Twenty-twenty-six is shaping up as a year of sharp policy fights, fast-moving science, and stubborn system failures. Spotlight’s 2026 Healthcare Watchlist will track nine stories that could shift budgets, reshape services, and test public trust.
A limited rollout of a new HIV prevention injection could be a turning point for prevention options. Weight-loss medicines are evolving rapidly, with new oral formulations and patent expirations that may change access and pricing. Meanwhile, National Health Insurance (NHI) is headed for a courtroom-heavy year, with multiple challenges that could redefine how healthcare is funded and governed.
Add deepening concerns about staffing, corruption accountability, and leadership stability, and the operating environment for health organisations in 2026 looks volatile. Internationally, the ripple effects of US aid cuts are still unfolding, while questions hang over the credibility and independence of key US health institutions.
The New HIV Prevention Jab Test
The public-sector rollout of a six-month HIV prevention jab containing lenacapavir is expected at around 360 clinics. The big questions are who gets access, how eligibility is applied, and whether uptake matches expectations. A longer-acting, 12-month formulation is also in development, and any new trial data could shift planning.
NHI Court Battles and Reform Options
Spotlight expects little chance of a political settlement on NHI in 2026. Instead, the key action is likely in the courts, with at least eight challenges targeting the Act, parts of it, or the process that produced it. One early issue is whether cases are consolidated. Spotlight also plans to broaden the debate beyond a simple “for or against” framing and to highlight alternative reform pathways.
Weight-Loss Medicines: Pills, Patents, and Prices
GLP-1 medicines have rewritten the obesity and diabetes markets. Now, oral versions are set to intensify disruption. The US FDA has registered a semaglutide pill for weight loss. The business-critical question is when South Africa will register these options and at what price. A key semaglutide patent expiry in India could also accelerate the launch of lower-cost generics, with potential knock-on effects for local affordability.
TB Vaccines: Could Trial Results Land Early?
Late-stage TB vaccine trials continue, including the high-profile M72 phase 3 study with sites in South Africa. Timelines suggest limited readouts in 2026, but early stopping rules can surprise. Spotlight will track any signals and push debate on rollout readiness if efficacy is strong.
Staffing Shortages: Will a Real Plan Arrive?
Provincial health departments remain short of healthcare workers across categories. Budgets have been tight for years, and governance failures have widened the gaps. Spotlight will watch for a credible, funded plan to implement the 2030 Human Resources for Health Strategy, rather than more unexecuted policies.
Corruption Consequences: Thembisa And Beyond
After explosive corruption claims at Thembisa Hospital, the question is whether prosecutions follow. The SIU can recover money, but criminal accountability depends on the NPA. Spotlight will also track other stalled matters, including concerns around dropped cases.
Leadership Shake-Ups: Who Might Fall?
Even without elections, leadership can shift fast. Spotlight flags uncertainty around KwaZulu-Natal’s health leadership if coalition politics change. It will also track pressure being put on senior national officials linked to procurement controversies.
Global Institutions Under Strain
Spotlight expects further erosion in perceived credibility at US agencies such as the FDA, CDC, and NIH, amid concerns about political interference and weakened evidence-based decision-making.
Life After US Aid Cuts
The medium-term impact of last year’s US aid reductions will become clearer in 2026 as new HIV and TB estimates are published. Spotlight expects the damage to linger, while WHO and UNAIDS face severe financial and political pressure.