South Africa’s public health system is in deep crisis, shaped by deep social, economic, and structural inequalities that are embedded into the system. The history of apartheid and the unequal distribution of resources continues to weigh heavily on historically marginalized communities. Inadequate housing, overcrowding, limited access to clinics and hospitals, unemployment, gender-based violence, mental health challenges, and ongoing trauma all combine to create severe barriers to well-being. 

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In many townships, such as Gugulethu and Khayelitsha, access to healthcare remains deeply lacking. Families often queue for hours at overcrowded and underresourced clinics, only to be referred across the city for specialized services. For people that lack stable forms of income, seeking treatment often means having to take time off of work, and, as a result, losing income that is vital to their and their families’ well-being and survival. Larger hospitals are also scarce in these neighborhoods, and smaller local facilities are unable to respond to the complex, interconnected social determinants of health. 

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Community members have long advocated for better services. In 2013, when the GF Jooste Hospital closed, Gugulethu lost its only public hospital, and local citizens have been fighting for another one ever since—but change has been slow. In practice, much of the support that exists comes not from the formal health system but from community care networks: local forums, mutual aid initiatives, storytelling campaigns, and grassroots organisations like MCSJ and its allies. These networks provide vital spaces for advocacy, psychosocial support, and collective problem-solving, but they remain fragile and under-resourced. 

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However, despite these struggles with healthcare services, the current moment also presents an opportunity. In 2024, the National Health Insurance Bill was signed into law, signalling renewed recognition of the need for systemic reform. Though full implementation may take decades, this bill creates openings to rethink healthcare delivery in ways that integrate and strengthen community-based care networks alongside formal systems. 

It is in this context—where public provision is weak and grassroots responses are essential—that our work is located. By strengthening community networks, building bridges with formal healthcare structures, and addressing the wider social conditions that shape people’s health, we aim to create pathways for more equitable and accessible healthcare in Gugulethu, Khayelitsha, and beyond.