By Katusha de Villiers and Gillian Vedan, University of Cape Town 

There are millions of wheelchairs in South Africa. Yet for years, there has been no dedicated, accessible system for servicing and repairing them at scale. Until now. It is all because of township innovator Zacharia Mashishi and his start-up, Chief Ralekhudu Enterprises. The business not only repairs and services wheelchairs and other medical devices, but also trains people with disabilities to do the work, helping them set up businesses in their own communities. 

This is exactly what social innovation and entrepreneurship can do in a complex and struggling healthcare environment: solve practical problems in ways that strengthen communities and create economic value. But it also illustrates a hard truth. For every Mashishi who breaks through, many more innovations fail. Not because they are poorly conceived, but because the system they must access is fragmented, under-resourced, and difficult to navigate.

A few outliers bring a glimmer of hope

South Africa’s health innovation ecosystem presents a fascinating paradox: despite world-class collaboration and expertise and clear capacity for sophisticated networking, it remains largely disconnected and uncoordinated at a national, systemic level. This duality represents both the ecosystem’s greatest strength and its most important opportunity.

The most visible strengths lie in formal, project-based networks. Partnerships are a defining feature, often involving anchor institutions such as the South African Medical Research Council (SAMRC), leading universities, public hospitals, and renowned international research bodies like the US National Institutes of Health (NIH) and the HIV Prevention Trials Network (HPTN).

Other examples of highly effective, top-level partnerships include the private-public sector Strategic Health Innovation Partnerships (SHIP) that helped put South Africa on the global stage by facilitating participation in international health networks.

SA innovators need more

Despite the growing number of accelerators and platforms, finance and funding are still out of reach for most health innovators. Our research into social innovation in the South African health ecosystem revealed the extent to which bias and discrimination are evident in the allocation of funding for SMMEs. Ninety per cent of successful SMMEs in the country are white-owned. Black entrepreneurs struggle with limited access to external finance and face bureaucratic barriers when applying for funding through Broad-Based Black Economic Empowerment (B-BBEE) channels – mostly because they are then competing with white-owned ventures.

Too many social entrepreneurs work alone and without access to procurement pathways or early finance. Many rely on social and informal connections, which creates a strong foundation of trust among those already connected, but can unintentionally make it harder for newcomers, especially those from marginalised areas such as townships, to gain entry. The importance of building relationships, connections and networks in the public sector is illustrated by the example of project managers who wait years for approvals from the right government decision-makers to gain signatures and sign-offs to secure programme development. As a result, many successful pilot programmes never make it into long-term projects.

A need for blended and innovative finance models

Despite strong policy ambitions, implementation remains uneven.

Mashishi’s story is a case in point. Even a brilliant entrepreneur with a high-impact innovation would have been unlikely to succeed without catalytic early support. After winning the UCT GSB’s Bertha Centre for Social Innovation and Entrepreneurship’s Healthy Futures South Africa incubator programme in 2025, he secured R500 000 in seed funding. 

This allowed him to scale from servicing seven to ten broken wheelchairs at Baragwanath Hospital into a model with national potential. He is now developing a training programme for people with disabilities who want to set up mobile wheelchair repair services on their own.

The health innovation space is too disconnected

South Africa’s health innovation ecosystem is too disconnected and uncoordinated. Partnerships like SHIP are game changers – not because they remove all barriers, but because they demonstrate what coordinated brokering can achieve. There is a need to address systemic bottlenecks at the national level caused by the regulatory environment and bureaucracy, but without compromising on quality control and necessary checks and controls.

South African innovators are out there, working away at solutions intended to help millions of South Africans. But they need more help to help them over the finishing line.

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Katusha de Villiers and Gillian Vedan are Senior Project Managers at the UCT GSB’s Bertha Centre for Social Innovation and Entrepreneurship. They are co-authors of the Social Innovation in the South African Health Ecosystem Report, with Amy Benn (RIIS), Mila Cook (RIIS), Eivor Ulateig Halle (Bertha Centre for Social Innovation and Entrepreneurship), Alana Kruger (Innovate UK Global Alliance Africa), Alexandra Lugagne (RIIS), Mukhethwa Malindi (RIIS) and  Nicola Redelinghuys (Innovate UK Global Alliance Africa). Download the Social Innovation in the South African Health Ecosystem Report here.

The views and opinions expressed in this opinion piece are those of the author, who is not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.