BACKGROUND:
A qualitative study confirmed the neglected academic and policy narrative on the older population's healthcare in South Africa, let alone sufficient programmes from the country’s national health departments. Whilst some evidence exists on clinical studies focusing on older people, their treatment and care, the public health debate is too silent, considering especially the ethical challenges associated with older people's healthcare.

METHODS:
A mixed-method study was completed, using the Q-methodology to identify what should be part of such a public health ethics framework for the older population. Following the data collection from facilities for older people, eight building blocks were identified for such a framework. Following the development of the framework, the question was whether a value chain approach could be used for implementing this framework. This value chain aims to assess the framework's effectiveness in relation to emerging AI technologies, narratives of vulnerability, and the transfer of skills and knowledge. This value chain was developed in response to increasing distrust towards AI in healthcare, a shortage of skills in evidence-based healthcare, and the widening gap in health data availability.

RESULTS:
The value chain pointed towards fundamental principles and ethics of public health as the basis for application. These principles will identify and address ethical challenges in service delivery for both the providers and recipients of health services. Additionally, it emphasises the importance of ethical leadership and the incorporation of ethics education. Promoting social justice in public health programmes should be based on professional ethics and care ethics. Furthermore, it is essential to develop ethical expertise and practice care ethics effectively.

CONCLUSIONS:
A preliminary evaluation of the value chain indicated a shortage of necessary skills and emphasised the importance of a collaborative approach in practising public ethics rather than a singular focus on it.