(formerly IRIN News) Journalism from the heart of crises

Public health care “is lamentable”

blood sample.

South Africa's public health system, which serves about 90 percent of the country’s 47 million people, is failing many, especially the most vulnerable, according to a report published on 16 April by a human rights oversight body.

The report, based on a public enquiry by the South African Human Rights Commission (SAHRC) that began in 2007, found the public health sector was in "a lamentable state" because of poor policy implementation and staff shortages, among other factors.

"It is difficult to assess with accuracy whether the situation regarding health care services in South Africa has improved or worsened over time, and whether there is indeed a progressive realisation of the right to access to health care services," said the report, released a few days shy of South Africa's 15-year anniversary of the advent of democracy.

"Access to health care services, especially for the poor, is severely constrained by expensive, inadequate or non-existent transport, by serious shortages with regard to emergency transport, and by long waiting times at clinics and other health care service providers," the 90-page report noted.

The researchers found there was a perception that the health system was underfunded, but this did not take account of the huge challenges presented by the HIV/AIDS pandemic. About 18 percent of people aged between 15 and 49 are infected with HIV.

Health care is a constitutional imperative and the government "has an obligation to provide health care services for everyone, to ensure that legislation and programmes are in place to provide these services, and ensure that everyone is able to access these services," the report said.

South Africa’s most vulnerable groups were most affected by poor health services. Citing the sliding scale of fees, which are determined by a patient's income, the report found that nearly 50 percent of those who would qualify for fee waivers due to their poverty had not received them.

The report said medical and health personnel "often have a poor or discriminatory attitude towards vulnerable individuals or groups, which leads to poor access to health care for vulnerable people."

The groups subjected to such prejudice included children, domestic workers, non-nationals, homosexuals, bisexuals, transgender people, persons with disabilities, prisoners and older persons.

Staff shortages

Bad attitudes towards patients were attributed to acute staff shortages – sometimes as high as nearly 40 percent – which resulted in long waiting times, overcrowded clinics and poor patient care.

"We always have to rush; we wash, we medicate, we move on. You miss some things," the report quoted one nurse as saying. "You cannot implement things that would improve health care and staff morale. We become demotivated and no longer have empathy."

Among the report's policy recommendations were that the provision of health services to foreign nationals be clarified; the integration of tuberculosis and HIV/AIDS services be improved, and that all-inclusive national health insurance eventually be adopted.


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