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
"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
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
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.
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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