South Africa's health sector is in crisis due to underfunding and unregulated private costs. A unified public-private rescue plan is needed: clear debts, fund staff, regulate prices and invest to achieve universal coverage.
South Africa's health sector is on the brink. A decade of declining public investment, rising private-sector costs, poor governance and structural rigidity has produced a system that is unable to meet the population's needs. The crisis now threatens the right to health.
Yet, the solutions are within reach - if the government acts decisively and coherently.
The problems
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The problem is that the system is buckling at both ends, where the public sector is collapsing due to underfunding. Provincial health budgets - where more than 95% of public health spending occurs - have been cut in real terms year after year.
By 2025/26, spending per capita will fall from R5,147 (2019/20) to a projected R4,508. Departments are drowning in R21.7-billion in accruals, start each year in debt, and slash essential procurement and staffing just to stay afloat.
The result is visible everywhere. Massive shortages of doctors and nurses, even though production of doctors is high; decaying infrastructure, delayed maintenance, rising medicolegal claims and a demoralised workforce. The staffing collapse is particularly acute. While junior doctors are legally employed, posts for registrars, specialists and nurses - the backbone of quality care - remain unfilled most of the time, until complaints drown...
