Health Care Reform in the New South Africa

Abstract

The social transition that must follow the political transition in South Africa will pose major challenges for many decades. The need to reduce inequities is undisputed. However, the means of effectively and sustainably achieving this reduction are less clear, especially in the face of rapid population growth and minimal additional resources in an economy that is growing less rapidly than hoped for by the new government. Health care reform exemplifies the many challenges facing South Africans. Profound shifts in thinking about the social forces influencing health and disease underlie the shift from the conventional biomedical model of health care to the primary health care approach within a fixed or even diminishing public health budget. The move toward a primary care approach in South Africa is not the same as a shift in emphasis toward primary care in highly industrialized nations. An attempt is made here to provide some insight into this process by describing the dilemmas facing health care reform in South Africa and the threats to academic activities that will be central to future progress.