South Africa’s healthcare landscape is defined by a sharp, uncompromising divide.
On one side sits a resourced private sector offering immediate access to cutting-edge specialised care. On the other lies an overstretched public system serving the vast majority, where rural patients must often travel thousands of kilometres just to see a specialist.
Protecting your health in this split reality depends entirely on where you live.
Yet, beneath national policy debates, grassroots Black women are quietly driving a medical revolution, turning personal tragedy and systemic exclusion into life-saving community enterprises.
At the Western Cape Bambelela Business Awards, hosted by the Hollywood Foundation at Kenilworth Racecourse, local enterprises shared a R1.1 million prize pool.
Beyond the celebration, two top prize-winners spoke with The National about the true financial, emotional, and physical cost of keeping South Africans healthy in an unequal society.
Zola Mbaxa and the battle for cognitive justice
“The unfair reality is that we live in an audible, speaking world,” says Zola Mbaxa, the brilliant, Eastern Cape-born audiologist who graduated with distinction from the University of Cape Town. Mbaxa explains that hearing loss is South Africa’s invisible epidemic, a silent reality that discriminates neither by age nor economic status.
"For the average citizen, specialised ear care is an unimaginable luxury. A standard hearing aid costs R15,000," Mbaxa points out, a figure that instantly prices out the working class.
The consequence of this financial barrier is a tragic, domino-effect developmental crisis:
The classroom misdiagnosis: In her work as a clinical educator, she notes that teachers routinely call her regarding "naughty," "disruptive," or "inattentive" children. The diagnosis is frequently completely wrong. The child isn't defiant; they simply cannot hear the teacher’s voice.
In a curriculum delivered entirely through speech, silence translates directly into delayed literacy.
The atrophy of ageing: For adults over 55, unaddressed hearing loss is a direct gateway to cognitive decline. "Everything you hear ends up in your brain," Mbaxa notes. Without the sensory stimulation of sound, the brain begins to recede, drastically escalating the risk of dementia.
Determined to shatter this imbalance, Mbaxa established Just Hearing, operating branches across Cape Town CBD, Blaauwberg, and critically, the working-class community of Mitchells Plain.
To bridge the socio-economic chasm, she created a radical circular economy of care: when wealthy clients at her upscale Gardens practice upgrade their devices, the old models are collected in a donation basket and seamlessly redistributed to the Noluthando School for the Deaf in Khayelitsha and under-resourced mainstream schools.
"People think they are restricted," Mbaxa says, reflecting on her journey from a small Eastern Cape village to a private medical practice straight out of community service.
"We are trained primarily to work in a public hospital and then retire. But this is an endless field with endless possibilities."
Escorted by angels
While Mbaxa fights the long battle for cognitive health, Puleng Babe operates in the high-stakes world of emergency medicine. In 2017, Babe launched Basadi Ambulance ("Basadi" meaning women).
This marked the creation of South Africa’s very first Emergency Medical Service company that is 100% black-, woman-, and youth-owned.
The origin of Basadi Ambulance is born out of deep familial heartbreak. Babe’s parents were both lifelong paramedics.
When her mother was unfairly dismissed by an employer on the precipice of retirement, the family was devastated.
"Instead of being sad," she shares, "I had this idea to start an ambulance business where I’m going to empower female paramedics."
“Running an independent ambulance service in South Africa is expensive and complicated. Meeting strict Department of Health compliance rules requires massive investments in advanced life-support equipment, which is compounded by unpredictable fuel prices,” Babe adds.
“But money is only half the battle.”
According to Babe, in South Africa's township layout, the biggest danger to emergency care is violent crime.
"Even so, Basadi Ambulance refuses to abandon disadvantaged communities. We still enter dangerous neighbourhoods that local authorities officially label as high-risk "red zones."
"Our crews were being attacked while trying to save lives," Babe recalls. Instead of removing ambulances from communities that already faced a severe shortage, we partnered with private security firms to provide armed escorts for her medical teams.
Today, her ambulances drive down township roads under armed protection so that paramedics can safely reach a patient's doorstep.
Behind the scenes: The real plan for growth
Siphelele Ntombela, Portfolio Manager for the Hollywood Foundation, explained that these awards aim to break the cycle of short-term corporate charity.
"With most small businesses, it is not because they are not capable," Ntombela noted. "It’s because they need somebody to believe in them and give them that stepping stone to get to the next level."
“The true measure of success begins only after the gala spotlights dim and the crowd goes home. The foundation is actively building an enduring enterprise ecosystem designed to link provincial winners to broader corporate supply chains, market visibility, and technical masterclasses.
"We want to create a network where we support these winners long after the congratulations," Ntombela says.
For Babe, the financial injection from the award translates directly to upgraded life-support equipment on her vehicles.
For Mbaxa, it represents a step closer to her ultimate dream: driving her audiology fleet thousands of kilometres back home to the Eastern Cape, ensuring that no child's voice or future is ever cut short by silence.
These women are proving that when access to medical care is equalised, the entire nation moves forward.
vuyile.madwantsi@national.com