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Conversation highlights:
Private hospitals have evolved into a cornerstone of the South African healthcare system, investing massively in world-class infrastructure, technology, and human resources over the past two decades.
Local collaboration between public and private sectors is already happening naturally on the ground, driven by healthcare workers' desire to serve patients, but it needs to be formalized and scaled up systematically.
The Hospital Association of South Africa is actively pursuing formal conversations with the government to identify immediate gaps where private hospitals can contribute their expertise and capacity.
The organization envisions starting with small, needs-based collaborations in areas like oncology before moving toward greater system integration through formal agreements and contracts.
Future hospital design will be an intuitive process, evolving to meet the changing needs of patients as the healthcare system transitions toward universal coverage.
The primary focus remains on patient-centered reform, with all efforts revolving around meeting the needs of patients and relieving the plight of those who struggle to access quality healthcare.
EF: Looking back over the past decade, what do you consider the greatest achievements of South Africa's healthcare ecosystem, and what should the sector focus on as we approach 2030?
DDB: The evolution of healthcare in South Africa has been fundamentally shaped by our societal needs. We have a large population where the majority faces significant challenges accessing quality healthcare, creating enormous demand for services. This has driven the development of our healthcare system through multiple streams: increasing pressure on the public health system to deliver, growing demand on the private sector to close gaps, and regulatory interventions by authorities trying to solve these problems.
During this period, private hospitals have invested massively in three key areas: infrastructure, technology, and human resources. We've evolved from operating on the periphery 30 to 40 years ago to now having a network with a footprint right across the country. This network delivers world-class services. We know this because people who have experienced healthcare systems around the world tell us so, and our patients confirm it.
These positions place us as a cornerstone in the South African healthcare system. When a cornerstone collapses, the house goes down. We are an essential part of the service delivery platform, not by choice but by necessity, and we need to respond accordingly.
As healthcare workers, our initial instinct and duty is to serve in the interest of the public good. We are promoting and would like to see the attainment of universal healthcare and the expansion of services to populations that still struggle to access care. We believe this is within reach in South Africa, but the wheels are turning too slowly.
Our vision is to serve the broader population to the extent that our capacity allows. We see public healthcare facilities being able to tap into private sector capabilities, and an even greater need for public sector patients to access private sector services.
EF: What are your current agenda priorities, and how are you developing capabilities in technology and administration for 2025?
DDB: We are working within existing channels to connect with policymakers and government so that, together, we can unlock our full potential. We see this collaboration as an important opportunity. Internally, there has been major reinvestment in private hospital infrastructure and systems. As a result, the sector is growing in size and capacity across human resources and technology. These ongoing investments reflect our members’ commitment to long‑term sustainability as part of their business responsibilities.
To better connect the public and private sectors, we would like to establish more formal conversations. We have been working to set up these discussions and believe we are close to meaningfully engaging with the relevant regulators. By including them in the process, we can move beyond a fragmented system, where we serve the private sector, and others serve the public sector.
We see the progress we are making as a practical blueprint for those striving for excellence. Our intention is not to keep these assets and capabilities limited to the private sector. They exist to support the health and well-being of the broader South African population.
EF: What would an ideal model look like that benefits the majority, including both public and private sectors?
DDB: We have to be realistic and start with baby steps. We are reaching out to the government, particularly the arms responsible for service delivery: the provincial Departments of Health. This is an ongoing process. We would like to coordinate with them on what their immediate needs and gaps are, and where we can contribute. The starting point that will establish and cement our working relationship is needs-based collaboration. For example, if the government says they have a problem in oncology and asks what expertise and capacity we have as private hospitals to help fill that gap. And, because we're looking to make this a systemic way of doing things, it has to start with formal interactions that lead to collaboration.
We want to start small, look at the needs, and see how we can close gaps working together with the public sector. The long-term goal would be greater integration, where private hospitals could see public sector patients through formal agreements and contracts embedded into our system as the standard way of working.
Given South Africa's diversity, something like this would be used more in certain parts of the country than others because of geographical differences. The idea is to start small with things we can manage easily and grow from there.
EF: With massive investments in infrastructure, technology, and human resources, what do you think the hospital of the future will look like?
DDB: The hospital of the future will be determined by the interactions I've described. It will be hospitals that are responsive to the needs at that time, and as needs evolve, the design and offering will also evolve.
The current offering and design of private hospitals are dictated by current needs imposed by the current system. As our vision expands our reach into the broader population and ensures universal health coverage, there will be changes needed in hospital design and clinical care offerings.
We don't look at what we see now as permanent. The look and design of future hospitals is an intuitive process of responding to need as needs change. We are sensitive to and looking seriously at what is happening within the system to support those needs and respond accordingly.
EF: What achievement would make you raise your glass in celebration by the end of this year?
DDB: For many years, we’ve been working toward a key milestone: sitting together with our counterparts to clearly map out what needs to happen as soon as possible. I’m genuinely optimistic that this will be the year we make real progress. Recent internal conversations have encouraged us to focus, to invest more energy, and to explore new ways of working together. We’ve learned a lot from previous attempts, and we’re using those lessons to approach things with fresh ideas and renewed commitment.
Even if we don’t achieve everything this year, I’m confident we’ll take meaningful, concrete steps forward. Several new internal initiatives are in development, and we’re excited about the potential they have to turn this collaboration into something tangible and lasting.
EF: What message would you like to deliver to our readers regarding healthcare reform in South Africa?
DDB: Our focus is to relieve the plight of the needy patient. All our efforts revolve around meeting patient needs. Even the things I've spoken about, having conversations, the baby steps of looking at clinical service needs, our focus is on what will make a difference in South African healthcare.
Our ability to double up and focus on patient needs is the reform that South Africa really needs, much more than any other reform. The reform that comes from the heart, from us as compassionate healthcare providers, is what we are preoccupied with. We believe that policies and other reforms must be driven from that foundation.
