The South African health-care system is showing a steady collapse which is worrying health officials countrywide. Yet nobody seems able to turn the problem around - there are far too many patients and not enough medical staff to treat them.
The health-infracture of South Africa, once the best on the continent, is deteriorating fast. This was the warning by the 2008 health review of the South African Human Rights Commission. Also see SA's ticking time bomb: water pollution.
The report notes that cholera is one of the major new health threats, with the country's health sector now becoming so overburdened, underfunded and understaffed over the past 15 years, that South Africa now has become one of the few countries in the world where the death rates for children under five years increase each year - in spite of all the worldwide scientific advances in this field.
One of the most worrying aspects of this trend is the fact that the country has so few health workers left in the public sector, the SAHRC noted. In 1994, it still had 2,1 million registered- and staff nurses...
900,000 apartheid-era nurses set to retire...
Over the next decade, 700,000 nurses, one-third of the country's health worker contingent, are set to retire. And they are not being replaced with enough new recruits: the country now has 116 registered nurses and 83 student-nurses for every 100,000 people - and an increasingly sick population to care for, besides its trauma units being overloaded with tens of thousands of violent-trauma victims a year who all need emergency treatment.
The country's public health sector, serving an indigenous population of 48 million -- of whom 6 million are infected with the deadly human-immune deficiency virus -- now only has 26 doctors for every 100,000 people and 34,9% of all the doctors' posts are vacant.
First AIDS-patient died in 1983, now 4m dead and 6-m infected:
Officially, the first identified AIDS-patient in South Africa, a white SA Airways flight attendant, died in 1983 - I still wrote the article for the Sunday Times of Johannesburg. In 1980, the SA government had already set up an AIDS Advisory Group. Initially HIV infections occurring amongst gay white men, but by 1985 it had spread to the heterosexual black population.
The first national antenatal survey to test for HIV found that 0.8% of pregnant women were HIV-positive. Some 74,000 to 120,000 people in South Africa were infected with HIV in 1990. In 1995, this had risen to 850,000 people.
Thabo Mbeki s anti-Science approach:
However due to ex-president Thabo Mbeki's negative approach towards all Western medical science, see the revealing video interviews here: and here the largest number of deaths from AIDS-TB in South Africa only started occurring after 1994.
Free drugs rejected:
In 2002, the SA High Court ordered the Mbeki-government to make the drug nevirapine available to pregnant women to help prevent mother to child transmission of HIV. International drug companies offered five-year-supplies for free but he resisted and told fellow-South Africans that the drug was 'poisonous'.
Since then, four-million people, 98.4% black, have already died of AIDS-TB related infections up to the year 2006 since 1994. To date, less than 1,-million of the 6-million people who need antiretroviral treatment, are actually getting it. And their attitude to this widely suspected treatment - due to Mbeki's claims -- can be seen by the fact that a lot of these drugs end up being sold to township youths, who smoke them to get high.
At the giant teaching Baragwanath in Soweto alone -- Africa's biggest hospital -- which treats an annual 137,000 bed-patients and births 35,000 babies a year (45% of whom, sadly, now die within a year) -- a whopping 935 of the 5,759 budgeted medical posts are now vacant.
The total number of vacant nursing posts in the public sector now stands at 40,3% - last year 31,5% of these posts were still vacant, so either these 'missing' nurses have left this year past, have died, moved to the private sector or retired.
The socio-economic impact of South Africa's failing health-care system on the entire population is also immense: millions of increasingly ill orphaned young township dwellers are now forming a growing army of desperately angry, uneducated, ruthless feral crime gangs: while the taxpayers - the country's middle-class, are fleeing the country in increasing numbers. See youth gang video hereOVERBURDENED WITH TRAUMA CASES:
Just like the public health sector, the police are also overwhelmed by an unprecedented violent crime epidemic which also greatly burdens the public hospitals with huge numbers of violence-related trauma cases every day. The remaining doctors cannot cope with the huge workload and faced with violent attacks which often target medical staff fighting in the front line of this crime battle, the country's brightest young people -- more than half of all the medical schools' graduates -- emigrate within a year.
So how was it during apartheid - really ?
The CIA world factbook on South Africa shows in 2008 that from the 1,000 live births, 45 of the newborns die within a year of birth now; and that the life expectancy of the average South African now has dropped to 48 years and still dropping each year - down from 64 years in 1994.
The average number of surviving children for each SA woman now stands at two surviving beyond the age of 1 and only one surviving beyond the age of five; in the last year of apartheid-rule in 1993, five black children born to one woman surviving into adulthood on average, and 1.5 child for each white woman.
There was a very good reason for these excellent public-health statistics in 1994, which were indeed at that point, the best in Africa: In 1977, the universally-hated apartheid government launched an ambitious health-care programme -- and within a decade, had turned its public health care system into the most modern and best on the African continent - for all the population groups.
In the rest of Africa, the public health care systems greatly relied on a constant stream of cash from foreign donors and free health care from missionaries and foreign volunteer groups such as Medisins Sans Frontieres -- instead of taxpayers -- but in South Africa by 1984, the taxpayer-funded public health care programme had already managed to eradicate most of the endemic diseases which were widespread in the rest of Africa, such as bubonic plague, bilharzia, TB, leprosy, polio, smallpox, malaria and typhoid fever.
And if such outbreaks occurred such as two cholera outbreaks in the KwaZulu and Bophutha-tswana homelands, the government reacted rapidly, dispensing a dedicated task force of military staff, field hospitals and portable water-purification plants to isolate and cure such outbreaks at the source. Not that they cared to brag about it: they didn't want it known that cholera outbreaks occurred, fearing negative publicity, and I had a hard time getting the true facts above water.
A free programme of innoculations and treatment was launched for all these preventable diseases in close cooperation with its veterinary services keeping a close eye on the African wildlife's health and the country's fresh-water supplies.
Some more old, boring statistics:
By 1986, there were a total of 122,401 taxpayer-funded public hospital beds in South Africa in 211 public hospitals countrywide. The (then-) four provinces spent R2 339-million annually on public health care for all population groups - of which less than 5% was spent on the public health care budgets for whites - the rest was allocated for treatment of patients in the health-care facilities of other races. This would be worth an annual budget of R2-billion today. This budget did not include the ongoing building programme of public-health facilities.
Patients in public hospitals paid according to their income levels
Patients paid for these public services according to their income levels: by 1994, those who earned less than R23,000 a year, paid nothing at all for any services at public hospitals, which included ground-breaking surgery such as heart-transplants and heart-bypass operations.
This government's was attacked worldwide for building seperate hospitals for the seperate racial and religious minorities, however the Indians in South Africa themselves did not protest when the government built the first public hospital for Indians in 1982 in Laudium near Pretoria, with 98 beds and costing R12,5m - at a time when the Rand was still at an equal value to the US Dollar. Today it would be worth R120,5 million.
And Sowetan residents also did not complain when Africa's biggest hospital with the most modern equipment on the continent was expanded from a former British military hospital, and turned into the giant Baragwanath hospital which serves the community today.
Biggest hospital in the world
It's so big that it made the 1997 Guinness Book of records as the largest hospital in the world - if all the corridors were placed in a straight line it would be 10km long. It's built on 173 acres of ground with 429 existing buildings, and has a total floor area of 233,795 square meters.
This hospital still remains the biggest specialist- nursing-education and teaching hospital in Africa. When it was opened, it treated an annual 120,000 bed-patients and 150,000 outpatients each year. Its shrinking number of doctors and nurses now face a growing workload: Last year it treated 137,690 bed-patients, with some 33,450 babies born there. Today, Baragwanath has 935 free vacant health-worker posts -- 43% of its staff contingent.
In 1982, the growing middle-class in Soweto also got their own private 78-bed clinic, Lesidi, three operating theatres, state-of-the-art radiology units, costing about R3,5-million.
In 1983, the government built a new health-care facility for the Mamelodi community near Pretoria, costing R2,2-million. Many clinics and rural hospitals also were built in the semi-autonomous ethnic-homelands.
And the Chamber of Mines, throughtout the years, also funded a chain of TB- and lung-disease hospitals countrywide for primarily black patients, run by a private trust and co-funded by the SA government, where they kept track of mine-related illnesses. Most of these TB hospitals were closed down and have become derelict -- exactly when South Africa's already weakened population also has also been hit by a second killer epidemic, namely XDR-TB. South Africans refer to is as "Turbo-Aids" because it kills patients within twenty days.
See YouTube video here.
It wasn't a perfect system -- not with just a small number of taxpayers having to pay for such an gigantic and constantly growing infrastructure. But it still was the best in Africa.