At the request of several health organisations in South Africa concerned about the end of apartheid in their country, Physicians for Human Rights UK and the Johannes Wier Foundation of the Netherlands carried out a three week mission to South Africa in 1991. The delegation aimed to assess the degree of desegregation in health care after the Minister of Health's statement that hospitals would be open for all; to identify obstacles to speedy desegregation and the development of equitable health services for all; to assess the situation in South Africa with regard to the medical treatment of detainees and to the violation of medical neutrality; and to identify areas where international support is needed and areas where pressure is still required.
The link to the international community, including organisations of health professionals, is of paramount importance. There is outstanding expertise on health matters in South Africa, both in the technical sense and in terms of policy formation. However, since fundamental human rights issues are at stake in South Africa, and since parts of the international community, including health professionals, have taken an interest in helping to bring about change in South Africa, the link between observations and recommendations coming from within South Africa and activities conducted by international bodies is a natural one.
While in South Africa, PHR-UK and JWF conducted interviews with individuals and with representatives of health organisations, universities, the government and community organisations in a variety of geographical locations. Health facilities and residential areas were also inspected.
The mission found that, although there are some instances of exemplary desegregation, the process is slow and ineffectual. The South African government has failed to provide detailed and timetabled guidelines, as well as financial and technical support and sanctions for the desegregation process. It is the responsibility of the government to provide equitable health care which is within the reach of all members of society irrespective of race or colour. In this respect, the government has failed to abide by these international human rights guidelines. Particularly disquieting is the government's failure to control the political violence, which profoundly affects the physical and mental state of health of large sectors of the society. Unfortunately, PHR-UK and JWF found that apartheid in health care still exists to a large extent.
The delegation also observed that the fragmentation of health services in the country forms an obstacle to speedy reform. Restructuring of the health services into a unitary system as well as redistribution of resources are necessary. This includes a shift away from over-emphasis on academic medicine to primary health care, which also covers millions of people who live in urban settlements and in commercial farming areas who are deprived of adequate care. The rapid growth of the private health sector is currently taking away about half of the resources for less than one-fifth of the population. Criminal and political violence form major obstacles to social development and to the establishment of community-based health care. In some areas, activities such as outreach vaccination have been temporarily halted, while AIDS-control programmes are very hard to get off the ground. The mission was informed of consistent and alarming reports about elements of the security forces fomenting the violence and committing serious human rights violations.
At the same time, the delegation noted that important progress has been made. Violations of medical neutrality have been reduced but certainly do not cease to exist. MASA and the SAMJ in South Africa are committed to reform. The progressive health sector is now entering into consultations with the government. As a result of this, a protocol has been agreed upon for the treatment of hunger strikers, which is probably one of the most advanced in the world. The mission was also impressed with the high level of expertise present in South Africa.
As a result of their extensive investigations, PHR-UK and JWF urged the South Africa Government to adopt a single health system and complete desegregation. The government must take more stern action to curb political violence and to investigate - in an independent manner - reported human rights violations. Support is needed from the international community to help enable progressive organisations to develop policies on primary health care and to set up monitoring systems on the process of desegregation and human rights abuses, including the effects of political violence on health care.
A fuller account of the South Africa 1991 Report is available for £10.00 from: