Document Type

Article

Disciplines

International Law

Abstract

South Africa has been working to overhaul its public health sector since the end of apartheid. In 1995, as an initial step, South Africa began offering free primary health care to its entire population.' In October 2003, the long awaited National Health Bill' was finally passed. The Bill implemented a district health system with a focus on providing primary care, and represents an important step in assuring that primary care services in the public sector are accessible to everyone who needs them. The new health care system has been implemented with a clear focus on redressing historical inequities in health status among population groups. The purpose of the Bill was to establish and sustain "a health system that would benefit all South Africans."" Health Minister Dr. Manto Tshabalala-Msimang noted that the Bill's "drafting has involved a number of trade offs and, in seeking to balance various interests, we have kept our eyes firmly on the need to prioritise services for the poor."

Part I of this note details the inequities in health status and imbalances between the private and public health sectors that will have to be overcome if the new health system is to be successful. Part II covers specific policies that have been implemented to deal with health care disparities. Part HI summarizes the precursors to the final National Health Bill. Part IV discusses the implementation of the district health plan, from its proposal to the passage of the Bill, and focuses on two specific challenges in implementation: redistricting and establishment of public private partnerships. Part V concerns financing of the public health sector, specifically as it relates to remedying historical inequities. Part VI addresses the National Health Bill itself, including the controversial certificate of need provision. Finally, Part VII concludes with a summary of early successes and failures of the district health system.

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