South Africa Tops Healthcare Index as Expats Weigh the Best African Countries to Live

Guides · Africa

The 2026 expat map of Africa is splitting between established hubs with proven healthcare and cheaper but less secure alternatives. For foreigners and investors, the decisive factors are no longer a single index but the gap between safety, monthly budgets and residency rules.

The 2026 Expat Ranking Leaders

Altezza Travel’s 2026 overview names Mauritius, Morocco, Rwanda, South Africa, Tanzania, Kenya and Namibia as the best African countries for expats. The list balances lifestyle, infrastructure and access for foreigners.

Mauritius appears repeatedly as a safety and expat quality leader. Its Global Peace Index score of 1.586 in 2025 gives it an overall rank of 26 globally.

Rwanda and Morocco combine lower rent burdens with improving infrastructure. Kigali and Rabat both show cost of living plus rent scores around 26 or lower in Numbeo city rankings.

South Africa remains a healthcare and purchasing power outlier. Its local purchasing power index of 111.2 in 2025 is far above regional peers.

Kenya and Ghana offer lower total living costs but weaker local purchasing power. That gap matters for expats earning local income rather than foreign salaries.

South Africa

South Africa recorded a Cost of Living Index of 30.0 in Numbeo’s 2025 country table, with a Rent Index of 11.1. The mid-2025 update placed cost of living at 32.0 and rent at 11.9.

City-level data shows Johannesburg at a 44.2 cost of living index on Numbeo’s 2026 mid-year table and Cape Town at 42.2. Cape Town’s rent index of 22.4 is the highest among listed South African cities.

Pretoria posted a 2026 cost of living index of 42.3, slightly below Johannesburg. All three major cities remain cheap for many expats earning US dollars or euros.

South Africa’s healthcare is the strongest draw. Numbeo’s 2026 mid-year data gives it a Health Care Index of 63.9, the highest in Africa.

Government healthcare spending reached R271.9 billion, roughly US$14.8 billion, in 2024/25. Residency options include temporary residence permits and permanent residency permits processed through South Africa’s Department of Home Affairs.

Safety is the main trade-off. South Africa ranks below several African peers, among them Mauritius and Namibia, on major 2025 peace indices.

Kenya

Kenya’s Numbeo cost of living index is 28.9 on the 2026 mid-year table, among the lowest of the main expat hubs. Its rent index of 7.5 is also modest.

Nairobi does not appear in Numbeo’s 2026 mid-year city table. Its rolling current index puts cost of living at 32.7, which is competitive for a regional business capital.

Kenya’s healthcare system is Africa’s second strongest in several recent rankings. Statista’s 2026 publication citing 2025 data put Kenya’s healthcare index at 62.2.

The government allocated about KES 127 billion, around US$980 million, to healthcare in 2024/25. Private clinics in Nairobi serve many expats but add to monthly budgets.

Kenya has introduced digital nomad visa pathways aimed at remote workers, adding a practical residency route. Safety and urban crime remain concerns compared with Mauritius or Rwanda.

Ghana

Ghana posted a Cost of Living Index of 30.6 in Numbeo’s 2025 country data and 31.1 in the mid-year update. Rent remained low at 12.1 and 10.5 respectively.

Accra’s 2026 city cost of living index is 43.1, with a rent index of 12.1. The city is affordable for housing but has weak local purchasing power of 11.6.

Ghana ranks among Africa’s safer countries. The 2025 Global Peace Index placed Ghana seventh in Sub-Saharan Africa with a score of 1.898.

World Population Review, using Global Peace Index data, ranks Ghana 61st globally among the continent’s safer options. This is better than Morocco, Egypt, Kenya or South Africa on that measure.

Ghana dedicated around GHS 16.2 billion, roughly US$1.4 billion, to health in 2024. Residency and work permit processes remain bureaucratic but open to investors and skilled expats.

Senegal

Senegal stands out as one of the more expensive African destinations. Numbeo’s 2025 mid-year data recorded a Cost of Living Index of 45.0 and Rent Index of 19.7.

The combined cost of living plus rent score of 34.0 is sharply higher than Kenya’s 19.6 or Morocco’s 20.5. Dakar’s expat housing and imported goods drive much of that cost.

Senegal offers a strong safety profile. It ranked ninth in Sub-Saharan Africa on the 2025 Global Peace Index with a score of 1.936.

That security advantage appeals to diplomats, NGO staff and investors seeking stability in francophone West Africa. Healthcare infrastructure is functional but less rated than South Africa or Kenya.

French language requirements shape the expat experience in Senegal. Residency procedures follow francophone administrative systems, with long-stay visas and cartes de séjour residence permits.

Rwanda

Rwanda’s 2025 Cost of Living Index was 34.6, but the mid-year figure improved to 29.7. Kigali’s 2026 city score was 34.5 with a rent index of 14.9.

Kigali remains clean, organised and safe by regional standards. The capital has become a preferred base for development workers and regional headquarters.

Infrastructure gains are documented. Rwanda’s quality of infrastructure score rose from 37 in 2010 to 52 in 2019, above the Sub-Saharan Africa average of 45.

Electricity access expanded from 6.1 percent of the population in 2000 to 80.1 percent in 2024. Of that, 56.2 percent is grid-connected and 23.9 percent off-grid.

Rwanda performs better than most Sub-Saharan peers on communicable disease management and maternal and child health services. Visa and residency rules are streamlined to attract investors and skilled migrants.

Morocco

Morocco’s 2025 Numbeo Cost of Living Index was 27.2, among the cheapest of the ranked hubs. The mid-year figure rose slightly to 30.0.

Casablanca’s 2026 city cost index was 35.2, Rabat’s 34.4 and Marrakech’s 32.7. Rent indexes remain moderate across the three cities.

Morocco ranks as one of Africa’s safer countries in World Population Review data, placing 120th globally. That places it behind Ghana and Senegal but ahead of Egypt.

Healthcare is accessible but has a lower Numbeo index of 46.5. Expats commonly use private clinics in Casablanca and Rabat.

Morocco offers several residency routes. Foreigners can apply for a carte de séjour residence permit, renewable under Moroccan immigration rules.

The Moroccan system requires proof of income, housing and health cover. European and Gulf expats find the country especially practical given transport links and banking access.

Egypt

Egypt appears on safety watchlists with a global rank of 142 in World Population Review’s 2025 table. That is the weakest safety position among the major North African expat options.

Healthcare is similarly mid-tier. The 2025 mid-year Numbeo summary lists Egypt’s Health Care Index at 47.01, below South Africa, Tunisia and Kenya.

Cairo remains a large, low-cost regional base for some media and business expats. Housing and services are affordable for those earning foreign salaries.

Residency in Egypt typically involves renewable tourist or work visas and residence permits tied to employment, property purchase or marriage. Bureaucracy can be slow.

Digital connectivity and electricity are reliable in central Cairo but uneven in outlying districts. Investors often pair Egypt with Gulf-facing business operations.

Monthly Budgets in US Dollars

Numbeo cost indexes do not publish fixed dollar budgets for every country. Instead they measure relative cost against New York as a base of 100.

A single expat in Nairobi or Kigali can expect lower rent pressure than in Dakar or Cape Town. Senegal’s rent index of 19.7 is roughly double Kenya’s 7.6.

South Africa’s cities have higher absolute cost indexes but strong purchasing power. An index of 111.2 means local salaries stretch further than in Ghana or Kenya.

For a modest one-bedroom apartment, utilities, groceries and transport, many African expat hubs require US$1,500 to US$2,500 monthly. Premium neighbourhoods in Accra, Kigali, Casablanca and Cape Town cost more.

Expats should budget for private health cover, security costs and backup power or internet in countries with unstable utilities. These add hundreds of US dollars per month.

Visas and Residency Rules

South Africa offers temporary residence visas for work, study, business and retirement, plus permanent residency permits for qualifying applicants. Processing times and documentation are demanding.

Kenya has moved towards digital nomad permits, allowing remote workers legal stay while earning foreign income. Standard work permits remain employer-linked.

Morocco requires foreign residents to hold a carte de séjour, renewed periodically. Proof of income, accommodation and health insurance is standard.

Ghana and Senegal use residence and work permits often tied to investment, employment or long-stay visas. Francophone Senegal follows a permit system similar to Morocco’s.

Rwanda has streamlined entry for investors and skilled workers. Faster company registration and resident permits support Kigali’s regional business ambitions.

Egypt ties long-term residence to work contracts, property ownership, study or family status. Renewals are generally annual and require local sponsorship in many cases.

Healthcare, Internet and Infrastructure

South Africa and Kenya lead Africa on healthcare indexes. South Africa’s score of 63.8 and Kenya’s 61.5 to 62.0 reflect better hospitals, specialists and private care.

Ghana and Egypt have lower healthcare scores but dedicated significant budgets. Ghana allocated about US$980 million in 2024 and Egypt’s 2025 index stands at 47.01.

Rwanda’s infrastructure progress is measurable. Electricity access reached 80.1 percent in 2024 from 6.1 percent in 2000.

Internet speeds vary by city and provider. Fibre is strong in Kigali, Nairobi, Casablanca and South African metros but weaker in secondary towns.

Reliable electricity and water remain infrastructure gaps in parts of South Africa and Ghana. Expats often install inverters, solar panels or water tanks.

Healthcare quality and electricity reliability should be checked at city level, not only national level. A strong national ranking can hide weak rural or secondary city services.

Safety and the Expat Trade-Off

Mauritius is the safest African country by most 2025 measures, with Global Peace Index scores around 1.577 to 1.586. Ghana and Senegal also score well.

Morocco and Egypt offer lower living costs but weaker safety rankings. Egypt’s global rank of 142 is a concern for families and single expats.

South Africa offers top healthcare and high purchasing power but has serious crime risks. Neighbourhood choice, security and transport habits heavily influence safety.

Rwanda and Ghana combine moderate budgets with better security. They are increasingly chosen by expats seeking predictability over large-city amenities.

Foreign investors often accept higher risk in exchange for market size in South Africa, Egypt and Kenya. Others pay more for safety and order in Mauritius, Rwanda or Ghana.

LatAm Markets: Live Signals → — real-time movers, turnover leaders and FX across Latin America.