RHD Prelude Chapter - Health Systems Trust

As Pillay and Bond have described, “the health system, like all other official institutions in
South African society, is the product of material processes related to the country’s economic and
social development, and has also been profoundly shaped by racist, sexist, and market ideologies.”
2 They further state, “there is no dispute that under apartheid, health care services were fragmented,
inadequate, ineffective, poorly distributed, and inefficiently delivered. There are many indicators
that document the disaster of apartheid health policy, and all available health status indicators
bear out huge discrepancies.” 3
The effectiveness of these services was particularly seen in the availability of contraceptives.
The fertility rate in South Africa dropped from 4.5 to 2.9 between 1978 and 2001. 4 The population
growth rate was 1.5 between 1995 and 2000 and predicted to be 0.8 between 2000 and 2005. 5
Maternal mortality ratio (MMR) and other indicators, however, have not decreased. MMR in
1999 was 230 maternal deaths per 100 000 live births and in 2002 it was 340 maternal deaths
per 100 000 live births. 6
In the ‘homelands’ all reproductive health services were part of the PHC services provided
through clinics and hospital within a health ward. The health ward system was similar to the
DHS providing health services within a defined geographical area to a defined population. The
services, however, were hospi-centric with the hospital management team being responsible for
first level hospital, clinic and community health services.
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The right to reproductive health is now entrenched in National Legislation and policies which
include:
• Reconstruction and Development Programme – 1994.
• African National Congress Health Plan – 1994.
• Maternal, Child and Women’s Health; Draft Policy Document – 1995.
• The Constitution of the Republic of South Africa – 1996.
• Choice on Termination of Pregnancy Act – 1996.
• White Paper for the Transformation of Health Services in South Africa – 1997.
• Notification of Maternal Deaths – 1997.
• Health Sector Strategic Framework – 1999 to 2004.
• Policy Guidelines for Adolescent and Youth Health – 2001.
• Guidelines for Maternity Care in South Africa – 2002.
• National Contraception Policy and Guidelines – 2002.
• Strategic Priorities for the National Health System – 2004 to 2009.
• National Health Act – 2003.
• Patients Rights Charter.
A Patients’ Rights Charter which includes right to privacy, treatment, respect, information and
to be treated with dignity is in place from the national level and is displayed in all clinics. This
charter is expected to be adhered to.
Reproductive health services have generally improved since 1994. There are more clinics
providing 24 hour services and these clinics are better equipped. There are standard protocols
for referral to hospital when required. This expansion of services is often equated with the
2 Pillay, Y.G. and Bond P. (1995) Health and Social Policies in the New South Africa, Int. J of the Health Services, Vol. 25,
No 4, 727-748 (p 728).
3 Pillay, Y.G. and Bond P. (1995) Health and Social Policies in the New South Africa, Int. J of the Health Services, Vol. 25,
No 4, 727-748 (p 728).
4 World Health Reports - 1999 and 2002.
5 United Nations Population Fund (UNFPA) Reports – 1999 and 2002.
6 United Nations Population Fund (UNFPA) Reports – 1999 and 2002.