In South Africa, private and public health systems exist in parallel. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population use the private system and are far better served. In 2005, South Africa spent 8.7% of GDP on health care, or US$437 per capita. Of that, approximately 42% was government expenditure. About 79% of doctors work in the private sector.
However, hospitals in poor areas tend to be overcrowded and medical services remain inferior in these rural locations.
Lower life expectancy
The HIV/AIDS epidemic
In the country as a whole, around 5.5 million people currently live with HIV/AIDS (more than one in ten). The epidemic has already caused the deaths of 3 million, mainly adults in their prime. This has left many children as orphans and reduced the average life expectancy among black South Africans to less than 50 years.
The health status of black South Africans is generally much lower than other ethnic groups. There is a large discrepancy in life expectancy and mortality rates between black people and those of white or coloured groups.
This difference is exacerbated by high unemployment, a rise in drug abuse and high rates of HIV/AIDS infection among black South Africans, where 14% of people are infected (compared with less than 2% of coloured or mixed race people and only 0.3% of Indians and whites).
South Africa is one of the few countries in the world where child and maternal mortality rates have risen since the 1990s because of the impact of HIV/AIDS, which accounts for more than one-third of deaths among children under five.
Infection rates declining
Though initially there was a period of denial about the causes and impact of the virus, the South African government now operates the world’s largest antiretroviral treatment programme. New rates of infection are now declining and there are signs the epidemic is being brought under control.
The vast majority of infected mothers now receive treatment to prevent mother-to-child transmission of HIV and the country is using nurses to scale up treatment for all those infected.
Poverty and malnutrition
The health of black South Africans is also threatened by high levels of poverty and malnutrition.
Even though South Africa has the largest economy on the continent, a quarter of its people live on less than a dollar every day. And as a general rule, you are what you eat.