As South Africa navigates the complexities of medicine access, ranging from regulatory delays and affordability to supply chain disruptions and governance, there is growing consensus that sustainable improvement requires system-wide coordination. This final article in the series outlines key strategic recommendations to advance equitable, affordable, and reliable access to medicines across both public and private sectors.
A national strategy for medicine access must prioritise equity and efficiency, ensuring that patients receive the medicines they need regardless of geography, income, or institutional affiliation. This requires refining the use of the National Essential Medicines List (EML), aligning Standard Treatment Guidelines (STGs), and modernising procurement frameworks to ensure consistent availability across the continuum of care.
To support timely access, the regulatory system must continue expanding its efficiency without compromising the quality of medicine assessments. While SAHPRA has made progress in reducing historical backlogs, further acceleration is necessary, especially for essential generics and biosimilars. Implementing full reliance models, streamlining review processes based on medicine classification, and integrating digital workflow tools can expedite approvals for critical medicines. Transparency around review timelines and regulatory decisions will also help build trust with stakeholders and strengthen industry participation.
Stabilising the supply chain will require coordinated investment in governance systems and digital integration. Strengthening tools such as RxSolution and the Stock Visibility System (SVS), combined with consistent deployment across provinces, can support real-time stock tracking and proactive redistribution. Accurate data and interprovincial coordination will help prevent both overstocking and shortages. To further reduce inefficiencies, supplier contract enforcement and regular performance audits should be standardised across the public system.
The success of these reforms also depends on investing in South Africa’s health workforce and institutional capacity. Trained professionals, including pharmacists, supply chain managers, and regulatory officers, play a vital role in ensuring medicine access. Workforce development should target gaps in rural and underserved areas while integrating continuous training programmes. Strengthening governance structures at facility, provincial, and national levels will improve accountability and service delivery.
A more resilient medicine access ecosystem also requires bolstering local pharmaceutical manufacturing. Reducing import reliance will not only enhance supply security but also support local industry development. Policies that offer tax incentives, prioritise domestic production in public procurement, and streamline regulatory processes for locally manufactured medicines can help promote a thriving local pharmaceutical sector.
Public-private collaboration will be essential to realising these objectives. By leveraging private sector capacity in logistics, manufacturing, and patient engagement, shared procurement systems, co-developed distribution models, and unified education initiatives can drive efficiencies and improve uptake of cost-effective medicines especially in the case of generics and biosimilars.
South Africa’s journey toward universal, affordable access to medicines is not without challenges. However, the tools and frameworks needed to overcome them already exist. By strengthening the alignment of health, industrial, and regulatory strategies, and fostering collaboration across public and private actors, the country can begin to close long-standing equity gaps in medicine access.
This article concludes a series that examined the structural challenges and strategic opportunities across the healthcare landscape. The road ahead requires more than policy; it demands coordinated implementation. If met with sustained commitment, South Africa can ensure that safe, effective, and affordable medicines are not a privilege for some, but a right for all.