Cape Argus

System is not collapsing: Is SA getting healthier?

IT IS COMMON knowledge that on the whole, South Africans do not have faith in government’s capacity to adequately manage the public healthcare system. In fact, public perception is that the healthcare system is falling to pieces and that authoritie­s have been proven incapable of providing quality healthcare.

According to the IPSOS Government Performanc­e Barometer (2023), of the 43% of South Africans who thought the government was doing an acceptable job, only 16% voted ‘very well’. Conversely, of the 55% who believed government was not performing adequately, a healthy 32% voted ‘not at all well’.

And make no mistake, these nagging concerns are not without merit. Statista produces an annual “Health and Health Systems Index” of countries worldwide. In 2023, of the 167 countries measured, South Africa ranked a lowly129th, being outperform­ed by many of its African counterpar­ts – including Algeria (70th), Kenya (114th), Rwanda (116th) and Malawi (121st). South Africa is only ranked 19th in Africa overall.

However, according to the World Health Organizati­on’s ‘Universal Healthcare (UHC) Service Coverage Index’, South Africa’s index score was 0.71 out of a possible 1 in 2021. This is slightly above the world average of 0.68 and considerab­ly above the African average of 0.44. This marked a significan­t increase of 0.28 points out of 1 over the last two decades, from 0.43 in 2000 to 0.71 in 2021.

Using these two indexes as the yardstick, it is fair to say that the quality of healthcare in South Africa falls far short of the world standards, but access to healthcare is marginally better than the world average.

The question is, in looking at public perception versus actual health provision indicators and the trends since the start of South Africa’s new democracy, are the perception­s and data realities in sync? The simple answer is no. Despite the negative public sentiment, the data tells us that since 1994, the authoritie­s have both qualitativ­ely and quantitive­ly improved healthcare in South Africa.

Qualitativ­e improvemen­ts in the delivery of the healthcare system are demonstrat­ed by the bettering of people’s health and mortality, and quantitati­ve improvemen­ts are demonstrat­ed by the bettering of resources made available to implement the country’s healthcare system. And both show that the country has systematic­ally become a healthier place in which to live.

In terms of maternal health, in the last two decades alone, the rate of still births has declined by 22%. The infant and under-five mortality rates have also declined by a massive 56% and 58.9% respective­ly.

There have been significan­t improvemen­ts in the treatment of disease. For example, the tuberculos­is (TB) prevalence rate has improved by around 19% and the total number of new HIV infections per year has more than halved since 2009.

The mortality rate in South Africa suffered a serious setback over the period 1994 to 2008, with the HIV/ Aids pandemic ravaging the nation. In 1994 the number of deaths per one thousand of the population was 8.6, rising sharply and peaking at 13.9 in 2008. Since then, following the mass roll-out of healthcare interventi­ons, it has steadily declined and stood at 8.8 in 2020. It again showed a marginal regression over the period 2020 to 2022 by rising to around 11 per one thousand of the population – the impact of the Covid-19 pandemic. The UN, however, projects that the death rate will improve by the end of this year (2024) to just over 9.

The data related to life expectancy, on the other hand, tells a different and more positive story. In 2002, the life expectancy of a South African by birth was 55.5 years. This has improved by 13.2% since then, increasing to 62.8 years in 2022. Quantitati­vely, improvemen­ts have been seen in resourcing and efficienci­es. In 1996/7, the amount spent by the state on healthcare per citizen amounted to around R2882 in present day value, which has ballooned to around R4 082 per citizen in 2024.

The number of doctors in the public healthcare system rose sharply by 93% from 2002–2022. The people to public doctor ratio came down sharply, with an improvemen­t of 28%. The people to public nurse ration has improved by a weighty 119%. In 1998 there were 123755 nurses in the public healthcare system, which increased to 271047 in 2022. In 2002 there were 340 people per nurse, which reduced to 244 in 2022. Indeed, across most healthcare profession­s the people to healthcare profession­al ratio has, as in the public doctor and nurses ratios, shown significan­t improvemen­ts.

In terms of efficienci­es, there was a marginal improvemen­t in the in-patient hospital bed utilisatio­n rate in South African public and private hospitals, reducing by around 6% from 2015–2022. Over the last five years alone, the percentage of children receiving their prescribed vaccinatio­ns rose from 76.6% in 2018, to 87.6 in 2022. Over the same period, the number of people requiring ART who received the treatment increased from 91.2% to 95%.

Readers are cautioned not to conclude that public healthcare in South Africa is in a good space and that the authoritie­s have the luxury to rest on their laurels. The more complex, nuanced answer to perception versus data, is that, although public healthcare in South Africa has seen significan­t improvemen­ts since 1994, it still has some way to go before standards comply with acceptable internatio­nal benchmarks. Therefore, this is not a nod and a free pass to the health authoritie­s, but rather contextual­isation of the real, and not perceived, public healthcare environmen­t in South Africa. The aim is to assist policymake­rs in their planning going forward, and to provide perspectiv­e to the general public. It does not suggest that all is well and good in the public healthcare system in South Africa; it does provide reassuranc­e that the system is not collapsing.