The hope for a new dawn for South Africa

Abstract

Shortly after former South African President Jacob Zuma's election in 2009, The Lancet published the South Africa Series. At the time, life expectancy in the country had plummeted and the country was experiencing the effects of a widespread HIV epidemic after previous President Thabo Mbeki's denial of the existence of HIV. A change in leadership offered hope. As Zuma now steps down from office, facing scandals and allegations of corruption, this hope seems misplaced. Substantial progress was made to address South Africa's public health emergencies during Zuma's presidency, under Minister of Health Aaron Mostoaledi's guidance. The largest mass antiretroviral therapy programme in the world was deployed and, although the HIV epidemic in South Africa is still rampant, new HIV infections decreased by 49% and AIDS-related deaths decreased by 29% between 2010 and 2016, according to UNAIDS. Life expectancy at birth rose from 52·28 and 49·27 years in 2006 to 65·51 and 59·24 years in 2016 for females and males, respectively. To address the disparity between private and public health systems, in 2013, the government announced that the long awaited National Health Insurance (NHI) was to be rolled out over the next 14 years, although it fell short of pushing a comprehensive policy forward. However, reports coming out of South Africa now show a country in the midst of a crisis. Corruption is rampant, economic growth has stalled, and unemployment and poverty are high. Mismanagement and corruption have eroded the health system's capability to provide services, as exemplified most strikingly by the scandal hitting the Gauteng province, where over 140 people with mental ill health died from starvation and neglect after the health department moved them to ill-equipped NGOs. The hope from the early Zuma years has faded as health-care delivery steadily deteriorates. Cyril Ramaphosa, South Africa's new president, has hailed a “new dawn” and promises to “turn the tide of corruption in our public institutions”. In his state of the nation address, he announced that the NHI bill will be submitted to Parliament within the next few weeks. South Africa will now be watching Ramaphosa and expecting meaningful improvements in health.