Dr Ali Hamdulay, CEO, Metropolitan Health
For many South Africans, the cost of healthcare is not limited to consultation fees, medicine or a medical-scheme contribution. It is also paid in time.
It is time spent travelling long distances, waiting in queues, arranging childcare or missing work. For too many people, accessing healthcare requires a full day’s effort – at precisely the time when illness has already placed them and their families under strain.
Two years ago, I visited communities in northern KwaZulu-Natal, where patients requiring chemotherapy faced a journey of approximately four hours each way to Inkosi Albert Luthuli Central Hospital in Durban. For someone undergoing cancer treatment, an eight-hour return journey is not simply inconvenient. It is physically exhausting, financially damaging and a real deterrent to maintaining care.
This is healthcare’s hidden time tax. It is one of the most significant and overlooked, barriers to meaningful access.
We should see access not only as a policy promise, but as a practical pathway to better lives. When we design healthcare around lived realities, we restore dignity, build confidence and create hope that quality care can be within reach for every South African.
The time tax is a social determinant of health
Health is shaped long before a person enters a consultation room. The social determinants of health – the conditions in which people are born, grow, live, work and age – profoundly influence whether they can access and benefit from care.
Income, employment conditions, transport, geography, education, caregiving responsibilities, digital connectivity and language all shape the choices people can make when they become ill. This is why healthcare cannot be built around facilities and funding alone. It must be designed around lived realities.
This framing is increasingly echoed by health-sector leaders. Prof Annie Temane, Executive Dean of Health Sciences at the University of Johannesburg, has argued that social determinants of health have become central to healthcare financing. When poverty, transport, unemployment, geography, education and caregiving responsibilities prevent people from accessing care early, the result is poorer health outcomes and higher downstream costs for funders, providers and the state. The time tax is not a soft social issue; it is a hard financing issue.
The right care, in the right place, at the right time
Reducing the time tax does not mean every service should move online, nor does it diminish the role of clinics and hospitals. It means building care pathways around clinical need and the daily realities of the people using them.
Primary care coordination is central to this. A GP or primary care clinician can assess and manage many common conditions. They are also trained to recognise when someone needs urgent intervention or specialist referral.
When patients bypass primary care for conditions that can safely be managed at first-contact level, costs rise and specialist capacity becomes more constrained. This can lengthen waiting times for people whose conditions genuinely require specialist expertise. The solution is not to limit appropriate specialist access, but to help people navigate a complex system with confidence.
Digital tools can help people navigate care
Technology can play an important role in reducing the time tax, particularly when designed for South African realities. Digital health should not replace clinicians or in-person care. Its value lies in making the journey to appropriate care simpler, faster and more convenient.
Metropolitan Health – an affiliate of Momentum Health – has seen this potential through tools such as Hello Doctor. The platform enables members to access healthcare practitioners remotely for appropriate concerns, reducing unnecessary travel. Momentum Health’s Health4Me membership base sees almost 460,000 healthcare engagements each month, highlighting demand for convenient, accessible services.
The opportunity is bigger than a virtual consultation. It is about helping people reach the appropriate level of care the first time.
As these capabilities evolve, AI-supported and data-enabled tools can strengthen triage, continuity and preventative outreach. Used responsibly – with clinical oversight, robust data privacy and clear escalation pathways – they can help identify risk earlier and reduce avoidable friction in the health system.
Digital access must, however, be inclusive by design. It must account for data affordability, language preferences, connectivity constraints and differing levels of digital confidence. Technology should narrow inequities, not create new ones.
Prevention and coordination make care sustainable
The opportunity is not only to make treatment easier to access once illness begins. It is to make preventative care and early intervention practical enough for people to sustain.
This requires healthier living and risk reduction; benefits and care packages that direct people to the appropriate level of care; clinical expertise and judgement; and funding models that support care which is clinically appropriate and valuable.
Together, these levers can support a more balanced system: one that helps people access care earlier, protects constrained specialist and hospital capacity, and reduces the avoidable costs of delayed treatment.
A practical test for universal healthcare
The ambition of universal health coverage reform is not achieved simply because a benefit is defined or a facility exists. It is achieved when people can reach the care they need with dignity, quality and reasonable ease.
Stronger, more equitable healthcare will not be achieved through funding or infrastructure alone. It requires solutions designed around lived realities – how people travel, work, earn, care for their families, access information and navigate the system.
Responsible collaboration across the public and private sectors can bring delivery experience, care-navigation tools, technology, skills development and evidence of what works. The aim should not be to create parallel systems, but to make accessible, quality care more practical and sustainable for the people who need it most.
ENDS
