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Abstract
The roots of a dysfunctional health system and the collision of the epidemics of communicable
and non-communicable diseases in South Africa can be found in policies from periods
of the country's history, from colonial subjugation, apartheid dispossession, to the
post-apartheid period. Racial and gender discrimination, the migrant labour system,
the destruction of family life, vast income inequalities, and extreme violence have
all formed part of South Africa's troubled past, and all have inexorably affected
health and health services. In 1994, when apartheid ended, the health system faced
massive challenges, many of which still persist. Macroeconomic policies, fostering
growth rather than redistribution, contributed to the persistence of economic disparities
between races despite a large expansion in social grants. The public health system
has been transformed into an integrated, comprehensive national service, but failures
in leadership and stewardship and weak management have led to inadequate implementation
of what are often good policies. Pivotal facets of primary health care are not in
place and there is a substantial human resources crisis facing the health sector.
The HIV epidemic has contributed to and accelerated these challenges. All of these
factors need to be addressed by the new government if health is to be improved and
the Millennium Development Goals achieved in South Africa.