RESUMO
BACKGROUND: Despite the end of apartheid in the early 1990s, South Africa remains racially and economically segregated. The country is beset by persistent social inequality, poverty, unemployment, a heavy burden of disease and the inequitable quality of healthcare service provision. The South African health system is currently engaged in the complex project of establishing universal health coverage that ensures the system's ability to deliver comprehensive care that is accessible, affordable and acceptable to patients and families, while acknowledging the significant pressures to which the system is subject. Within this framework, the Bertha Centre for Social Innovation & Entrepreneurship works to pursue social impact towards social justice in Africa with a systems lens on social innovation within innovative finance, health, education and youth development. The aim of this study is to demonstrate the capacity for social innovation in health with respect for South Africa, and to highlight some current innovations that respond to issues of health equity such as accessibility, affordability, and acceptability. METHODS: Different data types were collected to gain a rich understanding of the current context of social innovation in health within South Africa, supported by mini-case studies and examples from across the African continent, including: primary interviews, literature reviews, and organisational documentation reviews. Key stakeholders were identified, to provide the authors with an understanding of the context in which the innovations have been developed and implemented as well as the enablers and constraints. Stakeholders includes senior level managers, frontline health workers, Ministry of Health officials, and beneficiaries. A descriptive analysis strategy was adopted. RESULTS: South Africa's health care system may be viewed, to a large extent, as a reflection of the issues facing other Southern African countries with a similar disease burden, lack of systemic infrastructure and cohesiveness, and societal inequalities. The evolving health landscape in South Africa and the reforms being undertaken to prepare for a National Healthcare Insurance presents the opportunity to understand effective models of care provision as developed in other African contexts, and to translate these models as appropriate to the South African environment. CONCLUSIONS: After examining the cases of heath innovation, it is clear that no one actor, no matter how innovative, can change the system alone. The interaction and collaboration between the government and non-state actors is critical for an integrated and effective delivery system for both health and social care.