The state of health in South Africa: Reflections and future directions

While progress has been made in some sectors, there are critical gaps in the healthcare infrastructure 

As we navigate the complexities of the 21st century, the health status of our nation is a mirror reflecting both the triumphs and challenges that South Africa faces. In my recent address on “The State of Health in South Africa”, I had the opportunity to provide an overview of the nation’s health landscape, focusing on priority concerns as outlined in the South African Medical Research Council’s (SAMRC) Annual Performance Plan.

The SAMRC has long been at the forefront of health research and innovation, driven by our unwavering vision to improve the health of all South Africans. Our staff have collectively done an incredible job in upholding this mandate, and I am both encouraged and challenged by their dedication. I urged our team to continue this excellent work while also striving for even greater achievements as we move forward.

Reflecting on our history, it’s clear that some of the current problems within our healthcare system are deeply rooted in South Africa’s past. The legacy of apartheid-era decentralisation, with the establishment of many independent health departments across Bantustan areas, has left us with a fragmented healthcare system. This system, characterised by poor coordination and disparities in service provision, continues to challenge our efforts to deliver equitable healthcare today. 

Compounding this issue is the severe shortage of medical personnel, with a doctor-to-patient ratio of just 0.9 per 1 000 people, a situation even more dire in the public sector. This scarcity is set against a backdrop of unequal access to private healthcare through medical insurance, further deepening the divide across population groups. 

The country’s most disadvantaged individuals have access to free healthcare at 3 800 public clinics and hospitals, although these facilities are often hindered by broken equipment and medication shortages. Out of 696 facilities evaluated in the Office of Health Standards Compliance’s latest report, only five met 80% of the required performance standards, which include drug availability and proper infection control.

The health status of our country is heavily impacted by the quadruple burden of diseases. While we have made significant strides in maternal and child health, outcomes remain suboptimal in several provinces such as the Free State, North West, Northern Cape and Limpopo. Similarly, although we’ve seen great progress in the treatment of HIV and tuberculosis (TB), national cascades of care are still lacking, and the rise of drug-resistant TB poses an ongoing threat. The epidemic of non-communicable diseases (NCDs) continues to drive morbidity and mortality, exacerbated by underinvestment in healthcare and a lack of integrated clinical services. Additionally, the scourge of injuries and gender-based violence (GBV) remains unacceptably high.

In addressing these challenges, we must acknowledge the shortcomings within each of these areas — insufficient prevention and control of epidemics, persistently skewed resource allocation between public and private sectors, and the enduring impact of social determinants of health. However, it is not all doom and gloom. The SAMRC’s work is making a significant impact. Our contributions to legislation and policy, better healthcare management, and the formation of strategies to combat NCDs, cancer, and GBV are tangible evidence of our progress.

Looking ahead, addressing the determinants of health will require a holistic approach. Our research must reflect the behavioural, biological and socio-cultural drivers of disease. The SAMRC, with its multidisciplinary focus, is uniquely positioned to lead in this regard. We must employ a multisectoral approach that allows for better integration and sustainability of health research, ultimately contributing to improved health outcomes for all South Africans.

As the healthcare research arm of the South African government, the SAMRC has a critical role to play in leading research and innovation. We must ask the right questions and produce data and evidence that support government, civil society and academia. Our commitment to justice, dignity, and equitable health services for all citizens remains unwavering.

South Africa’s state of health reflects the complex interplay of a dysfunctional health system still grappling with the historical legacy of apartheid. While there has been a decline in infectious diseases, the country now faces a rising burden of NCDs. This shift has exposed critical gaps in the healthcare infrastructure, which is in desperate need of revitalisation. Addressing these challenges requires strong and ethical leadership, alongside multisectoral collaboration and innovation, to effectively tackle the broader determinants of health and ensure a more equitable and sustainable healthcare system for all.

Professor Ntobeko Ntusi is SAMRC President and CEO