and funded through private health insurance, while public facilities are under-resourced. The private sector attracts the majority of health care professionals. South Africa has an established pharmaceutical industry with operations spanning all stages of industry: manufacturing, wholesaling and retail. All the major global pharmaceutical names have offices in the country that act as a central base for many of their operations in the rest of the Southern African region. The most recent act of parliament relating to mental health in South Africa is the Mental Health Care Act 2002. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For South Africa to achieve its targets for the reduction of child mortality, which form MDG 4, it would need to have reduced under-five deaths per 1,000 live births to 20 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 44 deaths per 1,000 live births, down from 47 in 2011, and measles immunisation at 66 per cent a significant decrease from 79 per cent in 2012. With under-five mortality more than twice the target figure, the country is very unlikely to achieve this goal. In South Africa’s 2013 MDG progress report, several challenges were identified as requiring immediate attention if South Africa is to improve its under-five mortality rating and measles immunisation by 2015. These include research into the influence of socio-economic factors on child mortality levels; empowering women through maternal education; addressing the lack of integrated planning for transportation, safe water and sanitation; and increasing the monitoring of childhood mortality. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For South Africa, the maternal mortality rate should fall to 63 cases per 100,000 live births. In 2013 the country had an adjusted maternal mortality rate of 140 deaths per 100,000 live births (this figure was estimated at 300 deaths per 100,000 by UN agencies/World Bank in 2010). This is more than twice the target figure, so this goal is very unlikely to be achieved. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In the period 2007–12 this figure stood at 91 per cent, so this target may be achieved by 2015. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. South Africa’s prevalence of HIV was 17.9 per cent in 2012 (in the 15–49 age group). This figure is very high and there has been no discernible reduction in HIV prevalence since 1990. There also has been a significant increase in estimated TB incidence and mortality (when mortality data excludes cases comorbid with HIV) since 1990. Numbers of deaths from malaria increased in the period 2007–11. Consequently, the achievement of MDG 6 is not looking very realistic. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Around half of all health care in South Africa (52 per cent) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 8.8 per cent of GDP in 2012, of which 48 per cent (US$309 per capita) was covered by the government. S o u t h Af r i c a South Africa’s two-tier system of public and private health care makes adequate health care inaccessible to a large number of South Africans, as public sector institutions are so stretched (see ‘Health systems’ above). Initiatives, such as free health care for children under six and for pregnant or breastfeeding mothers, were introduced in the mid-1990s as a step towards making quality care more affordable. A new scheme of National Health Insurance (NHI) is aimed at completely overhauling the health system. The aim of NHI is to improve access to quality health care services for the whole population and to provide financial protection against high healthrelated costs. NHI is being phased in over a 14-year time frame, starting from 2012, and will eventually cover all South Africans. South Africa has signed and ratified the International Covenant on Economic, Social and Cultural Rights, which includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: Around 2.9 million people in South Africa are over the age of 65 – six per cent of the total population (2013). At the age of 60 a person in South Africa can be expected to live for an additional 16 years, on average (2013). South Africa’s Older Persons Grant dates back to 1927/28, when it was first introduced for the white population. In 1944 the scheme was extended to the whole population and in 1996 full parity was achieved. Today, monthly pension credits are paid by the state at a rate of $125 per person (2007–12) on a means-tested basis. Overall, public pension spending is equivalent to 2.2 per cent of the country’s total economic output (2010). Population over 65 In 2013 the Global AgeWatch Index issued a report on the quality of life of older people in 91 nations, with South Africa ranking highest in Africa at 65. The report found that, while it performed fairly well with respect to income security, South Africa performed poorly with respect to elderly people’s health status – there are only eight registered geriatric doctors in the whole country. Lack of health care facilities for the elderly are largely due to the AIDS epidemic, which has seen health professionals directed away from geriatric care and towards caring for mothers and children. As in other African countries, many elderly people also find themselves caring for grandchildren who have lost their parents to AIDS. Further information Ministry of Health: www.doh.gov.za Commonwealth Health Online: www.commonwealthhealth.org/health/africa/south_africa Commonwealth Health Partnerships 2015 269 6%
Commonwealth Health Partnerships 2015
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