From Cartel to Courtroom: Why Tembisa Is the Case the Competition Commission Should Be Bringing

By Joshua Eveleigh and Astra Christodoulou

Introduction

In 2016, an important amendment to the Competition Act 89 of 1998 (the “Act”) was brought into operation. The amendment introduced criminal liability for cartel conduct in the form of section 73A of the Act, which states:

“(1) A person commits an offence if, while being a director of a firm or while engaged or purporting to be engaged by a firm in a position having management authority within the firm, such person –

(a) caused the firm to engage in a prohibited practice in terms of section 4(1)(b); or

(b) knowingly acquiesced in the firm engaging in a prohibited practice in terms of section 4(1)(b).”

Section 74 states further:

“Any person convicted of an offence in terms of this Act, is liable –

(a) in the case of a contravention of section 73(1), or section 73A, to a fine not exceeding R500 000-00 or to imprisonment for a period not exceeding 10 years, or to both a fine and such imprisonment; or

(b) in any other case, to a fine not exceeding R10 000-00 or to imprisonment for a period not exceeding six months, or to both a fine and imprisonment.”

In other words, a manager or director who steers a firm into price fixing, market division or collusive tendering can, under section 74 of the Act, face a fine up to R500,000 or imprisonment for up to 10 years, or both. Section 73A(5) of the Act would provide that a consent order or a finding by the Competition Tribunal (the “Tribunal”) or Competition Appeal Court (the “CAC”) that a firm is guilty of price fixing, dividing markets or colluding on tenders could be used as prima facie proof in criminal proceedings against any of that firm’s directors or managers. It must be noted, however, that while section 73A(1) to (4) came into operation on 1 May 2016, subsections (5) and (6) (the former dealing with the prima facie evidentiary effect, and the latter prohibiting a firm from paying or indemnifying a convicted individual) have not yet been brought into operation.

Despite section 73A having been in force for over a decade, it has not yet been put into practice.

One of South Africa’s largest and ongoing corruption cases, the investigation into the Tembisa Hospital Scandal, offers an opportunity to consider why this is the case. The case involves collusive manipulation of South Africa’s procurement system to the tune of billions of rands; however, the criminal cartel offence and operation of the Act have played no part thus far in the State’s investigation. Setting aside the criminal offence, section 59 of the Act gives the Commission a route against the firms involved that carries administrative penalties measured against their turnover, and that could be pursued independently of the criminal process. Tembisa’s sharpest lesson may lie not in the dormant criminal route but in the unused civil one.

The criminal cartel offence

Section 73A criminalises individual involvement in hardcore cartel conduct prohibited in section 4(1)(b) of the Act, namely price fixing, the division of markets and collusive tendering. It does not address criminal liability for the firm, which remains subject to the civil regime, but for the natural person who directed it.  Liability extends beyond registered directors to anyone “engaged or purporting to be engaged by a firm in a position having management authority”; therefore, the whole management chain may be exposed.

The offence may be committed in one of two ways: by causing the firm to engage in the prohibited practice, or by knowingly acquiescing in it. Section 73A(2) indicates that acquiescence requires actual knowledge of the conduct; therefore, mere negligence or a failure to detect a cartel operating below management level will not found liability.

The consequences of conviction are found in section 74, which provides for a fine of up to R500,000, imprisonment for up to 10 years, or both. Any fine must be paid personally by the convicted individual, and section 73A(6) would, once in operation, prevent a firm from paying it or indemnifying the person against it. A conviction also carries collateral consequences under company law, including potential disqualification from serving as a director.

Crucially, an individual cannot be charged in a vacuum. Section 73A(3) provides that a person may only be prosecuted once the firm has admitted, in a consent order, that it engaged in a prohibited practice under section 4(1)(b), or once the Tribunal or the CAC has made a finding to that effect. The finding against the firm is therefore a precondition to the criminal charge against the individual. Section 73A(5) would then allow that finding to serve as prima facie proof in the criminal proceedings against the individual. That feature, though not yet in operation, has attracted sustained criticism on the basis that it may amount to a reverse onus and could raise constitutional concerns regarding the rights protected in section 35 of the Constitution of the Republic of South Africa, 1996, including the right to be presumed innocent and the right to a fair trial

Enforcing the offence

The difficulty lies not in the definition of the offence but in the conditions attached to prosecuting it. South Africa operates two separate enforcement processes for cartel conduct. The civil process is directed at the firm, is investigated and prosecuted by the South African Competition Commission (the “Commission”) and is adjudicated by the Tribunal. The criminal process is directed at the individual and may be prosecuted only by the National Prosecuting Authority (the “NPA”).

Due to the precondition in section 73A(3), the civil process must ordinarily conclude, whether by consent order or by a Tribunal or CAC finding, before the criminal process against an individual can begin. Cartel matters are frequently litigated for years on technical and jurisdictional grounds before any such finding is made, therefore meaning the ability to prosecute criminal liability tends to arise long after the underlying conduct has occurred.

The interface between the two authorities must also be considered. The Commission cannot prosecute individuals and cannot grant them immunity from criminal prosecution. Under section 73A(4), the Commission is limited to certifying that a person is “deserving of leniency”, in which case it may not itself seek or request that person’s prosecution, and it may make submissions to the NPA in support of leniency. The final decision, however, is that of the NPA, which is not bound by the Commission’s view. Effective enforcement therefore depends on close coordination between the Commission, the NPA and the South African Police Service.

This division of functions establishes a tension with the Commission’s Corporate Leniency Policy, which has historically been its most effective tool for uncovering cartels. Therefore, if a firm’s admission in a consent order can be used as the basis for criminal prosecution of the firm’s own directors and managers, the incentive to cooperate and settle diminishes. Further, as section 73A remains untested in practice, there is also the unresolved tension as to what extent the NPA may access the material a firm hands over in the course of seeking leniency.

Tembisa Hospital and the potential use of the Act

The Tembisa Hospital scandal concerns the alleged looting of more than R2 billion from the procurement budget of the Tembisa Provincial Tertiary Hospital in Gauteng. The scheme is said to have exploited the Request for Quotation system for purchases below the R500,000 threshold (set in National Treasury Practice Note No 8 of 2007/2008 “Supply Chain Management: Threshold Values for the Procurement of Goods, Works and Services by Means of Petty Cash, Verbal / Written Price Quotations or Competitive Bids”, since amended), deliberately splitting orders to circumvent the formal tender process. Investigators have identified several syndicates operating through large networks of companies. One alleged network is said to have controlled dozens of entities, the majority of which were irregularly appointed as suppliers; another is alleged to have funnelled contracts through a cluster of commonly linked companies.

The use of many nominally separate companies gives the matter a competition-law dimension. From the perspective of Tembisa Hospital, there would have appeared to be several separate entities competing for each quotation. In reality, those entities were, unbeknownst to the hospital, allegedly controlled by a single mind, which caused them to submit coordinated and inflated quotations, ensuring that the lowest of several artificially high bids would win. That is the classic mechanism of bid rigging. The appearance of competition is manufactured to conceal an allocation of business that has already been decided among the bidders. Where a single controlling mind allegedly causes several ostensibly independent firms to submit competing quotations, thereby creating the appearance of competition while allocating business among themselves, the conduct falls squarely within collusive tendering or market division of the kind prohibited by section 4(1)(b). On that characterisation, the individuals directing those firms could, in principle, fall within the reach of section 73A. The concealment of common control is foundational in the competition-law analysis because it is what allowed the entities to hold themselves out as independent competitors. The Commission would still need to establish an agreement or concerted practice between them, but the coordinated submission of rigged quotations is itself compelling evidence.

The difficulties of using the Competition Act at Tembisa

Several obstacles arise when considering whether Tembisa is a suitable vehicle for the first practical use of section 73A.

The first difficulty is that the core issue of the Tembisa scandal has been corruption, not cartelisation. Its core is the corrupt relationship between officials inside the hospital and the suppliers they favoured, a relationship between buyer and seller rather than between competitors. The cartel offence is aimed at competitors who secretly agree to rig a market against a buyer, not at insiders who capture a procurement system from within. Whatever residual element of collusive tendering might be found among the front companies is, for criminal purposes, overshadowed by the established offences of fraud, corruption and money laundering.

Furthermore, the structure of the offence makes the utilisation of the route slow. The criminal case against the individual depends on a prior admission by, or adverse finding against, the firm. The Commission would first have to investigate, refer and litigate to a conclusion its case against the firm. Cartel proceedings of that kind practically run for years. One of South Africa’s longest-running cartel investigations, into the alleged manipulation of the rand, lasted close to a decade before the Constitutional Court had ruled only on preliminary questions of pleading and jurisdiction, without yet deciding whether any collusion had occurred at all. A procurement-corruption matter of this severity and national importance cannot sensibly wait on that timetable.

A further consideration is the sanction available under section 73A, which may be viewed as modest against the scale of the conduct. Section 74 caps the penalty at a fine of R500,000 and imprisonment for up to 10 years. Against an alleged scheme running to billions of rand, a fine of that order may be seen as negligible, and the competition route offers nothing equivalent to the asset-recovery machinery that is at the core of the State’s response, namely the forfeiture and preservation of the proceeds of the fraud. By contrast, the ordinary offences of fraud, corruption and money laundering carry heavier penalties and unlock the confiscation of the stolen funds.

This modest cap, however, attaches only to the criminal sanction against the individual. The Act’s civil regime is another matter entirely. An administrative penalty imposed on the firms, by section 59 of the Act, can reach 10% (ten per cent) of the firm’s annual turnover, a figure that, on contracts totalling billions of rand, would be anything but negligible. While imprisonment for up to ten years remains a significant sanction, section 73A offers little by way of asset recovery and may therefore be less attractive to prosecutors than the ordinary offences. The availability of a substantial administrative penalty, by contrast, raises a distinct question about the regulator’s own role.

Taken together, these difficulties explain why the criminal cartel offence, for all its apparent reach, may be seen as a slow and, on its criminal side, ill-suited instrument for a matter such as Tembisa, which largely explains the criminal route the State has taken.

The route the State has taken  

The State has thus far opted not to utilise the Competition Act. The response has been driven by the Special Investigating Unit (the “SIU”), which was authorised by Presidential Proclamation 136 of 2023, to conduct a forensic investigation. Under the Special Investigating Units and Special Tribunals Act 74 of 1996, the SIU refers evidence of possible criminal conduct to the NPA for prosecution and is separately empowered to bring civil proceedings in the High Court or the Special Tribunal to recover the State’s losses.

On the criminal side, the charges brought and contemplated are the offences of fraud, theft, corruption, money laundering, forgery and uttering, and contraventions of the Public Finance Management Act. In August 2026, one of the alleged syndicate masterminds was arrested on his return to South Africa and appeared before the Specialised Commercial Crimes Court facing dozens of counts, before being released on bail; the NPA has indicated that further prosecutions arising from the three identified syndicates are to follow. On the civil side, the Asset Forfeiture Unit has obtained substantial forfeiture orders against assets linked to the alleged networks, and the SIU continues to pursue recovery of the diverted funds.

The logic of this route is straightforward. The ordinary criminal law reaches the corrupt heart of the scheme, which competition law cannot; its offences are broader and well established; it requires no prior finding by the Tribunal as a precondition to charging individuals; and it allows the various enforcement agencies to coordinate a single, faster response.

The route the Commission has not taken

Even if the criminal cartel offence is seen to be ill-suited to Tembisa, the Act’s civil prohibition is not. Section 4(1)(b), enforced by the Commission and the Tribunal, catches the collusive tendering described above directly, and without the features that make section 73A difficult to utilise. It does not depend on the NPA, on the criminal burden of proof, or on the outstanding subsections of section 73A, and it is directed at the firms rather than at the individuals. On a finding of contravention, it carries an administrative penalty of up to 10% (ten per cent) of a firm’s annual turnover, which on contracts of this value would be substantial.

Prosecuting cartel conduct with the goal of administrative penalties is a financial route the Commission can pursue independently of both the NPA’s prosecutions and the Asset Forfeiture Unit’s proceedings under the Prevention of Organised Crime Act. An administrative penalty differs from recovering the specific proceeds of the fraud, since it is calculated on turnover rather than on the amount looted, and it is paid into the National Revenue Fund rather than restored to the hospital. It is not, therefore, asset recovery in the sense that forfeiture is, but it is a substantial financial consequence for the very firms that profited. It operates alongside rather than instead of the forfeiture the State is already pursuing.

On this front, Tembisa is close to an ideal case for the Commission. The NPA is already going forward with prosecutions arising from the same collusive bidding; the conduct has been investigated in exhaustive detail; and the sums involved are vast. It is therefore difficult to understand why the Commission, as the regulator charged with enforcing the very prohibition in question, has not itself moved to secure a finding and the administrative penalties that would follow. Delay is the obvious objection, since a referral to the Tribunal could take years; but that is a reason for the Commission to begin now having its prosecution running alongside the criminal one. The penalty does not turn on the criminal outcome, and the passage of time weakens neither the turnover figures on which it is based nor the public interest in imposing it. A parallel referral would not compete with the criminal prosecutions but complement them and would signal that rigged public tenders attract a competition-law response as well as a criminal one.

What Tembisa means going forward

Tembisa is a revealing test of the criminal cartel offence precisely because it was never invoked. It shows that section 73A is unlikely to become the vehicle for the headline procurement-corruption cases that draw national attention, for the reason that corruption is the core issue the NPA wish to prosecute rather than cartel cases, and the ordinary criminal law is better fitted in this regard.

However, the more pointed lesson of Tembisa concerns the Commission rather than the NPA. The same conduct that supports the criminal charges is also a civil contravention of section 4(1)(b) that the Commission can pursue in its own right. That route asks none of the questions that make section 73A so hard to use. The weight of the administrative penalty alone is justification for the Commission pursuing prosecution in its own right. Over and above the administrative penalties, the message it would send to firms participating in public procurement would be that uncompetitive conduct will not go unpunished by the competition authorities.

Where a genuine horizontal cartel sits behind a public tender, section 73A remains available, and a future consent order or Tribunal finding could still open the door to the prosecution of the directors and managers responsible. The real test of the criminal offence will arise when the Commission secures a clear finding under section 4(1)(b) and the NPA elects to prosecute an individual on the strength of it. Until then, the deterrent value of the offence will remain largely theoretical, depending as it does on the interface between the Commission and the NPA being made to work, on the dormant provisions being brought into operation, and, above all, on a prosecution finally being brought.

The more immediate lesson, however, concerns not the dormant criminal offence but the civil route beside it. The administrative penalty route requires only a civil referral against the firms; it can be pursued by the Commission alone, and it is available now. That is why Tembisa speaks less to an untested criminal provision than about the unused civil one.

Healthcare Fraud at Tembisa Hospital: R2 Billion Procurement Fraud Exposed

Courtney Kaplan

A long-running investigation, which is still ongoing, has yielded insights into a massive healthcare fraud at a local South African hospital.

Background

On 23 August 2021, Babita Deokaran, a whistleblower and acting Chief Director of Financial Accounting in the Gauteng Department of Health, was assassinated after exposing around R850 million worth of suspicious procurement payments at Tembisa Hospital. In July 2025, the SIU confirmed that it was finalising the investigation into the assassination.

On 1 September 2023, Proclamation No. 136 of 2023 (the “Proclamation”), was published in the Government Gazette, which gives the Special Investigating Unit (“SIU”) power to investigate accusations of corruption and maladministration regarding Tembisa Hospital and the Gauteng Department of Health. The Proclamation was signed under the Special Investigating Units and Special Tribunals Act 74 of 1996 (“SIU Act”).

In terms of the Proclamation, the SIU is authorised to:

  • Investigate procurement, which is not fair, competitive, transparent, equitable, or cost-effective, or which is prohibited by National Treasury guidelines;
  • Investigate unauthorised, irregular, or fruitless and wasteful expenditure;
  • Institute civil litigation in the High Court or Special Tribunal to recover losses suffered by the State;
  • Pursue pension benefits of resigned or retired officials during investigations;
  • Conduct criminal referrals to the National Prosecuting Authority (“NPA”);
  • Refer conduct to the South African Revenue Service (“SARS”) and National Treasury for blacklisting.

Key Findings

On 29 September 2025, the SIU released an interim report, indicating that approximately R2.043 billion was misappropriated via nine syndicates, including the Maumela, Mazibuko, and X syndicates, manipulating the hospital’s procurement system, which was not used for hospital equiptment. The total amount connected to officials amounted to R122,228,000, with 15 officials being implicated, and 116 disciplinary referrals arranged.

Criminal Charges against Former CFO

On 16 October 2025, criminal charges were laid against the former CFO of the Gauteng Department of Health, Lerato Madyo, who had originally frozen R104 million in questionable payments which had been flagged by Babita, but allowed them to go through and conducted an incomplete related audit report. Lerato resigned in August 2024 before a disciplinary finding was finalised. The charges against Lerato include violations of:

  • Section 34 of the Prevention and Combating of Corrupt Activities Act 12 of 2004 (the “PRECCA”) for failing to report corruption exceeding R100,000;
  • Section 21 of PRECCA for conspiracy;
  • Section 18 of the Criminal Procedure Act 51 of 1977 (conspiracy to commit fraud);
  • Section 38 of The Public Finance Management Act 1 of 1999 (the “PFMA”) for the failure to report irregular expenditure;
  • Section 51 of the PFMA for negligent procurement oversight;
  • Section 81 of the PFMA for financial misconduct; and
  • Theft and fraud.

Asset preservation

On 29 September 2025, the Special Tribunal granted an interim preservation order regarding around R900 million in assets allegedly acquired unlawfully from Tembisa Hospital. On 9 October 2025, an SIU Curator obtained R133,5 million in assets in Gauteng and Mpumalanga. In terms of the preservation order, implicated individuals must declare all assets to the SIU, with failing to do so being considered contempt of court. The SIU is authorised to institute a maximum of 41 civil recovery proceedings within 60 court days.

Arrests and bribery

In April 2025, evidence was given by the SIU to the NPA, Directorate for Priority Crime Investigation (“DPCI”), and Asset Forfeiture Unit (“AFU”) against the Operations Manager of Tembisa Hospital, Zacharia Tshisele, regarding asset recovery and criminal prosecution.

The SIU found that Tshisele obtained unlawful gratification from service providers between 2020 and 2023 and in November 2025, Tshisele paid R13,530,904.27 to the SIU, representing a portion of his proceeds from corrupt conduct.

On 23 November 2025, Papi Tsie, DPCI Sergeant, and Tshisele allegedly gave a R100,000 cash bribe to an investigating officer to attempt to interfere with prosecution. The exchange was a sting operation and led to the arrest of both Tshisele and Tsie, who both pleaded not guilty and were granted R5,000 bail. The case was moved to 27 February 2026 and Lt-Gen Siphosihle Nkosi, Hawks Acting National Head, stated that the investigation would proceed against officials participating in criminal dealings.

Suspensions and estate recovery

On 14 October 2025, Lesiba Arnold Malotana, Gauteng Health Head of Department, was suspended by Gauteng Premier Panyaza Lesufi. On 21 October 2025, an SIU lifestyle audit was released, indicating that Malotana was considered high-risk, and revealed R1,627,300 in ATM deposits which did not coincide with his salary. Malotana challenged his suspension in the Labour Court, which held that the suspension was lawful and rational.

On 4 November 2025, Dr Aaron Motsoaledi, Minister of Health, stated that the government would pursue the estate of the late Tembisa Hospital CEO Dr Ashley Mthunzi for asset recovery as he had allowed irregular purchase orders to go through. As of 8 November 2025, only one of 467 implicated entities had been placed on the National Treasury’s Restricted Supplier Register, prompting an ActionSA complaint to the Public Protector.

Implications

The investigation is still ongoing, with the SIU’s final report not having been released yet. This case illustrates systemic failures in anti-fraud controls in South Africa. Acting Police Minister Firoz Cachalia confirmed to Parliament on 5 November 2025 that criminal cartels have corrupted South Africa’s healthcare procurement at a systemic level beyond Tembisa. The SIU has indicated that Tembisa may represent only the tip of the iceberg across Gauteng’s public health system.

South African Market Inquiries: What Lies Ahead and is it Justified?

By Michael-James Currie

The South African Competition Commission (SACC) recently announced that it will be conducting market inquiries into both the Public Passenger Transport sector (Transport Inquiry) as well as investigate the high costs of Data (Data Inquiry).

These inquiries are in addition to the SACC’s market inquiries into the private healthcare sector and grocery retail sector (which are still on-going) and the recently concluded LPG market inquiry.

There are mixed feelings about the benefits of market inquiries in South Africa. Market inquiries are extremely resource intensive (both from the SACC’s perspective as well as for the key participants in the inquiry) and the outcomes of the inquiries which have been concluded (including the informal inquiry in the banking sector) are lukewarm at best. There is little evidence available which suggests that the resources incurred in conducting market inquiries in South Africa are proportional to the perceived or intended pro-competitive outcomes.

Leaving aside this debate for now, the SACC’s most recent market inquiries are particularly interesting for a variety of additional reasons.

Firstly, in relation to the Transport Inquiry, the Terms of Reference (ToR) set out the objectives and the key focus areas of the inquiry. In this regard, the ToR indicate that pricing regulation is one of the key factors which allegedly creates an uneven playing field between metered taxis for example and app-based taxi services such as Uber.

It should be noted that the metered taxi association of South Africa had previously and unsuccessfully submitted a complaint to the SACC against Uber for alleged abuse of dominance. The success of Uber in South Africa has widely been regarded as pro-competitive.

Both prior and subsequent to the complaint against Uber, however, an overwhelming number of metered taxi drivers (both legal and illegal) have resorted to deliberate violent tactics in order to preclude Uber drivers from operating in key areas (i.e. at train stations). In fear of having themselves, their passengers and their vehicles harmed, many Uber drivers oblige. It would be most interesting to see how the SACC tackles this most egregious forms of cartel conduct, namely market allocation (albeit entered into under duress).

Over and above the ‘metered taxi v Uber’ debate, there are additional issues which the Transport Inquiry will focus on – including alleged excessive pricing on certain bus routes, regulated route allocation and ethnic transformation within the industry.

What will likely become a topic (directly or indirectly) during the Transport Inquiry are the allegations, as African Antitrust (AAT) had previously reported, that ‘the “taxi and bus” industry is riddled with collusive behaviour. In light of the fact that most of South Africa’s indigent are fully dependent on taxis for transportation in South Africa and spend a significant portion of their disposal income on taxi fees, this is an issue which needs to be addressed urgently by the competition agencies by acting “without fear, favour or prejudice”’.

In this regard, the ToR indicates that “between 70% and 80% of the South African population is dependent on public passenger transport for its mobility”. The majority of these individuals would make use of ‘minibus taxis’.

The Transport Inquiry ToR do not mention this seemingly most blatant violation of competition law principles and it remains to be seen to what extent the SACC’s is prepared to investigate and assess hardcore collusion in the industry.

In relation to the second market inquiry, the SACC will also conduct an inquiry in relation to the high data costs in South Africa.

The High costs of data in South Africa seems to be key issue from the government’s perspective and the Minister of Economic Development, Mr Ebrahim Patel called for the SACC to conduct an inquiry into this sector. Further, the high costs of data in South Africa seems so important to economic growth and development that the Minister of Finance, Mr Malusi Gigaba, not only echoed Minister Patel’s calls for a market inquiry into high data costs, but identified such a market inquiry as part of his ‘14 point action plan’ to revive the South African economy.

Given that the three formal market inquiries which the SACC has commenced with to date have, only one (the LPG inquiry) has been finalized. Even the LPG inquiry took nearly three years to conclude. The private healthcare inquiry and the grocery retail inquiry which commenced in 2014 and 2015 respectively, still seem someway off from reaching any finality.

The length of time taken to conclude a market inquiry is, however, not the end of the matter from a timeline perspective. Following a market inquiry, recommendations must be made to Parliament. These recommendations may include legislative reforms or other remedies to address identified concerns with the structure of the market. Parliament may or may not adopt these recommended proposal.

Accordingly, it seems unlikely that from the date a market inquiry commences, that there will be any pro-competitive gains to the market within 5-7 years. That is assuming that the market presents anti-competitive features which can be remedies through legislative reform

While there appears to be consensus among most that data costs in South Africa are disproportionately high when compared to a number of other developing economies, the positive results envisaged to flow from a market inquiry is not only difficult to quantify, but will only be felt, if at all, a number of years down the line. Hardly a first step to revive the economy on a medium term outlook (let alone the short term).

Furthermore, and entwined with the SACC’s market inquiry into Data Costs, is that the Independent Communications Authority of South Africa (“ICASA”) decided to also conduct a market inquiry into the telecommunications sector, which includes focusing on the high costs of data.  ICASA has indicated that it will liaise with other regulatory bodies including the SACC.

It is not clear what level of collaboration will exist between the SACC and ICASA although one would hope that due to the resource intensive nature of market inquiries, there is minimal duplication between the two agencies – particularly as their objectives would appear identical.

As a concluding remark, absent evidence which convincingly supports the beneficial outcomes of market inquiries in South Africa, perhaps a key priority for the authorities is to conclude the current inquiries as expeditiously as possible and conduct an assessment of the benefits of market inquiries (particularly in the manner in which they are presently being conducted), before initiating a number of additional market inquiries.

Gun jumping: Record antitrust fine for failure to notify merger

S.A. Competition Tribunal imposes record fine for missed merger filing in healthcare

By AAT guest author Meghan Eurelle

On 7 April 2016, the South African Competition Tribunal (“Tribunal”) confirmed that merger parties Life Healthcasouth_africare Group Proprietary Limited and Joint Medical Holdings Limited had entered into a consent agreement with record-breaking consequences.  The two hospital groups admitted to not complying with the Competition Act, 1998 (“the Act”) by failing to notify the competition authorities of their merger and to obtain the required approval prior to the merger being implemented; and subsequently agreed to jointly pay an administrative penalty of 10 million Rand, or approximately U.S. $690,000.  (Interestingly, the parties also conceded that they were guilty of fixing the price of services back in 2004 but the Tribunal dropped these charges.)

gunjumpingThe R10-million administrative penalty is a record amount for gun-jumping, or the failure to notify the competition authorities of a merger.  Previously, the highest penalty for a failure to notify was just over R1-million. The new record penalty follows numerous warnings by the Competition Commission (“Commission”) that it intended to materially increase penalties for failure to notify mergers — says Andreas Stargard, an antitrust practitioner with Pr1merio advisors, “South Africa has a suspensory merger-notification system, like most international antitrust regimes do.  And unlike other African countries, such as Senegal or Mauritius, the domestic S.A. competition legislation prohibits transacting parties from effecting the transfer of control or beneficial ownership prior to obtaining clearance from the authorities.”

In terms of the Act, transactions that are defined as “intermediate mergers” and “large mergers” must be notified to the Commission and may only be lawfully implemented if it has been approved, with or without conditions, by the relevant competition authorities. Small mergers do not have to be notified in the ordinary course and may be implemented without approval unless required by the Commission.

Merger notification thresholds in South Africa remain as follows:

Acquiring and Target firm (merger group) Target firm
Large Merger Combined assets and/or turnover of at least R6.6-billion. AND Assets and/or turnover of at least R190-million.
Intermediate Merger Combined assets and/or turnover equals or exceeds R560-million but is less than R6.6-billion. AND Assets and/or turnover equals or exceeds R80-million but is less than R190-million.
Small Merger Combined assets and/or turnover of less than R560-million. OR Assets and/or turnover of less than R80-million.

In light of the above, it serves as an important reminder to parties that they ensure compliance with the competition authorities and the Act so as to avoid costly consequences.

Commission details plans for private healthcare sector inquiry

south_africa

Further details revealed by inquiry panel

On Friday, subsequent to outlining the time table of the project, the South African Competition Commission Competition Commission released important frameworks for its sectoral inquiry into the competitiveness of the private healthcare sector in the RSA. The key documents are a draft “statement of issues” (which the Commission warned may further “evolve” during the course of the inquiry) and “guidelines for participation” for the market inquiry into the private healthcare sector, which is headed by retired Chief Justice Sandile Ngcobo. The public and affected stakeholders are invited to make written submissions on these before Monday, 30 June 2014 (South African Competition Commission direct e-mail address: health@compcom.co.za).

Notably, the statement of issues includes the role of the public sector in competition in the market for healthcare. This was a key sticking point for observers and stakeholders, as the initial framing of the inquiry appeared solely focused on the private players, failing to take into account the competitive restraints imposed by the strong public insurance schemes and other state-related participants in the healthcare arena.  (AAT published on this and related issues here and here.)

Other topics include, predictably from an antitrust point of view, regulation, market power and dominance, barriers to entry, as well as consumer-protection aspects. Taken together, the areas of concern have been grouped by the Commission’s inquiry panel into six possible theories of harm, which the Commission defines as follows: “A theory of harm refers simply to a hypothesis about how harm to competition might arise in a market to the detriment of consumers and to the detriment of efficient and innovative outcomes in that market.” (Statement of Issues at para. 9 and 53, as follows):

  1. Theory of harm 1: Market power and distortions in healthcare
    financing.
  2. Theory of harm 2: Market power and distortions in relation to
    healthcare facilities.
  3. Theory of harm 3: Market power and distortions in relation to
    healthcare practitioners.
  4. Theory of harm 4: Barriers to entry and expansion at various levels
    of the healthcare value chain.
  5. Theory of harm 5: Imperfect information.
  6. Theory of harm 6: Regulatory framework.

Private Health-Care Sector Inquiry: Time Table & Details

south_africa

Inquiry panel’s head details logistics

On 16 April 2014, the South African Competition Commission held a media briefing, in which the administrative guidelines, the administrative timetable and statement of issues for the inquiry were announced.  AAT previously reported on the health-care sector investigation here.

Addressing the media and other stakeholders at the briefing, the chairperson of the inquiry, former Chief Justice Sandile Ngcobo, provided a brief explanation of what a market inquiry is, provided an overview of its possible outcomes, the Competition Commission and panel’s approach, the use of information during the inquiry and the management of confidential information.

Furthermore, the former Chief Justice elaborated on the important dates and timelines of the inquiry, the statement of issues, theories of harm and that stakeholders ought to provide accurate information in order to assist the panel.

The important dates are:

Date Event
31 May Statement of Issues and Administrative Guidelines issues for public comment
30 June Deadline for submission of public comment on Statement of Issues and Administrative Guidelines
1 July – 31 July Incorporation of comments on Statement of Issues and Administrative Guidelines
01 August Publication of final Statement of Issues and Administrative Guidelines
01 August Call for submissions on subject matter of the inquiry
March and April 2015 Public hearings
November 2015 Forecasted completion of the inquiry

Philips & innovation in Africa: Driving worldwide growth

Philips’ CEO Frans van Houten recognizes untapped potential, invests in Africa

new multi-part series

In February, AAT launched its multi-part series on innovation & antitrust as a thematic collection focusing on the concept of innovation markets and how competition and IP laws are able to address the, by definition, novel issues that arise.  Recently, and timely so, Philips has joined this debate.

Philips & the future of African innovation: From “things” to “ideas”

For one, Frans van Houten, its President and CEO, has been quoted as saying: “Innovation is our lifeblood and will be the main driver of profitable growth going forward. … I intend to drive innovation with more intensity to help us win new customers.”

Notably, Philips changed its official company slogan from “We make things better” to “We create better ideas.”

Mr. van Houten (source: Philips)

Even more pertinent, Mr. van Houten not only recognizes the crucial forward-looking importance of innovation.  Unlike many Western corporate leaders, he positively links it with the economic growth prospects of Africa.  In an insightful piece entitled “How Africa’s innovation will change the world” (published on the Davos World Economic Forum blog), Mr. van Houten discusses the promises, challenges, and realities of African innovation and resulting economic growth.

The article highlights the intuitive, yet elusive, insight that challenges become opportunities when looked at with an inventive spirit.  It also addresses the importance of multi-disciplinary approaches (such as the one at the foundation of our #AntitrustInnovation series, combining law, economics, and business innovation) and that of partnerships:

Seven years ago, millions of Kenyans were struggling to access basic financial services such as a bank account; they were unable to transfer money or receive microcredit. Then, a locally developed mobile payment system called M-Pesa [see AAT coverage here; — Ed.] radically changed everything. Today, more than two-thirds of Kenya’s population uses M-Pesa to make and receive payments and an estimated 43% of the country’s GDP flows through the system. This is transforming life in the country, increasing income in rural households and spawning a range of start-ups.

This speedy adoption of mobile payments captures the enterprising spirit of African innovation. It reflects the resourcefulness with which people in Africa find local solutions to local issues. It also shows how Africa’s challenges are opportunities in disguise and how the continent can bypass development stages without paying for their replacement. Mobile phones, for example, were rapidly adopted in Africa because of the lack of fixed telecom infrastructure. And solar panels are being adopted faster than in other parts of the world, because kerosene is so expensive that the payback time for investments in solar power is months rather than years.

Healthcare is another exciting area. According to a report from the World Economic Forum, Africa faces 28% of the global disease burden with only 3% of the world’s healthcare workforce. In response, Africa is adopting new operating models and technologies. By training health extension workers to focus on education, family planning and sanitation, Ethiopia achieved a 32% drop in child mortality and 38% drop in maternal mortality. In Kenya, e-learning has taught 12,000 nurses how to treat major diseases such as HIV and malaria, compared to the 100 nurses a year that can be taught in a classroom.

Africa is also embracing new business models that tap into the vitality of the country’s communities. Philips, for example, teamed up with Inyenyeri, a Rwandan NGO, to give families access to an innovative cookstove. Crucially, the cookstove is given away for free and families pay for the stove by harvesting twigs, leaves and grass. This biomass is compressed into fuel pellets, half of which are returned to the family for personal use and half of which are sold by the NGO. The cookstove is produced in Africa, highly energy efficient and, because it is smoke free, significantly healthier.

This example also shows the power of partnerships, without which many African innovations would not come to fruition. Solar-powered light centres, for example, increase the social activity and productivity of communities by generating light after sundown. These communities, however, are often unable to invest in a light centre, so this technology is rolled out through NGOs and governments. Sometimes these light centres are used to power medical equipment such as an ultrasound, or refrigerators that store vaccines. This type of cooperation ensures that innovation generates both financial and social value.

The complexity of Africa’s challenges also requires a multidisciplinary approach to innovation. Kenya, for example, is investing in systems that encourage open innovation. This sees local universities and small and medium enterprises join forces with NGOs, governmental organizations and foreign multinationals such as IBM and Philips, which have set up regional research and innovation centres in Nairobi. Nairobi is also home to iHub, a booming community of local entrepreneurs, investors and some of the world’s leading technology firms.

For innovation to really succeed in Africa, other factors need to be addressed, too. There is a lack of prototyping equipment and workshops, so local innovators depend on Europe or China, making the process costly and cumbersome. And while there are good patent laws in place, there are still too many counterfeit versions of successful products. Also, international firms should source locally and work with local distributors, whenever possible. And governments should focus their development money on stimulating entrepreneurship and innovation.

While in Africa millions of people still live on less than $2.50 a day, the continent looks set to have a brighter future thanks to local solutions for finance, healthcare and energy that could become globally relevant. M-Pesa, for example, has already been rolled out in other African countries, India, Afghanistan and Eastern Europe. Perhaps sooner than we think, African innovations will help the rest of the world create lasting social and economic value.

[Frans van Houten, President and CEO, Royal Philips, emphasis and links added, “How Africa’s innovation will change the world” published on Davos World Economic Forum blog.]

Investment: done

More than just writing op-ed pieces, Philips’ leadership has put its money where it matters: On March 20, 2014, the company (with 23-plus billion Euros in annual revenue) announced that it was establishing a “Research & Innovation Hub” in Nairobi, Kenya.  The full Philips statement says:

  • The Philips Africa Innovation Hub in Kenya will be the center for developing innovations “in Africa-for Africa” in the areas of healthcare, lighting and healthy living

  • Hub underlines Philips’ commitment to invest in Africa and provide Africa-relevant innovations to address key challenges facing the continent

 Nairobi, Kenya – Royal Philips (NYSE: PHG, AEX: PHIA) today announced the establishment of its Africa Innovation Hub in Nairobi, Kenya, which underlines the company’s commitment to invest in Africa. The Philips Africa Innovation Hub will work both on the creation of new inventions, as well as bringing these inventions to the market.

The Philips Africa Innovation Hub will do application-focused scientific and user studies to address key challenges like improving access to lighting and affordable healthcare as well as developing innovations to meet the aspirational needs of the rising middle class in Africa.

The Philips Africa Innovation Hub will be located at the Philips East African Headquarters in Nairobi, where African talents and international researchers will operate on the concept of “open innovation” and will work in close collaboration with the R&D ecosystem of Kenya and Africa. Philips is in discussions with local organizations and Universities on R&D collaborations to co-create meaningful solutions for Africa.

“We welcome the establishment of Philips’ Innovation Hub in Kenya; Philips is a globally recognized innovation powerhouse and their selection of Nairobi as the site to establish their African Innovation hub is a testament to the Kenyan government’s commitment to nurture the drive for research and innovation in the region”, says, Hon’ble Adan Mohammed, Cabinet Secretary for Industrialization. “We lend our full support to the investment being made by Philips and look forward to the outcomes of their Africa-specific research and projects that can contribute to transforming society, business and government across the continent”.

JJ van Dongen, Senior Vice President & CEO Philips Africa states: “Philips is passionate to invent, apply technology and partner to help people succeed. Our ambition is to create impactful innovations that matter to people and address the key challenges that confront society. With Kenya as a leader in the continent in science and entrepreneurship as well as a hub of collaboration on technology and innovation, Nairobi, is the ideal location to establish Philips’ African research presence. We want to tap into the city’s vibrant R&D eco-system and contribute to the process of co-creating new solutions, new business models and meaningful partnerships to provide innovations that make an impact.”
Enhancing people’s lives in Africa though meaningful innovations
Some innovations that Philips was already working on have now become part of the Innovation Hub, hence, the Philips Africa Innovation Hub will kick-off with ventures that are under development as well as in the pilot phase; these include:

Respiratory rate Monitor to support pneumonia diagnosis: Pneumonia is the leading cause of death among children under the age of five, resulting in 1.1 million deaths worldwide annually¹. Of these, 99% of deaths occur in developing countries in low-resource settings, which typically entail rural areas with very limited or poor healthcare facilities or with low-skilled health workers. The current diagnostic tools in such settings are not easy to use, can easily distract the workers from an accurate conclusion, and thus lead to a poor diagnosis.

The Innovation hub is working on the development and clinical testing of a robust and affordable Automated Respiratory Rate Monitor that aims to support the diagnosis of pneumonia among infants and children, using smart sensing technology on the body which is intended to be more accurate and reliable compared to manual processes being currently observed. This device will be specially designed for use by community health workers and nurses in rural areas. In Kenya, discussions are on with the Kenya Medical Research Institute (KEMRI) to further develop this project and co-create an effective solution tailored to circumstances in rural Africa.

Community care services: The development and testing of a work-flow innovation designed to reduce the number of avoidable maternal and child deaths. The purpose of the workflow is to enable remote area health centers to diagnose, triage, treat, stabilize and (prepare for) transport expectant mothers that come in for a check-up and treatment.

Smokeless cook stove: Philips has designed and is manufacturing this innovative stove to improve the lives of those who rely on wood or biomass for their daily cooking. These specially designed stoves are extremely efficient and significantly reduce the use of wood as fuel. The cook stove can reduce smoke and carbon monoxide emissions by more than 90% compared to an open fire² thus reducing the health risks of indoor cooking. The contribution of the innovation hub is to create new go-to-market models for these stoves.

Consumer solar solutions: Today an estimated 560 million Africans live without electricity; Philips is committed to improving access to lighting in Africa, for the majority of the population that lives in off-grid communities. The Innovation hub is designing and developing new consumer products using the combination of solar power and energy efficient LED technology. New go-to-market models are also being established to ensure these solutions become accessible to people that would not be able to afford them otherwise.

The Philips Africa Innovation Hub while headquartered in Kenya, will be responsible for pan-African research and projects and will have operations across Africa, linked to the Philips regional offices across the continent; the hub will be headed by Dr. Maarten van Herpen and will work in close collaboration with the Philips research labs in Bangalore, Shanghai and Eindhoven.

¹ Source : Unicef  www.unicef.org/media/media_70890.html
² Reference source:  Water boiling test version 4.2.2 done at accredited stove laboratory, Aprovecho Research Center, Oregon, USA.

 

Antitrust sectoral healthcare inquiry

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Clarification of scope and timetable of sector investigation

According to official statements by the South African Competition Commission (“Commission”), the agency has clarified the administrative guidelines, administrative timetable, and statement of issues.  AAT has reported previously on the sectoral healthcare inquiry by the Commission, critically noting the apparent exclusion of the public healthcare segment, to the detriment of the private care providers.

Theories of harm – “just” theories

The Commission’s main document on the “stakeholder engagement meeting last week states as follows regarding its theories of harm:

[I]n order for the market inquiry to make determinations, it has developed a set of ideas or hypothesis about how harmful competitive effects might arise in the relevant markets under consideration. These ideas are generally referred to as “theories of harm”.
‘It is important to emphasise that these theories of harm are simply hypotheses, or tools, that will enable us to identify whether there are features or a combination of features that may prevent, distort, or restrict competition in the private healthcare markets. Theories of harm are not findings of harm; but are simply analytical tools to guide our analysis. They will be deepened and revised as the inquiry’s thinking develops,’ adds former Chief Judge Ngcobo.

Public comments, and timetable

The agency is “inviting stakeholders to make further comments” on its theories of harm, noting that:

The inquiry is set to follow a very precise and tight administrative timetable which is mindful of the timelines for gathering information including an invitation for written submissions, public hearings, site visits, seminars, and workshops and conducting surveys. Broadly, key milestones will include the issuing of information requests no later than 01 August 2014. The first round of public hearings will take place between 01 March 2015 to 30 April 2015 then from May 2015, the inquiry will analyse and review the information gathered. Presently, the panel aims to make provisional findings and recommendations available for public comment in October 2015.

healthcareinquirytimetabl

Commissioner calls agency’s work “reactive”, will appeal SABMiller case, counters “toothless dog” moniker

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Revelations from Bonakele’s interview with CNBC Africa

South African interim Competition Commissioner Tembinkosi Bonakele called his agency, the Competition Commission (“Commission”), a “kind of reactive” enforcement body, aiming primarily to uncover cartel conduct.  In an interview with CNBC Africa‘s “Beyond Markets” segment, journalist Nozipho Mbanjwa asked the acting Commissioner tough questions on the Commission’s enforcement tactics, legislative mandate, fines imposed, the adequacy of the Commission’s capitalization, and whether the South African antitrust watchdog was, in fact, a “toothless dog.”

Bonakele held his ground, referring multiple times to the Commission’s recent successes, including the construction cartel, the bread case, cooking oils, and other “basic products” matters on which he said his agency would place the largest focus going forward.

The Acting Commissioner

The Acting Commissioner

Some of the highlights from the interview:

  • Bonakele is “quite satisfied” with the agency’s funding and performance of its 180 staff, but may ask for “more funding” specifically for the Commission’s sectoral health-care inquiry.
  • The Commission will focus its cartel-busting efforts on sectors in the basic products category such as foods and health-care.
  • The Commission will “definitely appeal” its loss of the SABMiller abuse-of-dominance matter, a “very tricky kind of offence in terms of competition law” according to Bonakele.  He said he did “not like” the 7-year long duration of the SABMiller saga, but felt compelled to extend the matter by bringing the case before the Competition Appeal Court.
  • “No comment” on the “classic” Unilever investigation.
  • On the much-maligned MultiChoice broadcaster, Bonakele called the company a “monopoly created by legislation” in a regulated market, and deferred to parliament to rectify the situation.
  • The Commission receives approximately 30% of its funds from revenues that are the result of merger filing fees.

South Africa Healthcare panel- a swing to the left?

While it certainly appears that the newly appointed panel to the first ever market inquiry into the South African private healthcare sector consists of a number of members who have a strong medical background, there is a concern, however, that this is significantly skewed in favour of those who have more of a public healthcare background.

This brings into question the degree to which the inquiry will be focused more on the question of accessibility of healthcare to all citizens (An aspect for which South African government has the main responsibility) on the one hand, and the perceived inefficiencies within the private healthcare sector where members/patients pay a premium for access to the latter.

The only economist on the panel is, interestingly, not from South Africa which may bring to question his ability to effectively understand the South African private healthcare sector, how it has evolved in the last two decades, particularly given the changes observed in regulations governing the different levels of the value chain.

A clear concern will be how well the panel will appreciate any commercial arguments, which would undoubtedly be brought forward by the industry, particularly providers.  At the end of the day these are private entities which rely on investors who seek certain levels of return, often irrespective of where those returns come from.

The Competition Commission should  be able to provide some assistance, however, given the level of attrition experienced at the Commission in the last 18 months the quality of those resources remains an issue.

A second aspect is the apparent exclusion of an assessment of the public sector.  Since government is ultimately tasked with providing healthcare services to the vast majority of unemployed in South Africa, these would be the very same majority which could never afford private healthcare today.  Ignoring the public sector is tantamount to ignoring the real issue.

The panel comprises of former Chief Justice Sandile Ngcobo, Professor Sharon Fonn, Dr Ntuthuko Bhengu, Dr Lungiswa Nkonki and Cornelis van Gent.  A brief overview of panel members is as follows:

  • Former Chief Justice Sandile Ngcobo served as the Chief Justice of the Constitutional Court from 2009 to 2011.
  • Professor Sharon Fonn is a medical doctor and registered public health specialist and she is currently the acting dean of the Faculty of Health Sciences at the University of the Witwatersrand.
  • Dr Nthuthuko Bhengu holds an MBChB and his most recent executive appointments have been with Metropolitan Health, Clinix Health Group and Biotech Laboratories.
  • Dr. Lungiswa Nkonki holds a PhD in health economics and is currently a senior lecturer at the University of Stellenbosch.
  • Cornelis van Gent is an economist with experience in competition economics, economic regulation and competition in healthcare markets.