Some people who don’t medically need GLP-1s are using them, while others who could benefit from these potentially life-saving medicines go without. (Photo: Shutterstock)News & Features
25th February 2026 | Catherine Tomlinson
In South Africa, access to weight loss medicines like Ozempic and Mounjaro remains limited to those who can shell out a few thousand Rand a month. In the second article of a Spotlight special series, we look at the medical need for these medicines in the country and what it would take for government to provide them in the public sector.
The World Health Organization (WHO) has called on countries to address access inequities for people living with obesity who may benefit from a new class of medicines called glucagon-like peptide-1 (GLP-1) receptor agonists. These medicines can play a critical role in reducing weight-related illness and deaths, says the WHO, and should be equitably provided through countries’ health systems. The WHO says access to the medicines should be prioritised based on clinical need, rather than people’s ability to pay high prices.
“While medication alone won’t solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms,” said Dr Tedros Adhanom Ghebreyesus, who heads the WHO. Living with obesity increases one’s risk of developing many other serious health conditions – often referred to as weigh-related illnesses – including type 2 diabetes, high blood pressure, kidney disease, and some types of cancer.
As we unpacked in part 1 of this series, access to GLP-1s for people with obesity in South Africa largely depends on whether one can afford the monthly price tag of roughly R3 000 to R 6 000. Medical aid scheme members living with obesity often receive no support in paying for GLP-1s, as South African law does not require schemes to cover the cost of obesity care.
While medical schemes do provide some coverage for GLP-1s for treating type 2 diabetes, the eligibility criteria are strict. The dosages used for the treatment of diabetes are typically lower than those used for weight management. Such lower dose GLP-1 products are generally more affordable than their higher dose weight-loss counterparts, starting at R1 400 (excluding dispensing fees).
In the public sector, GLP-1s are simply not available.
As a result, some people who don’t medically need GLP-1s are using them, while others who could benefit from these potentially life-saving medicines go without.
Why GLP-1s are essential to combating weight-related illnesses and death
South Africa’s public sector approach to obesity management prioritises the use of lifestyle messaging and education to encourage people to eat healthier and exercise more, while recognising the need for government to create a conducive environment to enable this. But there is compelling evidence that these interventions alone are often unable to sustainably reverse obesity and its associated health effects.
Government has also adopted targets to promote healthy eating through providing healthy foods to schools through the national school nutrition programme and by using legislation to discourage unhealthy eating.
The focus on recommending healthy lifestyle changes for those using public health services overlooks the reality that many people in the country live in environments that make following diet and exercise guidance incredibly difficult. “I don’t know what neighbourhood you live in, [but] do you feel free as a woman to jog and run?” asked Dr Nomathemba Chandiwana about the challenges people face in following exercise recommendations. She is the chief scientific officer at the Desmond Tutu Health Foundation.
The Human Sciences Research Council’s Dr Thokozani Simelane pointed out that 69% of obese adults [in South Africa] live in food insecure households where families have little dietary choices and are forced to eat food with little nutritional value.
Excitement around medicines with brand names like Ozempic, Wegovy and Mounjaro have grown tremendously over the past few years. When will generics come to South Africa?
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The dearth of medical interventions to manage obesity available in the public sector thus effectively leaves many people abandoned, as it’s now well understood that, for many people living with obesity, diet and exercise on their own cannot achieve sustained weight-loss. This is because a person’s weight is not just influenced by their choices and actions, but also the environment in which they live and their genetic make-up.
For people living with obesity who are unable to achieve sustained weight-loss through healthy lifestyle changes alone, GLP-1s can be a literal lifesaver. GLP-1s not only support weight-loss, but they also reduce one’s risk of developing other weight-related illnesses, such as type 2 diabetes, and heart, liver and kidney complications. Emerging evidence also indicates that GLP-1s may reduce rates of obesity-related cancers.
A local push for change
Some obesity specialists in South Africa are pushing for change. In November 2025, the South African Metabolic Medicine and Surgery Society (SAMMSS) released the first national clinical guidelines for obesity management in the country.
The guidelines recommend the use of medicines, including GLP-1s, surgical interventions, and mental health services, alongside support for healthy behaviour changes, in managing obesity.
“The conversation is really only starting now that we have a concrete document,” said Dr Marli Conradie-Smit, director at SAMMSS and endocrinologist at the University of Stellenbosch and Tygerberg Hospital.
“For the first time, we have a clinical practice guideline that indicates ideal care of [people living with obesity],” she said.
Conradie-Smit said SAMMSS is engaging both private and public stakeholders to promote the integration of its recommendations for obesity management into clinical practice.
How big is the need?
“South Africa has got some of the highest rates of obesity,” said Chandiwana. Weight-related diseases, she said, have overtaken HIV and TB as the leading contributors to “sickness and a shorter lifespan” in the country. “As a healthcare system we are totally unprepared,” she reckons.
Estimates for the number of people living with obesity are drawn from national surveys that use Body Mass Index (BMI) measurements to calculate obesity rates. Widely cited survey data from 2017 found that 28% of people in South Africa are living with obesity. Among women, this figure was at 43%, dramatically higher than the roughly 12% in men.
Unlike HIV, where the number of people in need of HIV treatment neatly aligns with the number of people living with HIV, it is tricky figuring out how many people would need, or be eligible for GLP-1s, if these medicines were provided in the public sector.
This is because there are no universally accepted eligibility criteria for providing these medicines through countries’ public health systems. At the same time, the criteria for diagnosing clinical obesity is changing, with experts now recommending looking beyond one’s body size to consider where body fat is located and how it impacts one’s health.
Countries around the world are therefore grappling with how to balance their population’s need for GLP-1 therapies with very real budgetary constraints. The WHO recommends that people at risk of obesity-related illnesses and death should be prioritised.
In a recent paper in the Lancet medical journal, researchers estimated the need for GLP-1s globally, if the eligibility criteria for these medicines was an obesity diagnosis together with a hypertension or diabetes diagnosis, or both. Using these criteria, the researchers estimated that 799 million people globally were eligible to receive GLP-1s. In South Africa, they estimated, 12 million people would be eligible.
While expanding access to GLP-1s will come at a substantial cost to government and medical schemes, failing to provide these medicines also carries significant costs.
In 2022, health economists from the SAMRC/Wits Centre for Health Economics and Decision Science calculated how much of the country’s health budget goes toward managing obesity and its complications. To do this, the health economists calculated what share of the treatment costs of illness commonly associated with obesity, such as cardiovascular disease and diabetes, could be attributed to obesity. They estimated that “around 12 million people suffer from weight-related diseases for which they receive treatment in the public sector. These include diabetes, hypertension, cardiovascular disease, arthritis and some cancers” and that 15.38% of health expenditure in South Africa, or R33 million, already goes to treating weight-related illnesses.
At what price can the public sector provide GLP-1s?
In determining whether South Africa can provide GLP-1s in the public sector, government will need to weigh the costs of providing the medicines versus the cost of not providing them. Government will also have to undertake a budget impact analysis to determine whether it can find funds in the already stretched public health budget to buy the medicines.
It is not known at what prices these medicines might be offered to the public sector. The current prices charged in the private sector are likely far too high for public sector procurement.
Jeanette Hunter, deputy director general of primary healthcare at the National Department of Health, told Radio 702 in December 2025 that the National Essential Medicines List Committee is prioritising the review of GLP-1s for inclusion on South Africa’s National Essential Medicines List. The health department did not respond to questions from Spotlight to confirm that this review is underway and when public feedback would be available.
An important step, however, that the health department could take towards enabling access, with the support of local health economists, would be to publicly identify a threshold price at which provision of GLP-1s would become affordable for public sector rollout. This insight would provide fuel for local and global advocacy to pressure industry to drop drug prices.
The good news
Most people cannot afford GLP-1s at their current prices in South Africa, but the good news is that the prices are expected to drop in the coming years as generic products become available. In the longer term, there are also oral formulations on the way. Such oral formulations will be simpler to roll out in the public sector than injections – for now GLP-1s are only available as injections in South Africa.
Semaglutide, which is sold by Novo Nordisk under the brand names Ozempic and Wegovy, should see downward price pressure this year as generic products enter several major markets, including Canada, China, India, and Brazil.
There is some uncertainty as to when generic semaglutide products could be sold in South Africa. This is because, as explained in more detail in part 1 of this series, multiple secondary patents on semaglutide have been granted in South Africa and it is unclear to what extent they might block generic competition.
It is likely, however, that generic companies will seek to introduce generic semaglutide in South Africa in 2027, when the main patent on semaglutide expires.
While the prices that generic companies will charge for generic GLP-1s remain unknown, a study supported by Doctors Without Borders has shown that low dose injectable semaglutide can be manufactured and sold profitably for under R80 (US$5) per month. This is substantially lower than the current cost of branded semaglutide products sold in South Africa’s private sector, which start at R1 400.
Note: Only Novo Nordisk’s branded semaglutide products have been evaluated for safety and efficacy and approved by the South African Health Products Regulatory Authority (SAHPRA). There are currently no approved semaglutide generics in South Africa. Therefore, products marketed as generic or compounded “semaglutide” have not undergone necessary safety evaluations by SAHPRA and may pose serious health risks. Sale of these products in South Africa is unlawful.
