“South Africa’s Department of Health has authorised emergency imports of 19 essential medicines under Section 21 of the Medicines and Related Substances Act, covering treatments for tuberculosis, cancer, cardiovascular emergencies, and rabies exposure. While this provides short-term relief, experts warn that reliance on imports exposes the healthcare system to global supply chain risks and currency fluctuations.”
South Africa’s healthcare system is once again under strain as essential medicine shortages force the government to rely on emergency imports. On 17 September 2026, the National Department of Health confirmed that 19 medicines are currently being sourced internationally under Section 21 authorisations, a mechanism that allows unregistered medicines to be imported when no local alternatives exist.
What Section 21 Means
Section 21 of the Medicines and Related Substances Act empowers the South African Health Products Regulatory Authority (SAHPRA) to grant temporary approval for medicines not registered in the country. This process is typically reserved for urgent clinical needs, such as life-threatening conditions where no substitute is available.
Currently, the register includes:
- Rifampicin & Rifabutin – cornerstone drugs in tuberculosis treatment.
- Bleomycin & Mitomycin – chemotherapy agents for cancer.
- Streptokinase & Glyceryl Trinitrate injections – used in cardiovascular emergencies.
- Rabies immunoglobulin (equine and human) – critical after rabies exposure.
- Thiopentone – anaesthetic for critical care.
Why Shortages Occur
Medicine shortages in South Africa stem from multiple factors:
- Global supply chain disruptions – raw material shortages and transport delays.
- Manufacturing challenges – limited local production capacity.
- Procurement delays – bureaucratic hurdles in tender processes.
- High demand – rising cases of tuberculosis and cancer increase pressure on supplies.
Impact on Patients
For patients, the shortages mean:
- Treatment delays – especially in oncology and infectious disease wards.
- Switching medicines – doctors may prescribe alternatives, but efficacy can vary.
- Increased anxiety – patients worry about continuity of care.
Healthcare professionals emphasize that while Section 21 imports provide relief, they are not a sustainable solution.
Government Response
The Department of Health insists that medicine availability remains stable overall, noting that shortages often affect specific brands rather than entire therapeutic categories. The Stock Visibility System (SVS) provides real-time monitoring of supply levels nationwide, enabling rapid intervention.
Expert Opinions
Pharmacologists warn that reliance on imports exposes South Africa to currency fluctuations and international competition. This could make medicines more expensive and harder to secure in the long run.
Conclusion
South Africa’s emergency reliance on Section 21 imports underscores the urgent need for strengthening local pharmaceutical manufacturing capacity, streamlining procurement processes, and building resilient supply chains. Without these reforms, the country risks recurring shortages that threaten patient care and public health security.
