The South African healthcare market is complex and fragmented; foreign companies require extensive representation to gain a foothold in the medical device market. The old administration was decentralised and extremely run down, at least outside the major urban areas. Gaining access is still no simple matter, reflecting the complicated and transitory nature of South Africa's health system in general. There are many points of access and it is not always clear as to where the real purchasing power lies.

Despite recent cutbacks, the government sector is still the major purchaser of healthcare equipment and supplies. The procedure within the public sector is disorganised and confusing. While a form of national tendering exists, each province has its own tendering system. In comparison with international standards, the process in South Africa is formal and somewhat old-fashioned.

Government tenders are now geared to supporting the government's broader objectives. Tenders favour small, medium and micro enterprises (SMMEs), which complement the government's aims of employment creation and income generation. Local suppliers are preferred, as are companies actively taking affirmative action, such as employing a certain percentage of Black, female or handicapped workers and managers. Selling to the public sector in South Africa is no longer a simple matter of supplying goods to a market; companies must demonstrate a commitment to the improvement of the health of the population, in order to maintain a successful and continued presence in the market.

The best prospects for advanced technology and equipment remain in the private sector, despite a current moratorium in place with regard to new private hospitals. Public tertiary hospitals have had severe budget constraints imposed in recent years. Consequently, they are often barely able to maintain existing equipment, let alone purchase more. It is worth noting that the government is almost certainly expected to include some form of constraint on private hospital buying in its medical device regulations, but only when, and if, they are finally implemented. There is an element of this in the legislation set out by the National Health Act, which was due to be implemented in 2005. At the time of writing, no further information was available about its progress.

Companies supplying primary healthcare products and services may find opportunities within the clinic building/upgrading programmes, although needs here are directed more towards basic infrastructure than clinical supplies. Many mining companies also run their own hospitals. South Africa also serves as an important trade route, with many imported products destined for other countries in Southern Africa.

A lasting presence in the South African market will require the appointment of a distributor. There are many of these in South Africa, most of which are members of the South African Medical Device Industry Association (SAMED). A limited number of distributors also manufacture, and virtually all companies dealing with electromedical equipment provide after-sales service. Being generally small in size, few distributors offer adequate nationwide coverage, although a few are able to.