Health inequalities: the legacy of apartheid in South Africa

How successful is South Africa at providing decent healthcare for all its citizens?  Is the gap in healthcare between the poorest members of society and the richest getting narrower? The Universities of Cape Town and Witwatersrand, South Africa, looked at South Africa’s efforts to ensure all sections of the population have proper access to health services. 

Under apartheid there were huge differences in income and access to health services between different racial groups.  The people with the poorest health, who needed the health services the most, had the least access to such services.  When the African National Congress came to power in 1994 they were committed to redressing these inequalities.  They wanted to reduce poverty and ensure that everyone had equal access to public services.  They planned to improve water supplies, sanitation and provide equitable, accessible and quality healthcare. Government investment in primary care allowed it to become universally free at the point of use.  A programme was introduced for building and repairing clinics.

A right to good health services is enshrined in the country’s constitution and has played an important part in ensuring the health service remains a priority.  Nevertheless the study found certain problems have arisen in the drive to create an equitable health system. These include:

• The need to balance the government budget could put constraints on health expenditure.
• The poor distribution of resources between public and private health sectors, relative to the population they serve, have not been addressed.
• Members of the community have not been involved in decision-making.
• Social programmes that would benefit people's health, such as water, sanitation and electrification, have not received enough support.
• There have been difficulties in building the clinics, in the provision of drugs, and in poor staff attitudes to patients.

In order to achieve equality in healthcare the report recommends:

• giving priority to primary healthcare 
• deciding who should receive preferential treatment: the 50 per cent of the population who are identified as poor, or the poorest 27 per cent (who earn less than ZAR 352.53 per month)
• involving the poor in decision-making
• more resources should be given to the poorest areas where they are needed most
• providing clinics within reasonable distances, so patients can access them easily.

The courts, the media, and non-governmental organisations can all play a part in making sure the needs of the poorest members of society are brought to the attention of decision-makers.

 

Source(s):
‘Putting equity in health back onto the social policy agenda: experience from South Africa’, Social Science and Medicine 54: 1637-1656, by D. McIntyre and L. Gilson, 2002
HINARI subscribers can access the full-text article here. Full document.

Funded by: UK Department for International Development; USAID; UNDP; Government of South Africa; UNICEF; World Bank; Government of the Netherlands; Rockefeller Foundation

id21 Research Highlight: 23 April 2003

Further Information:
Di McIntyre
Health Economics Unit
Department of Community Health
Faculty of Health Sciences
University of Cape Town
Anzio Road
Observatory
7925 Cape Town
South Africa

Fax: +27 21 406 6559
Contact the contributor: dimac@cormack.uct.ac.za

Health Economics Unit, University of Cape Town

University of the Witwatersrand, South Africa

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'Insurance policy: the concept of social health insurance in South Africa'

'Unequal measures: who benefits most from government spending on healthcare?'

'Health-wealth unhappiness: healthcare inequalities in South Africa'

'The equity impacts of community financing initiatives in Africa'

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