South Africa’s health system carries the heavy imprint of history, with the apartheid era having bequeathed a fragmented, inequitable system in which race determined access to care, geographic distribution of resources favoured white minority areas, and public facilities serving the black majority were systematically under-resourced. Nearly three decades after the democratic transition, these inequities persist, writes Mark Burke in Polity.

Burke writes:


The country spends roughly 8.5% of GDP on health (comparable to many OECD nations), yet achieves outcomes more typical of lower-income countries. Life expectancy, which rose from 52 years in 2005 to 61 by 2021, largely driven by the scale-up of antiretroviral therapy, remains below the global average for upper-middle-income countries.

Two decades of investment in strengthening primary health care (PHC), district health services, and digital transformation have produced a landscape of parallel initiatives. Each well-intentioned, operating within its own logic, yet collectively failing to deliver the integrated, patient-centred care that patients experience as a continuous journey. ….more