Rattibha

People talk about how public hospitals were well-run during official Apartheid.
OK, here's how the public health sector really was back then (and why little has changed today):

First, public health facilities in Apartheid cities were indeed better than today because they served a privileged minority. The health needs of the majority of South Africans were ignored, with most resources benefiting Whites in Whites-only public facilities.

Some health services were developed in the Bantustans, but they were poor. These facilities and their services were extremely underfunded, and health workers battled to deal with the overwhelming demand—patients, including children and the elderly, would queue for hours for care.

Hospitals serving the Black population were notoriously overcrowded, with patients frequently sleeping on mattresses on the floor. Even then, the terrible Black urban services were still far better funded than the underdeveloped Black rural services.

Furthermore, what we understand today as private hospitals were limited to mission hospitals and industry facilities such as hospitals at large mines and factories. This ensured that almost the entire population of the country used public hospitals. Black and White.

(Mission hospitals were healthcare facilities established to meet the needs of missionaries and their families exposed to new tropical illnesses and required hospital services for this.)

When private hospitals started increasing, doctors congregated where the money was. At which point there was one doctor for every 308 White people in Cape Town compared to one doctor for every 22 000 people in Zululand and one for every 30 000 people in the Northern Transvaal.

Because private specialists generally have consulting rooms in private hospitals and admit their patients there, the increase in private hospital beds contributed to an even greater movement of specialists into the private health sector.

As a result of Apartheid, when the private sector grew, Whites-only public hospitals were empty (and therefore “better”). In contrast, hospitals catering to Africans were still poorly staffed, poorly equipped and over-crowded.

Needless to say, Apartheid health services ensured full provision for the minority while discriminating against the majority. Black health services did not emphasise preventive medicine, such as nutrition and sanitation. They simply concentrated on curative treatment.

Being a Black patient in the public health sector meant spending the entire day, including the evening, waiting for treatment at a busy major hospital. There were clinics in the townships, but they were poorly staffed, often only with nurses. (And SAIMR operated there)

The Black residents of rural areas were the worst off, as they were only served by makeshift mission hospitals, to which many patients had to travel long distances.

White patients, on the other hand, had easier access to better facilities. This included less crowded hospitals, faster referrals, and better-equipped surgeries. All facilities were segregated, with those for Whites being world-class and those for Blacks being far inferior.

In one instance at Baragwanath Hospital in 1983, journalists found 40 beds occupied by 89 women in one ward. Stickers marked ‘urgent’ were stuck on the foreheads of critically ill patients because it was the only way doctors could identify urgent cases.

With 2 000 beds, King Edward Hospital in Natal was supposed to serve the entire Black population of the province. According to statistics, the hospital sees 600,000 outpatients per year.

In 1977, the Livingstone Hospital in Port Elizabeth demonstrated appalling conditions, with women in labour being forced to sleep two to a bed, on mattresses on the floor, and trolleys in the corridors. Meanwhile, there were empty beds in the hospital’s White section.

In 1976, black patients at Cape Town’s Groote Schuur Hospital slept on trolleys for weeks. During this time, bed occupancy in the Black section was 110% and 75% in the White section.

Discriminatory attitudes were evident in family planning services, primarily concerned with reducing the Black population’s size. Whites feared being swamped by a numerically larger Black population, as evidenced by their increasing family size.

The Department of Health, Welfare, and Pensions, warned in 1971 that unless certain ethnic groups accepted family planning measures, sterilisation and abortion might have to be made compulsory. In 1976, the state’s spending on family planning was increased.

By the end of 1981, 3 920 medical specialists and 16 787 general medical practitioners were registered with the South African Medical and Dental Council. The doctor/patient ratio was 1: 330 for Whites, 1: 730 for Indians, and 1: 91 000 for Africans.

The distribution of medical practitioners was unequal. Although rural areas housed approximately 60% of the population, only 5% of doctors practised there.

The distribution of doctors by universities also demonstrates the urbanisation of skills and expertise. For example, non-South African universities produced 30% of all doctors working in rural areas.

Okay, that was during Apartheid; why has the public healthcare system not adequately improved in the past 30 years? There are a few reasons, and one of the main ones, as mentioned above, is the propagation of private medical aid schemes and healthcare facilities.

Private, for-profit general hospitals expanded rapidly in the 1980s, and private hospital beds almost doubled between 1988 and 1993. When 1990, public hospitals were opened to all races; White people fled to the private sector, as the government neglected the public hospitals.

Second, the Apartheid govt’s privatisation policy led to private hospital expansion. Also, it wasn’t just White patients who flocked to private practice. In the 1980s, 40% of doctors worked in the private sector; by the early ’90s, 62% of GPs and 66% of specialists were private.

The privatisation of health services just before 1994 was designed to empower White interest groups that would influence government medical policy when the Blacks took over. Capitalists took control of the country's health sector before 1994 and did not let go.

Unsurprisingly, the private health sector is well-resourced, serves a wealthier, formally employed and more urban population. The public sector, which serves the majority of South Africans, faces lower human-resource ratios, financial constraints, and old infrastructure.

Furthermore, there is a significant difference in resource availability between the public and private sectors. For instance, less than 15% of South Africans are members of private sector medical schemes, but these schemes account for 46% of all SA's healthcare expenditure.

84% of South Africans receive care at public hospitals, with just over 50% of the country’s health expenditure. Therefore, the public sector is financially constrained relative to the private sector.

The people served by the private for-profit health sector vehemently oppose the National Health Insurance Act because it threatens to level the playing field. It would lead to the more affluent, predominantly White people sharing more facilities with Blacks, and they just can’t.

There has been change in the public health sector since 1994, but not much has changed either. Apartheid is no longer official, and society has been desegregated. However, old segregation and inequality patterns persist, and some South Africans prefer things this way.

The people who moan the loudest about how the government has failed to fix the public health sector in the past 30 years, are the first ones to oppose and hamper the government's measures to do so.

Apartheid-era features persist in the healthcare system. The health of much of the Black population remains poor because of poverty and other social and educational factors that negatively impact general community health in Black communities.

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