A prescription for Gauteng's health: Generics, state pharma and the power of local

Mail & Guardian

04-06-2025

Generic medicine produced locally are the cornerstone of affordable healthcare.
In the heart of Gauteng, where the pulse of South Africa's healthcare system beats loudest, a quiet revolution is overdue. It's not about high-tech hospitals or billion-rand budgets. It's about generics, local pharmaceutical manufacturing and the untapped potential of small businesses. If we're serious about equitable healthcare, we must rethink how we produce, price and provide medicine.
Generics, the unsung heroes
Generic medicines are chemically identical to their branded counterparts but are sold at a fraction of the price. They are the cornerstone of affordable healthcare globally. In South Africa, where the cost of living continues to rise and public hospitals face chronic shortages, generics offer a lifeline.
Yet, despite their proven efficacy, generics remain underutilised and under-promoted. Why? Because the pharmaceutical market is still skewed in favour of brand-name monopolies, often protected by patent extensions and marketing muscle. Meanwhile, patients in Gauteng are forced to choose between paying for transport to clinics and buying essential medication out of pocket.
The single exit price (SEP) policy, introduced to regulate medicine pricing, has helped standardise costs across the private sector. But it has also inadvertently squeezed out smaller players and discouraged innovation. While SEP has made medicines more affordable, it has not addressed the deeper structural issues that limit access — chief among them, our reliance on imported drugs and the lack of local manufacturing capacity.
More than a factory
Imagine a state-owned pharmaceutical company — not as a bureaucratic behemoth, but as a strategic engine for public health. Such an entity could prioritise the production of essential generics, stabilise supply chains, and reduce dependence on imports. It could also serve as a price anchor in a volatile market, ensuring that life-saving drugs remain within reach for all South Africans.
India's model offers a compelling precedent. By allowing local manufacturers to produce generics even when patents exist elsewhere, India has become the world's largest supplier of affordable medicines. South Africa, with its scientific talent and industrial base, could do the same — if we had the political will.
A state pharmaceutical company could also play a critical role in addressing medicine shortages, particularly for antibiotics and chronic disease treatments. These shortages are not just logistical failures — they are symptoms of a system that prioritises profit over public health. A state-led approach could ensure that essential medicines are always available, especially in underserved areas.
The missing link in local pharma
Gauteng is home to a vibrant ecosystem of small and medium-sized enterprises (SMEs), many of which are eager to enter the pharmaceutical space. But they face steep barriers: regulatory red tape, lack of financing and an uneven playing field dominated by multinational giants. Supporting these SMEs isn't just good economics — it's smart health policy. Local businesses can respond faster to regional needs, create jobs and build resilient supply chains. With targeted incentives, training and procurement support, these enterprises could become the backbone of a home-grown pharmaceutical sector.
Moreover, SMEs are often more agile and innovative than their larger counterparts. They are well-positioned to develop niche products, explore green manufacturing practices and collaborate with academic institutions on research and development. But without access to capital and streamlined regulatory pathways, their potential remains untapped.
South Africa imports the vast majority of its active pharmaceutical ingredients, making us vulnerable to global supply chain disruptions. The Covid-19 pandemic exposed this fragility in stark terms. Delays in vaccine procurement, shortages of basic medicines and inflated prices were all consequences of our overreliance on foreign suppliers. Local production is not just about economic sovereignty — it's about health security.
By investing in domestic manufacturing, we can ensure a steady supply of essential medicines, reduce costs and create high-skilled jobs. Gauteng, with its industrial infrastructure and access to research institutions, is the ideal hub for such an initiative.
But local production must be accompanied by regulatory reform. The South African Health Products Regulatory Authority must streamline its approval processes and provide clear guidance for new entrants. Delays in drug registration not only stifle innovation — they cost lives. We need a three-pronged strategy: normalise generics through public education, prescriber incentives and regulatory support. Patients must be empowered to ask for generics and healthcare providers must be incentivised to prescribe them.
Establish a state pharmaceutical entity focused on essential medicines and public health priorities. This entity should operate transparently, with clear mandates and measurable outcomes. Empower local businesses with access to capital, streamlined licensing and inclusion in public procurement. Government tenders should prioritise local manufacturers, especially those producing high-demand generics.
Additionally, we must invest in skills development. Young South Africans should be trained in pharmaceutical sciences, regulatory affairs and supply-chain management. A thriving local industry requires not just factories, but a skilled workforce to run them.
The bigger picture
The pharmaceutical industry is not just about pills and patents — it's about power. Who controls the supply of medicine controls the health of a nation. For too long, that power has rested in the hands of a few multinational corporations. It's time to reclaim it.
The Covid-19 pandemic taught us that health is a public good, not a private commodity. It also taught us that resilience comes from within. By embracing generics, supporting local businesses and establishing a state pharmaceutical company, we can build a healthcare system that is not only more affordable but more just. It's time to stop importing solutions and start manufacturing them.
Fentse Maseko works for the pharmacy and pharmacology department at the University of Witwatersrand and is a PhD applicant.