(Updated 16 July 2026)
For a treatment to be genuinely accessible, it needs to be both available and affordable. Transcranial Magnetic Stimulation, or TMS, faces challenges on both fronts in South Africa.
TMS machines are imported and expensive. Clinics therefore need to recover substantial equipment, staffing and maintenance costs through treatment fees. This makes treatment costly for patients and limits the number of facilities able to offer it.
Progress is happening, although access remains uneven.
For many years, the only TMS machine in the public sector was based at Stellenbosch University. More recently, the University of Pretoria and Wits have also introduced TMS services. Getting more machines into state and university facilities is an important part of improving access, particularly for patients who cannot afford private treatment.
The second route to better access is medical-scheme funding.
The evidence for TMS is now well established. For patients whose depression has not responded adequately to lifestyle interventions, psychotherapy and medication, or who cannot tolerate further medication trials, TMS may offer a meaningful chance of improvement.
TMS is a non-invasive, medication-free treatment that uses magnetic stimulation to target brain networks involved in mood regulation. It is supported by local and international guidelines. Side effects are generally mild and may include scalp discomfort or a temporary headache.
It is not the right treatment for every patient, and it should not be presented as a miracle cure. But it is a valuable, evidence-based option for people who have often already tried multiple treatments without sufficient relief.
The pressures on the healthcare system
The reality is that every part of the South African healthcare system is under pressure.
Medical schemes are dealing with uncertainty around the NHI, slow membership growth and increasing claims. This makes them cautious about funding treatments they regard as new or costly.
Private healthcare providers are expected to deliver better outcomes with progressively fewer resources.
The public sector remains severely overloaded, with demand often exceeding available capacity.
In the middle of all these competing pressures is the patient, who simply wants to get better.
Why TMS should be considered
Our system readily funds medication and hospital admission. Both are important and, at times, essential. However, neither is a solution for every patient.
Patients with difficult-to-treat depression may undergo repeated admissions or accumulate increasingly complicated medication combinations without achieving remission. Side effects also increase as more medication is added.
We should not continue repeating the same treatment approach when a safe, guideline-supported alternative is available.
TMS belongs on the treatment table alongside medication, psychotherapy and hospital care. It is not a replacement for all of them, but it should be considered when standard treatment has not been enough.
Where medical-scheme funding currently stands
Funding remains inconsistent and usually depends on the patient’s scheme, plan and clinical circumstances.
Discovery was the first major scheme to recognise TMS funding in selected cases, particularly on higher plans and with an appropriate motivation. The patient generally needs to have their Prescribed Minimum Benefit diagnosis registered under the relevant F32 or F33 code, with their chronic medication benefit activated. The treating psychiatrist then submits a clinical motivation.
Some Medscheme-administered options will consider TMS on a case-by-case basis in defined circumstances.
Momentum, CAMAF, GEMS and Polmed have also considered individual applications in selected cases.
The broader trend is encouraging. More schemes are at least reviewing motivations submitted by psychiatrists rather than rejecting TMS automatically.
This is not the same as routine funding, but it is movement.
What we are doing to improve access
As TMS providers, we continue to work on access in several ways.
We submit structured clinical motivations that clearly document diagnosis, previous treatment, treatment response, side effects, and the proposed TMS protocol.
We provide treatment outcomes and real-world clinical data.
We work with colleagues to align patient selection criteria, safety screening, and treatment protocols.
We continue to engage with medical schemes and propose practical funding models, including defined clinical criteria and risk-sharing arrangements.
Most importantly, we continue to motivate patients one by one. Funding decisions should be based on evidence, illness severity and function, rather than simply on what has traditionally been funded.
What seems to make the biggest difference
The strongest applications usually involve two people working together: the treating psychiatrist and the patient.
The psychiatrist needs to provide a thorough and clinically credible motivation.
The patient, as the medical scheme member, should follow up, request feedback and insist that the application is properly considered.
Medical schemes can feel like enormous and impersonal institutions, but decisions are still made by people. A short, honest personal account from the patient can help explain the human impact of the illness and why another treatment option is being requested.
Schemes are also member-led. Policies are more likely to change when enough members submit formal requests, ask for written reasons, and appeal declined applications.
Many of the doors that are beginning to open have opened because patients asked politely, persistently and in writing.
How to Request TMS Funding
1. Ask your psychiatrist to prepare a motivation
The motivation should usually include:
- Your diagnosis and relevant comorbidities.
- A clear record of previous medication trials, including doses, duration, response and side-effects.
- Details of psychotherapy or other relevant treatment.
- Evidence of treatment resistance or medication intolerance.
- The proposed TMS protocol.
- The details of the treating psychiatrist and TMS clinic, including HPCSA registration.
The psychiatrist will normally submit the motivation directly. However, it is also useful for the patient to submit or follow up on the request so that the scheme can communicate directly with the member.
2. Submit a written request to the medical scheme
A suitable subject line would be:
Funding authorisation request: TMS for treatment-resistant depression
Attach the psychiatrist’s motivation and include a brief personal note describing how depression has affected your life, what treatments you have already tried and what you hope TMS may help you regain.
Keep it honest and specific. The aim is not to exaggerate but to help the reviewer understand the illness’s real-world impact.
Ask the scheme to provide its decision in writing.
If the request is declined, ask:
- Which policy clause was used to make the decision?
- What are the scheme’s criteria for approving TMS?
- What additional clinical information would be required?
- What is the formal appeal process?
3. Appeal a declined application
Do not assume that the first rejection is necessarily the final answer.
Request the clinical reasons for the decision and the full appeal pathway, including any applicable timelines.
Ask directly what information or clinical criteria would need to be met for the decision to change.
If the scheme’s internal appeal process is unsuccessful, unclear or unreasonably delayed, the matter can be escalated to the Council for Medical Schemes.
4. Allow your outcome data to contribute
Where appropriate, patients who undergo TMS may be asked to consent to the sharing of de-identified outcome data with medical aids.
South African real-world evidence matters. It helps demonstrate which patients benefit, how much they improve and whether treatment may reduce medication use, hospitalisation or loss of function.
Each properly documented treatment outcome helps move TMS from an exceptional, case-by-case request towards a recognised treatment benefit.
Where we are now
Access to TMS in South Africa is still not where it should be.
It remains expensive, geographically limited and inconsistently funded. Those are real barriers, and they should not be minimised.
However, the situation is changing. More public-sector institutions are introducing TMS. More medical schemes are considering individual applications. More South African clinicians are collecting outcomes and engaging with funders.
We will continue to motivate, negotiate and provide evidence.
Patients can also help move the process forward by formally requesting funding, obtaining written decisions, appealing where appropriate, and ensuring their experience becomes part of the record.
Evidence should drive access. We need to keep working until it does.
