Mapping the ‘prevalence’ and frugal characteristics of healthcare innovations in South Africa

Background Despite postdemocracy reforms, South Africa’s healthcare system remains fragmented and under-resourced, limiting equitable access. Although the National Health Insurance (NHI) promises to bridge some of these gaps, public sector health innovations remain poorly documented with siloed information across care levels, hindering a comprehensive understanding of system-wide responses to challenges. Objective To identify, categorise and assess the prevalence and frugality of public sector healthcare innovations at multiple facility types across the country. Design A cross-sectional study was conducted involving 142 participants drawn from 71 public healthcare facilities including primary healthcare (PHC) clinics, hospitals and pathology laboratories. At each facility, two participants independently evaluated their respective innovations using structured self-administered questionnaires to assess frugality on a 7-point Likert scale. Analysis Innovations were classified into three categories including product, process and business model. The degree of frugality was assessed using a three-dimensional framework: accessibility, affordability and adaptability. Descriptive statistics was employed to summarise the data and χ 2 tests were conducted to examine associations and identify significant characteristics. Results A total of 201 facility-innovation instances were recorded. Product innovations were most prevalent (n=78), followed by business model (n=69) and process innovations (n=54). Frugal innovations were found across all facility types, with PHC clinics and National Health Laboratory Service (NHLS) reporting the most innovations. In total, 57% of innovations were frugal. Widely diffused innovations included the Central Chronic Medicines Dispensing and Distribution, Point of Care Testing and Health Patient Registration System. Most (89%) innovations were push-driven. Conclusions The study uncovered a widespread but under-reported ecosystem of frugal healthcare innovations addressing key public healthcare challenges. Insights can inform policy on embedding frugality to promote access and equity within the NHI framework.