How South Africa Plans to Fix an Ailing Health System

The South African Constitution’s Bill of Rights accords everyone the right to health care. Yet 84% of the nation’s 58.8 million people have no medical insurance and rely on a public health system with too few doctors and dilapidated facilities, resulting in delayed or inadequate treatment. In 2007, the ruling party agreed to enact universal national health insurance, or NHI, but its implementation stalled while funding and operational details were being ironed out. Now the government has proposed a program to be phased in by 2026, but serious doubt remains about whether it will be the panacea for the country’s health-care woes.

The country’s poorest people have access to free treatment at about 3,800 public clinics and hospitals, but these facilities are all too often plagued by broken equipment and shortages of medicine. Only five of 696 facilities covered in the Office of Health Standards Compliance’s most recent report met 80% of their required performance criteria in areas such as drug availability and proper infection control. South Africa also has insufficient medical personnel, with a doctor-patient ratio of 0.9 per 1,000, lower than in Brazil, Russia, China and Mexico. The biggest reason cited by doctors leaving the public sector is poor working conditions.