Forum on the Financialisation and Private Investment in Healthcare

At the request of NDOH, as part of the G20 event held in Johannesburg November 2025, the Centre for Health Policy, in partnership with United Nations University International Institute for Global Health (UNU-IIGH) and the Institute for Economic Justice held a workshop on the 10th November 2025 to discuss these issues. International presenters included David McCoy (UNU-IIGH), Ben Hunter (University of Glasgow), Felix Stein (University of Amsterdam), Anna Marriott (Oxfam International), Abhay Shukla (SATHI-CEHAT, India), Lena Lavinas (Federal University of Rio de Janeiro, Brazil) and Ana Carolina Cordilha (University of Rennes2, France). The international presentations covered:

• Trends in increasing private financial investment in health, especially in relation to blended finance initiatives, in LMICs.

• The context of increasing private financial investment in health: the broader process of financialisaton, and the underlying and immediate causes of the public fiscal crisis in many LMICs.

• The universe of blended financing models including: social impact bonds, advanced market commitments, matching funds, and public-private infrastructure investment models.

• Past examples of blended finance and present country case studies of healthcare financialisaton

The South African presenters provided an overview of the concentration of ownership in the South African private health sector (Fatima Hassan) and described a successful social impact bond in the Western Cape (Fareed Abdullah). The discussion noted: a) the lack of capacity in the NDOH to regulate the private sector; b) the effectiveness of SA treasury regulations to prevent public-private partnerships that didn’t clearly benefit the public sector; and c) despite the ambitious plans for NHI, and the numerous current legal challenges to NHI, that there is a need to find a way forward that is aligned with the country’s current capacities.