Western Cape Approves First AI Policy for Public Healthcare, Prioritising Ethics, Equity, and Access

The Western Cape Government has approved its first provincial artificial intelligence (AI) policy framework for public healthcare, establishing ethical guardrails to balance innovation, patient safety, and human dignity in a resource-constrained health system.

The framework seeks to leverage AI to improve healthcare efficiency, reduce waiting times, and expand equitable access while ensuring that human oversight, fairness, and transparency remain central to AI adoption.

Why It Matters: Healthcare Under Pressure

South Africa faces severe shortages in healthcare resources, with only 0.31 doctors per 1,000 people, far below the World Health Organization’s benchmark. As patient demand exceeds system capacity, AI offers powerful tools to enhance diagnostics, efficiency, and service delivery.

However, integrating AI into a sensitive environment like healthcare — where privacy, dignity, and equitable access are paramount — comes with significant risks. The Western Cape’s policy aims to balance these tensions by embedding strong ethical principles into decision-making.

Five Ethical Principles Guiding the Framework

The policy is grounded in globally recognised values designed to protect citizens and ensure responsible use of AI in healthcare:

1. Beneficence — AI must serve the public good.
2. Non-maleficence — Systems must protect privacy, minimise bias, and avoid harm.
3. Human Oversight — Final decisions remain in human hands, not machines.
4. Fairness — AI should not entrench or create discrimination.
5. Transparency — Citizens deserve to know if, why, and how AI tools are used, and who is accountable.

Case Study: Khayelitsha’s AI Retinal Screening Success

One of the most promising pilots demonstrating AI’s potential is underway in Khayelitsha, Cape Town’s largest township, home to nearly 500,000 residents.

The Challenge:

• High prevalence of diabetes
• Increasing cases of diabetic retinopathy, a leading cause of adult blindness
• Limited access to specialist eye-care services

The Solution:

• AI-enabled retinal screening introduced at four primary healthcare clinics
• Trained staff capture retinal images, which are analysed by an AI diagnostic tool
• Tool calculates the probability and severity of diabetic retinopathy
• Urgent cases are fast-tracked to ophthalmologists at Khayelitsha District Hospital for laser treatment
• Patients with less severe conditions receive appropriate care within their communities

The Impact:

• Accelerated early detection
• Reduced pressure on specialists
• Increased equitable access to quality eye care

This approach demonstrates how AI can expand capacity, reduce inequality, and improve patient outcomes without replacing human medical expertise.

Opportunities for South Africa’s Public Healthcare

The Western Cape’s AI policy highlights key areas where AI can deliver systemic benefits:

• Reducing Administrative Burdens — AI tools like medical scribes can handle documentation, allowing doctors and nurses to spend more face-to-face time with patients.
• Preventing Medical Errors — Pilot programs in East Africa show AI-assisted decision-support systems reduced medical errors by over 70%.
• Bridging Language Gaps — Real-time translation tools can support multilingual consultations, improving equity in care.
• Driving Innovation — By creating a framework for responsible experimentation, the policy positions the Western Cape as a leader in AI-driven public health solutions.

Balancing Innovation With Rights

The government stresses that adopting AI is not optional — avoiding its use could worsen inequalities by:

• Delaying life-saving diagnoses
• Extending patient waiting times
• Allowing well-resourced private providers and wealthier nations to widen the healthcare gap

However, the policy emphasises that innovation must never come at the expense of privacy, dignity, or fairness.

“When used thoughtfully, AI strengthens the work of nurses, doctors, and specialists, rather than replacing them,” the Western Cape Government stated. “We must lead with integrity, transparency, and respect for human rights to ensure that technology serves people — not the other way around.”

The Road Ahead

With this framework, the Western Cape is positioning itself as South Africa’s leader in AI-driven healthcare policy, laying the foundation for:

• Smarter, more inclusive digital health systems
• Scaling AI-powered diagnostics across the province
• Building public trust through responsible governance

The ultimate goal is a future where every resident, regardless of income, geography, or background, can access quality healthcare powered by innovation — without compromising on equity and dignity.