According to WHO, every year, more than 56 million people around the world need some form of end-of-life or palliative care — comfort and dignity in their final days. And nearly 80% of them live in low- and middle-income countries, where access to such care is painfully scarce.
Nowhere is this gap more visible than in Africa, which alone accounts for over half of those in need.
Despite the staggering numbers, only about 14% of patients globally who require palliative care actually receive it. And as non-communicable diseases — like cancer, heart disease, and diabetes — continue to rise sharply in these regions, the crisis is deepening.
What should be a time of compassion and relief often turns instead into one of pain and neglect.
Here's what nobody tells you about end-of-life care: everybody loses. The medical scheme haemorrhages money. The patient spends their final months in a fluorescent-lit hospital room. The palliative care doctors — the ones actually trained to make dying dignified — are so underfunded they can barely pay their staff.
The nurses and home-based carers are starved for resources because all the money flows upstream to acute hospitalization.
It's a lose-lose-lose scenario for all the stakeholders. The kind of broken system that should be obvious to fix but somehow never is.
The Alignd solution
Alignd, a South African startup, founded in 2018 by Linda Holding (Co-founder and Clinical Guardian) and Shivani Ranchod (Co-founder & Strategic Advisor), is fixing these end-of-life care challenges with an innovative value-based model.
"It's a lose-lose-lose scenario," Ranchod explains. "The funder is losing by spending too much money. The patient and their family are losing in terms of care they don't really want. And the whole ecosystem of providers — nurses, social workers, home-based carers, palliatively trained doctors — is actually underfunded. All this money going into acute hospitalization instead of into a much wider network of people who could actually help."
"We came together with this passion for what we saw and felt was doable to change, to make a more compassionate health care system, especially for that end-of-life phase," Holding recalls. "We were thinking: how can we help? What if everybody could win?”
That question — what if this could be a win-win-win? — launched Alignd.
Five years since their first patient, Alignd has treated over 5,000 patients and their families and impacted 2.9 million+ lives, saved medical schemes millions, turned a sector-wide tragedy into an ecosystem that actually works. And in doing so, proving that in healthcare, genuine care isn't a constraint on profitability. It's the prerequisite for it.
The insight that started it all
Before founding Alignd, Ranchod was working as a healthcare actuary; she witnessed firsthand how millions would flow into end-of-life care with zero to show for it. Holding was a clinically-trained executive in the healthcare funding industry. Lungi Nyathi (CEO) was in South Africa running managed care services across multiple schemes, witnessing the same futility play out across millions of families.
“The combination of our skills, the clinical and financial skills, meant that we had similar instincts around the problem, and it would be possible to create a win-win-win scenario,” Ranchod adds. "We thought, why can't we create a scenario where everybody benefits?"
The answer wasn't a technology. It wasn't a drug. It was a business model. Alignd built what's called a "value-based care" solution — a term gaining increasing traction across emerging markets as the global healthcare industry begins questioning whether treating volume instead of outcomes makes any sense.
Unlike traditional fee-for-service models, which incentivize doctors to see as many patients as possible regardless of outcomes, Alignd's model aligns incentives across the entire ecosystem: medical schemes pay based on results, not procedures. Patients receive comprehensive palliative care starting at diagnosis, not just at death's door. And providers — nurses, social workers, home-based carers — get paid fairly for the complex, time-intensive work of holding space for dying patients and their families.
Its technology platform connects multidisciplinary teams in real time. And they have built an algorithm that proactively identifies which patients can benefit. They have built a network of 400-plus trained providers, robust clinical oversight, and a relationship with funders willing to manage risk differently.
The hard part of building the startup
Launching during a pandemic is typically a death sentence for startups. Alignd decided to try anyway.
The timing was catastrophic. Ranchod and Holding were approaching South Africa's private medical insurers — the only entities with the capital and incentive structure to fund a palliative care intervention — precisely when COVID-19 hit. Medical schemes weren't thinking about innovative future models. They were in crisis mode, trying to survive the present.
"They didn't have bandwidth for entrepreneurs with their new future ideas," Holding recalls. "They were trying to comply with shutdown requirements and focus on how to cope with the pandemic."
For nine months, Alignd couldn't get a license from the regulators, who had no playbook for a managed care company that didn't fit existing categories.
What kept them motivated was their refusal to quit.
"We weren't going to give up until we got that foot in the door," Holding says. "You always need somebody to give you a chance to do that concept. And we managed to do that with one particular private medical insurance team."
That "one particular team" became the wedge. Alignd got a pilot. Then evidence. Then results. Then the institutions started calling.
Five years later, the outcomes speak for themselves: huge cost savings, patients dying at home instead of in fluorescent-lit hospital rooms, and families saying their loved ones had good endings.
The investor piece is crucial here. Alignd wasn't just lucky, it was matched with the right kind of capital. Institutional investors that are willing to believe that commercial viability and social impact aren't enemies. That you can simultaneously generate returns and transform a system.
"The willingness to have those conversations has shifted over the five years," Ranchod observes. "It's been wonderful to find investors who have a deep resonance with that reality."
Expanding beyond end-of-life and addressing infrastructure gaps
Having cracked the code on palliative cancer care in South Africa's private healthcare system, Alignd is now moving into adjacent spaces — the pregnancy and birth journey and chronic kidney disease — both areas where current systems fail patients badly and waste enormous resources.
Alignd is sharing its templates, its learnings, its entire operating model because they understand that no single company is going to solve healthcare in every country.
"We go to these international conferences, and we don't see other people positioned the way we are," Nyathi notes. "It feels like there's a real opportunity in other markets, but also just to share what we've learned. We can help other people solve problems in their local countries."
That openness is radical. And it reflects a larger shift happening in African healthcare innovation — one that Alignd is both part of and helping to accelerate. Across the continent, the healthtech sector has already attracted over $150 million in startup funding in 2025, emerging as the third-largest investment category after fintech and climate tech.
And the problems being solved aren't theoretical. Africa bears 25% of the global disease burden but has just 3% of the global healthcare workforce. The global shift from fee-for-service to value-based care models is influencing Africa, with health tech solutions enabling remote monitoring and health analytics gaining traction.
Yet Alignd's story also reveals the infrastructure gaps in Africa. Many African countries lack the healthcare service supply that even South Africa struggles with in rural areas. Access to essential pain medication like morphine remains restricted in parts of the continent. Whilst government or donor funding models work differently than the private insurance ecosystem where Alignd built its model, the innovations hold promise for all funders who want to purchase healthcare differently.
This is where the company's hybrid approach becomes its greatest asset. In rural South Africa, where national insurers want coverage but providers don't exist, Alignd developed three delivery models: face-to-face care where infrastructure allows, hybrid teams that blend in-person and remote support, and fully virtual telemedicine delivery for underserved regions.
"We've learned so much from that work," Holding explains. "That will hold us in good stead in other African countries — anywhere with large rural areas where the infrastructure gaps are real."
Alignd isn't expanding into new markets by copying its South African playbook. It's expanding by understanding what a "win" looks like in that market's funding structure, infrastructure reality, and cultural context — then redesigning the model to deliver it.
"Our fundamental way of work is to think about what does a win look like?" Nyathi emphasizes. "We start by understanding what works in their world. We may have to shift some of the way we think about our model, but we understand our core pillars — the interconnections that make the solution come alive — well enough to transpose it."
That cultural foundation has also become one of Alignd’s greatest advantages. Its model — built on the belief that all stakeholders must win simultaneously — naturally resonates in markets where cooperation and shared benefit are deeply ingrained values. As Holding notes, “We’ve been very pleasantly surprised by the receptivity in neighbouring countries.”
“In a Western, Global North context, we tend to think in much more individualistic ways,” Ranchod reflects. “We think in terms of competition, not interdependency. But in an African context, where there’s a stronger sense of community and collectivist orientation, it’s easier to understand what we do.”
Proving that purpose and profit can thrive together
In the end, what separates Alignd from the various "pseudo competitors" out there — the providers who've added palliative care elements or the funders (insurance companies) — is something both harder to measure and harder to fake: genuine care.
"Genuine care is our big differentiator," Nyathi says. "You can use the language. You can look like you're doing similar things. But the reason I think we have been so effective is that the heart of our business is genuine care. We work hard to maintain that across our team."
Alignd's care partners each manage around 100 patients and their families at any given time. A hundred families struggling with serious illness. A hundred sets of hopes and terrors and last wishes.
"Building an environment where there is a culture of genuine kindness, of genuine care, of genuine compassion — it's hard to find in today's work world, and we have seen very few organizations that really bring that depth of commitment that we do," Nyathi notes.
It's the kind of business that requires investors willing to trust that meaning and money aren't mutually exclusive. That solving a real problem for real people, at scale, sustainably, is actually the highest form of return.