Healthcare in South Africa

In South Africa, private and public health systems exist in parallel. 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. In 2005, South Africa spent 8.7% of GDP on health care, or US$437 per capita. Of that, approximately 42% was government expenditure.^[1] About 79% of doctors work in the private sector.^[2]

Health infrastructure

Hospitals

UPFS

The public sector uses a Uniform Patient Fee Schedule as a guide to billing for services. This is being used in all the provinces of South Africa, although in Western Cape, Kwa-Zulu Natal, and Eastern Cape, it is being implemented on a phased schedule. Implemented in November 2000, the UPFS categorises the different fees for every type of patient and situation.^[3]

It groups patients into three categories defined in general terms, and includes a classification system for placing all patients into either one of these categories depending on the situation and any other relevant variables. The three categories include full paying patients—patients who are either being treated by a private practitioner, who are externally funded, or who are some types of non-South African citizens—, fully subsidised patients—patients who are referred to a hospital by Primary Healthcare Services—, and partially subsidised patients—patients whose costs are partially covered based on their income. There are also specified occasions in which services are free of cost.^[4]

HIV/AIDS antiretroviral treatment

Because of its abundant cases of HIV/AIDS among citizens (about 5.6 million in 2009) South Africa has been working to create a program to distribute anti-retroviral therapy treatment, which has generally been limited in low economic countries. An anti-retroviral drug aims to control the amount of virus in the patient’s body. In November 2003 the Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa was approved, which was soon accompanied by a National Strategic Plan for 2007–2011. When South Africa freed itself of apartheid, the new health care policy has emphasised public health care, which is founded with primary health care. The National Strategic Plan therefore promotes distribution of anti-retroviral therapy through the public sector, and more specifically, primary health care.^[5]

According to the World Health Organization, about 37% of infected individuals were receiving treatment at the end of 2009. It wasn’t until 2009 that the South African National AIDS Council urged the government to raise the treatment threshold to be within the World Health Organization guidelines. Although this is the case, the latest anti-retroviral treatment guideline, released in February 2010, continue to fall short of these recommendations. In the beginning of 2010, the government promised to treat all HIV-positive children with anti-retroviral therapy, though throughout the year, there have been studies that show the lack of treatment for children among many hospitals. In 2009, a bit over 50% of children in need of anti-retroviral therapy were receiving it. Because the World Health Organization’s 2010 guidelines suggest that HIV-positive patients need to start receiving treatment earlier than they have been, only 37% of those considered in need of anti-retroviral therapy are receiving it.

A controversy within the distribution of anti-retroviral treatment is the use of generic drugs. When an effective anti-retroviral drug became in available in 1996, only economically rich countries could afford it at a price of $10,000 to $15,000 per person per year. For economically disadvantaged countries, such as South Africa, to begin using and distributing the drug, the price had to be lowered substantially. In 2000, generic anti-retroviral treatments started being produced and sold at a much cheaper cost. Needing to compete with these prices, the big-brand pharmaceutical companies were forced to lower their prices. This competition has greatly benefited low economic countries and the prices have continued decline since the generic drug was introduced. The anti-retroviral treatment can now be purchased at as low as eighty-eight dollars per person per year. While the production of generic drugs has allowed the treatment of many more people in need, pharmaceutical companies feel that the combination of a decrease in price and a decrease in customers reduces the money they can spend on researching and developing new medications and treatments for HIV/AIDS.^[6]

National health insurance

The current government is working to establish a national health insurance (NHI) system out of concerns for discrepancies within the national health care system, such as unequal access to healthcare amongst different socio-economic groups. Although the details and outline of the proposal have yet to be released, it seeks to find ways to make health care more available to those who currently can’t afford it or whose situation prevents them from attaining the services they need. Because of the discrepancy of money spent in the private sector (which serves the wealthy) and than spent in the public sector (which serves the majority of the population), the total population does not have health care coverage, most of whom are low or middle class, and in many cases, need it more than anybody else.

The NHI is speculated to propose that there be a single National Health Insurance Fund (NHIF) for health insurance. This fund is expected to draw its revenue from general taxes and some sort of health insurance contribution. The proposed fund is supposed to work as a way to purchase and provide health care to all South African residents without detracting from other social services. Those receiving health care from both the public and private sectors will be mandated to contribute through taxes to the NHIF. The ANC hopes that the NHI plan will work to pay for health care costs for those who cannot pay for it at all themselves.

There are those who doubt the NHI and oppose its fundamental techniques. For example, many believe that the NHI will put a burden on the upper class to pay for all lower class health care. Currently, the vast majority of health care funds comes from individual contributions coming from upper class patients paying directly for health care in the private sector. The NHI proposes that health care fund revenues be shifted from these individual contributions to a general tax revenue.^[2] Because the NHI aims to provide free health care to all South Africans, the new system is expected to bring an end to the financial burden facing public sector patients.^[7]

Water supply and sanitation

After the end of Apartheid South Africa's newly elected government inherited huge services backlogs with respect to access to water supply and sanitation. According to one source, about 15 million people were without safe water supply and over 20 million without adequate sanitation services in 1990.^[8] The share of the population with access to an improved water source increased from 83% in 1990 to 91% in 2010. Almost 15 million people gained access during that period.^[9]

With respect to sanitation, progress has been slower. According to estimates by the WHO/UNICEF, the share of South Africans with access to improved sanitation increased from 71% in 1990 to 75% in 2000 and 79% in 2010. In 2010, an estimated 11 million South Africans still did not have access to improved sanitation: They used shared facilities (4 million), buckets (3 million) or practiced open defecation (4 million).^[9]

According to Statistics South Africa access is higher, partially because it includes shared facilities in its definition of sanitation. According to the 2011 census figures, access to sanitation increased from 83% in 2001 to 91% in 2011, including shared and individual pit latrines as well as chemical toilets.^[10] The share of households with access to flush toilets increased from 53% in 2001 to 60% in 2011. The health impacts of inadequate saniation can be serious, as evidenced by the estimated 1.5 million cases of diarrhoea in children under five and the 2001 outbreak of cholera.^[11]

Health status

Life expectancy

The 2014 CIA estimated average life expectancy in South Africa was 49.56 years.^[12]

HIV/AIDS

HIV and AIDS in South Africa are major health concerns, and around 5.3 million people are thought to be living with the virus in South Africa.^[13] HIV (human immunodeficiency virus) is the retrovirus that causes the disease known as AIDS (Acquired Immunodeficiency Syndrome). South Africa has more people with HIV/AIDS than any other country.^[14]

The South African National HIV Survey estimated that 10.8% of all South Africans over 2 years old were living with HIV in 2005. There is an average of almost 1,000 deaths of AIDS a day in South Africa.^[15]

Other infectious diseases

Other infectious diseases prevalent in South Africa include Bacterial Diarrhea, Typhoid Fever, and Hepatitis A. These infectious diseases are generally caused when the food or water consumed by an individual has been exposed to fecal material.^[16] South Africa is an under developed nation and because of this the sanitation facility access in urban areas is 16% unimproved while in rural areas the sanitation facility access is 35% unimproved.^[17]

Malnutrition

15% of South African infants are born with a low birth weight.^[18] 5% of South African children are so underweight they are considered to be wasted.^[18] Since the 1990s South Africa's malnutrition problem has remained fairly stable.^[18]

The prevalence of malnutrition in South Africa varies across different geographical areas and socio-economic groups.^[18] Many infants in Africa suffer from malnutrition because their mothers do not breastfeed them. The mothers in South Africa that do not breast feed their children do not do it mainly to try to avoid the possibility that in doing so, their children may contract AIDS.^[19] The 2010 South Africa Department of Health Study found that 30.2% of pregnant women in South Africa have AIDs.^[20]

Mental health

In a study conducted by the Mental Health and Poverty research Program, it was found that approximately 16.5% of the adult population in South Africa suffers from mental illness, with 1% suffering from a severe life debilitating mental disease.^[21][22] However, these statistics are most certainly an underestimation. Among the native population, many still hold to the traditional belief that mental illness results from a demonic possession. As a result, many individuals for fear of social ostracism, keep their mental illness secret instead of seeking the much needed medical attention.^[22] This means that there is still a significant population suffering from mental illness that is currently unrepresented in mental health statistics.

Probably one of the largest contributors to the high frequency of mental disorders is violence. Of the adult population ages 16 to 64, it was found that 23% were exposed to a traumatic event of violence in the past year. These traumatic events include acts such as fighting a war, being tortured, or participating in violence. Among this population, it was determined that mental illness including symptoms of Posttraumatic stress disorder (PTSD) was 8.5 times more prevalent than among the general population.^[23]

Another factor contributing to mental illness in South Africa is substance abuse. Many provinces are used as drug trafficking routes, and as the South African government lacks the necessary resources to control this problem, many of these illicit drugs find their way into local populations as a drug.^[22] In addition, the availability of the wild growing Cannabis plant allows for its rampant abuse among all age categories. It was found that 52% of street children smoke the Cannabis plant and 22% on a daily basis.^[24] Educational campaigns are limited, and as a result, many do not realise the impinging health effects that will result from substance abuse.

Diseases such as malaria, typhoid fever, and HIV provide a significant contribution to the prevalence of mental illness. Some of these diseases such as cerebral malaria can bear a direct physiological effect on the mental functionality of the patient. However, even more poignant is the ability of disease to strike a radiating blow to the patient's emotional psyche. For instance, the prevalence of mental illness among those suffering from HIV is 43.7% compared to the 16.5% observed among the general population.^[25]

An often overlooked yet equally destructive cause of mental illness is the Westernisation of African culture. In a research study, it was found that only 6% of women in the urban environments were free from all symptoms of mental disorder. However, in the traditional integrated population 60% were free from mental illness.^[26]

Maternal and child healthcare

In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for South Africa is 410. This is compared with 236.8 in 2008 and 120.7 in 1990. The under 5 mortality rate, per 1,000 births is 65 and the neonatal mortality as a percentage of under 5's mortality is 30. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal health. In South Africa the number of midwives per 1,000 live births is unavailable and the lifetime risk of death for pregnant women 1 in 100.^[27]

See also

• Africa Health Placements
• Emergency medical services in South Africa
• Medical education in South Africa
  • List of medical schools in South Africa
• South African Department of Health
• South African Malaria Initiative
• South African Medical Research Council
• South African Military Health Service

Notes

References

• User Guide-UPFS 2009. Department of Health of Republic of South Africa. June 2009
• Ruud KW, Srinivas SC, Toverud EL. Antiretroviral therapy in a South African public health care setting – facilitating and constraining factors. Southern Med Review (2009) 2; 2:29–34

External links

• South Africa – Information by World Health Organization
• The State of the World's Midwifery - South Africa Country Profile

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