South Africa's health. Restructuring South Africa's health care: dilemmas for planners.

Abstract

Restructuring South Africa's health care involves providing care to the majority who have so far been deprived of it without destroying the excellent tertiary health care facilities and the high standards of academic medicine that exist in the country. South Africa spends 6.4% of its gross domestic product on health, which is more than the goal—5% by the year 2000—set by the World Health Organisation. But 46% of this amount is spent on the private sector, which serves 19% of the population, as was explained by Dr Nkosazana Zuma, South Africa's health minister, in her health budget speech to the parliament on 20 October 1994. Moreover, 75% of the health budget, which was 14 billion Rand for 1994-5, is spent on hospitals and academic institutions. In effect, the amount spent on health care for most of the population is much less than the 5% recommended by the World Health Organisation. This is the last in a series of articles reporting on health care in South Africa Dr Zuma said in her speech that the cornerstone on which the future health care system will be built would be a district health system offering a package of primary health care provided by a district health authority. She clarified that primary health care was not synonymous with preventive health care and that the proposed system would achieve a balance between promotion, prevention, rehabilitation, and curative services. She also outlined definite goals that the government was committed to achieve: these focused on the control of infectious diseases, an obvious priority for any developing country (box). Finding the money for primary health care is difficult. Much of it will have to come from the academic institutions. Dr Zuma said that the government and the deans of the academic institutions had agreed to cut their expenditure …