From Demand to Local Supply: Mapping South Africa’s Medical Technologies Market

Commissioned by the LSF and prepared by HealthValue Consulting and IQVIA, the South African Medical Technologies Demand Mapping Study maps demand for medical technologies across South Africa’s health system and assesses where local manufacturing can realistically supply more of it. The analysis draws on SARS trade data, Statistics South Africa’s national accounts, National Treasury’s BAS and LOGIS procurement records, transversal contracts, and NHLS and Council for Medical Schemes annual reports, validated through key informant interviews, industry validation sessions and a supplier survey distributed through the sector’s industry associations.

A Growing Market Met Largely by Imports

South Africa is the largest MedTech market on the African continent, and demand continues to rise, driven by population growth, urbanisation, a rising burden of disease and the expansion of health services. Between 2021 and 2022, total supply of medical appliances grew by around 18% to R67.5 billion, while domestic production held broadly flat at R12.9 billion. The import share of supply rose from 78.1% to 80.8% – four in every five medical appliances in the local market are now imported. Between 2021 and 2025, South Africa imported approximately R155 billion worth of medical technologies, with surgical and medical instruments the largest category. Advanced imaging, implantable and diagnostic technologies are sourced largely from the United States and Europe, while China leads in many lower-complexity consumables, rehabilitation products and dressings.

Where Public Demand Sits

Public-sector MedTech procurement recorded in National Treasury’s BAS system totalled approximately R50.3 billion between 2021 and 2025. Demand is concentrated: Gauteng, the Western Cape and KwaZulu-Natal account for two-thirds of spend, and ten product categories account for close to nine-tenths of it. Item-level LOGIS procurement data shows that growth is not confined to complex technologies – assistive and rehabilitation products, dressings, respiratory accessories, infection prevention and control products, medical furniture and everyday consumables all show sustained and growing demand. Public spend on medical furniture, respiratory accessories, dressings and sutures grew by between 81% and 100% a year from FY2022/23 to FY2025/26.

Diagnostics: A Distinct, Platform-Driven Market

Public-sector diagnostic testing is provided by the National Health Laboratory Service (NHLS), whose activity is concentrated in Gauteng and KwaZulu-Natal. Its highest-volume tests have remained stable over recent years – routine chemistry and haematology, alongside HIV viral load and TB molecular testing. In the private sector, medical schemes paid R15.4 billion in pathology benefits in 2024, up 10.3% on 2023 and driven largely by chronic disease monitoring. Yet fewer than half of insured patients with diabetes receive guideline-recommended monitoring, pointing to further unmet demand. National testing programmes run on platforms and reagents from a small number of multinational manufacturers, and local IVD manufacturing is limited to a few firms producing rapid tests and molecular reagents.

Local Capability Exists – and Has Room to Grow

South Africa’s MedTech manufacturing base is led by small and medium enterprises, concentrated in lower-complexity, high-volume products, and clustered in the Western Cape and Gauteng. It is also mature: nearly three-quarters of the full local manufacturers surveyed have operated in South Africa for more than 20 years, and they already export close to a third of their output. Nearly half of the local product lines surveyed run at or below half of installed capacity, pointing to room to supply more without major new investment. In some categories, local manufacture already competes on cost – standard ward furniture made locally is cheaper than the imported equivalent in most directly comparable items and is delivered faster. These survey findings are directional, based on 27 responses, and were triangulated with procurement and trade data.

What Holds Local Supply Back

Manufacturers identify high input costs and regulatory burden as their leading constraints, followed by skills gaps and access to finance. Most rate the public sector as the hardest customer to serve, citing payment timelines and lengthy tender processes. Public demand is spread across national, provincial and facility-level systems with limited forward visibility, tenders are predominantly price-weighted, and the absence of local testing and certification facilities pushes firms to offshore laboratories. Manufacturers were clear that they are not asking for protection, but for a predictable environment that justifies investment in equipment, quality systems and people. The study also finds that procurement, expenditure and utilisation data sit in separate systems, without a common product classification or consistent volume and price data, which limits visibility of national demand.

Where Localisation Is Realistic

The study prioritises categories only where demand, import dependence, local capability, a feasible regulatory pathway and stakeholder support converge. It sets out five complementary pathways:

• Consolidate and scale: established local manufacture in sutures, wheelchairs and assistive devices, gloves, sterilisation wraps and bags, mechanical hospital furniture and intravenous administration sets, where demand certainty rather than new capacity is the binding need.

• Deepen partially localised categories: combine technology partnerships with regulatory capability building in categories such as advanced wound care and drainage and tubing products.

• Support backward integration: help established importers and distributors move into labelling, assembly and manufacture – with respiratory accessories, selected syringes, crutches and walking frames, and infusion accessories the clearest cases.

• Localise assembly, servicing and refurbishment: for advanced imaging, laboratory and medical equipment, where full manufacture is not realistic but in-country service capability can capture value across long equipment lifecycles.

• Build rapid diagnostic test manufacture: as the most viable near-term in vitro diagnostics opportunity, sequenced by regulatory risk class, with malaria tests the primary objective and a secure antibody supply a precondition.

  
  

Recommendations

The study recommends coordinated action across five areas, aligned with the Medical Technology Master Plan:

• Procurement and demand signalling: aggregate and forecast demand for high-volume consumables, use framework and multi-year agreements with review points, apply local content preference selectively where competitive local capability exists, and extend health technology assessment beyond medicines to medical devices and diagnostics.

• Regulatory and certification support: make the pathway more predictable through clear guidance, early engagement and defined timelines, and pool testing, validation and certification capacity.

• Capability, skills and finance: align skills development to demand-mapped categories, support incremental upgrading of quality systems, and provide dedicated manufacturing and commercialisation finance.

• Data, coordination and governance: establish a unified MedTech market intelligence framework linking procurement, utilisation, regulatory and supplier data, encourage voluntary private-sector data sharing, and clarify institutional interfaces through a coordinated MedTech programme.

• Market access and investment: develop collaborative supplier programmes and voluntary pilot procurement models and build scale through regional value chains under the AfCFTA and SADC.

Localisation here is not an end, nor a trade-off against quality or value for money. Applied selectively and in partnership, it can strengthen health-system resilience, deepen South Africa’s industrial base and create jobs – building on capability the country already has.

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