Despite the clinical promise of GLP-1 receptor agonists such as semaglutide and tirzepatide, at least one South African healthcare leader is cautioning that the drugs cannot, on their own, fix the country’s deepening diabetes crisis. Lungile Kasapato, chief executive of value-based care provider PPO Serve, argues that meaningful progress will require rethinking how healthcare is organised and paid for — not just prescribing newer medicines.
The affordability wall
GLP-1 receptor agonists typically cost between R3,000 and R6,000 a month in South Africa, placing them out of reach for the majority of patients who need them most. Diabetes has become the country’s leading cause of death, and Kasapato is quoted saying that “South Africa’s diabetes epidemic will not be solved by the next pharmaceutical breakthrough. It will be solved by fundamentally reshaping how healthcare is organised and paid for.”
A fragmented system undermines outcomes
Even where patients can access GLP-1 therapy, the article points to a fragmented healthcare system that lacks the clinical infrastructure and social support needed to sustain long-term outcomes. Diabetes management depends on consistent follow-up, dietary support and coordinated care between multiple providers — conditions that are difficult to maintain in a system built around isolated, once-off consultations.
Fee-for-service vs value-based care
The piece highlights how South Africa’s dominant fee-for-service payment model rewards volume of procedures rather than patient outcomes, discouraging the kind of coordinated, preventive care that chronic conditions like diabetes require. As an alternative, PPO Serve points to its own value-based care model, in which interdisciplinary teams of GPs, nurses, dietitians and care coordinators share accountability for outcomes rather than being paid per billable procedure.
Diet, infrastructure and the bigger picture
The article also cites the scale of the underlying problem: roughly 40% of low-income South African diets are estimated to consist of ultra-processed foods, a major contributor to rising obesity and type 2 diabetes rates nationally. That context reinforces the argument that pharmaceutical innovation, including GLP-1 drugs, needs to be paired with systemic reforms in nutrition access, primary care delivery and how chronic disease management is funded.
What this means for patients
- Access to GLP-1 medicines remains only part of the solution for diabetes management — ongoing clinical support, nutrition guidance and follow-up care matter just as much for long-term outcomes.
- Patients relying on fee-for-service medical aid plans may want to ask their scheme or provider whether coordinated, multidisciplinary diabetes care programmes are available.
- Cost remains the single biggest barrier to GLP-1 access for most South Africans with diabetes, reinforcing the importance of generic and lower-cost alternatives entering the market.
- Diet and lifestyle interventions continue to play a central role in diabetes prevention and management alongside any medication.
This article is for general information purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, stopping or changing any medication or treatment plan.
Sources
- GLP-1 RAs Will Not Solve Diabetes — Quicknews, 9 September 2026