past, present and future: what you need to know about health and health care in south africa
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This article was downloaded by: [George Mason University]On: 19 December 2014, At: 15:01Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Development Southern AfricaPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/cdsa20
Past, present and future: What youneed to know about health and healthcare in South AfricaMarsha Orgill aa Health Economics Unit, School of Public Health and FamilyMedicine, Health Sciences Faculty , University of Cape Town ,South AfricaPublished online: 05 Nov 2012.
To cite this article: Marsha Orgill (2012) Past, present and future: What you need to knowabout health and health care in South Africa, Development Southern Africa, 29:5, 765-766, DOI:10.1080/0376835X.2012.730976
To link to this article: http://dx.doi.org/10.1080/0376835X.2012.730976
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Book reviews
Past, present and future: What you needto know about health and health care inSouth AfricaHealth and health care in South Africa, 2nd edition
HCJ Van Rensburg (Ed.)
Van Schaik, Pretoria, 2012, ISBN 9780627030130
In South Africa today we are seeing large-scale public sector health care reform, ranging
from re-engineering primary health care to establishing an office of health standards
compliance, with the aim of achieving a universal health care system. The time is thus
ripe for the second edition of this rich compendium of knowledge on health and
health care in South Africa. The book will appeal to any reader wishing to understand
the history, progress and challenges of health and health care in South Africa. It
provides updates on what has changed since the 2004 first edition, information on
current health trends and health policy developments, and a useful background of
global trends related to the topics discussed in each chapter.
Beyond actual health issues, researchers in the health field often need practical
information about the structure of a health care system, the building blocks of the
system, and which job functions are located where in the system. This information is
not always easy to come by, so we are often obliged to consult multiple sources to get
the big picture. This book covers the country’s health system from the spheres of
health governance and the distribution of hospitals to the spectrum of primary health
care facilities.
As academics we rarely afford ourselves the luxury of digesting a whole book. However,
this is a book worth reading in its entirety, and worth having on your shelf for its detailed
content and copious references. For anyone interested in health issues in South Africa, it
has the particular merit of bringing together a mass of relevant information in one place.
I do not have space to do justice to all the 12 chapters, but will highlight those that I found
particularly valuable.
The second chapter, ‘A history of health and health care in South Africa: 1652–1994’,
and the third, ‘Transformation of the South African health system: Post–1994’, provide a
thick historical description of the South African social and political landscape. Detailed
accounts are offered of how health issues are embedded in this history, going back as far
as 1675, when the first midwife practised at the Cape. As the country’s political and
social history are critical to understanding the country’s health and health care, these
chapters offer a relevant context for engaging with the book’s topics. In fact, any
researcher or student from any discipline seeking to learn about South Africa’s
political and social history should read these chapters; they are most informative and
enjoyable.
The book views health and health care through a range of disciplinary or subject lenses.
Chapter 4, on ‘The health, environment and development nexus in South Africa’, taught
Development Southern Africa Vol. 29, No. 5, December 2012
ISSN 0376-835X print/ISSN 1470-3637 online/12/050765-5 # 2012 Development Bank of Southern Africa
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me a lot about our changing biophysical environment and how it affects health in South
Africa, including such issues as climate change, water resources, soil degradation and
pollution.
Throughout the book, terms and concepts are explained, and real effort is made to bring
the reader on board with the issues. For example, Chapter 5 on ‘Health and health status
of the South African population’ offers in effect a tutorial on what it means to measure
the health and health status of populations, how one can go about doing this, and what the
limitations of different measures are. This is useful for non-specialists who need to be
familiar with complex issues of health and health care. The chapter also describes
the disease burden in South Africa, and includes background information on world
health. Chapter 6, ‘HIV and AIDS and tuberculosis in South Africa: Trends,
challenges and responses’, goes into more detail about these. Disturbingly, the authors
note that the country’s TB epidemic, which they say is ‘far from conquered’, is
characterised by one of the highest levels of TB/HIV co-infection worldwide and that
MDR-TB rates are growing (p. 348).
Chapters that I particularly enjoyed for their diversity and richness and the new
perspectives they gave me were Chapter 7, on ‘Human resources for health and the
health professions in South Africa’, Chapter 11, on ‘Complementary and alternative
medicine and traditional health in South Africa’, and the concluding chapter on
‘Perspectives from bioethics on health care challenges for South Africa’.
A particularly valuable chapter is Chapter 8, on ‘Health care financing and
expenditure: Post-1994 progress and remaining challenges’. Many of the current
debates in South Africa are centred on health care financing. For those who
investigate, promote or work in health and health care but do not have an
economics or finance background yet seek to understand health financing in this
country, this is the chapter to read. It explains a variety of topics in an accessible
way, such as how the country’s health system is financed, including progress and
problems, how funding is pooled, and how the benefits from using health services
are distributed. It considers the unequal distribution of these benefits and the
challenges for efficiency, equity and sustainability. It also usefully describes the
variety of health financing policy proposals that have been put forward over the
years, up to the 2011 release of the Green Paper on National Health Insurance in
South Africa, and explains the planned phased approach this Paper outlines for
moving towards universal coverage.
In conclusion, this book will provide you with a substantial amount of new knowledge
and revive some of your existing knowledge. After reading it, I understood health and
health care in my own country better, and it encouraged and inspired me for further
research.
Marsha Orgill
Researcher, Health Economics Unit
School of Public Health and Family Medicine
Health Sciences Faculty
University of Cape Town, South Africa
Correspondence: [email protected]
http://dx.doi.org/10.1080/0376835X.2012.730976
766 Book reviews
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