The health and health system of South Africa: Historical roots of current public health challenges
Abstract
The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.
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In this study, rural vocational placements and a rural background increased the likelihood of working in a rural area, confirming what has been shown in other studies.
“In our study, rural vocational placements and a rural background increased the likelihood of working in a rural area, confirming what has been shown in other studies [44, 45].”
From Doctor retention and distribution in post-apartheid South Africa: tracking medical graduates (2007–2011) from one university (2019) · cites this paper as [45]
Whether residing in the Bantustan or not, black people were stripped of their South African citizenship and the accompanying constitutional rights.
“Consequently, whether residing in the Bantustan or not, black people were stripped of their South African citizenship, and the accompanying constitutional rights (Mamdani 1996; Coovadia et al. 2009: 819; Hobden 2018: 3).”
From Exclusion and invented water scarcity: a historical perspective from colonialism to apartheid in South Africa (2024) · cites this paper as Coovadia et al. 2009: 819
In South Africa and other low- and middle-income countries, substance abuse, aggression, and HIV risk behaviours are highly prevalent.
“In the South African context (as in many other low-and middle-income countries), there are twin problems with regard to intervening in risk behaviours: substance abuse, aggression and HIV risk behaviours all occur at high levels (Coovadia et al., 2009)”
From Screening and Brief Intervention for Substance Misuse: Does It Reduce Aggression and HIV-Related Risk Behaviours? (2015) · cites this paper as Coovadia et al., 2009
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Self-citation
- Authors
- Coovadia, H., Jewkes, R., Barron, P., Sanders, D., & McIntyre, D.
- Affiliations
- University of KwaZulu-Natal (ZA)
- University of the Witwatersrand (ZA)
- University of the Western Cape (ZA)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2009-09
- Volume
- 374
- Issue
- 9692
- Pages
- 817-834
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2142534753
- Cited by
- 1,413
- References
- 71
- Citations by year
- 2026: 57 · 2025: 45 · 2024: 73 · 2023: 91 · 2022: 80 · 2021: 108 · 2020: 93 · 2019: 106 · 2018: 103 · 2017: 121 · 2016: 86 · 2015: 88 · 2014: 110 · 2013: 78 · 2012: 63
- FWCI
- 13.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- health care system, South Africa, apartheid, colonialism, racial discrimination, gender discrimination, migrant labour, income inequality, HIV/AIDS epidemic, infectious diseases, non-communicable diseases, primary care, health workforce shortage, health policy implementation, social grants, Millennium Development Goals
- MeSH terms
- Health Workforce, Humans, Mining, National Health Programs, Politics, Prejudice, Public Health, Race Relations, Sexual Behavior, South Africa, Transients and Migrants, Violence, Women's Rights, HIV Infections, Private Sector, Colonialism, History, 19th Century, History, 20th Century, History, 21st Century, Healthcare Disparities
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