Part $3$ Complementary Content

Consider the content that we covered around the History of Health Systems in South Africa. Having read two chapters of Van Rensburg and linking the material that were presented class, trace a timeline of important events in the history of health systems in South Africa:

The Struggle for Democracy: $1990-1994$

The purpose of this session is to describe the tumultuous years leading up to the end of apartheid. The session starts by examining the state of health of different groups of people in the immediate years preceding democracy. We will also look at the violent political context of the years leading up to the $1994$ elections, and examine the key platforms and policy decisions made during this time.

Discuss the state of health as well as the political context leading up to the elections in $1994.$

Discuss key political processes and policy decisions such as:

The Convention for a Democratic South Africa $($CODESA$).$

The Interim Constitution of the Republic of South Africa of $1993.$

The Reconstruction and Development Programme $1994.$

The National Health Plan for South Africa.

Assessing the Healthcare Landscape

The early $1990$s in South Africa was a period marked with great tension and fear. It was also a time marked with hope, where we slowly began moving towards a new democracy. The healthcare landscape at this time was plagued with gaping inequities as a result of the many years of apartheid. Healthcare workers and clinicians knew that South Africa needed to collect data that would shed light on the unequal health system, and provide us with a clear picture of what needed to be fixed. The type of data that gave a clear indication of the disparity of healthcare in South Africa included infant, maternal and adult mortality and morbidity data, the burden of disease, and profiles of disease. This data, when compared between urban and rural, across racial lines in urban areas, and between public and private healthcare systems, indicated the startling inequities.

The Struggle for Democracy: Political Tension and Violence

In the early $1990$s$,$ there was also massive political tension, where multiple stakeholders and various political groups with very different voices began to negotiate. The atmosphere at this time was volatile, marked with fragile hope, false news, growing suspicions, mass action, and a reactive army. Many South Africans lost their lives during this time, including Chris Hani, the leader of the South African Communist Party and chief of staff of uMkhonto we Sizwe.

That South Africa did not spiral into a civil war at this time, was as a result of the maturity and calm of people like Mandela, the team around him, and other leaders.

Policy Reform under Pressure during the HIV Pandemic

The purpose of this session is to explore the early years of South Africa$$s democracy and the many policies that were created to reform the provision of health care. We will see while many well$-$written policies were formulated, the HIV$/$AIDS pandemic put huge amounts of pressure on the health system, which adversely affected how these policies were implemented. At the same time, a period of AIDS denialism catapulted civil society to appeal to the newly crafted Constitution of South Africa to fight for the right to antiretroviral therapy $($ART$).$

Early Policy Development

The early years of democracy in South Africa was a time of energy and renewed hope, the opening up of information and a focus on uniting a fractured country. During this time apartheid policies were dismantled and the fragmentation of the South African health service, created over the previous $90$ years was overturned within the decade. It was during this time that the Constitution of South Africa, with the Bill of Rights at the start. It was signed into law on $10$ December $1996$ and promulgated on the Government Gazette $18$th$.$

During this period, a whole new suite of policies across education, social development, infrastructure and health was consolidated, and brand new policies were instituted. Policy development was underpinned by a human rights approach, with policy$-$makers drawing on the principles and ideologies drawing on South Africa$$s Freedom Charter, the Women$$s Charter and the Gluckman Commission.

During these early years, South Africa$$s Reconciliation and Development Programme $($RDP$)$ was also developed, with the aim of re$-$shaping our country, re$-$dressing past inequities and healing a fractured country, integrating rural and urban parts of South Africa, and creating a District Health System.

The District Health System was all$-$encompassing and included planning and the provision of equal access for all South Africans to healthcare, water, sanitation, housing development, electricity, schooling and grants.

RDP projects included feeding schemes for primary school children, free health care for children under the age of six and free pre$-$ and post$-$natal care, the building of new clinics, rural water provision, land reform.