Trialogue conducts annual research into CSI spend on each development sector in South Africa. In 2023, 68 large companies participated in Trialogue’s primary research survey. According to the research, health was supported by 38% of companies and received 6% of average CSI expenditure.
National context of health in South Africa
- The national health budget was broadly unchanged at R259 billion for 2023/24, constituting 11.6% of the consolidated government expenditure of R2.24 trillion for the year.
- According to Affinity Health, tuberculosis is the leading cause of death in South Africa, killing approximately 89 000 people per year. According to a Statistics South Africa (Stats SA) 2021 report, diabetes is the second-deadliest disease in South Africa.
- The latest Mental State of the World report released in 2021 rated South Africans’ mental wellbeing as the lowest in the world, with the country’s mental health quotient (MHQ) at 46 out of 100, a decline of 3% from 2020. South Africa also had the highest percentage of people experiencing emotional distress or struggling with mental health (36%). Mental healthcare is allocated 5% of the total national public health budget, as reported by the South African Society of Psychiatrists. In 2023, one in three South Africans suffer from mental illness, with 75% unable to access treatment.
- Stats SA’s 2022 census reported a South African population of over 62 million. Of this, there were 8.4 million people living with HIV, an increase over time due to improved access to and an uptake of antiretrovirals (ARVs) that enable HIV-positive people to live longer and healthier lives. The estimated overall HIV prevalence rate is 13%, while an estimated 19% of adults aged 15–49 years were HIV positive.
- There had been 47 suspected and confirmed deaths as a result of the cholera outbreak across South Africa by July 2023. The Free State and Gauteng were the hardest hit, with confirmed cases in Mpumalanga, Limpopo and North West province. Cumulatively, South Africa recorded 1 073 suspected cases of cholera across five provinces in 2023.
- In March 2023, a measles outbreak was declared in eight of the nine provinces of South Africa and by June 2023, 1 060 confirmed cases had been reported. Children under 14 accounted for most cases (86%), with the highest rates in the 1–9-year-old age group. The national immunisation coverage for both measles-containing vaccines was estimated at 86% in 2022.
Overview of CSI spend
Health was supported by 38% of companies and received 6% of average CSI expenditure.

Level of healthcare
Average % CSI healthcare spend 2023 n=23
81% Primary healthcare
8% Secondary healthcare
7% Tertiary healthcare
4% other
- Primary healthcare continued to receive the majority of CSI spend in the health sector (81% in 2023).
- The average healthcare spend allocated to secondary healthcare was 8% in 2023, while the spend on tertiary healthcare was 7%.

Type of intervention
Average % CSI healthcare spend 2023 n=19
37% Non-specific general donations
18% Wellbeing initiatives
13% Healthcare education, training and capacity building
10% Infrastructure, facilities and equipment
6% HIV/Aids and related
4% Covid-19-related
12% Other
- Over one-third of the CSI healthcare expenditure (37%) consisted of non-specific general donations in 2023, an increase from 8% in 2022.
- Covid-19-related interventions received the smallest share of healthcare spend in 2023 (4%), a significant decrease from 32% in 2022.
- The average healthcare spend allocated to wellbeing initiatives increased from 11% in 2022 to 18% in 2023.
Read more about health:
- Read the case study AI in African healthcare – a new frontier.
- Read the 2022 research findings: Overview of CSI spend on health 2022.
Source: The original version of this article was published in the Trialogue Business in Society Handbook 2023 (26th edition).