For years South Africa had the reputation as a country of disparity. During most of the 20^th century it remained divided along racial lines, until its 1994 election and the abolition of apartheid. With noticeable growth in its Black African middle class, the country has undoubtedly made progress in reducing its previous inequalities.

However, disparity still defines much of South African life. It has a highly disproportionate number of people living with HIV/AIDS. While South Africa contains only 0.7 percent of the global population, it is responsible for 17 percent of the world’s infections. In fact, it bears the highest HIV/AIDS rate of any country in the world, with close to 20 percent of its population infected.

Disparity also marks healthcare in South Africa, in which there is a massive gulf between private and public care. This stratified imbalance often reflects racial divisions and hinders an effective response to the national AIDS epidemic. For most South Africans, the quality of healthcare is woefully inadequate.

The data tells it all. Though 84 percent of South Africans, or 50 million people, rely on public healthcare, only 30 percent of the nation’s doctors work at public hospitals. By contrast, private coverage applies to only 8 million South Africans, yet this small minority receives 70 percent of the physicians. A majority of those reliant on public healthcare are black, while whites comprise most of those on private plans.

Per capita, expenditures on healthcare reveal the extent of this inequality. According to The New England Journal of Medicine, “Annual per capita expenditure on health ranges from $1,400 in the private sector to approximately $140 in the public sector, and disparities in the provision of health care continue to widen.”

The lack of funding has left public hospitals in decay all across the country. What funds these hospitals do receive are often mismanaged and squandered due to corruption and incompetency. It is not uncommon for these public facilities to endure medicine shortages, broken equipment and deteriorating buildings.

The inadequacy of public healthcare became widely apparent during the presidency of Thabo Mbeki, when the government systematically denied the threat of AIDS. Over 330,000 people died needlessly after the government failed to initiate an antiretroviral treatment program.

However, if one were to visit one of South Africa’s 200 private hospitals, conditions would appear satisfactory or even superior. The private health sector spends 13 times as much as the public sector on medicine and features the country’s best doctors.

It is this elite standard of care that is actually suffocating the countries healthcare system, as private spending on state of the art medicine increases drug manufacturers and hospitals are only raising prices. Some estimate the annual medical inflation rate is at 25 percent.

Yet even the top notch private sector cannot hold onto its best doctors; reports have estimated that 30 percent of South African doctors have left to countries like Australia, the United States, the United Kingdom and Canada. What’s more, another 58 percent admitted that they would consider immigrating to Western countries for work.

This trajectory is common amongst doctors from sub-Saharan countries. In total, their exits represent 2 billion in lost investments. According to the New England Journal of Medicine, “South Africa incurs the highest costs for medical education and the greatest lost returns on investment for all doctors currently working in such destination countries.”

To remedy its national health crisis, South Africa has proposed a National Health Insurance program. It aims first and foremost to provide universal coverage and level healthcare disparity. It would also attempt to contain prices by negotiating with medicine and healthcare providers.

However, due to the overwhelming demand for healthcare as a result of the AIDS epidemic, a universal health care plan would be burdensome on the nation’s budget. Some have estimated that the cost for such a program would essentially equal the amount of money collected from personal income tax nationwide.

In the meantime, South Africa can aim on producing more physicians to deal with the AIDS crisis. The current demand for AIDS treatment exceeds the county’s entire healthcare workforce by three times. To better train this workforce, South Africa needs to invest more in its teaching facilities so that doctors can learn to treat patients more effectively.

As one of the world’s up and coming economies, South Africa should seek to fix its healthcare crisis. It is hard to have gravitas on the international stage when extensive issues in equity and quality of care get piled on top of an already staggering AIDS epidemic.

– Andrew Logan

Sources: Al Jazeera, New England Journal of Medicine, The Telegraph, The World Health Organization
Photo: Flickr