TRC Final Report

Volume 4

Chapter 5

Subsection 4

■ HISTORICAL OVERVIEW OF HEALTH CARE IN SOUTH AFRICA

22 While the Act establishing the Commission directed it to examine the years 1960 to 1994, many of the events under scrutiny by the Commission can only be understood adequately within the context of the history and events leading up to this period.

23 Although the Union Constitution of 1910 gave control of the hospitals to the provinces, there were no specific provisions for the delivery of health services until the Public Health Act was passed in 1919⁹ . The Act created a Department of Public Health, but left hospitals under provincial control. It also gave local authorities responsibility for the control of infectious diseases and environmental sanitation.¹⁰ This led to a fragmented health system.

24 In 1942, the National Health Services Commission, headed by Dr Henry Gluckman, found that there were 2 000 active medical practitioners in South Africa. More than half of them (about 1 100) practised in urban areas where only 28.2 per cent of the population lived. The doctor to population ratios ranged from 1:5 000 in the rural areas (where mainly black people lived) to 1:380 for urban areas (where mainly white people lived). The infant mortality rate for whites was 50 per 1 000 live births; for Africans, it was estimated to have been between 150 and 600 per 1 000 live births (it was impossible to arrive at accurate figures due to inconsistencies in reporting).¹¹

25 The Gluckman Commission report was published in 1945 and contained significant recommendations, including proposals that access to health care for all be considered a right rather than a privilege and that the state assume responsibility for the provision of health services.¹² Ironically, although none of these recommendations were implemented then, many constitute the core of the transformation of the health care system today.

26 It is important to note that racial discrimination and the lack of appropriate health care provision predated the National Party (NP) and formal apartheid. Indeed, the effective rejection of the recommendations of the Gluckman Commission took place before the NP was voted into power. However, during its first decade in power, the NP made no significant changes in the provision of public health care, except to reduce expenditure on public health on which mainly black people were dependent: expenditure was, for example, reduced by 8 per cent for the period 1950-55.¹³ Hence, by 1960, the health care of black South Africans had been prejudiced by years of unequal allocation of resources – based on the assumption that ‘natives’ required less sophisticated health care than whites and a complete lack of coherence in or centralisation of health policy development.

27 The 1960s saw the replacement of apartheid rhetoric with concrete apartheid programmes aimed at enforcing racially separate development and the establishment of the homelands. Homeland health services were appalling. This is not always apparent from government-supplied health indicators, as homeland health figures were usually excluded from the statistics.¹⁴ In fact, official statistics often gave the impression that the health situation was improving in South Africa. However, both in the homelands and in the Republic, segregated health care services seriously compromised the health of disadvantaged communities.