Horrors of Public Health System in South Africa

“Reducing health inequities is … an ethical imperative. Social injustice is killing people on a grand scale.”

Capitalism embodies and sustains an Enlightenment agenda of freedom and equality. Typically there is freedom to trade and equality under the law, meaning that most adults – rich or poor – are formally subject to the same legal rules. However with its inequalities of power and wealth. Capitalism thus nurtures economic inequality alongside equality under the law.

Capitalism builds on historically-inherited inequalities of class, ethnicity, and gender. In the economy, there are many ways of spreading power and influence more especially in the health system.

Various prominent studies, have revealed that health is inseparably connected to underlying political, social, and economic conditions. A range of “social determinants of health” have been identified, including income and income distribution; education, unemployment and job security; employment and working conditions; early childhood development; food insecurity; housing; social exclusion; social safety networks; and access to, and quality of, health services.

Factors such as gender, race, and disability are also relevant in shaping our lifespan. Poverty and lack of nourishment are harmful to our health. At the risk of simplifying what is a highly complex issue, generally speaking, those who are well-off and live in well-off areas can expect to live longer, healthier lives than those who are poor, vulnerable, and or suffering from unemployment. The poorer you are, the shorter and less healthy your life is likely to be.

Any conception of social justice that accepts the need for a fair distribution as well as efficient formation of human capabilities cannot ignore the role of health in human life and the opportunities that persons, respectively, have to achieve good health—free from escapable illness, avoidable afflictions and premature mortality.

In South Africa the public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population use the private system and are far better served.  The South African government spent 8.7% of its GDP on health care system.

The Bill of Rights in Section 27 of the Constitution of the Republic of South Africa of 1996 states unequivocally that access to healthcare is a basic human right but with the inequalities of capitalism the country’s health system is teetering on the brink of total collapse.

Public health facilities are no longer places of healing, they have become death-traps for the poor, who have no other options available to them.

Hospitals and clinics are plagued by long waiting times for patients, this can be directly linked to the chronic staff shortages which have also led to the neglect and even deaths of many patients. All the facilities lack staff in critical positions.

Horribly, a staggering 1338 babies died at birth at Soweto’s Chris Hani Baragwaneth Hospital over the last three years. Factors causing the deaths included premature birth, infection, asphyxia (lack of oxygen) and congenital (or inherent) abnormalities.

The country has been marred with a shortage of oncologist and facilities without any cancer treatment equipment. In 2017, KwaZulu-Natal was left with no oncologists in the public sector. While Mpumalanga only received its first hospital that provides cancer treatment in 2019.

The country’s poorest people have access to free treatment at about 3,800 public clinics and hospitals, but these facilities are all too often plagued by broken equipment and shortages of medicine. Only five of 696 facilities covered in the Office of Health Standards Compliance’s most recent report met 80% of their required performance criteria in areas such as drug availability and proper infection control.

South Africa also has insufficient medical personnel, with a doctor-patient ratio of 0.9 per 1,000, lower than in Brazil, Russia, China and Mexico. The biggest reason cited by doctors leaving the public sector is poor working conditions.

South Africa has also faced mental healthcare crisis such as the Life Esidimeni tragedy that led to the deaths of 144 mental health state patients who were transferred from private healthcare facilities to 27 illegal non-government organizations. To date, none of the health officials or practitioners implicated has been prosecuted or have their medical licenses revoked.

Medical-legal claims against the provincial departments of health are a threat to the country’s fiscal. The estimates that medical-legal claims together with cases against the police amount to about R100bn. Between 2017 and 2019, claims increased from R80bn to R99bn. Departments have paid out about R2bn in 2018/19, half a billion more than the previous financial year

There is overwhelming evidence that the quality of health care in South Africa has been compromised by various challenges that impact negatively on healthcare quality. Improvement in quality care means fewer errors, reduced delays in care delivery, improvement in efficiency, increased market share and lower cost. Decline in quality health care has caused the public to lose trust in the healthcare system in South Africa.

Major weakness in South African health systems is inadequate human resources. Africa is said to have less than one health worker per 1000 population compared to 10 per 1000 in Europe.

Some of the health problems in South Africa are worsened by unequal distribution of health professionals between the private and public sectors, coupled with unequal distribution of public sector health professionals among the provinces. 

Participants affirmed the insufficiency and inadequacy of health workers which they described as leading to physical and mental exhaustion, and in some cases to further deterioration of their medical condition.

Problems of the health system reflect the problems of our larger society and cannot be separated from those problems.

“The representation of private interests … abolishes all natural and spiritual distinctions by enthroning in their stead the immoral, irrational and soulless abstraction of a particular material object and a particular consciousness which is slavishly subordinated to this object.” Marx, On the Thefts of Wood, in Rheinische Zeitung (1842)