SOUTH AFRICA | Summary

OVERVIEW

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HISTORY 

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The current state of the health system is due to many epidemics and policies from the country’s eras such as colonial subjugation, apartheid, and the post-apartheid period.¹⁴ South Africa has had racial and ethnic discrimantion laws beginning in colonial times that have dominated the culture of the country until recent decades.⁵ There was a major attempt to restrict black individuals from urban areas to the reserves during this time. Disparities in healthcare also arose because there was one doctor for every 308 white people compared with one doctor for 22,000 to 30,000 black people in the reserves. Furthermore, the urban black population grew 94% between 1921 and 1936.There was racial segregation of urban areas as well because the reservation of land was mostly for white people. The lack of proper housing and land led to the creation of overcrowded, unsanitary hostels and slums in the urban black areas. From 1948, the National Party came to power and created the policy of apartheid, which consolidated the political exclusion, economic marginalization, social separation, and racial injustices of the last 300 years. The system determined where a person could live, work, and go to school, whom they could marry, whether they could vote, and the resources allocated to education, health care, and pensions based on their racial classification. The laws were reinforced by state control and repression. Black people were denied citizenship in South Africa and continued to be forcibly removed to the rural labour reserves. In 1952, a segregated medical school was established for black students.¹⁴ In 1994, Nelson Mandela became the first black president and ended apartheid policies. Legal discrimination ended and more favorable policies towards the black populations. However, apartheid policies left an outstanding aftermath that still causes detrimental outcomes for vulnerable populations. 

 

Since the 17th century, South Africa has faced a significant burden of epidemics such as poverty, smallpox, measles, malaria, and others. To combat these illnesses, the country relied on traditional healers, Europeans trained doctors, missionaries, and other health providers. The 19th century brought epidemics of syphilis, tuberculosis, bubonic plague, and cholera, among others. In 1807, the first health legislation created the Supreme Medical Committee to oversee all health matters. There were expansions of health practices throughout the colonies but it wasn’t until 1883 that the first public health act was passed in response to the epidemics. Public health began to take priority during this time with the first unionwide public health department established in 1919. Community health centers began in 1945 and were the foundation of community-based primary health care and increased access to health for many. Most recently, South Africa experienced one of the highest burdens of HIV/AIDS and continues to be detrimental today. There was complete government denial which caused an extremely slow action towards an HIV/AIDS response until the early 2000s. An ambitious program was introduced to provide antiretroviral therapy to all patients.¹⁴ Spending on HIV increased at an average annual rate of 48.2% between 1999 and 2005.¹¹ 

 

Private health care has existed in South Africa since the 19th century but was funded by out-of-pocket payments until 1889. That year, medical schemes were introduced to meet the healthcare demands of white mine workers. These plans were exclusive to the white population until the late 1970s when black people were allowed to access this health coverage, however cost was a major barrier to obtaining it. The private sector grew exponentially throughout the 20th century and redirected medical resources to it. By 1980, 40% of doctors worked in the private sector and that number grew to over 60% by 1990.¹⁴ 

HEALTH & HEALTH SYSTEM