Have pro-poor health policies improved the targeting of spending and the effective delivery of health care in South Africa?

Since the advent of the post-apartheid era in 1994, the South African health care system has undergone numerous radical policy changes. Free primary health care was introduced in 1996, and budget allocations have largely shifted to traditionally poorly endowed provinces. This paper examines how these, and other, changes have affected the incidence of spending and the accessibility and quality of health care.

The authors find that South Africa's spending on clinics and hospitals is well targeted and more progressive than other developing country public health system. However, this finding is somewhat misleading. The quality of services and facilities is generally considered to be of poor quality, so more and more people are opting out of the public health system in favour of private treatment. This alone increases the pro-poor incidence of public health spending.

Complaints by users of public health facilities include long waiting times, staff rudeness and problems with drug availability. Dissatisfaction with health services is significantly higher in the public sector than in the private, and this gap has extended over time.