01. The Power of Public Clinics
South Africa’s public system is not starting from scratch. With roughly 3,500 clinics and community health centres, the country has a footprint most health systems would envy. For over 90% of the population, care is within 5 km.
That is access in theory, on a map, in policy. The next step is access in reality: the kind where a clinic can do more than triage and refer.
Primary care is not simply the most reachable layer of healthcare. It is the only layer that can grow with the population without breaking the budget.
Source: WHO PRIMASYS Case Study (2017)
02. SA’s Primary Power Up
There are signs the shift is already underway. Leaders in Gauteng are talking less about hospital expansion and more about reconfiguring primary care services: infrastructure upgrades, practical training and task-shifting that actually sticks.
This is the right direction. Not because hospitals are unimportant, but because hospitals are finite. The future is not every problem flowing uphill to the same overcrowded wards. It is capable clinics handling more, earlier, closer.
Source: Gauteng Department of Health (2024)
03. Seismic Task-Shifting
South Africa has been quietly building a new kind of backbone: community health workers and Ward-Based Outreach Teams that bring care to households, not just facilities.
Ward-Based Outreach Teams now cover 68% of wards. That matters. It changes who gets seen, how early conditions are picked up and whether prevention is real or rhetorical.
But task-shifting is not magic. It needs good supervision, clear escalation pathways and clinics that can absorb the work being generated. Otherwise, the system simply moves the bottleneck.
Source: WHO PRIMASYS Case Study (2017)
04. Primary Health as the Foundation for NHI
National Health Insurance rises or falls on primary care. Not on paper, but in capacity.
If clinics cannot carry screening, prevention, basic diagnostics and follow-up, the system will keep defaulting to hospitals and hospitals will keep carrying what should have been caught earlier.
Even cervical cancer policy points in the same direction: the path to equitable access runs through a strong PHC layer that can act early and act consistently.
Source: eNCA: Calls to Boost Primary Healthcare (2024)
Source: Cervical Cancer Policy, Department of Health South Africa (2017)
05. Scaling Primary Healthcare
The next chapter is partnerships that multiply capability. The Africa Higher Education Health Collaborative is a clear example: universities, health institutions and community organisations aligned around practical workforce development.
The goal of equipping 30,000 skilled practitioners and community health workers signals something important.
The future will be built by people, trained and supported, working inside a system that respects their time and extends their reach. That is how community wellness becomes durable, not seasonal.
Source: The Africa Higher Education Health Collaborative (2024)
