South Africa
A large NGO hospice sector followed by a national policy to integrate palliative care into public services, which tests whether NGO-led growth can stand in for legal and public-system change.
9 domains reviewed · 9 high-confidence · 3 dated estimates · 9 material gaps
WHO region: Africa. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 11
- Sources behind this dossier
- 21
- Newest source 2026
Lessons from South Africa
- A strong NGO hospice sector did not remove the need for public integration or legal change: NGOs could not meet national need, and a 1984 schedule rule still keeps morphine out of nurses' hands. NGO services are a base for public integration, not a substitute.130,132
- A national policy that asked for integration using existing resources produced partial integration. A policy should come with a budget line.130
- A hospital palliative unit on a single foundation grant collapsed once before. Donor-funded units need a transition path onto the public budget.131
- Paying NGOs per bed-day from the provincial budget is a concrete public-NGO contract other subnational governments could copy.130
- A national hospice network run by charities can reach about twenty thousand patients a month, but without government income it depends on fundraising and stays unevenly distributed.296,297
- Home-based care programs that rely on unpaid community caregivers can concentrate burden on poor women unless gender is considered in program planning.435
- Funeral costs are large enough to shape poor households' saving and insurance, so end-of-life financial support in South Africa should account for them.437,438
- A publicly funded, community-based program can deliver opioid substitution therapy within wider harm reduction services, and keeping it affordable and simple to navigate helps people stay in treatment.615,616
Palliative care
Is morphine available in South Africa?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 28 mg per personSOURCE-CHECKED · 2020 DATA
Morphine consumption, South Africa, 2020130
Last checked 2026-09-24.
As cited by the source from the Walther Center; the UK figure given is 55 mg. The source reports a fourfold rise from 2018, not checked against INCB data here.
Cite this figure:
Consumption rose after the 2017 policy but remained well below high-income levels, and NGOs could not meet national need.130
What is consumption on an INCB-verified basis, and how much morphine is produced locally?
Help answer it:Search PubMedHow does South Africa regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
A 2017 national policy framework mandates integration of palliative care into public services, using existing resources rather than new funding, and implementation varies by province.130,132
Has the regulator issued the process for authorising nurses to prescribe Schedule 5 and 6 medicines?
Help answer it:Search PubMedWho can prescribe morphine in South Africa?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Nurses may hold a permit to prescribe, but a 1984 regulation still in force limits them to lower schedules, excluding morphine. The nursing council has not authorised Schedule 5 or 6 prescribing.132
How many nurses hold prescribing permits, and has the schedule limit been lifted?
Help answer it:Search PubMedHow does palliative care reach patients in South Africa?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 594 bedsSOURCE-CHECKED · 2021 DATA
NGO intermediate care beds funded by the provincial department, Cape Metro, South Africa, 2021130
Last checked 2026-09-24.
564 in 2019.
Cite this figure:
Care grew through NGO hospices under a national association founded in 1987. The 2017 policy moved integration into public primary care and hospitals, achieved partially in the Cape Metro through provincially funded NGO beds and multidisciplinary teams.133,130,131
How many NGO hospices and public palliative units operate nationally, and where?
Help answer it:Search PubMedWho pays for palliative care in South Africa?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Funding mixes NGO fundraising, donor grants and limited government lines. A major academic hospital's palliative unit runs on a foundation grant with no provincial budget, after an earlier project collapsed when donor funds ran out. The Western Cape funds NGO beds per bed-day.131,130
What has donor withdrawal done to hospice services nationally?
Help answer it:Search PubMedHow are palliative care clinicians trained in South Africa?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
- 2.90 percentSOURCE-CHECKED · 2021 DATA
District health professionals trained in palliative care, Cape Metro, South Africa, 2021130
Last checked 2026-09-24.
621 of 21,382, up from 1.5 percent in 2019.
Cite this figure:
Implementation scaled a forty-hour introductory course across nurses, doctors, social workers and community health workers, building on hospice association training with the University of Cape Town.130,133
How many hold the University of Cape Town postgraduate diploma or MPhil, and is palliative medicine a registered subspecialty?
Help answer it:Search PubMedHow does South Africa prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Tshwane's Community Oriented Substance Use Programme, the first publicly funded community-based harm reduction program, provided counseling and opioid substitution therapy to 1513 adults at 17 sites. Service users named therapy costs and program bureaucracy as reasons for dropping out. In Cape Metro, morphine use rose in some sub-districts after the national palliative care policy was implemented, though integration stayed uneven.615,616,130
Is naloxone available in the community in South Africa, and does a prescription monitoring system cover scheduled opioids?
Help answer it:Search PubMedHow do children get palliative care in South Africa?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
A UNICEF and ICPCN assessment estimated that less than 5% of children needing palliative care in South Africa received it, with fear of opioid use among the barriers. Families of children with cancer at one Bloemfontein hospital reported erratic psychosocial support and no support for siblings.620,621
What is pediatric palliative care coverage since the 2017 national policy, and are oral morphine formulations for children stocked in primary care?
Help answer it:Search PubMedHospice care in South Africa
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in South Africa?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
South African hospices are mainly non-profit NGOs that provide inpatient, day care and home-based care. St Luke's Combined Hospices in Cape Town was founded in 1980, and hospices formed the Hospice Palliative Care Association as a national body in 1987. The national association has 104 member organisations, and not all of them call themselves hospices.295,296,297,133
Who can get hospice care in South Africa?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
The national hospice association says member hospices serve people of any age with a life-limiting condition. Patients at one Cape Town hospice described initial reluctance to be linked to hospice because they associated it with death and dying.133,296
Do South African hospices apply prognosis limits or referral requirements, and how late in illness are patients admitted?
Help answer it:Search PubMedWho pays for hospice care in South Africa?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
About 150 hospices are funded mainly by the charitable sector with no income from government, and member organisations depend largely on donor funding to offer a mostly free service. As of 2021, the government had not committed to publicly funded palliative care services.296,297,298,101
How many people reach hospice in South Africa?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
Hospice association members projected about 20,078 patients cared for each month nationally, based on a survey in which 40 of 96 organisations responded. The authors describe a maldistribution of hospices linked to apartheid, with about 33% of the population in rural areas.297
What share of deaths in South Africa involve hospice care, and how does use differ for rural, Black and non-cancer patients?
Help answer it:Search PubMedWhat fills the gap in South Africa
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
In two semi-rural communities, HIV home-based care fell mainly on poor, unemployed and unmarried women who were also homemakers and breadwinners. Men were largely absent, and caregivers faced physical strain, emotional problems and elevated HIV and TB risk.435
Subnational evidence- Community health workers and home-based care
A small study of male caregivers from a hospice and three home-based care organisations in rural KwaZulu-Natal found they provided gender-appropriate care to male patients. Some female patients were wary of male caregivers.436
Subnational evidence- Traditional and complementary healers
Palliative care nurses and home-based care workers in rural South Africa reported that patients valued traditional rituals around illness, dying, death and bereavement. They suggested training traditional healers in palliative care, while noting healers could foster a false sense of longevity.434
- Charity, religious giving and mutual aid
In a KwaZulu-Natal surveillance area, households spent on average the equivalent of a year's income on an adult's funeral, and about as many households borrowed for the funeral as had insurance. Financial diaries from 181 poor households showed nearly all held funeral insurance, yet 61% were underinsured.437,438
Subnational evidence
Sources cited here
- 130Arendse JO, Zweigenthal V, Gwyther L.
Integration of palliative care into South Africa's health system: a before and after implementation study. Health SA Gesondheid 2026;31:3242. DOI 10.4102/hsag.v31i0.3242. Implementation of the 2017 National Policy Framework and Strategy for Palliative Care in the Cape Metro District, 2019 against 2021: training of district health professionals, NGO intermediate care beds funded by the provincial department, referrals; cites national morphine consumption and access figures from secondary sources. Full text read.
- 132Crowley T, Gray AL, Geyer N.
Nurse prescribing and dispensing in South Africa: gaps in the current legislative framework. Health SA Gesondheid 2024;29:2582. DOI 10.4102/hsag.v29i0.2582. Section 56 of the Nursing Act and section 22A of the Medicines Act; a 1984 regulation still in force limits nurse prescribing to Schedules 0 to 4, excluding Schedules 5 and 6, which include morphine. Full text read.
- 133Drenth C, Sithole Z, Pudule E, Wust S, GunnClark N, Gwyther L.
Palliative care in South Africa. Journal of Pain and Symptom Management 2018;55(2S):S170-S177. DOI 10.1016/j.jpainsymman.2017.04.024. Abstract read. The Hospice Palliative Care Association of South Africa, founded in 1987, and its mentorship of accredited hospice services.
- 131Pilime S, Ratshikana M, Ojifinni O, Ibisomi L.
Barriers to and enablers of availability and integration of palliative care into routine services at Charlotte Maxeke Johannesburg Academic Hospital, South Africa. BMC Palliative Care 2025;24(1):155. DOI 10.1186/s12904-025-01778-3. The hospital's palliative unit runs on a foundation grant with no provincial or hospital budget line, and an earlier project collapsed through over-reliance on donors. Full text read.
- 615Scheibe A, Shelly S, Hugo J, et al.
Harm reduction in practice - The Community Oriented Substance Use Programme in Tshwane. Afr J Prim Health Care Fam Med 2020;12(1):e1-e6. Program description of the Community Oriented Substance Use Programme in Tshwane from 2016 to 2019; written by the implementing university team, so self-evaluation. Abstract read.
- 616Goeieman DS, Nonyane DS, Nzaumvila DK, et al.
Retention of service users on opioid substitution therapy in the City of Tshwane, South Africa. Afr J Prim Health Care Fam Med 2023;15(1):e1-e10. Qualitative focus groups with 19 male service users who interrupted opioid substitution therapy at COSUP sites; single-city scope. Abstract read.
- 617Streid J, Harding R, Agupio G, et al.
Stressors and resources of caregivers of patients with incurable progressive illness in sub-Saharan Africa. Qual Health Res 2014;24(3):317-28. Qualitative interviews with 37 family caregivers in South Africa and Uganda on stressors and resources; findings are not split by country. Abstract read.
- 618Inderlall R, Naidoo P.
Role of pharmacists in the provision of palliative care services and support in South Africa. Int J Pharm Pract 2021;29(2):157-163. Cross-sectional survey of 263 community and hospital pharmacists on palliative care roles, including bereavement counseling; self-reported, KwaZulu-Natal authors. Abstract read.
- 619Arendse JO, Zweigenthal V, Gwyther L.
Operationalising palliative care integration: Experiences of implementers in South Africa. Afr J Prim Health Care Fam Med 2026;18(1):e1-e12. Qualitative study of 29 implementers and managers at five primary care facilities in Cape Metro; variable confidence in psychosocial support; single district. Abstract read.
- 620Connor S, Sisimayi C, Downing J, et al.
Assessment of the need for palliative care for children in South Africa. Int J Palliat Nurs 2014;20(3):130-4. UNICEF and ICPCN mixed-methods needs assessment; estimates under 5% of children needing palliative care received it; ICPCN is an advocacy network. Abstract read.
- 621Plessis J, Stones D, Meiring M.
Family experiences of oncological palliative and supportive care in children: can we do better?. Int J Palliat Nurs 2019;25(9):421-430. Qualitative interviews with 16 family members of children with cancer at one Bloemfontein academic hospital; single-site quality improvement study. Abstract read.
- 295Petersen-Damon M, Swartz L
Addressing the concept of total pain in palliative care: A postcolonial South African hospice view. Palliat Support Care 2025;23:e35. Interviews with 12 staff at one Cape Town hospice (St Luke's Combined Hospices); background describes NGO provision and the hospice's history. Full text read.
- 296Vasileiou K, Smith P, Kagee A
"The way I am treated is as if I am under my mother's care": qualitative study of patients' experiences of receiving hospice care services in South Africa. BMC Palliat Care 2020;19(1):95. Interviews with 13 terminal cancer patients receiving inpatient or day care at one non-profit Cape Town hospice; background gives national hospice count and funding. Full text read.
- 297Mahilall R, Swartz L
Challenges and opportunities for spiritual care practice in hospices in a middle-income country. BMC Palliat Care 2021;20(1):62. National online survey of Hospice Palliative Care Association of South Africa member organisations (40 of 96 contactable responded); reports member count, patient volumes and NGO funding. Full text read.
- 298Mahilall R, Swartz L
Spiritual care practices in hospices in the Western cape, South Africa: the challenge of diversity. BMC Palliat Care 2021;20(1):9. Focus groups with 11 of 12 registered hospices in one province (Western Cape); states all are NGOs depending on public funding. Full text read.
- 101Luyirika E, Lohman D, Ali Z, Atieno M, Mahenge A, Mmbando P, et al.
Progress update: palliative care development between 2017 and 2020 in five African countries. Journal of Pain and Symptom Management 2022;63(5):729-736. DOI 10.1016/j.jpainsymman.2021.12.026. Abstract read. Tanzania's government had not yet committed to publicly funded palliative care as of 2021.
- 435Akintola O.
Gendered home-based care in South Africa: more trouble for the troubled. Afr J AIDS Res 2006;5(3):237-47. Ethnographic study in two semi-rural communities with 21 primary caregivers, 20 volunteer caregivers and 10 key informants in HIV home-based care; HIV-era data. Abstract read.
- 437Case A, Garrib A, Menendez A, et al.
Paying the Piper: The High Cost of Funerals in South Africa. Econ Dev Cult Change 2013;62(1). Analysis of funeral arrangements after 3,751 deaths in the Africa Centre Demographic Surveillance Area (KwaZulu-Natal), 2003 to 2005, covering spending, insurance and borrowing. Abstract read.
- 438Collins DL, Leibbrandt M.
The financial impact of HIV/AIDS on poor households in South Africa. AIDS 2007;21 Suppl 7:S75-81. Year-long financial diaries from 181 poor rural and urban households showing how households hold funeral insurance portfolios against death costs. Abstract read.
- 436Campbell L.
Men's experiences delivering palliative home health care in rural South Africa: an exploratory study. Int J Palliat Nurs 2012;18(12):612-8. Exploratory study of three male caregivers (one nurse, two home-based caregivers) from a hospice and three home-based care organisations in rural KwaZulu-Natal; very small sample. Abstract read.
- 434Campbell LM, Amin NN.
A qualitative study: potential benefits and challenges of traditional healers in providing aspects of palliative care in rural South Africa. Rural Remote Health 2014;14:2378. Photo-elicitation interviews with 4 palliative care nurses and 17 home-based care workers in rural South Africa on patients' use of traditional rituals and healers; reports provider views, not patient or healer views. Abstract read.