Africa: Explainer - the NHI and Evolution of Primary Health Care in South Africa

analysis

Our first contact with the health system, primary health care, is an important issue for us all. What does the National Health Insurance Bill envision for primary health care in the light of our history? What essential changes of law are planned for the district health system?

During the apartheid years, "whites" used to mostly go to private general practitioners in a fee-for-service arrangement, before being referred, if necessary, to specialists or for admission to "whites-only" public hospitals which were funded and managed by the provincial health departments. "Blacks" were expected to do the same, except that they were referred to "black" hospitals, preferably in the homelands and mostly to the mission- or army-hospitals.

However, in light of public health concerns, the apartheid government tasked local government to set up clinics in every municipality to only provide preventive services: immunisations, family planning, treatment for tuberculosis, etc, for free to the full population. No personal primary health care (PHC) services were offered.

There was one medical school (Natal Medical School), with about 100 places per year for "black" doctors to study, resulting in many bright young "black" students having to choose nursing as a career path - along with the likes...

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