Introduction
Health care in South Africa varies from the most basic primary health care, offered free by the state, to highly specialised, hi-tech health services available in the both the public and private sector.
However, the public sector is stretched and under-resourced in places. While the state contributes about 40% of all expenditure on health, the public health sector is under pressure to deliver services to about 80% of the population.
The private sector, on the other hand, is run largely on commercial lines and caters to middle- and high-income earners who tend to be members of medical schemes. It also attracts most of the country’s health professionals.
This two-tiered system is not only inequitable and inaccessible to a large portion of South Africans, but institutions in the public sector have suffered poor management, underfunding and deteriorating infrastructure. While access has improved, the quality of health care has fallen.
The situation is compounded by public health challenges, including the burden of diseases such as HIV and tuberculosis (TB), and a shortage of key medical personnel.
However, the South African government is responding with a far-reaching reform plan to revitalise and restructure the South African health care system, including:
Fast-tracking the implementation of a National Health Insurance scheme, which will eventually cover all South Africans.
Strengthening the fight against HIV and TB, non-communicable diseases, as well as injury and violence.
Improving human-resource management at state hospitals and strengthening co- ordination between the public and private health sector.
Deploying “health teams” to communities and schools.
Regulating costs to make health care affordable to all.
Increasing life expectancy from 56.5 years in 2009 to 58.5 years in 2014.
Expenditure
The bulk of health-sector funding comes from the South Africa’s National Treasury. The health budget for 2012/13 was R121-billion, which was aimed at improving hospitals and strengthening public health ahead of the National Health Insurance scheme.
In 2011, total spend on health was R248.6-billion – or around 8.3% of GDP, way above the 5% recommended by the World Health Organisation (WHO). Despite this high expenditure, health outcomes remain poor when compared to similar middle-income countries. This can largely be attributed to the inequities between the public and private sector.
According to the National Treasury’s Fiscal Review for 2011, the GDP spend on health was split as follows:
R120.8-billion (48.5%) in the private sector, which covers 16.2% of the population or 8.2-million people, many of whom have medical cover.
R122.4-billion (49.2%) in the public sector, which is made up of 84% of the population, or 42-million people, who generally rely on the public health care sector.
The remaining R5.3-billion (2.3%) is donor and NGO spend.
See South Africa gears up for National Health
The latest budget on the National Treasury’s website
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