Prospective Community Studies in Developing Countries

By Monica Das Gupta; Peter Aaby et al. | Go to book overview

9 The Pholela Health Centre: Understanding Health and Disease in South Africa through Community-Oriented Primary Care (COPC)

STEPHEN M. TOLLMAN, SIDNEY L. KARK, AND EMILY KARK


9.1 The Pholela Health Centre: Origins

The Pholela Health Centre, located in rural Natal, South Africa, was established in April 1940. To grasp its significance, even then, the socio-political circumstances prevailing in the country must be appreciated.

Following passage of the 1913 Land Act, South Africa's African peoples, comprising some 85 per cent of the total population, were relegated to 13 per cent of the country's land area ( Thompson 1990). This precursor of the racially exploitative apartheid system was reinforced by the Land Act of 1936. These 'homelands', largely rural and inhospitable, were distant from the major urban centres and unable to sustain a growing agricultural population or develop a solid industrial base.

From 1939 to 1948 the Smuts-Hofmeyr government pursued a policy that was liberal for those times. This had a considerable influence on health policy in South Africa. Dr Henry Gluckman was appointed Minister of Health in 1946, having previously served as chair of the 1942 National Health Service Commission, and a subsequent Health Centre Advisory Committee. The Gluckman report recommended a National Health Service available 'to all sections of the people of this country according to their needs and not according to their means' ( Gluckman 1947). Under the leadership of Dr Gluckman and Dr George Gale, Chief Health Officer of the Department of Health until the accession of the whites-only National Party in 1948, major steps were taken to lay the basis for a comprehensive health service in South Africa that would be founded on a network of health centres throughout the country. The first of these, the Pholela Health Centre, was to be a model and a forerunner for the network.

In 1938 Sidney Kark, having completed several years of graduate internships, was appointed Medical Officer to head the field team for a 'National Bantu Schoolchildren Nutrition Survey', planned for 1938/9 under the direction of Dr H. S. Gear, Deputy Chief Health Officer of the Department of

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