South Africa's Health System Finally Recovering from Apartheid Era

When the HIV / AIDS pandemic hit South Africaother activist groups won a significant
with what seemed to be catastrophic force in theconstitutional court ruling to force the government
mid-1990s, the country's health care system wasto provide life-saving drugs to pregnant women
already under severe pressure. Following the endand newborn babies. That, and other cases,
of apartheid in 1994, the health system was incompelled the government to take a different
the process of being transformed from one thatview. Now, even though President Mbeki has not
focused on the needs of whites to one that metunequivocally acknowledged that HIV causes
the needs of the entire population. AIDS madeAIDS, and Tshabalala-Msimang frequently causes
that transformation even more difficult. A decadecontroversy about appropriate responses to the
on there are indications that South Africa isdisease, South Africa has implemented a major
beginning to recover.program to combat AIDS. Anti-retroviral drugs
It was the screening of pregnant black women by(ARVs), considered the most effective treatment
the South African public health care system in thein fighting AIDS, are a major component of the
mid-to-late1990s that revealed a sudden andprogram.
dramatic increase in prevalence of HIV, the virus"Well, the way we view the ARV rollout is that
that causes AIDS. A few years earlier, becausewe recognize that South Africa has one of the
of the poor health care available to black Southbiggest, if not the biggest treatment program of
Africans under apartheid, many of those womenany country in the world. We have gone from
would probably not have been covered by thenothing to 110,000 people in the public sector in
public health care net.the space of two-and-a-half years, and we have
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help at very affordable rates.In addition to those receiving treatment in the
But with the end of apartheid, health care, like sopublic health care system, some 100,000 more
many other public services, was expanded toare receiving treatment as private patients, or in
reach all the country's citizens. Whites-onlyprograms run by churches and other
hospitals were opened to all, and a network ofnon-governmental organizations. But in its widely
more than 1,000 walk-in clinics was set uprespected statistical model on the disease, the
throughout the country. Programs to tackle basicSouth African Actuarial Society estimates that as
health issues in the black community weremany as 500,000 South Africans currently have
established.full-blown AIDS and require treatment.
But then, HIV / AIDS hit. South Africa had aDr. Letitia Rispel of the Human Sciences Research
prevalence rate that would soon become one ofCouncil in Pretoria, says that the public health
the worst in the world. The burden on the healthsystem is also slowly tackling other major health
care system was almost overwhelming.issues, such as measles outbreaks, which are now
To make the situation worse, many seasoned,isolated and infrequent.
mostly white, health care professionals opted to"I used to work in the Western Cape, one of the
take a government buyout offer aimed atproblems that used to be there, neo-natal syphilis
reducing excess support and administrationwhich is a particular syndrome when the mother
personnel.has had untreated syphilis the baby suffers from
Mark Hayward, of the Aids Law Project at- some instances these children had to be in an
Johannesburg's Witwatersrand University, saysincubator in an - it is [now] a rare occurrence to
the loss of trained medical personnel hadsee that in South Africa," said Dr. Rispel.
far-reaching consequences.But Rispel says that major challenges still remain.
"The HIV epidemic tests the country's healthSince South Africa was welcomed back into the
system in very significant ways," said Mr.international community in 1994, the country's
Hayward. "It puts additional strain on people whohealth professionals are in demand in the oil-rich
work in the health system, on doctors andcountries of the Middle East and in those of
nurses, because of the additional burden ofEuropean Union. Many leave and few return.
patients, people who are being admitted toAnd most those who remain are reluctant to
hospitals with opportunistic infections associatedwork in rural and impoverished areas where the
with HIV."need is greatest. Rispel notes that Gauteng, the
And after President Thabo Mbeki came to officerichest province with 19 percent the population
in 1999, the practical difficulties of responding tohas 3,000 doctors in the public health sector.
the pandemic were exacerbated when heLimpopo, the poorest of the eleven provinces and
questioned the causal link between HIV and AIDS.with 12 percent of the population, employs just
Hayward says Mr. Mbeki's unorthodox views on300.
AIDS went unchallenged by members of hisBoth Hayward and Rispel says the government
cabinet, including Health Minister Mantomust develop policies that will encourage health
Tshabalala-Msimang, which was particularlyprofessionals to stay in South Africa and also to
damaging. He says the effects of Mr. Mbeki'swork in rural areas.
beliefs are still being felt.Hayward argues that despite some positive
"I think what worries me and what worries manydevelopments, the crisis in South Africa's health
of us in the [AIDS activist group the] Treatmentsystem demands an urgent shift in focus by
Action Campaign, is that there is also a crisis ofpolitical leaders, notably Health Minister
senior management and of political managementTshabalala-Msimang. Rispel too urges urgent
of the health system -- particularly South Africa'sattention from government leaders to challenges
Minister of Health who frequently seems to preferin the health system. But she also argues that the
to deny there are serious problems rather thanadvances made in a decade of huge demand and
admit to the problems and find a consensus onmuch controversy point to a growing strength
how those problems can be solved," he added.within the health system that bodes well for the
In 2003, the Treatment Action Campaign andfuture.