Creating the future of medical technology in South Africa

In celebration of World Creativity and Innovation Day on 21 April, I want to begin this piece with something many South Africans experience: the nurse reaches for a blood pressure cuff that does not work. The patient is told to return next week because the X-ray machine is down. The district hospital that received an imported or donated device that no staff member can maintain now has it sitting in a storeroom.

These are not isolated incidents or unfortunate exceptions. They are recurring patterns — symptoms of a health system that spends billions on technologies it cannot effectively use, sustain or replace, most of which are designed and manufactured elsewhere.

Medical technology encompasses any device, instrument or tool used to prevent, diagnose, monitor or treat illness — ranging from the most basic, such as a thermometer, bandage or blood pressure cuff, to highly sophisticated equipment such as MRI scanners, robotic surgical systems and AI-powered diagnostic platforms. South Africa’s medical technology landscape is characterised by deep structural dependence and systemic inefficiencies. The sector remains heavily import dependent. Valued at an estimated R21–29 billion in 2021, the sector relies on imports for about 90% of its products, with the government as the primary purchaser. This dependence is mirrored across most low- and middle-income countries (LMICs), where up to 95% of medical equipment is imported and largely financed by international donors.

However, this model delivers limited value: the World Health Organisation estimates that 50–80% of medical equipment in under-resourced health systems is non-functional at any given time. More specifically, between 40% and 70% of donated equipment remains unused because of poor contextual fit, inadequate planning, insufficient training and a lack of maintenance capacity — effectively creating “medical device graveyards”.

In our Innovation Systems research programme in the Department of Industrial Engineering at Stellenbosch University, two recent PhD graduates, Dr Maureen Etuket and Dr Tinashe Chikunichawa, have examined in depth why a system with genuine technical capability consistently fails to translate that capability into solutions that reach patients at scale. Their work shows that innovators run into the same walls again and again, regardless of how good their technology is or how hard they work.

Start with the first wall: money that arrives at the wrong time. The problem is not that South Africa does not fund innovation, but that funding does not follow the journey of a device. As Etuket’s 90-stakeholder survey shows, resource mobilisation is both the most important function and the weakest. Funding appears early, disappears when risk increases and returns only once that risk has already been reduced. The result is predictable: devices stall exactly when they need to move from prototype to validation and scale. The issue is not necessarily the amount of funding, but its structure. What is needed are mission-driven pathways that carry technologies from early development through to first procurement.

The second wall — the regulatory maze — points to a different kind of failure. Rules are not the problem; navigability is. The evidence shows how firms reach critical points — certification, export readiness and compliance — and find no clear path forward. Small, local innovators are expected to meet complex requirements without structured guidance, often realising what is required too late. Government stakeholders recognise this as a priority, yet it remains one of the weakest-performing areas. The need is not deregulation but support: regulatory guidance that helps innovators navigate the system in real time.

The third wall — building the wrong thing — is perhaps the most revealing. Devices miss the mark not through carelessness, but because the system does not reliably connect developers to real clinical and procurement needs for the public sector. This is not a design failure, but a system failure. It is reinforced by how technologies reach the market. For most South African health technology ventures, the path runs through the private sector first — not by choice, but by necessity.

Public procurement is slow, risk-averse and not designed for unproven innovations. Developers are therefore forced to test and refine their products in well-resourced private settings, shaped by different cost structures and patient profiles. The detour is long, and many do not survive it. Those that do often emerge with products calibrated for a very different system from the one they were originally intended to serve. The implication is clear: demand is not visible early enough. Until developers are connected directly to public-sector needs — from clinicians to procurement — South Africa will continue to produce technologies that work, but not where they are most needed.

The fourth wall is the instability of teams. Building a medical device takes years, but the system rarely sustains people long enough to finish. Intermittent funding and uncertainty repeatedly drive talent away at critical moments. This is not a reflection of individual commitment. It reflects the system’s design.

Running through all of this is the missing voice of Health Technology Assessment (HTA). HTA asks the questions procurement will ultimately demand — does it work, for whom, at what cost and compared with what. But for medical devices in South Africa, these questions are asked too late. Innovators generate the wrong evidence, or no evidence at all, and technologies reach procurement without the data needed for adoption. The solution is to embed HTA capacity at the beginning — within universities, incubators and innovation programmes — so that evidence generation becomes part of design.

Taken together, these insights point to a set of interventions that are less about adding new elements and more about fixing how the existing ones connect. Close the demand gap by making clinical need, procurement criteria and system priorities visible from the start. Embed HTA early so that innovators build towards the evidence that the system will require. Create funding pathways that match the lifecycle of a device, not the administrative cycles of grants. Establish navigable regulatory support so that compliance becomes a process, not a barrier. And open a public-sector entry pathway — through pilots, conditional procurement and structured testing environments — so that local technologies have a place to prove themselves.

None of this is radical. All of it is already visible, in fragments, within the system. The difference is whether those fragments are connected. What is required now is the will to invest in innovation infrastructure, because the cost of not doing so is paid every day by the patients waiting for equipment that does not work and the clinicians who cannot treat them because their hands are tied.

Sara Grobbelaar is a professor in the Department of Industrial Engineering at Stellenbosch University.