International Handbook of Medical Education

By Abdul W. Sajid; Christine H. McGuire et al. | Go to book overview

26
South Africa

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.


OVERVIEW OF THE HEALTH CARE DELIVERY SYSTEM

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

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International Handbook of Medical Education
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Illustrations ix
  • Foreword xi
  • Preface xv
  • 1: An Overview of Medical Education in the Late Twentieth Century 1
  • References 12
  • 2: Evaluation and Change in Medical Education 13
  • References 18
  • 3: Australia 21
  • References 35
  • 4: Belgium 37
  • References 48
  • 5: Brazil 53
  • 6: Canada 65
  • References 75
  • 7: The Commonwealth (English-Speaking) Caribbean 81
  • References 96
  • 8: Chile 101
  • References 107
  • 9: The People's Republic of China 109
  • References 123
  • 10: Czech and Slovak Federative Republic 131
  • References 139
  • 11: Egypt 141
  • References 154
  • 12: France 155
  • References 169
  • 13: Germany 175
  • References 186
  • 14: Hungary 191
  • References 203
  • 15: India 207
  • References 219
  • 16: Israel 231
  • References 246
  • 17: Italy 249
  • References 254
  • 18: Japan 259
  • References 267
  • 19: Malaysia 275
  • References 288
  • 20: Mexico 291
  • References 300
  • 21: The Netherlands 305
  • References 317
  • 22: Nigeria 321
  • References 327
  • 23: Pakistan 331
  • References 342
  • 24: Poland 347
  • References 358
  • 25: Russia (Former USSR) 359
  • References 368
  • 26: South Africa 369
  • 27: Thailand 377
  • References 390
  • 28: United Kingdom 393
  • References 403
  • 29: United States of America 405
  • References 415
  • 30: Venezuela 417
  • References 428
  • Appendix A: General Country Demographics, 1989 437
  • Appendix B: Medical School Demographics, by Country 441
  • Appendix C: Admission Policies and Requirements, by Country 447
  • Appendix D: Policy Making Bodies with a Role in Medical Education 459
  • Appendix E: Professional Organizations with a Role in Medical Education, by Country 465
  • Appendix F: Governmental Agencies with a Role in Medical Education, by Country 469
  • Appendix G: Selected Bibliography 473
  • Appendix H: Acronyms and Abbreviations Used in This Handbook 485
  • Index 495
  • About the Contributors 511
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