Will foreign workers leave South Africa?

South African blood cancer patients face significant obstacles in receiving stem cell transplants even after a matching donor is found, due to financial and systemic issues. Palesa Mokomele, head of corporate affairs at DKMS Africa, highlights the need for better patient-tracking data, structured public-private co-funding, and optimized regional infrastructure.

A patient with blood cancer may still face issues like late diagnosis, fragmented referrals, delayed testing, limited specialist capacity, unavailable transplant beds, and high treatment costs. Additional burdens include transportation, accommodation, and time away from work, making the treatment unattainable.

South Africa currently has over 200,000 registered potential donors, aiming to reach one million by 2030. This will enhance patient outcomes but is insufficient when the focus solely remains on donor recruitment. Finding a donor match is just the first step, and without proper financing, the potential for a life-saving transplant is lost.

With the health financing environment tightening, Africa CDC reports a drastic decline in development assistance for health on the continent. Africa now accounts for 1% of global health expenditure, despite carrying 22% of the global disease burden. South Africa cannot rely on external funding and must adopt a disciplined model to determine what should be locally funded, what can be shared regionally, and where international infrastructure can fill gaps.

Recent research from the South African Stem Cell Society (SASMO-SASCeTS) Congress emphasizes the urgency of the financing debate. A 2025 DKMS study analyzed HLA data from 56,961 potential donors registered between 2019 and 2024. The study concluded that a pool of one million registered black African potential donors could provide a 80% probability of finding at least one fully matched donor for black African patients. This indicates that growing a representative local donor pool is a cost-effective investment.

These findings should concern financial decision-makers as much as clinicians. The success of donor recruitment should not be considered in isolation. Instead, the focus should be on the percentage of clinically eligible patients who ultimately receive a transplant. A financed pathway transforms the potential of a donor match into life-saving treatment.

Three reforms are necessary to close the financing gap:

1. Track patient and donor data to understand the various stages of the transplant process, including diagnosis, referral, testing, matching, transplantation, and the reasons for patients falling out of the system.

2. Establish structured co-funding before the transplantation stage, with core treatment not dependent on charity, but targeted support bridging defined gaps such as HLA testing, donor-related services, travel, accommodation, or uncovered treatment costs.

3. Use scarce specialist infrastructure more efficiently by sharing resources across borders and focusing domestic investment on capabilities that must remain close to patients, such as early diagnosis, referral networks, trained professionals, transplant beds, patient navigation, and long-term care.

International support should be catalytic, transferring skills, strengthening existing institutions, and responding to South African clinicians' priorities. It should not create parallel structures that disappear when a funding cycle ends.

In conclusion, expanding the donor registry and financing access to transplantation must happen simultaneously. The number of registered donors and matching successes matters, but the ultimate measure of success should be the number of clinically eligible patients who receive a transplant. A donor match creates the possibility of saving a life, but a financed pathway turns that possibility into treatment.

South Africa's next investment decision should acknowledge the importance of funding the beginning of the journey while recognizing that too many patients are still being left behind.