Overview of CSI spend on health in 2025

National context  

• The national health budget increased from R271 billion for 2024/25 to R298 billion for 2025/26, constituting 11.5% of consolidated government expenditure of R2.59 trillion for the financial year. Spending is set to grow to R329 billion by 2027/28 to support equitable public health services, including free primary healthcare. 
• According to Stats SA’s 2025 mid-year population estimates, the average life expectancy at birth is 66 years, up from 53 years in 2005. The rise can be partly attributed to a drop in the child mortality rate, which has been linked to improved access to HIV prevention and treatment, along with better healthcare and living conditions. The infant mortality rate has dropped from 61.9 deaths per 1 000 live births in 2002 to 23.1 in 2025.  
• According to Stats SA, the total number of people living with HIV in 2025 is approximately 8.2 million. For adults aged 15–49 years – the group most affected by HIV/Aids – the prevalence rate stands at 18.1%, up from an estimated 16.7% in 2024.  
• The 2024 Sapien Lab Mental State of the World Report revealed that South Africa ranks third worst globally (69 out of 71 countries) and has the highest percentage of distressed or struggling respondents at 35%. 
• In February 2025, Health Minister Dr Aaron Motsoaledi reported there were 23 810 doctors and 69 652 nurses working in the public healthcare service across the nine provinces. In April 2025, the minister announced that new posts for 1 200 doctors, 200 nurses and 250 other healthcare practitioners had been approved at a cost of R1.78 billion.  
• Phase 2 of the National Health Insurance (NHI) programme, which includes establishing the NHI Fund and starting to purchase services, is due to begin in 2026. The NHI Act was gazetted in May 2024, but no precise implementation date has been set. The Act is currently being challenged in the courts.  
• According to Statista, in 2025, South Africa had the highest healthcare index in Africa with a score of 63.8 out of 100, followed by Kenya with 62 points. These scores indicate that the countries’ healthcare systems are considered reasonably strong, especially compared to other African nations, though they are still far from global leaders (which often score above 80). The healthcare index takes into account factors such as the overall quality of the healthcare system, healthcare professionals, equipment, staff and cost.  

Overview of CSI spend  

Health was supported by 46% of companies and received 11% of average CSI expenditure. 

• Primary healthcare continued to receive the majority of CSI spend in the health sector at 73% in 2025.  
• Average CSI health spend on secondary healthcare, although still the least supported in this sector, increased slightly from 3% in 2024 to 6% in 2025. 
• Average CSI health spend on tertiary healthcare (specialist care) declined from 19% in 2024 to 11% in 2025. 
• Ten percent of CSI spend in the health sector was allocated to other levels, with companies also reporting support for interventions within communities, schools and in partnership with the health department. 

• The average percentage of health spend on infrastructure, facilities and equipment doubled, from 19% in 2024 to 38% in 2025, making this the most supported intervention type in the sector.  
• Conversely, support for wellbeing initiatives dropped substantially from 37% in 2024 to 21% in 2025, in line with previous recorded averages (18% in 2023). 
• On average, 14% of health CSI spend went to interventions targeting specific diseases such as HIV/Aids, diabetes, tuberculosis and cancer. 
• Average investment in healthcare education, training and capacity building also decreased by half, from 22% in 2024 to 11% in 2025.