There are millions of wheelchairs in South Africa. Yet for years, there has been no dedicated, accessible system to service and repair them on a large scale. So far. It's all because of township innovator Zakaria Mashishi and his start upMajor Ralekhudu Enterprises. The business not only repairs and services wheelchairs and other medical equipment, but also trains people with disabilities to work, helping them set up businesses in their communities.

This is exactly what social innovation and entrepreneurship can do in a complex and conflicted healthcare environment: solve practical problems in ways that strengthen communities and create economic value. But it also reflects a bitter truth. For every maishi that succeeds, many more innovations fail. Not because their imagination is bad, but because the systems they must access are fragmented, under-resourced, and difficult to navigate.

Some external things bring a ray of hope

South Africa's health innovation ecosystem presents a fascinating paradox: despite world-class collaboration and expertise and clear potential for sophisticated networking, it remains largely isolated and disorganized at the national, systemic level. This duality represents both the ecosystem's greatest strength and its most significant opportunity.

What should I follow WhatsApp | Linkedin for latest headlines

The most visible strengths lie in formal, project-based networks. Partnerships are a defining feature, often involving major institutions such as South African Medical Research Council (SAMRC)Leading universities, public hospitals, and renowned international research bodies such as the US National Institutes of Health (NIH) and HIV Prevention Testing Network (HPTN).

Other examples of highly effective, top-level partnerships include private-public sector Strategic Health Innovation Partnership (SHIP) which helped put South Africa on the global stage by facilitating participation in international health networks.

SA innovators need more

Despite the growing number of accelerators and platforms, finance and funding are still out of reach for most health innovators. Our research on social innovation in the South African health ecosystem revealed the extent to which bias and discrimination is evident in the allocation of funds to SMMEs. Ninety percent of successful SMEs in the country are white-owned. Black entrepreneurs struggle with limited access to external finance and face bureaucratic barriers when applying for funding through Broad-Based Black Economic Empowerment (B-BBEE) channels – mostly because they are then competing with white-owned enterprises.

Many social entrepreneurs work alone and without access to buy-in or start-up finance. Many rely on social and informal ties, which builds a strong foundation of trust between those already connected, but may inadvertently make it harder for newcomers to gain entry, especially those coming from marginalized areas such as townships. The importance of building relationships, connections and networks in the public sector is illustrated by the example of project managers who wait for years for approval from the right government decision makers to gain signature and sign-off to secure program development. As a result, many successful pilot programs never turn into long-term projects.

Need for blended and innovative finance models

Despite strong policy ambitions, implementation remains uneven.

The story of Mashishi is an example of this. Even a talented entrepreneur with a high-impact innovation was unlikely to succeed without catalytic early support. After winning UCT GSB's Bertha Center for Social Innovation and Entrepreneurship's Healthy Futures South Africa Incubator Program in 2025, they secured R500 000 in seed funding.

This allowed them to transform from serving seven to ten broken wheelchairs at Baragwanath Hospital to a model with national potential. He is now developing a training program for disabled people who want to set up mobile wheelchair repair services on their own.

The field of health innovation is highly fragmented

South Africa's health innovation ecosystem is very fragmented and disorganized. Partnerships like SHIP are game changers – not because they remove all barriers, but because they demonstrate what coordinated brokering can achieve. There is a need to overcome systemic barriers at the national level due to the regulatory environment and bureaucracy, but without compromising quality control and necessary checks and controls.