Public healthcare in a post-apartheid South Africa : a critical analysis in governance practices.

Abstract

The South African public healthcare system has undergone fundamental changes since 1994. There is a solid constitutional and legislative policy framework in place that guarantees the right to access to healthcare. However, difficulties remain in its implementation. The HIV/AIDS epidemic has negated many of the health gains made since 1994. Numerous studies have concluded that South Africa lacks the necessary skilled workforce and infrastructure. Nevertheless, while this is not disputed, this study argues that the implementation of public health policies in South Africa needs a governance approach that will strengthen cooperative governance across national, provincial and local spheres of government; as well as strengthen relationships between the private and public healthcare providers if the government is to meet its legislative obligations. This study determines why, after almost 20 years of democracy; substantial transformation in the healthcare sector; significant increase in national revenue allocation; and numerous healthcare policy interventions; the South Africa government continues to struggle to provide public healthcare services. This study identifies the various public healthcare sector reforms that have been undertaken and the respective governance approaches that have been adopted. The study concludes that the lack of resources (human, financial and technical) are not the only or primary stumbling block to providing universal public healthcare. There is a serious disparity between theory and practice: One the one hand, there is a comprehensive legislative health policy framework in place, on the other hand, there is a vacuum on how this is meant to be implemented. The institutional arrangements within the public health sector; the intergovernmental relations between the different spheres of government; as well as the lack of mechanisms, processes and institutions which govern the relationships between the private and public sector remains vague. As long as this remains, policy implementation in the public healthcare sector will remain flawed and limited.