Global or local: what factors most affect health policy in South Africa?

The emergence of an increasingly global economy suggests that the ability of individual countries to shape their own destinies is becoming more difficult.  International trends and pressures now influence national, and even local, health care policy making. Researchers from the University of the Witwatersrand, South Africa, together with Oxford University, looked at the effect of globalisation on health issues in South Africa and assessed its influence compared to national and local forces.

South Africans have seen huge transformations in their country in the last decade.  The African National Congress took power in 1994 with a mandate to redress the wrongs of the past, to provide basic health care, education and other public services to the whole population.  Health policy reforms carried out in the first five years of the new administration included:

• free health care for children, under the age of six, and pregnant women
• school-feeding programmes
• national immunisation campaigns for polio, measles and hepatitis B.

Counter to these national reforms, there are a number of international pressures that could affect health care in South Africa. The strongest voices in international health policy have shifted from the holistic strategies of World Health Organisation (WHO) to the rationalisation programmes of the World Bank.  While early preventive care is still a priority, the amount of money available to the public health sector is shrinking.  Reductions in health expenditure in developing countries have brought the re-emergence of manageable diseases such as typhoid, tuberculosis and hepatitis.

Many people believe that small states are no longer able to determine their own policies and keep their own identities in the face of the large multinational companies. As elsewhere in the world, faith in the power of Western medicine is decreasing and complementary and alternative medicine is becoming increasingly accepted.

The research found that in South Africa:

• the old apartheid emphasis on a private health system of specialised curative care for the white minority has been replaced with a focus on basic health care for all. Despite a neo-liberal macroeconomic policy in South Africa, its health policy is almost the reverse of current international thinking
• the government has successfully challenged one of the most powerful industries.  It took on the pharmaceutical industry over the need to import the cheapest AIDS drugs and won with the help of local and international pressure groups
• traditional medicine has continued to flourish, because the vast majority of the population were denied access to Western medicine.  It now plays an important part in the attempts to combat the HIV/AIDS epidemic.

Political and economic developments in the international arena will inevitably influence health issues in South Africa.  Institutions such as the WHO and the World Bank, together with international events such as the spread of AIDS, affect health care in the country.  However local forces also play a large part in shaping the future of the South African health service.

Source(s):
‘Globalisation and local power:  influences on health matters in South Africa’, Health Policy 67: 245-255, by T. Gilbert and L. Gilbert, 2004
HINARI subscribers can access the full-text article here. Full document.

id21 Research Highlight: 20 May 2004

Further Information:
Leah Gilbert
Department of Sociology
School of Social Sciences
University of the Witwatersrand
Private Bag 3
Johannesburg
South Africa

Tel: +27 11 717 4429
Contact the contributor: gilbertl@social.wits.ac.za

University of the Witwatersrand, South Africa

University of Oxford, UK

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