In 2023, data that the World Bank published showed that 55% of South Africans as living below the poverty line. Of those South Africans experiencing poverty, a 2023 national study found these citizens were twice as at risk of the communicable disease HIV. For the southernmost nation on the African continent, existing diseases are separated into two categories: communicable and non-communicable. Despite easy transmission of communicable diseases, 2019 World Health Organization (WHO) statistics show that non-communicable diseases account for 51% of all national deaths. With high prevalence rates of both infection varieties among those experiencing poverty, the stifling effects of Apartheid policy remain central within the national struggle to curb diseases impacting South Africa.

Communicable Diseases 

The three most prevalent communicable diseases impacting South Africa are malaria, tuberculosis (TB) and HIV/AIDS. Malaria mitigation strategies have been largely successful. In line with the 2021 Global Technical Strategy (GTS) for Malaria, WHO found that the number of South Africans at risk dropped to a low 10% of the population that same year. In South Africa, particularly the Kwazulu-Natal district, which contains one of the highest incidence rates of TB around the world, TB impacted 427 of 100,000 people in 2023. Positively, this incidence rate has fallen since 2021, where TB affected 512 per 100,000 citizens.

Following the United Nations (UN) AIDS 95-95-95 target, South Africa has also made promising strides in HIV/AIDS mitigation. Though 2023 figures show that 16.3% of South Africans are living with HIV, screenings and treatment have improved. Striving towards this 95-95-95 UN target, 94% of South Africans living with HIV knew their diagnosis, 79% were receiving treatment and 91% were being virally suppressed in 2021.

Non-Communicable Diseases 

The other half of diseases impacting South Africa are non-communicable diseases (NCDs) including cardiovascular disease, chronic respiratory disease, cancer and diabetes. In 2021, the collective incidence rate for these particular NCDs stood at 1,301 per 100,000 people. Obesity, which increases the risk for these NCDs, represents another health indicator impacting South African morbidity. Along with WHO’s other findings, it found that 30.8% of the adult population suffered from obesity in 2022, up from 2021.

Health System

The national healthcare system mainly initiates response to diseases impacting South Africa. The Department of Health’s inadequate health care response is typically pinpointed to policy carried over from the nation’s apartheid era. After the 1994 end to apartheid law, the government faced the ongoing challenge of restructuring the health care system. Despite this, the WHO has projected that 6.2 million citizens should experience universal health coverage by the end of this year. This number represents a steady, sharp increase from 2021 where only 1.8 million retained universal health care access. 

Impact of Poverty 

A 2023 study conducted with support from the South African government articulated that HIV, one of the most nationally prevalent communicable diseases, affects those living in townships twice as severely as those living elsewhere. Townships are South African neighborhoods inhabited primarily by those experiencing poverty. The study found that socioeconomic factors like access to stable housing and quality education do increase the odds of HIV infection and reduce the likelihood of access to testing and care. The researchers recommended a mitigation strategy that includes policy towards improving education and living quality.

Another national study from 2021 asserted that to address the reality of health care inaccessibility due to societal inequities, there needs to be cohesive efforts from multiple actors. The study calls on the necessity of both government and non-state intervention.

Doctors Without Borders

One international organization working diligently against the spread and prevalence of disease in South Africa is Doctors Without Borders (MSF). With the United States currently slashing its funding of South Africa’s TB and HIV/AIDS research programs, MSF has been vital in calling upon international donors, organizations and philanthropists to direct funds towards these life-saving research initiatives. Actors like the South African Department of Health and MSF rely on these funds to help develop promising vaccines and treatments for those experiencing these diseases impacting South Africa.

In addition to MSF’s TB and HIV/AIDS research, where funding is unsteady, it recently introduced a new project aimed at addressing South African NCDs. In collaboration with South Africa’s Department of Health, MSF has been training health care organizations across the Eastern Cape province of Butterworth. Reaching more than 1,500 people within the region, the project has increased the screening and medical management of NCDs like diabetes and hypertension.

Progress

Though funding cuts from the United States have caused uncertainty about the future of national research and mitigation response, strides in health care coverage and the involvement of organizations like the MSF are promising for the future of eliminating the diseases impacting South Africa. National initiatives for screening and improvements in treatment technologies have greatly improved and have been key in addressing and reducing incidence rates, particularly for the highly prevalent TB. In 2019 alone, testing for TB caused a 28% reduction in incidence.

With organizations and donors allocating funds towards national efforts to fight disease, South Africa will further mitigate the spread and prevalence of such harmful illnesses, particularly for those living in poverty.

– Piper Aweeka

Piper is based in Reno, NV, USA and focuses on Global Health for The Borgen Project.

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