TRC Final Report

Volume 4

Chapter 5

Subsection 5

■ STATE HEALTH ORGANISATIONS

The Department of Health¹⁵

28 The Department of Health was the arm of the national government responsible for public health services. It provided for care at the local, provincial and national levels, allocated state funds, drew up regulations and appointed senior officials to the hospitals. During the years under review, the Department’s policies appear to have been driven by the political objectives of the national government, rather than a desire to ensure the well-being of all South Africans. The Department helped develop health care legislation that discriminated against people according to race. It enforced segregation of health care facilities and allocated funds in a racially biased way. These policies shaped, and continue to influence, health care delivery and the health of South Africans.

29 Inequities in health services can, to a significant degree, be attributed to the Department of Health as the body responsible for state-run hospitals. Most hospitals and ambulances were assigned exclusively to specific racial groups. Where hospitals served more than one group, separate wards were allocated to different racial groups. Generally, the facilities available to whites were far superior to those available to blacks in terms of technology, sanitary conditions, supplies and the number of patients per health care worker. For example, at the King Edward VIII Hospital in Durban, which served African patients, conditions were appalling. At times, the obstetrics and gynaecology ward would operate at 200 per cent capacity. Women who had just given birth, or who were about to give birth, lay on mattresses on the floor and had to share five toilets with up to 140 other patients.¹⁶

30 The practice of segregating facilities was particularly serious in emergencies. If an ambulance of the ‘wrong colour’ arrived at the scene of an accident, the driver would leave, and another ambulance would have to be summoned. Even if a ‘white’ ambulance was closer to the scene of an accident in which a black person was injured, an ambulance from further away would be summoned – regardless of the seriousness of the emergency or the threat to the life of the patient.

31 Between 1960 and 1994, the Department of Health failed to use its resources to provide the best possible public health service. Probably the greatest problem in the health sector was the maldistribution of resources. Because of apartheid restrictions on where people could live and work, it was very easy for the Department to ensure that the distribution of resources favoured white people. By far the largest proportion of government funds was spent on the white population, despite the endemic poverty and socio-economic deprivation of the majority black population. In 1985, for example, annual per capita health expenditure according to race was R451 for white people, R249 for Indian people, R245 for coloured people and R115 for African people (see Figure 1). Since black hospitals were regularly overcrowded and white hospitals underutilised, the funding should have been redistributed to provide better overall care. The silence of the Department about the effects of socio-economic conditions on the general health of the population was deafening.

32 According to the Department of Health today:

The exact effects of segregation and inequitable distribution of health resources based on race are impossible to calculate in terms of exact morbidity and mortality. However, this, together with the indignity of racially based services, resulted in abuse that cannot be allowed to be repeated.

33 The Department was also responsible for the regulations that governed conditions of service and the appointment of personnel in hospitals. Compensation for doctors varied by race, and salary differentials persisted into the 1980s. Even when parity in salaries was achieved, differences in total compensation remained, including medical aid packages, amount of leave, housing subsidies, and travel allowances.

34 The appointment of doctors to government hospitals had to be approved by the Department of Health. Often people were denied positions because of their political activities.¹⁷ The Department appointed the hospital superintendent, who enforced the policies in that hospital. This was significant, as many of the racist provisions enforced by the superintendent were not part of any law, but simply reflected a desire to conform to the ideology of the state.

35 The Department did little to prevent police from obtaining medical records from hospitals or clinics without the consent of patients. The police used these files to identify ‘anti-apartheid protesters’, which made many people afraid to go to a government hospital to receive care, as they feared arrest. The Department did not take issue with inhumane practices, such as handcuffing or shackling patients to beds.