Health care in South AfricaSouth Africa's health system consists of a large public sector and a smaller but fast growing private sector. In this article:
- Expenditure on health
- National, provincial and local
- National Health Insurance
- Doctor shortages
- Statutory bodies
- Health profile
- Traditional medicine
IntroductionHealth care in South Africa varies from the most basic primary health care, offered free by the state, to highly specialised, hi-tech health services available in the both the public and private sector. However, the public sector is stretched and under-resourced in places. While the state contributes about 40% of all expenditure on health, the public health sector is under pressure to deliver services to about 80% of the population. The private sector, on the other hand, is run largely on commercial lines and caters to middle- and high-income earners who tend to be members of medical schemes. It also attracts most of the country's health professionals. This two-tiered system is not only inequitable and inaccessible to a large portion of South Africans, but institutions in the public sector have suffered poor management, underfunding and deteriorating infrastructure. While access has improved, the quality of health care has fallen. The situation is compounded by public health challenges, including the burden of diseases such as HIV and tuberculosis (TB), and a shortage of key medical personnel. However, the South African government is responding with a far-reaching reform plan to revitalise and restructure the South African health care system, including:
- Fast-tracking the implementation of a National Health Insurance scheme, which will eventually cover all South Africans.
- Strengthening the fight against HIV and TB, non-communicable diseases, as well as injury and violence.
- Improving human-resource management at state hospitals and strengthening co- ordination between the public and private health sector.
- Deploying "health teams" to communities and schools.
- Regulating costs to make health care affordable to all.
- Increasing life expectancy from 56.5 years in 2009 to 58.5 years in 2014.
ExpenditureThe bulk of health-sector funding comes from the South Africa's National Treasury. The health budget for 2012/13 was R121-billion, which was aimed at improving hospitals and strengthening public health ahead of the National Health Insurance scheme. In 2011, total spend on health was R248.6-billion or around 8.3% of GDP, way above the 5% recommended by the World Health Organisation (WHO). Despite this high expenditure, health outcomes remain poor when compared to similar middle-income countries. This can largely be attributed to the inequities between the public and private sector. According to the National Treasury's Fiscal Review for 2011, the GDP spend on health was split as follows:
- R120.8-billion (48.5%) in the private sector, which covers 16.2% of the population or 8.2-million people, many of whom have medical cover.
- R122.4-billion (49.2%) in the public sector, which is made up of 84% of the population, or 42-million people, who generally rely on the public health care sector.
- The remaining R5.3-billion (2.3%) is donor and NGO spend.
National, provincial and localBefore South Africa's first democratic elections, hospitals were assigned to particular racial groups and most were concentrated in white areas. With 14 different health departments, the system was characterised by fragmentation and duplication. But in 1994 the dismantling began, and transformation is now under fully under way. However, high levels of poverty and unemployment mean health care remains largely the burden of the state. The Department of Health holds overall responsibility for health care, with a specific responsibility for the public sector.
- Visit the Department of Health
- Download a copy of the Revised Draft Health Charter [PDF]
- See the Council for Medical Schemes, an autonomous statutory body created by parliament.
National Health InsuranceThe Department of Health is focused on implementing an improved health system, which involves an emphasis focus on public health, as well as improving the functionality and management of the system through stringent budget and expenditure monitoring. Known as the "10-point plan", the strategic programme is improving hospital infrastructure and human resources management, as well as procurement of the necessary equipment and skills. Under this plan, health facilities such as nursing colleges and tertiary hospitals are being upgraded and rebuilt to lay the way for the implementation of the National Health Insurance (NHI) scheme. The NHI is intended to bring about reform that will improve service provision and health care delivery. It will promote equity and efficiency to ensure that all South Africans have access to affordable, quality health care services regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund. The NHI will be phased in over 14 years, beginning in 2012. In 2012/13, the government earmarked R1-billion to its pilot projects. Apart from infrastructure and management overhauls, another factor for ensuring the success of the NHI will be the strict regulation of the sector to make it more affordable to all South Africans.
- See the Department of Health's FAQs on the NHI
FacilitiesThere are 4 200 public health facilities in South Africa. People per clinic is 13 718, exceeding WHO guidelines of 10 000 per clinic. However, figures from March 2009 show that people averaged 2.5 visits a year to public health facilities and the usable bed occupancy rates were between 65% and 77% at hospitals. Since 1994, more than 1 600 clinics have been built or upgraded. Free health care for children under six and for pregnant or breastfeeding mothers was introduced in the mid-1990s. The National Health Laboratory Service is the largest pathology service in South Africa. It has 265 laboratories, serving 80% of South Africans. The labs provide diagnostic services as well as health-related research.
Doctor shortagesIn March 2012, 165 371 qualified health practitioners in both public and private sectors were registered with the Health Professions Council of South Africa, the health practitioner watchdog body. This includes 38 236 doctors and 5 560 dentists. The doctor-to-population ratio is estimated to be 0.77 per 1 000. But because the vast majority of GPs 73% work in the private sector, there is just one practising doctor for every 4 219 people. In response, the Department of Health has introduced clinical health associates, midlevel health-care providers, to work in underserved rural areas. About 1 200 medical students graduate annually. In some communities, medical students provide health services at clinics under supervision. Newly graduating doctors and pharmacists complete a year of compulsory community service in understaffed hospitals and clinics. In an attempt to boost the number of doctors in the country, South Africa signed a co- operation agreement with Cuba in 1995. South Africa has since recruited hundreds of Cuban doctors to practice here, while South Africa is able to send medical students to Cuba to study. South Africa believes the Cuban opportunity will help train the doctors it so desperately needs for the implementation of the National Health Insurance Scheme. Other agreements exist with Tunisia and Iran, as well as between Johannesburg Hospital and Maputo Central Hospital. The government has also made it easier for other foreign doctors to register here. The Allied Health Professions Council of South Africa had 3 773 registered "complementary health" practitioners in 2012.
Statutory bodiesStatutory bodies for the health-service professions include:
- Allied Health Professions Council of South Africa
- Council for Medical Schemes
- Health Professions Council of South Africa
- Medicines Control Council
- The National Health Laboratory Service
- South African Dental Technicians Council
- South African Medical Research Council
- South African Nursing Council
- South African Pharmacy Council
LegislationThe National Health Act, 61 of 2003, provides a framework for a single health system for South Africa. The Act provides for a number of basic health care rights, including the right to emergency treatment and the right to participate in decisions regarding one's health. The implementation of the Act was initiated in 2006, and some provinces are engaged in aligning their provincial legislation with the national Act. Other legislation relating to health care, some recently passed, include laws which aim to:
- Ensure all health establishments comply with minimum standards through an independent entity (National Health Amendment Bill, 2010)
- Make drugs more affordable and provide for transparency in the pricing of medicines (Medicines and Related Substances Amendment Act, 59 of 2002)
- Regulate the medical schemes industry to prevent it from discriminating against "high risk" individuals like the aged and sick (Medical Schemes Act, 1998)
- Legalise abortion and allow for safe access to it in both public and private health facilities (Choice on Termination of Pregnancy Act, 92 of 1996)
- Limit smoking in public places, create public awareness of the health risks of tobacco by requiring certain information on packaging, and prohibt the sale of tobacco produces to anyone younger than 18 (Tobacco Products Control Amendment Act, 23 of 2007)
- Provide for the introduction of mandatory community service for nurses (Nursing Act, 2005)
- Introduce a process to develop and redesign mental health services so as to grant basic rights to people with mental illnesses (Mental Health Care Act, 2002)
- Allow non-pharmacists to own pharmacies, with the aim of improving access to medicines (Pharmacy Amendment Act, 2000). This came into effect during May 2003.
- The Health Professions Amendment Bill of 2006
- The Traditional Health Practitioners Act, 35 of 2004
- Regulations relating to the Labelling and Advertising of Foodstuffs came into effect in May 2012, and aim to empower citizens to make healthy food choices.
- Find full copies of health-related Acts, Bills, and other legal documents on the Department of Health's website
Health profileHIV and tuberculosis Aids and other poverty-related diseases such as tuberculosis and cholera place a tremendous strain on South Africa's health care system. According to Statistics South Africa, in 2011:
- The overall HIV prevalence rate was 10,6%. About one-fifth of South African women in their reproductive ages were HIV positive.
- There were 5,38-million people living with HIV. This was up from 4,21-million in 2001.
- 16,6% of the adult population (aged 1549) years was HIV positive.
- There were about 2,01-million orphans due to HIV.
- New HIV infections for 2011 among adults was estimated at 316 900.
- An estimated 1,06-million adults and 105 123 children were receiving antiretroviral treatment in 2010. This was up from 101 416 and close to 12 000 children in 2005.
- See the WHO's factsheet on tuberculosis
- Download the National Strategic Plan for HIV/AIDS and TB for 2012 [PDF]
- Download the Global Aid Response Progress Report 2012 [PDF]
- Visit UNAids profile of South Africa, which includes statistics and progress reports
- Download the Strategic Plan for Maternal, Newborn, Child and Womens Health and Nutrition in South Africa 2012 - 2016 [PDF]
- See the UN website on its Millennium Development Goals
- Read more about the African Union's CARMMA campaign
- Download a copy of the Health of our Children report
- See the WHO's Malaria Country Profile, 2010 for South Africa [PDF]
Traditional medicineAn estimated 80% of South Africans consult with traditional healers alongside general medical practitioners. The Medical Research Council (MRC) founded a traditional medicines research unit in 1997 to introduce modern research methodologies around the use of traditional medicines. It also aims to develop a series of patents for promising new entities derived from medicinal plants.
- See the MRC's Traditional Medicines Research Unit
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Aids links South Africa
Government and related sites
- South African National Aids Council
- Department of Health
- South African Aids Vaccine Initiative