Since 1994 South Africa has invested substantial resources in health care services. As a result, it’s has made significant health gains. For example, nearly 4 million people get HIV treatment and mother-to-child transmission has nearly been eliminated.
Service delivery has also been significantly expanded to more than 4 000 health facilities. And there’s been a large increase in the number of healthcare professionals.
But health care needs aren’t static. For example, non-communicable diseases like diabetes and hypertension are now responsible for more deaths than HIV and TB combined. And in some instances, successes have created challenges. For example, the expansion of HIV treatment has meant that there’s now a large cohort of chronic patients requiring ongoing care. In addition, the reality of a largely youthful population requires interventions so that health gains aren’t lost.
Health services in South Africa are delivered by a large public health system as well as very sophisticated (and profitable) private health providers. Funding in the public sector has declined progressively for the past six years. The result is that public health services are under increasing strain and unable to deliver adequate care to poor people, particularly those living in rural areas.
The private sector has also been under pressure. This has led to price hikes, making many medical aid schemes unaffordable. Membership numbers aren’t growing, partly due to the country’s very high unemployment levels – medical aid membership is linked to formal employment. The result has been even more pressure on the public sector.
Reform is clearly needed. All that’s in dispute is what it should look like…..more