Easing competition regulations as a response to the COVID-19 pandemic in South Africa - mobilising a collective health service response
1
Global Health, Stellenbosch University, Cape Town, South Africa
2
Walter Sisulu University, Mthatha, South Africa
3
School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
4
School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
In May 2025, the Seventy-eighth World Health Assembly adopted a new agreement on pandemic prevention, preparedness, and response, reaffirming global commitment to coordinated action during health emergencies. There were calls for the development of coordination mechanisms in competitive healthcare markets across high-, middle-, and low-income countries. However, there is limited evidence to guide such efforts. This presentation describes how the easing of competition regulations in South Africa, through the implementation of a block exemption during the COVID-19 pandemic, facilitated collaboration between the public and private healthcare sectors.
METHODS:
Using purposive sampling, we conducted 20 in-depth interviews with key stakeholders from the public and private health sector, the intended recipients of the exemption.
RESULTS:
The pandemic forced, and the block exemption enabled, unprecedented collaboration between national and provincial health departments, national laboratory services, private hospital groups, corporate private laboratories, medical schemes and administrators, private practitioners, and small and corporate pharmacies. Key features facilitating this collective response were pre-existing relationships and forums between public and private sectors. This facilitated effective cooperation without having to build trust from scratch during a crisis. While many actors expressed a positive attitude toward these interactions, they also revealed underlying structural tensions and operational mismatches between the two sectors. Interviewees appreciated the role of a functional regulator that was proactive and responsive.
CONCLUSIONS:
Overall, our findings suggest that pre-existing systems, relationships, and forums that function routinely before emergencies occur play a critical role in promoting operational readiness during crises. We identified the enablers of coordination, long-standing relationships, interoperability between public and private systems, and easing competition regulation. Well-functioning respected regulators play an important role. Developing and maintaining relationships, interoperable systems and good regulators are the investments that can and should be made now to advance preparedness and achieve integrated responses in future public health emergencies.
In May 2025, the Seventy-eighth World Health Assembly adopted a new agreement on pandemic prevention, preparedness, and response, reaffirming global commitment to coordinated action during health emergencies. There were calls for the development of coordination mechanisms in competitive healthcare markets across high-, middle-, and low-income countries. However, there is limited evidence to guide such efforts. This presentation describes how the easing of competition regulations in South Africa, through the implementation of a block exemption during the COVID-19 pandemic, facilitated collaboration between the public and private healthcare sectors.
METHODS:
Using purposive sampling, we conducted 20 in-depth interviews with key stakeholders from the public and private health sector, the intended recipients of the exemption.
RESULTS:
The pandemic forced, and the block exemption enabled, unprecedented collaboration between national and provincial health departments, national laboratory services, private hospital groups, corporate private laboratories, medical schemes and administrators, private practitioners, and small and corporate pharmacies. Key features facilitating this collective response were pre-existing relationships and forums between public and private sectors. This facilitated effective cooperation without having to build trust from scratch during a crisis. While many actors expressed a positive attitude toward these interactions, they also revealed underlying structural tensions and operational mismatches between the two sectors. Interviewees appreciated the role of a functional regulator that was proactive and responsive.
CONCLUSIONS:
Overall, our findings suggest that pre-existing systems, relationships, and forums that function routinely before emergencies occur play a critical role in promoting operational readiness during crises. We identified the enablers of coordination, long-standing relationships, interoperability between public and private systems, and easing competition regulation. Well-functioning respected regulators play an important role. Developing and maintaining relationships, interoperable systems and good regulators are the investments that can and should be made now to advance preparedness and achieve integrated responses in future public health emergencies.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
