The Blackwell Companion to Medical Sociology

374 H. C. J. van Rensburg and Charles Ngwena
industry, and generally inflated costs (Naylor 1988; van Rensburg and Fourie
1988).
Current health sector reforms are driven by the desire to rectify these structural
distortions in the health sphere and in particular are aimed at unifyingthe
fragmented health services into a comprehensive and integrated National Health
System; reducingdisparities and inequities in service delivery and health outcomes;
and extendingaccess to an improved health service (Department of
Health 1996a, 1996b, 1997a, 1997c). Note however, that health sector reforms
in South Africa have not only to do with internal restructuring. Reform also fits
into a broader reform process in Africa and further afield ± that is reform to cope
with risingdemand, and to render more accessible and more affordable care,
especially for the deprived.
Reform of the South African Health System
CONSTITUTIONAL AND LEGAL REFORMS ± THE RIGHT TO HEALTH
SERVICES
The present health reforms in South Africa are not entirely the initiative of the
new government. Several reforms, some anticipating those of the current government,
had been introduced by the previous government. However most of these
were nullified by the confines of an unchanging sociopolitical order which left
little leeway for fundamental reform of the health system (van Rensburget al.
1992; van Rensburg1999). The new political order changed it all. The ANC
(African National Congress)-led government embarked on fundamental reform,
encompassingboth the broader societal order and the narrower health sector.
Since 1994, the reform frameworks have been detailed and mandated by a series
of official policy papers and legislation at both national and provincial levels
(Department of Health 1997a, 1997c). More fundamentally, the new Constitution
lay the basis for the reform of the health sector.
Prior to the current reforms, health care services were a privilege rather than a
right and the main beneficiaries were whites. The Constitution of the Republic of
South Africa of 1996, which replaced the interim Constitution of 1993, gives
conspicuous expression to the idea of a fundamental right to health care for all.
It translates to the health care sector the values of social justice, equality under
the law, and respect for human rights that were not priorities under colonial and
apartheid dispensations. By doingso the Constitution clearly lays the foundation
for both a liberal and egalitarian health care system and thereby signals a break
with the legacy of gross inequality and guarantees everyone the right of access to
basic health care services. At the same time, it enjoins the state to take reasonable
measures within its available resources to achieve the progressive realization of
such a right of access to health care (De Waal et al. 1999).
Outside the Constitution, there are a number of other measures which have
been taken with a view to achievingequitable access to health care. Noteworthy
are the provision of free health care to mothers and children under six, the
Choice on Termination of Pregnancy Act, which gives women easy access to