• Spending overview
• Policy overview
• Diseases overview

Spending overview

South Africa spent an estimated 8.7% of GDP on healthcare in 2008. Total expenditure on healthcare is higher than in most other upper-middle income countries and similar to that of some high-income countries. Despite substantial expenditure on healthcare, South Africa's health status indicators are much worse than those of many other countries of a similar level of economic development. Projected increases in government outlays, together with a gradual increase in private medical-aid membership schemes, suggest that spending on healthcare products and services will rise at a fairly rapid pace during 2010-14, although much more slowly than in recent years owing to the recession in 2009 and weaker public finances.

The public health sector provides healthcare to 86% of the population but accounts for only around 40% of total national health spending. The private sector services the remaining 14% of the population that purchases private healthcare insurance, and accounts for around 60% of national health spending. The national health amendment bill was approved in April 2008 and contains proposals for collective bargaining on private healthcare fees. The private sector has argued that such measures will increase emigration of medical professionals as financing becomes tighter and reduce the sector's ability to raise sufficient revenue to finance infrastructure projects. However, the health ministry justifies the new legislation as a means of introducing transparency in the pricing of healthcare services, and as the first step towards containing spiralling costs that are putting private healthcare outside the reach of most South Africans.

Policy overview

South Africa's health system consists of a large under-resourced and over-used public sector and a much smaller well-funded and -equipped private sector. The public health sector provides healthcare to 86% of the population, with the remainder covered by the private sector through healthcare insurance schemes. In terms of funding, around 40% of total health spending is directed to the public sector, with the remaining 60% dedicated to the private healthcare system. High and rising medical-aid premiums render the private sector unaffordable for the majority of South Africans, and the sector tends to cater to middle- and high-income earners and to affluent foreigners looking for high-quality surgical procedures at relatively affordable prices.

The African National Congress (ANC), South Africa's governing party, has proposed that a National Health Insurance (NHI) system be introduced within the next five years. Other proposals include the upgrading of hospitals and clinics, investment in research, and treatment, care and support for the majority of HIV/AIDS sufferers and their families. In the 2009 budget particular emphasis was placed on much-needed improvements to the healthcare system, including expansion of the hospital revitalisation programme, improved remuneration for health officials and improved disease prevention.

In May 2006 the South African National AIDS Council (SANAC) was tasked with drawing up a new, five-year comprehensive plan for combating HIV/AIDS. This resulted in the HIV and AIDS and STI Strategic Plan for South Africa 2007-11, which aims to halve the number of HIV infections and ensure that treatment is extended to at least 80% of the AIDS population by 2011.

Diseases overview

Key health indicators are markedly different for the poor black majority and the affluent sections of society. For example, the infant mortality rate among the South African population as a whole is high, on a par with that for Bangladesh, but the rate for the more affluent is similar to that in OECD countries. The government is trying to improve the overall health status of the population by expanding the free primary healthcare system, but the lack of skilled medical and administrative professionals, owing in part to uncompetitive salaries and harsh working conditions, will continue to impede the provision of adequate public health services.

South Africa has the highest number of people living with HIV/AIDS in the world. UNAIDS, the UN programme on HIV/AIDS, estimated that by the end of 2007 around 11.9% of the population was infected with HIV. In recent years, the government has stated its intention to provide comprehensive treatment for HIV/AIDS sufferers. However, the HIV/AIDS pandemic has reached a mature stage and will prove difficult to reverse.

Although South Africa is overwhelmed by infectious diseases, there has also been a steady increase in non-communicable diseases (NCDs). The urban poor bear the brunt of NCDs, with the main risk factors being smoking, lack of exercise and an unhealthy diet. Diabetes is a growing problem in South Africa, which has the paradoxical problem of high rates of obesity and malnutrition. Poverty, inactivity and limited ability to choose healthy food are the main causes driving the rising incidence of obesity.