In a resource-limited country it is important to highlight targets reached, but one must not forget all that is still underachieved. While many had the elections to consider, the South African (SA) landscape projected critical health challenges – even after 20 years of democracy. Highlighted here are a few publications that deal with the challenges facing SA, post democracy.
Researchers Joanne Corrigall and Richard Matzopoulos report that mental health and the disease burden are linked (1). They suggest that ‘low priority is given to mental health services with associated minimal resource allocations.’ According to the review, the National Health Insurance (NHI) Green Paper acknowledges mental health issues are considered by government to be a contributor to the disease burden, however, strategies to address them are hazy. In addition, SA is a country with 11 official languages yet a multilingual society still receives monolingual provision of health care services.
The Twenty Year Review 1994-2014, published by government, in part, explores the health of our nation 20 years after democracy (2). The review portrays achievements, successes and limited – but not simple – challenges. It mentions SA’s battle to lower the quadruple burden of disease, high maternal and child mortality, high incidence of HIV and AIDS, tuberculosis (TB) and NCDs such as diabetes, heart problems, injury and violence. On top of that, spiralling private health care costs and the public health sector’s quality of care doesn’t ease the load. Likewise, poor enforcement of key legislation impacting disability, discriminatory attitudes, inaccessible public transport systems, environmental, communication and information barriers still need to be addressed adequately.
While ‘5 percent of Gross Domestic Profit (GDP) is spent on 16 percent of the population, while the remaining 3.5 percent of GDP is spent on 84 percent of the population,’ says the Twenty Year report, it seems inevitable that the NHI coupled with a new health financing system will come saddled with it’s own economic and social challenges.
Recent focus group studies conducted by Freedom House and author Susan Booysen give citizen views on the subject of health (3). The publication is a bottom-up qualitative study representing the views of 27 focus groups in all nine provinces of SA. Views from all income and racial groups from urban and rural areas between June and October 2013 are accounted for.
Six to nine participants were chosen based on geographic and demographic criteria. According to Booysen, the 27 focus groups provided national coverage. Groups were categorised according to Living Standard Measures (LSM) that indicated rough class groups from low to upper class. Varying age groups and single gender to mixed gender discussions were held. The discussions were moderated and conducted in multiple official languages.
‘Even when you call for an ambulance you are going to wait for a long time.… By the time they arrive someone will probably be dead.’ ‘It is the elderly in the rural areas who cannot walk the distance to the clinics,’ says a Richard’s Bay participant. This is the sort of public commentary one can find about the health challenges facing the nation 20 years after democracy. Citizens say about clinics, ‘They will take their sweet time to attend to you, while you are sick.’ ‘You go there with tooth ache and they tell you to make an appointment first, and then keep on changing appointments.’ (Thokoza) and ‘I take a child to a clinic because she is in pain.… after many hours of waiting I get a Panado.’ (Jozini). Lastly, participants in the study voice their concern about hospitals not serving meals and the poor maintenance. Citizens in this study say that health care has improved but there are exceptions.
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