JOSEPH H. LEVENSTEIN
The Republic of South Africa is situated at the southernmost portion of Africa and is bordered by the Atlantic and Indian Oceans. It has a population of more than 33 million people of black, white, Asian and "colored" ethnic groups. Approximately 50 percent of financing for health care comes from the government sector and a similar percentage from the private sector. About 80 percent of the population (mainly nonwhite people) receive health care from the public sector, which employs about 45 percent of the medical practitioners.
The health care delivery system is three-tiered: (1) the central government, (2) the provincial government, and (3) the local authorities. The central government is responsible for the overall policy for national health services, planning, health education, and communicable diseases, for example. The provincial government provides facilities such as public hospitals and ambulatory care clinics At least 70 percent of the health care budget is allocated to the provinces. Finally, the local or municipal authorities have responsibilities related to immunization, rehabilitation, sanitation, and other public health activities for their community, i.e., preventive and promotive activities. This already fragmented system was fragmented further by the apartheid policy, which sought to create black homelands within the confines of the South African border. There were ten such homelands, and all had separate health care systems. Private health care is mainly conducted through about two hundred medical insurance companies.
Both the private and the public sectors are under pressure from rising medical costs. South Africa spends 5.9 percent of its gross national product on health care, with most of this being allotted to secondary and tertiary care. Less than 5 percent of the total allocation is spent on primary and preventive medicine. In a country that represents both industrialized and developing countries, medicine