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Health Care Reform & Restructuring in Post-Apartheid South Africa: Post-COVID-19 Implications

This week’s #GLOVicariously webinar featured Jacob du Plessis, a lecturer in Sociology in the Department of Sociology and Social Anthropology at Stellenbosch University in South Africa. Jacob has also been the Academic Director for the Northwestern University Public Health and Development program in South Africa for the past 15 years. His research interests are focused on health systems, community development and higher education teaching and learning. For this webinar, Jacob shared background of South Africa’s struggle with healthcare and the effects of COVID-19.

To better understand the modern-day implications of a pandemic on South African society, Jacob insists we need to look back to recent history. By the end of apartheid, health care was highly fragmented, focused on curative care and much less on public or preventative health, which directly impacted on the cost of health care. Through these challenges, the government has largely failed to provide universal health care and access to quality health for all, as required by the health-related stipulations of the human rights based South African Constitution, which inherently intended to redress past social inequities. 

“We have to think of the daily battle we fight to have an equitable healthcare system in South Africa. It’s very interesting if we look at the historic context as far as 400 years back and even longer…health has intersections with political interests, it has a pervasive and compounding impact on the health status of a nation over a long period of time,” Jacob says.

“There’s this beautiful story from this place called Pholela in the 1950s. They have this clinic success story that illustrated that a primary healthcare system- if well run on key principles of equity and informing/collaborating with community members- can have health outcomes totally different to the outcomes of a nation. Everyone studied Pholela, how can they be so successful in having different health outcomes and suggested that the South African government should have a system characterized by primary and preventative health. This was not in the interest of the national party. What they saw as their future achievement was to create a private healthcare system. The pervasive influence is that today we still experience how the majority of resources is allocated to the private healthcare system, which is serving a small portion of the population while about 35 million people receive inequitable health care services,” explains Jacob.

Well intentioned policies are not always aligned with the desired outcomes. “If we think about South Africa, with such a wonderful constitution, a human rights based focus, we have legislation and achievements in post-Apartheid years, advancing thinking about the whole population accessing universal healthcare…that ideal of having a perfect private healthcare services is a major obstacle in implementation of policy and legislation.”

The relevancy is to think of South Africa as an already unequal space. When a pandemic like COVID-19 hits, the problems that grow from these well-meaning policies are further exasperated. Lock down restrictions make it difficult for people who live in close proximity to maintain social distancing regulations, to have access to masks, etc. A lot of resources have already been spent on infrastructure. Among the concerns of action to prevent the spread of COVID-19 are the effects on those living in townships.

Jacob highlighted several unintended consequences that parallel vulnerable population in other countries:

  • Concerns about corruption to protect the families of government officials instead of medical personal
  • During lock down, people are at home in close proximity, many are unemployed and there’s an increase in gender-based violence
  • Fear and anxiety have a mental health dimension
  • The peak of COVID-19 is projected to be in November for South Africa, but there is concern about the fudging of statistics to push political agendas
  • Increased police violence, gang violence, and military violence, leading to increased non-COVID-19 related injuries

The societal response to a pandemic, in a place that is already unequal and xenophobic, has been telling of deeply rooted problems and classism. “A crisis like COVID-19 forces us to think about what kind of society we want to live in, what kind of health care system should we have, and what is the role of political power within this system,” Jacob says in closing.

 Watch the full webinar:

About #GLOVicariously Webinar Series:

Amidst the global COVID-19 pandemic and ongoing anti-racism protests, global engagement across difference and development of intercultural skills are critically needed to build a more just and peaceful world. We want to continue fostering global learning opportunities for students throughout this summer 2020 through our virtual webinar series, #GLOVicariously. #GLOVicariously webinars feature speakers involved in GLO programs who have expertise on a variety of critical global issues. View upcoming #GLOVicariously webinars.