Health Care in South Africa

A Research Paper

South Africa is recognized as the first state to perform a heart transplant to a living person. It is also home to the most advanced health care system in Africa. However, in the World Health Report 2000 of the World Health Organization (WHO), South Africa ranked a depressing "175th in overall performance and 182nd in efficiency" among 191 countries worldwide.
The WHO asks, "How is it possible that such a well-developed infrastructure supports one of the worst health systems in the world?" Some studies show that besides medical care, public health measures matter as well. South Africa is well known to be living in a post-apartheid era. Along with this epoch, inequity continues to prevail in much of its society.

Apartheid Instituted
The word "apartheid" comes from the Afrikaans word for “separateness”. In 1949, Daniel Malan of the National Party (NP) became prime minister of the country. He enacted the doctrines of apartheid, or racial separation upon winning. NP "legalized white economic exploitation, political domination, and social privilege." The Group Areas Act was passed in 1950, which provided separate areas for the four major racial groups in the country: whites, blacks, coloured, and Asians. The blacks were divided into ethnic groups and assigned to 10 "bantustans", or homelands. Access of blacks to areas reserved for whites was restricted. In fact, millions of blacks who remained for more than 72 hours in an area reserved for a white without a pass were imprisoned. The government also banned marriages between whites and blacks.
When Malan retired, his policies were continued by another NP leader, Johannes Strijdom. Strijdom was succeeded by Hendrik Verwoerd. Verwoerd passed the Promotion of Bantu Self-Government Act, which offered blacks participation in a political process within their Bantustans and ended their representation in the parliament. The government was relieved of welfare responsibilities toward millions of blacks while keeping the benefits of cheap black labor.
All apartheid legislation was repealed only in the early 1990s. In April 27, 1994, Nelson Mandela was elected as the first president in a representative democratic election. Mandela was a known anti-apartheid activist and was the leader of African National Congress (ANC). Mandela became a worldwide “icon of freedom and equality” and was often compared to Mahatma Gandhi. Unlike Gandhi, he was pliable to using violence for political change. Called by many South Africans as “mkhulu” (or grandfather), Mandela received the 1993 Nobel Peace Prize.

Discrimination in health care
Health care greatly affected by the legacy of apartheid. During the reign of apartheid, hospitals were consigned to racial groups (i.e. white) and concentrated in white districts. Those from rural zones had to travel long distances for basic health care. There are post-apartheid implications.
South Africa’s health system has a “large public sector and a smaller but fast-growing private sector”. The service provided varies substantially between the two. Basic primary health care is provided free by the state; on the other hand, “highly specialised hi-tech health services” are available only for those who can afford, including the private sector and those with insurance.
Though the government allocates 40 percent of its expenditure to health, it is pressured to serve 80 percent of the population. The private sector, largely commercial, satisfies middle- and high-income earners which represent only 18% of the total population. The government spends US$ 3.1 billion on 35 million people, while the private sector splurges US$ 36.5 billion on only seven million. Foreigners are also included in the private sector. Most health professionals, except nurses, are drawn to this sector because of higher compensation and more benefits.
In 2000, drug expenditure was 8.25 billion rands. Of this, only 24 percent was spent by the government. Therefore, 800.29 rands was spent for every person in the private sector, while a meager 59.36 rands was spent per person in the public sector. Forty percent of pharmacists work for the private sector in the province of Gauteng (the business capital) alone. Also, there are 50 available MRI scanners in the private sector and only four in the public sector. In 2002, there were 161 private hospitals. Of these, only 19 are found in non-urban areas. The government’s allocation of health resources and the quality of health care differs in each of the nine provinces. “Cash-strapped provinces” like the Eastern Cape, with less resources and greater poverty, face more health risks than richer provinces such as Gauteng and the Western Cape.
This first- and third-world variation was in the mind of Sampie Terreblanche. Terreblanche was a member of the pro-apartheid National Party before he transferred to ANC. In his popular book “A History of Inequality in South Africa 1652-2002”, he subtly criticized inequality and globalization in his country. He wrote about an “incomplete transformation” from 1994 which featured “enormous problems of poverty, health, hunger, and lingering racism and exploitation.”

Overall health and Aids
“Poverty-related” illnesses are prevalent in South Africa. South Africa is one of 22 countries with the highest cases of tuberculosis (TB). More than half of these are HIV-related.
Another widespread illness is malaria, which affects mostly north-eastern provinces. In 2000, 62000 came down with the disease—423 of which died. Drug resistance, cross-border travel from Mozambique, decrease in DDT use, and HIV are all pointed as causes of malaria’s upturn.
However, Aids presents the “biggest threat” to the country: South Africa is considered as having the most severe HIV outbreak in the world. Six million are “expected to die from Aids-related diseases over the next 10 years.” The UNAIDS 2006 Global Report estimated that in 2005, there were 320000 AIDS-related deaths in South Africa. A survey by the country’s Department of Health estimates that 4.5 million South Africans are infected with HIV in 2000.
The United Nations estimates that of all adults in South Africa, 20 percent are HIV-positive. Life expectancy is expected to fall to only 35 years by 2010. It is not clear how much of AIDS can be blamed to the flawed health system. Many believe that other factors, particularly “cultural, anthropological, or social”, are propelling AIDS in South Africa.
The largest cities in the country are Cape Town, Durban, and Johannesburg. Cape Town is the legislative capital, Durban is the leading port, and Johannesburg is the “commercial capital and metropolis of the goldfields”. These are considered most urban of the cities; thus, are provided with relatively better health care. They also have higher numbers of English-speaking whites.
The Hope Cape Town Trust & Association was formed in Cape Town in 2001. HOPE Cape Town is a non-profit organization “providing outreach, education and counselling at the community level” with focus on HIV, Aids, and TB in the Western Cape Province. In 2006, it launched a trust fund to guarantee the association’s existence on a long-term basis.
Meanwhile, people of Durban fear HIV spread because of its increasing number of commercial sex workers (CSWs). These CSWs have high HIV-awareness, yet continue to engage in “risky sexual behaviour”. Many of them adopted strategies to cope with possible infection, including denial of risk, fatalism, economic rationalization, partner categorization through condom use, deliberate ignorance of HIV status, and repudiation of responsibility to practice safe sex.
In Johannesburg, women have gathered from all sectors to proclaim their position on Aids on April 6 and 7, 2006. Including HIV positive women, women's rights activists and feminists, scholars, professionals, community workers, and policy makers even from outside the city, the women of Johannesburg recognized that the pandemic has “devastating impact” on the lives of African women. They urged a “critical need to move from rhetoric to action” to combat Aids.

Children and Aids
Three years ago, there were 2.2 million orphaned children in South Africa. This number corresponds to 13% of all children. Almost half of these orphans were estimated to have lost parents because of Aids-related illnesses (UNAIDS, UNICEF, USAID, 2004)”. The children most affected are those in “deeply impoverished households”. Their health is in danger because of “infection, inadequate nutrition, and poor health care. Their livelihoods are also lost because of the illness and death of their family’s breadwinners and other working adults. Their families are broken when they are separated from their parents and siblings and sent to live with relatives. Finally, children’s social networks are fragmented as they are separated from their loved ones and friends, both physically and psychologically.
In addition, the rape of almost 60 children every day is linked to the "Virgin Cure", which is the belief of many South Africans that having intercourse with a virgin prevents or cures HIV/Aids.
Doctors play an important role in health care and Aids prevention. Sadly, South African doctors suffer from “brain drain” and are sought after in other countries such as Canada and Great Britain. Many leave because of the higher standard of living and superlative technology abroad.
Meanwhile, Aids Foundation South Africa, blame “poverty and social instability, high levels of sexually transmitted infections, the low status of women, sexual violence, high mobility (particularly migrant labour), and lack of good governance.” A 2005 report of the United Nations’ "3 by 5" initiative, blames “bureaucracy, poor management and inadequate funding”.

Battle against Aids
The whole society is affected by Aids and its disastrous effects on a disproportionate health care system. A 1984 Nobel Peace Prize winner, Desmond Tutu was a cleric who became known as an opponent of apartheid in the 1980s. Tutu is currently very active in leading the battle against Aids. In fact, he has served as honorary chairman for the Global AIDS Alliance. After Pope Benedict XVI’s election in 2005, Tutu voiced out his sadness because of the Catholic Church’s rejection of condoms. Tutu believes that the use of condoms can prevent Aids.
Many businesses initiated awareness and education programs against HIV. Most Anglo-American companies offer free antiretroviral (ARV) medicine treatment for their employees.
Only in April 2002, the Cabinet agreed that ARV should be given to all rape survivors as “post-exposure prophylaxis”, and that the state must introduce ARVs to the public. On November 19, 2003, THE Cabinet “announced the rollout of a comprehensive AIDS treatment plan that would offer free ARVs”; however, Health Minister Tshabalala-Msimang encouraged a diet consisted of beetroot, olive oil, African potato and garlic for people with HIV.
For the health care system as a whole, legislations have been passed in recent years to “make drugs more affordable and promote the use of generic equivalents, regulate the medical schemes industry to prevent it from discriminating against "high risk" individuals like the aged and sick; legalise abortion and allow for safe access to it…; and limit smoking in public places and make the public aware of the health risks of tobacco...”

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