After nearly two decades of progress following the abolishment of apartheid, South Africa’s societal gains are now deteriorating. These are the conclusions of a report published on March 28 by The World Bank that analysed the country’s progress in reducing poverty and inequality from 1994 to 2015. While overall the country’s poverty levels have fallen since 1994, at least 2·5 million more South Africans since then have become poor. Over half the population lives under the poverty line, many of whom are black or South Africans of mixed race. Unemployment stands at a staggering 28%. Most worryingly, the gap between the rich and poor has worsened for this upper-middle-income country—71% of wealth is now held by a 10% elite; the bottom 60% of the population hold just 7% of assets—making South Africa the most unequal country in the world.

The triple challenge the report describes—poverty, unemployment, and inequality—is a toxic mix for health. The warning signs for a future health crisis are here: 39% of South Africans live in overcrowded housing. Food security, stunting, and child malnutrition are worsening since 2012. The already vulnerable are most at risk: for the poorest 10% of households, more than a third are 20 km from the nearest hospital compared with just 7% of the richest. Among the bottom 10%, just half of households have access to adequate water sources, compared with 97% of the richest 10% of South Africans.

These recent declines fly in the face of apparent progress. The post-apartheid Black Economic Empowerment agenda aimed to stimulate black business ownership and inclusive economic markets. The country has been lauded for investments in education, universal health coverage, and social protection. But the report’s findings cannot be ignored and must galvanise the new government charged with judiciously pursuing the nation’s development plan and meeting the Sustainable Development Goal of ending extreme poverty by 2030. Accelerated attention to stem any further backward slide is required. Extended policy action to improve incomes and employment opportunities, redistribute resources, and deepen the government’s social wage is needed to protect the health and livelihood of all South Africans……more

South Africa Spends 16 Times More On Healthcare Than Nigeria