Health care

Transforming the health sector

After South Africa's first democratic elections in 1994, the dismantling of the country's race-based health system began.

Previously, 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. There was no real attempt to deliver primary health care to the majority of people, and the health sector was largely focused around hospitals. Those living in rural areas had to travel long distances for medical care.

A transformed health system
Over the past few years the health sector has undergone rapid change to make it more equitable and accessible to the needy.

A district-based health system is being developed to ensure local-level control of public health services, and to standardise and co-ordinate basic health services around the country to ensure that health care is affordable and accessible to everyone.

There are 42 health regions and 162 health districts in the country. A new administrative structure is being put in place which will see primary health care clinics fall under the auspices of district authorities while hospitals remain under the control of provincial authorities.

Greater access to primary health care
Since 1994, more than 700 clinics have been built or upgraded, 2 298 clinics upgraded and given new equipment, and 125 new mobile clinics introduced. There are now more than 3 500 clinics in the public sector. Free health care for children under six, and for pregnant or breastfeeding mothers, is also available at these clinics.

Doctor shortages
To combat the long-standing shortage of doctors in rural areas, 450 foreign doctors, mainly from Cuba, were employed. The government has also made it easier for other foreign doctors to register here. Newly graduating South African doctors and pharmacists now complete a year of compulsory community service in understaffed hospitals and clinics.

The country continues to suffer from a tremendous "brain drain" of South African doctors who are highly sought after in countries like Britain and Canada because of the high standard of training and the cutting-edge medical experience they receive here.

In 2000, 29 788 doctors in both public and private sectors were registered with the Health Professions Council of South Africa, the health practitioner watchdog body. Doctors must comply with the Continuing Professional Development System, which compels them to attend regular workshops, seminars and refresher courses to retain their yearly registration.

New legislation
In recent years, legislation has been passed 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 in both public and private health facilities;
Limit smoking in public places and make the public aware of the health risks of tobacco by placing restrictions on tobacco advertisements.

Public/private partnerships
To address some of the resource and personnel shortages facing the public sector, partnerships between the public and private sectors are slowly being forged. Some private hospitals are now offering beds and providing medical care to public sector patients. They are also beginning to offer post-graduate teaching facilities to university medical faculties in an effort to stop the flow of doctors out of the country.