Blog 9: health.disease South Africa

Healthcare in South Africa

 

      Elizabeth Chester is the Associate Field Director at AMPATH Orphans & Vulnerable Children Program based in Kenya. AMPATH is a partnership between several North American academic health centers and the Kenyan Ministry of Health.  Originally established to deal with the HIV crisis in Africa, it has expanded to address the primary healthcare, chronic disease care, and specialty care needs of the African people. Chester presented a guest lecture at George Mason University to graduate students in a Comparative International Health Systems class. In the presentation, she shares her analysis of the successes and challenges of the healthcare system in South Africa.

      When apartheid ended in 1994, South Africa was forced to overhaul its healthcare system.  While this was an opportunity to build a healthcare system to address the needs of the entire population, success was not widespread. Healthcare became centered on hospitals, and during apartheid hospitals were placed in areas with a primarily white population. There were few medical facilities in rural areas, and the majority of the population - which is black – did not hare access to healthcare.  Provincial Departments of Health were then established in order to decentralize and hopefully meet the healthcare needs of the rural black population.

      South Africa is divided into nine provinces or provincial regions.  The country’s healthcare system is structured so that there are nine Provincial Departments of Health under one Federal Department of Health.  Within each of the nine Provincial Departments of Health are Health Regions and Districts. District-based primary care keeps control and delivery at a local level, and promotes affordable and accessible care. Clinics have been constructed to deliver this care and all 3,500 are managed by district authorities.  Children under the age of six receive free healthcare at these clinics, as do pregnant or breastfeeding mothers.  The hospitals are managed by provincial-level authorities.

      Chester notes that the AIDS epidemic has hit South Africa hard. Of the population, 23.5% are living with AIDS, and there have been more than six million HIV/AIDS deaths in South Africa through 2012.  AIDS has resulted in higher infant mortality, a lower life expectancy of 43 for males and 42 for females, and a negative population growth rate. So much time and funding has gone to fighting AIDS/HIV in South Africa that primary care needs of the non-affected population have not been met.

      The federal government pays for 40% of total healthcare expenditures for 80% of the population and this expenditure is 11% of South Africa’s budget. There is still inconsistent funding of South Africa’s healthcare system. The majority of South Africa’s population cannot afford to assist the government in funding healthcare. In urban areas the poverty level is 50% and in rural areas is 71%. Unemployment remains close to 40%.  Only 18% of South Africa’s population carries private health insurance.  South Africa depends heavily on non-profit groups and non-governmental organizations (NGOs) to fund its healthcare.

     There is a shortage of physicians in South Africa, particularly in the underserved rural areas. Many foreign doctors are brought in by the government to fill this need and the government has actually simplified the regulations to encourage more foreign doctors to come to South Africa.  Additionally, all new physicians and pharmacists are required to practice in an underserved area for one year before practicing in the area of their choice.  . Sadly, these changes have not improved the issue of physician shortage in the country. Unfortunately, many South African doctors are leaving the country and choosing to practice in Canada or the United Kingdom. Of those physicians who remain, the majority of physicians choose to work in the private sector, and most physicians, hospitals and pharmacists are found in the wealthier provinces of the country.

      Traditional medicine still plays a role in the healthcare of the people of South Africa. These traditional healers have deep roots in the culture, and 60% of the population consults them. In 2004, traditional healers were formally recognized by the government.  About 40% work out of a hut, house, or office, and 60% work at the clinics or hospitals.

 

 gunston.gmu.edu/healthscience/InternationalHealth/SouthAfricanHealth