

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    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Value Chain 4
    2.2. Geographic Position 5
    3. SIZE OF THE INDUSTRY 7
    4. STATE OF THE INDUSTRY 11
    4.1. Local 11
    4.1.1. Corporate Actions 22
    4.1.2. Regulations 24
    4.1.3. Enterprise Development and Socio-Economic Development Initiatives 28
    4.2. Continental 29
    4.3. International 31
    5. INFLUENCING FACTORS 34
    5.1. Government Interventions 34
    5.2. Economic Environment 35
    5.3. Input Costs 36
    5.4. Technology, Research and Development (R&D) and Innovation 37
    5.5. Labour Resources 41
    5.6. Cyclicality 46
    5.7. Civil Society 46
    5.8. Environmental Concerns 47
    6. COMPETITION 49
    6.1. Barriers to Entry 51
    7. SWOT ANALYSIS 52
    8. OUTLOOK 53
    9. INDUSTRY ASSOCIATIONS AND OTHER ENTITIES 53
    10. REFERENCES 58
    10.1. Publications 58
    10.2. Websites 58
    APPENDIX 1 - SUMMARY OF NOTABLE PLAYERS 61
    Government Hospitals 61
    Private Hospitals 61
    Medical and Dental Practices 66
    Optical 67
    Blood Banks 67
    Pathology Practices 68
    Ambulance Services 93199b 69
    COMPANY PROFILES – GOVERNMENT AND PRIVATE HOSPITALS 71
    ADVANCED HEALTH LTD 71
    BUSAMED (PTY) LTD 75
    CLINIX HEALTH GROUP (PTY) LTD 78
    LENMED INVESTMENTS LTD 81
    LIFE HEALTHCARE GROUP (PTY) LTD 85
    MEDICLINIC INTERNATIONAL PLC 93
    NATIONAL DEPARTMENT OF HEALTH 97
    NATIONAL HOSPITAL NETWORK 113
    NETCARE LTD 122
    COMPANY PROFILES – MEDICAL AND DENTAL PRACTICES 127
    KAELO PRIMECURE (PTY) LTD 127
    MEDICROSS HEALTHCARE GROUP (PTY) LTD 129
    METROPOLITAN HEALTH RISK MANAGEMENT (PTY) LTD 133
    NOVAHEALTH (PTY) LTD 135
    COMPANY PROFILES – OPTICAL 136
    MELLINS I STYLE OPTOMETRISTS INC 136
    MOFFATT INC 139
    SPEC SAVERS SOUTH AFRICA (PTY) LTD 141
    TORGA OPTICAL (PTY) LTD 143
    COMPANY PROFILES – BLOOD BANKS 148
    SOUTH AFRICAN NATIONAL BLOOD SERVICE 148
    WESTERN CAPE BLOOD SERVICE 151
    COMPANY PROFILES – PATHOLOGY PRACTICES 154
    AMPATH TRUST 154
    BIO ANALYTICAL RESEARCH CORPORATION SOUTH AFRICA (PTY) LTD 157
    DIETRICH VOIGT MIA (PTY) LTD 160
    LANCET LABORATORIES (PTY) LTD 164
    NATIONAL HEALTH LABORATORY SERVICE 167
    COMPANY PROFILES – AMBULANCE SERVICES 171
    ER24 EMS (PTY) LTD 171
    GARDMED AMBULANCE SERVICE TRUST 176
    NETCARE LTD 179

    Report Coverage

    The detailed report on South Africa’s healthcare sector describes current conditions, developments and investments, as well as other factors that influence the success of the sector. The report profiles 25 companies that operate in the sector ranging from Busamed, a black-owned and operated national specialist private hospital network, to pathology practice, A C Mauff and Partners t/a Lancet Laboratories. Also profiled are two blood banks, the South African National Blood Service (SANBS) and the Western Province Blood Transfusion Services.

    Introduction

    South Africa’s healthcare sector, supported by 249,827 registered practitioners, performs a critical role in society providing essential services to the country’s population of more than 56.5 million people. With total expenditure rising to almost R378bn during the 2016/17 financial year, the sector accounts for approximately 8.3% of the national GDP. The South African Cabinet’s recent approval of the rereleased White Paper on National Health Insurance (NHI) paves the way for the radical restructuring of the health sector. While the proposed system has been widely welcomed, concerns have been raised about the funding and implementation of the universal health coverage model, as well as the future role of private healthcare providers and medical schemes. Moreover, the National Department of Health’s capacity to deliver quality healthcare services has been called into question. The recent collapse of public oncology services in Durban and the tragic consequences of Gauteng’s mental health crisis have further eroded confidence in a public health sector crippled by medical negligence claims.

    Strengths

    • South Africa’s major private healthcare groups have an expanding global footprint and are regarded as leading players in various international markets.
    • The National Department of Health has affirmed its commitment to enhancing the quality of healthcare and to improving the management of public healthcare facilities.
    • The quality of healthcare in the private sector, as well as at certain academic hospitals in South Africa is of a high standard.

    Weaknesses

    • Deteriorating infrastructure and a lack of basic services, such as waste removal.
    • Private healthcare is costly and remains beyond the reach of more than 80% of South Africa’s population.
    • Public healthcare management is generally inefficient, there is excessive bureaucracy, corruption is prevalent and service delivery is poor.
    • South Africa’s polarised healthcare system is characterised by extreme inequity.
    • There are critical staff shortages in the public sector, where conditions are challenging, morale is low and working hours are extremely long. The retention of healthcare practitioners remains an issue.

    Opportunities

    • Local and regional research and development initiatives, including the development of health apps.
    • Provision of IT systems in older public health facilities, which are still paper-based.
    • The burgeoning medical tourism industry.
    • The development and training of healthcare practitioners.
    • The implementation of NHI offers opportunities for private-public collaboration across all healthcare disciplines.
    • The provision of both public and private mental health facilities and services.

    Threats

    • Climate change and the high Environmental Burden of Disease (EBD) could result in substantial increases in the number of people requiring treatment for illnesses and injuries.
    • Funding constraints resulting from macro-economic pressures.
    • The possibility that NHI will not be able to meet the needs of the population.

    Outlook

    Although many South African citizens are apprehensive about the country’s impending transition to National Health Insurance (NHI), the National Department of Health (NDoH) regards the model as a ‘Marshall Plan’ for South Africa’s ailing public healthcare sector. Several commentators say that if the NDoH is to deliver on its promise of quality care for all South African residents, it will need to collaborate closely with the private health sector. While the new system may still be ‘rough around the edges’, numerous role players say that it presents innumerable opportunities for private healthcare service providers in the form of public-private partnerships. Going forward, given the current climate of uncertainty and the challenging macro-economic environment, stakeholders predict that South Africa’s private healthcare service providers will remain under pressure as they await the release of the Competition Commission’s Provisional Findings and Recommendations Report on 30 November 2017.

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    Table of Contents

    [ Close ]
    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Value Chain 3
    2.2. Geographic Position 5
    3. SIZE OF THE INDUSTRY 5
    4. STATE OF THE INDUSTRY 16
    4.1. Local 16
    4.1.1. Corporate Actions 27
    4.1.2. Regulations 29
    4.1.3. Enterprise Development and Socio-Economic Development Initiatives 32
    4.2. Continental 33
    4.3. International 34
    5. INFLUENCING FACTORS 38
    5.1. Government Interventions 38
    5.2. Economic Environment 39
    5.3. Input Costs 40
    5.4. Technology, Research and Development (R&D) and Innovation 41
    5.5. Labour Resources 46
    5.6. Cyclicality 50
    5.7. Civil Society 50
    5.8. Environmental Concerns 51
    6. COMPETITION 53
    6.1. Barriers to Entry 56
    7. SWOT ANALYSIS 56
    8. OUTLOOK 57
    9. INDUSTRY ASSOCIATIONS AND OTHER ENTITIES 58
    10. REFERENCES 62
    10.1. Publications 62
    10.2. Websites 63
    APPENDIX 1 65
    Classification of Public Healthcare Facilities 65
    APPENDIX 2 66
    Provincial Distribution of Nursing Manpower as at 31 December 2016 66
    APPENDIX 3 67
    The Potential Impact of eHealth and mHealth on Africa 67
    COMPANY PROFILES – GOVERNMENT AND PRIVATE HOSPITALS 68
    ADVANCED HEALTH LTD 68
    BUSAMED (PTY) LTD 72
    CLINIX HEALTH GROUP LTD 74
    DEPARTMENT OF HEALTH 77
    LENMED INVESTMENTS LTD 95
    LIFE HEALTHCARE GROUP (PTY) LTD 100
    MEDICLINIC INTERNATIONAL PLC 108
    NATIONAL HOSPITAL NETWORK 112
    NETCARE LTD 120
    COMPANY PROFILES – MEDICAL AND DENTAL PRACTICES 126
    MEDICROSS HEALTHCARE GROUP (PTY) LTD 126
    METROPOLITAN HEALTH RISK MANAGEMENT (PTY) LTD 130
    PRIME CURE HEALTH (PTY) LTD 132
    COMPANY PROFILES – OPTICAL 134
    MELLINS I STYLE OPTOMETRISTS INC 134
    MOFFATT INC 137
    SPEC SAVERS SOUTH AFRICA (PTY) LTD 139
    TORGA OPTICAL (PTY) LTD 141
    COMPANY PROFILES – BLOOD BANKS 147
    SOUTH AFRICAN NATIONAL BLOOD SERVICE 147
    WESTERN PROVINCE BLOOD TRANSFUSION SERVICES 150
    COMPANY PROFILES – PATHOLOGY PRACTICES 153
    AMPATH TRUST 153
    BIO ANALYTICAL RESEARCH CORPORATION SOUTH AFRICA (PTY) LTD 156
    DIETRICH VOIGT MIA (PTY) LTD 159
    LANCET LABORATORIES (PTY) LTD 163
    NATIONAL HEALTH LABORATORY SERVICE 166
    COMPANY PROFILES – AMBULANCE SERVICES 171
    ER24 EMS (PTY) LTD 171
    GARDMED AMBULANCE SERVICES TRUST 175
    NETCARE LTD 177

    Report coverage

    The detailed report on the country’s healthcare industry describes current conditions, the latest developments in the public and private sectors and discusses factors influencing the success of this vital sector. The report profiles 25 role players, including Blood Banks, Pathology Practices and Ambulance Services. Also profiled are Netcare Limited, Life Healthcare and Mediclinic Southern Africa, which together account for 75% of the domestic private healthcare market.\r\n

    Report coverage

    The detailed report on the country’s healthcare industry describes current conditions, the latest developments in the public and private sectors and discusses factors influencing the success of this vital sector. The report profiles 25 role players, including Blood Banks, Pathology Practices and Ambulance Services. Also profiled are Netcare Limited, Life Healthcare and Mediclinic Southern Africa, which together account for 75% of the domestic private healthcare market.\r\n

    Introduction

    This report focuses on Human Health Activities in South Africa. The highly polarised sector, which is currently the subject of a Competition Commission inquiry, comprises 240,024 registered healthcare workers serving a population of around 55 million people. Although total health expenditure for the financial year 2015/2016 increased to approximately R357.03bn, the healthcare sector continues to grapple with a multitude of challenges, not least of which is the retention of medical staff. With South Africa’s doctor to population ratio having declined well below the global average of 15 doctors per 10,000 people, to six doctors per 10,000 people, many stakeholders believe that the critical shortage of medical professionals in South Africa is a national crisis.

    Strengths

    • Medical students generally receive a high standard of education and training.
    • South Africa’s major private healthcare groups have an expanding global footprint and are regarded as leading players in various international markets.
    • The NDoH has affirmed its commitment to enhancing the quality of healthcare and to improving the management of public healthcare facilities.
    • The quality of the South African private healthcare system is generally of a high standard.

    Weaknesses

    • Deteriorating infrastructure and a lack of basic services, such as waste removal.
    • Private healthcare is not affordable, remaining beyond the reach of more than 80% of South Africa’s population.
    • Public healthcare management is generally inefficient, there is excessive bureaucracy, corruption is prevalent and service delivery is poor.
    • South Africa’s healthcare system is characterised by extreme inequity.
    • Staff shortages and staff retention, particularly in the public sector, where working conditions are challenging, morale is low and working hours are long.
    • The absence of a standardised reference price list drives medical expenditure higher.
    • The ongoing exodus of healthcare workers from South Africa.

    Opportunities

    • Local and regional research and development initiatives, including the development of health apps.
    • Provision of IT systems in older public health facilities, which are still paper-based.
    • The burgeoning medical tourism industry.
    • The phasing-in of the NHI offers opportunities for private-public collaboration.
    • The provision of in-patient mental health facilities.

    Threats

    • Climate change and the high Environmental Burden of Disease (EBD) could result in substantial increases in the number of people requiring treatment for illnesses and injuries.
    • Drug-resistant infections.
    • Lack of progress in infrastructure development, service delivery and NHI roll-out that could erode the morale of public sector healthcare professionals even further.
    • Mismanagement and corruption in the public health sector.
    • The critical shortage of healthcare workers.
    • The importation of the Zika virus and Yellow Fever into South Africa.
    • The possibility that the NHI will not be able to meet the needs of the population, due to the high burden of disease.
    • The rising cost of private health care, which is becoming increasingly unaffordable for the majority of the population.

    Outlook

    Pending the outcome of the Competition Commission inquiry into South Africa’s healthcare market, the growth prospects of the industry are expected to remain relatively muted, as players wait to hear whether former Chief Justice Ngcobo and his panel will recommend any far-reaching changes to the sector’s current policy and regulatory regime. Given the prevailing climate of uncertainty in South Africa, analysts predict that the sector’s leading private healthcare companies will continue to focus on expanding their respective international networks. With the phasing-in of the NHI, various role players in the private healthcare sector are eager to capitalise on potential opportunities. However, many analysts have expressed concern about the funding of the system and anticipate that the roll-out of NHI will be a gradual process. \r\n\r\nGoing forward, the critical shortage of healthcare professionals across all disciplines remains a grave concern and stakeholders warn that the prevailing situation is untenable. Addressing delegates at the 2015 Hospital Association of South Africa (HASA) Conference, Mediclinic’s Dr Nkaki Matlala said that a Marshall Plan to increase the number of doctors was needed, if South Africa’s healthcare system was to remain sustainable.

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    Table of Contents

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    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Value Chain 3
    2.2. Geographic Position 4
    3. SIZE OF THE INDUSTRY 5
    4. STATE OF THE INDUSTRY 17
    4.1. Local 17
    4.1.1. Corporate Actions 26
    4.1.2. Regulations 28
    4.1.3. Enterprise Development and Socio-Economic Development Initiatives 31
    4.2. Continental 31
    4.3. International 34
    5. INFLUENCING FACTORS 37
    5.1. Government Intervention 37
    5.2. Economic Environment 38
    5.3. Input Costs 40
    5.4. Technology, Research and Development (R&D) and Innovation 40
    5.5. Labour Resources 45
    5.6. Lack of Facilities 48
    5.7. Civil Society 50
    5.8. Environmental Concerns 51
    6. COMPETITION 53
    6.1. Barriers to Entry 55
    7. SWOT ANALYSIS 56
    8. OUTLOOK 57
    9. INDUSTRY ASSOCIATIONS 58
    10. REFERENCES 60
    10.1. Publications 60
    10.2. Websites 61
    APPENDIX 1 64
    Classification of Public Healthcare Facilities 64
    APPENDIX 2 65
    APPENDIX 3 66
    Total Number of Active HPCSA Registrations as at 03 May 2016 66
    APPENDIX 4 71
    The Potential Impact of eHealth and mHealth on Africa 71
    COMPANY PROFILES – GOVERNMENT AND PRIVATE HOSPITALS 72
    Advanced Health Ltd 72
    Department of Health 76
    Lenmed Investments Ltd 93
    Life Healthcare Group (Pty) Ltd 98
    Mediclinic International Plc 106
    National Hospital Network 110
    Netcare Ltd 119
    Origin 6 Healthcare (Pty) Ltd 127
    COMPANY PROFILES – BLOOD BANKS 128
    South African National Blood Service 128
    Western Province Blood Transfusion Services 130
    COMPANY PROFILES – MEDICAL AND DENTAL PRACTICES 133
    CareCross Health (Pty) Ltd 133
    Medicross Healthcare Group (Pty) Ltd 135
    Metropolitan Health Risk Management (Pty) Ltd 138
    Prime Cure Health (Pty) Ltd 140
    COMPANY PROFILES – OPTICAL 142
    Mellins I Style Optometrists Inc 142
    Moffatt Inc 145
    Spec Savers South Africa (Pty) Ltd 147
    Torga Optical (Pty) Ltd 149
    COMPANY PROFILES – AMBULANCE SERVICES 154
    ER24 EMS (Pty) Ltd 154
    Gardmed Ambulance Services Trust 158
    Netcare Ltd 161

    Introduction

    This report focuses on Human Health Activities in South Africa. The sector, which comprises both public and private entities, has 221,508 registered personnel and serves a population of approximately 52 million people. For the financial year 2013/2014, total expenditure is predicted to be in the region of R293.2bn, or approximately 8.3% of GDP. Of this total amount, approximately R140.4bn is expected to be spent in the public sector, while an estimated R146.6bn will be spent in the private sector.\r\n\r\nKey issues currently facing the sector include the delivery of quality, affordable healthcare to all the people of South Africa through the National Health Insurance (NHI) programme, the possible importation of the Ebola virus into South Africa, as well as the spiralling cost of private healthcare and allegations of price manipulation, which are the subject of a Competition Commission inquiry. Although significant progress continues to be made in certain fields, notably the roll-out of a highly effective antiretroviral campaign that is increasing life expectancy, there are still monumental challenges that burden the sector. Addressing a Parliamentary media conference held in February 2014, Health Minister, Dr. Aaron Motsaoledi commented, “The tide of death, because of HIV and Aids-related illnesses, is turning, but there is still a lot of work to be done.”

    Strengths

    • Medical students generally receive a high standard of education and training.
    • South Africa is a world leader in research in viral haemorrhagic fevers.
    • The National Department of Health has affirmed its commitment to enhancing the quality of healthcare and to improving the management of public healthcare facilities.
    • The quality of the South African private healthcare system is generally of a high standard.

    Weaknesses

    • Deteriorating infrastructure and a lack of basic services, such as waste removal.
    • Private healthcare is not affordable, remaining beyond the reach of more than 80% of South Africa’s population.
    • Public healthcare management is generally inefficient, there is excessive bureaucracy, corruption is prevalent and service delivery is poor.
    • South Africa’s healthcare system is characterised by extreme inequity.
    • Staff shortages and staff retention, particularly in the public sector, where working conditions are challenging, morale is low and working hours are long.
    • The absence of a standardised reference price list drives medical expenditure higher.
    • The exodus of healthcare workers from South Africa (“brain drain”).

    Opportunities

    • Local and regional research and development initiatives.
    • Provision of IT systems in older public health facilities, which are still paper-based.
    • The burgeoning medical tourism industry.
    • The phasing-in of the NHI offers opportunities for private-public collaboration.

    Threats

    • Climate change and the high Environmental Burden of Disease (EBD) could result in substantial increases in the number of people requiring treatment for illnesses and injuries.
    • Continuing mismanagement and corruption in the public health sector.
    • Lack of progress in infrastructure development, service-delivery and NHI roll-out that could erode the morale of public sector healthcare professionals even further.
    • The possibility that the NHI will not be able to meet the needs of the population, due to the high burden of disease.
    • The spread of the Ebola epidemic to South Africa could have a devastating effect on the sector.

    Outlook

    South Africa continues to face enormous challenges, with the quadruple burden of disease placing the country’s healthcare system in a unique global predicament. Although Minister of Health, Dr. Aaron Motsoaledi, has instituted several ambitious policies that seek to curb negative trends in the sector, mismanagement and corruption in the public health sector, combined with soaring costs in the private health sector, would suggest a rather bleak outlook for the future. Analysts say that the Competition Commission’s inquiry into the private health sector, which will be concluded by 30 November 2015, could have a profound effect on companies operating in the industry and that punitive action could be taken against transgressors. The continued roll-out of the NHI and its future success will largely depend on the eradication of mismanagement in the public sector, as well as positive private-public collaboration. Although many stakeholders remain reluctant to engage with the NHI programme, the performance review of the UMgungundlovu pilot Health District issued ahead of the impending release of the NHI White Paper is cause for cautious optimism.

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    Table of Contents

    [ Close ]
    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Industry Supply Chain 2
    2.2. Geographic Position 3
    3. SIZE OF THE INDUSTRY 4
    4. STATE OF THE INDUSTRY 16
    4.1. Local 16
    4.1.1. Corporate Actions 20
    4.1.2. Regulations 20
    4.1.3. Enterprise Development and Social Economic Development 22
    4.2. Continental 25
    4.3. International 26
    5. INFLUENCING FACTORS 28
    5.1. Government Intervention 28
    5.2. Economic Environment 28
    5.3. Rising Input Costs 29
    5.4. Information Technology and Technology 29
    5.5. Labour 31
    5.6. Lack of Facilities 33
    5.7. Civil Society 34
    5.8. Environmental Concerns 34
    6. COMPETITION 35
    6.1. Barriers to Entry 36
    6.2. Research and Development (R&D) and Innovation 37
    7. SWOT ANALYSIS 38
    8. OUTLOOK 38
    9. INDUSTRY ASSOCIATIONS 39
    10. REFERENCES 40
    10.1. Publications 40
    10.2. Websites 41
    ORGANOGRAM 93111 42
    General Hospitals 42
    COMPANY PROFILES 43
    ADVANCED HEALTH LTD 43
    DEPARTMENT OF HEALTH 45
    LENMED INVESTMENTS LTD 48
    LIFE HEALTHCARE GROUP (PTY) LTD 51
    MEDICLINIC INTERNATIONAL LTD 56
    NATIONAL HOSPITAL NETWORK 62
    NETCARE LTD 68
    ORGANOGRAM 9312 76
    Medical and Dental Practice Activities 76
    COMPANY PROFILES 77
    CARECROSS HEALTH (PTY) LTD 77
    MEDICROSS HEALTHCARE GROUP (PTY) LTD 79
    METROPOLITAN HEALTH RISK MANAGEMENT (PTY) LTD 81
    PRIME CURE HEALTH (PTY) LTD 83
    ORGANOGRAM 93191a 85
    The Medical Optical Industry 85
    COMPANY PROFILES 86
    MELLINS I STYLE OPTOMETRISTS INC 86
    MOFFATT INC 88
    SPEC-SAVERS (PTY) LTD 90
    TORGA OPTICAL (PTY) LTD 91
    ORGANOGRAM 93199a 95
    Pathology Practices in South Africa 95
    COMPANY PROFILES 96
    AMPATH TRUST 96
    BIO ANALYTICAL RESEARCH CORPORATION SOUTH AFRICA (PTY) LTD 98
    DIETRICH VOIGT MIA (PTY) LTD 100
    LANCET LABORATORIES (PTY) LTD 102
    NATIONAL HEALTH LABORATORY SERVICE 104
    ORGANOGRAM 93199b 107
    Ambulance Services 107
    COMPANY PROFILES 108
    ER24 EMS (PTY) LTD 108
    GARDMED AMBULANCE SERVICES TRUST 111
    NETCARE 911 (PTY) LTD 113
    ORGANOGRAM 93199c 115
    Blood Banks 115
    COMPANY PROFILES 116
    SOUTH AFRICAN NATIONAL BLOOD SERVICE 116
    WESTERN PROVINCE BLOOD TRANSFUSION SERVICES 118

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