Good governance is the cornerstone of sustainable healthcare
Kevin Aron, Principal Officer at Medshield Medical Scheme
27 November 2025
Johannesburg - In an era where trust defines longevity, good governance is no longer a corporate formality; it is the foundation of sustainable healthcare. For medical schemes, it determines how effectively they manage risk, ensure accountability, and build the confidence of members who rely on them for their well-being.
At Medshield Medical Scheme, governance is more than compliance. It is the discipline that underpins every decision, every policy, and every relationship with members, employees, healthcare providers and other stakeholders. Through integrity, transparency, and ethical leadership, Medshield ensures that its governance framework translates directly into stability, credibility, and better health outcomes for its members.
Governance as the framework for trust
For Medshield, governance is the "G" that gives structure to its ESG commitments – a system of checks, balances, and accountability that keeps the Scheme both compliant and compassionate.
Effective governance ensures that Medshield operates with fairness, transparency, and integrity, while safeguarding the assets and trust of its members. It also promotes ethical behaviour through clear guiding principles, structured oversight, and mechanisms that ensure the Scheme makes decisions responsibly and in the best interests of members.
Governance plays a particularly vital role in ensuring long-term sustainability. It reduces legal risks, promotes compliance with laws and regulations, and creates tools to identify and manage risk effectively. It also establishes standards for service delivery and continuous improvement, ensuring that member health outcomes and quality of care are strengthened. When done well, governance builds the kind of trust that cannot be legislated, only earned.
Structure, standards and compliance
Medshield's governance practices are guided by King IV principles, aligning with global best practice while addressing the realities of South Africa's healthcare sector. In a system shaped by transformation and affordability pressures, good governance must be both ethical and adaptable.
The Board of Trustees provides strategic oversight and fiduciary direction in accordance with the Medical Schemes Act and Scheme Rules. Independent experts support the Board through specialist committees, while the executive management team executes operational goals under their supervision. This structure ensures independence between oversight and management while promoting accountability.
Transformation and diversity remain central to the Board's composition. Co-opted Trustees and independent experts are appointed based on skill, experience, and representation, aligning with South Africa's transformation goals. Succession Planning across all management levels further ensures leadership continuity and stability within the organisation.
Robust governance frameworks and internal controls underpin Medshield’s operations and set clear standards for ethical conduct, decision-making and accountability.
A combined assurance approach, regulatory alignment, and ongoing compliance monitoring ensure adherence to the Medical Schemes Act and related regulations. Active participation in industry associations keeps the Scheme informed of regulatory developments and best practice within the healthcare sector.
Integrity is further reinforced by transparent reporting mechanisms and safe channels enabling employees and stakeholders to raise concerns. In this way, transparency is not only encouraged but also protected.
Risk, resilience and continuous improvement
Medshield takes a Scheme-wide approach to risk management, integrating mitigation strategies into planning and daily operations. The Scheme's Risk Management Framework, aligned with ISO 31000 and King IV, identifies and manages risks across strategic, operational, financial, and compliance areas.
Emerging risks such as cyber threats, political instability, and climate-related disruptions are reviewed annually with assurance providers. The risk appetite adopted by the Scheme supports proactive identification and management of both threats and opportunities.
- Fraud prevention is a key governance priority. Medshield partners with dedicated industry providers to detect and address Fraud, Waste, and Abuse (FWA), safeguarding member funds, promoting accountability, and enhancing industry integrity.
- Technology has become an essential tool in governance execution. Medshield uses digital board packs, e-governance tools, virtual meetings, and automated compliance reports to streamline oversight and enhance accuracy. Its ISO 9001 certification mandates regular policy reviews and continuous improvement, ensuring processes remain relevant and competitive.
- Training and development underpin this approach. All employees receive ESG-related onboarding, while trustees and independent experts participate in formal governance education, including the Council for Medical Schemes' Trustee Programme. It ensures a consistent understanding of fiduciary duties and embeds governance as a living practice rather than a static policy.
- Stakeholder engagement is equally critical. Internally, governance reports are presented quarterly to the Board and committees. Externally, the Scheme uses members', providers' and Brokers’ newsletters, awareness campaigns, and social media updates to engage stakeholders. Insights from customer experience surveys inform operational decisions, ensuring that governance remains responsive to members’ needs and expectations.
As part of its regulatory compliance, Medshield follows directives from the Council for Medical Schemes (CMS), which issues guidelines on the application of the Medical Schemes Act. The Scheme undergoes regular internal audits and implements corrective actions to maintain compliance and transparency.
The foundation of trust
Ultimately, governance is about trust – trust that the Scheme manages members' contributions responsibly, that decisions are transparent, and that leadership remains accountable to the members of the Scheme.
The governance environment for medical schemes continues to evolve within a complex regulated healthcare landscape. By embedding proactive risk management, maintaining transparency, and collaborating with peers, Medshield demonstrates that strong governance is the most effective response to complexity.
At Medshield, good governance is not an obligation; it is a deliberate choice that defines who we are. It is the architecture of accountability that supports everything else, from financial stability and service quality to long-term member confidence. Because in healthcare, trust is everything, and trust begins with governance.
FIN
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