HOW SOUTH AFRICA CAN STRENGTHEN ITS FIGHT AGAINST DIABETES

AS WE mark World Diabetes Day today, we cannot ignore that South Africa faces a rapidly escalating public health crisis.

- SHIVANI PILLAY and MICHAEL PATHER

EXPERTS say South Africa must reorient primary healthcare towards prevention and community care to tackle the country's growing diabetes crisis. I FILE

Type 2 diabetes has become the country’s second leading cause of death and is spreading within a health system historically designed for short-term, episodic illness rather than the lifelong demands of chronic disease. Without decisive reform, diabetes will continue to erode both the well-being of citizens and the sustainability of public health expenditure.

South Africa’s dual burden of disease, in which noncommunicable diseases (NCDs) now overshadow HIV and tuberculosis, has increased the pressure on an already overstretched primary health care (PHC) system.

In 2018, the direct public-sector costs of diabetes were estimated at R2.7 billion for diagnosed cases and R21.8 billion for undiagnosed ones, with projections suggesting an increase to R35.1 billion by 2030.

Alarmingly, nearly half of this cost is attributed to preventable complications arising from inadequate management of blood sugar levels.

Yet diabetes care across the country remains largely confined to facilities that function reactively rather than preventively. People with diabetes are expected to attend followup appointments during standard working hours, a structural obstacle that undermines adherence to treatment and continuity of care.

Services for chronic disease are often limited to specific clinic days, restricting accessibility even further. Compounding these challenges, Africa’s regional health-worker density averages only 2.9 per 1 000 population which is far below the World Health Organization’s recommended threshold of 13.4. The resulting capacity gap emphasises the urgent need to re-orientate PHC toward integrated, community-responsive, and preventive models of care.