Introduction: South Africa
Changes continue being witnessed in health care institutions across the world. Despite significant progress being made to lower mortality rates globally, much still remains to be done as some nations lag behind. Against this backdrop, the current paper reviews South Africa in regard to critical statistics related to health care. For this paper, South Africa has been selected because it is among the top countries of the African continent. Hence, the selection is important in highlighting the state of health is a leading African country.
The Republic of South Africa is located in the southern part of Africa. Beinart (2001) observes that the country is situated approximately within three thousand kilometers of the Southern African coastline that stretches around Indian and South Atlantic Oceans. In the northern part of the country are situated Zimbabwe, Namibia, and Botswana. In the eastern part of the country, there are Swaziland, Mozambique, and the Kingdom of Lesotho. Based on the area occupied, South Africa is the 25th largest state globally.
As a nation, South Africa is home to approximately fifty-three million people. The statistic implies that the country is the twenty-fourth most populous country across the world. The nation is a multiethnic society that brings together an array of religions, languages, and cultures. The plural nature of the country is evident based on the constitution, which recognizes eleven languages. Among the languages are Dutch and Afrikaans, both of which are of European origin. South Africa also happens to be the home to approximately five million immigrants. Most of the illegal citizens are from Zimbabwe.
The government of the country is based on a parliamentary system of governance. However, unlike many parliamentary republics, in South Africa, the president heads the state and the government. The tenure of the president is largely dependent on the level of trust that parliament has on the occupant. As in democratic states, the doctrine of separation of powers reigns in the country. The three arms of government (executive, judiciary, and legislature) are required to respect the supremacy of the country’s constitution. All actions, including those carried out by the executive and the legislature, must be in line with the constitution or be struck down by the courts.
The country runs a mixed economy, which is the second-largest across the African continent. Only the Nigerian economy is bigger than that of South Africa. The GDP is relatively high given that in 2008 it stood at $11,750. Despite the development, South Africa encounters high rates of poverty and unemployment. The position of the country gets worse regarding its income disparities. Contrary to the state of affairs in poor states, South Africa lacks a performing informal sector. Based on estimates by the OECD, only fifteen percent of work comes from this sector. Citing the organization, Mwakikagile (2008) indicated that the presence of a welfare system as the main reason for the underdevelopment of the informal sector.
The country is a leading tourist attraction, which helps in the generation of resources. However, concerns regarding the involvement of illegal migrants in informal trading have proved to be controversial. Overall, immigrants lead poor lives as the immigration policy of the country became restrictive from 1994.
State of Health
After the defeat of the apartheid system in South Africa, the country made efforts to reverse the discriminatory approach that characterized political, economic, and social structures. Despite a range of measures, health care remains challenged by a number of problems. For instance, noncommunicable and infectious diseases are burdensome to the citizens of the nation. Similarly, inadequacies of human resources and persistent social inequalities are some of other concerns that the South African health care system has failed to address adequately.
Extreme poverty affects a large proportion of the population in South Africa. Consequently, access to the primary requirements of life, such as adequate nutrition, clean water, reasonable housing, appropriate sanitation, and related health issues emerge as a problem. Given that disparities are rampant in the country, health problems emanating from poverty must be addressed.
The majority of South Africans come from rural areas. These people come from a largely poor background. Among the poor, cultural traditions are still applicable to health matters. Few individuals embrace traditional medicine, though westernization takes its toll in the country.
Health care System and Delivery
Within South Africa, public and private health care systems co-exist. Given the economic and social status of South Africans, the public sector plays a bigger role by serving the vast majority of citizens. However, underfunding and understaffing are major concerns affecting the public health care system. The upper class (20%) of the country depends on the private sector. The country spends about 8% of its GDP on health care.
Governmental Health-Related Agencies
In practice, governmental agencies, such as the ministry of education and regulatory bodies, exist to guide operation in the health sector. Within the country, various organizations have been assigned different roles geared towards improving nursing quality in the country. In particular, the state through the ministry of education and parliament has worked on influencing the sector. The role of the legislature has also become apparent in its role in the creation of Acts, which direct operations.
The Department of Education has also been involved in matters pertaining to nursing education. Similarly, the Department of Health plays a role in nursing education and health matters. In the past, the department have held workshop to explore ways of improving health care.
Based on the country’s Department of Health, South Africa had a shortfall of over eighty thousand care professionals in 2008. However, the private sector, which serves around sixteen percent of the population, employed seventy percent of health care professionals.
On an annual rate, South African medical schools produce roughly one thousand two hundred doctors. However, fifty percent of doctors move overseas while a vast majority serves in the private sector, leaving only 35 doctors from the graduating lot to serve the public.
Nursing Education System and Accrediting Organizations
One of the most powerful agencies tasked with overseeing activities in the nursing profession is the South African Nursing Council (SANC). Initially, the council was created following the enactment of the Nursing Act, No. 45 in 1944. However, the Act was repealed by the Nursing Act, No. 50, which took effect in 1978. SANC is in charge of a number of functions. For instance, the body leads to the inspection and approval of nursing programs and schools. The council also oversees the registration, examination, and enrollment of nurses, midwives, as well as nursing auxiliary and other core functions discharged by the body including licensing of nursing agencies and monitoring of nursing employers.
Although a big number of organizations exist within the South African context, the Allied Nursing Association of South Africa (ANASA) stands out. The affiliation commits to the enhancement and professionalization of health care in the country. The association boasts over twenty-five years of experience in the provision of guidance and support to agencies, and hospital group assignees intention is to operate based on the sector’s regulations. One of the key achievements of the Association is the improvement of the country’s health care through the provision of unity to recruitment organizations.
One of the priority areas in the South African health care system has been the HIV/AIDS pandemic. South Africa, which constitutes 0.7% of the global population, accounts for seventeen percent of HIV patients. The condition is associated with devastating effects on the victims, their families, communities, and government. Despite the gravity of the problem, it took the intervention of international and local pressure for the government to accept an ambitious antiretroviral therapy (ART) care to patients. Between 1999 and 2005, spending on the program has been increasing by 48% per year. Thus, it was not surprising that HIV care outgrew other areas of health care.
Based on the World Health Organization, by 2008, approximately 39% of HIV patients were receiving anti-retroviral drugs to lower the adverse effects of the condition. It was also not until the same year when the South African National AIDS Council implored the government to improve on the treatment expectations to meet the threshold set by the WHO. Despite the critical step, follow-up checks found discrepancies between WHO recommendations and treatments administered in the country.
One of the most notable programs adopted to aid the fight against the disease in the United States President’s Emergency Plan for AIDS Relief. The program focuses on the prevention and cost-effective strategies to lower the expenditure directed to the issue.
Looking at water and sanitation also serves as a pointer to the priority health areas in South Africa. Following the end of the apartheid era, the country and the new government encountered many backlogs in reference to the water supply and sanitation. At the time, fifteen million people had no access to safe water, while over twenty million lacked adequate sanitation services. Hence, it was not surprising that the authorities embarked on improving sanitation and access to water became critical health considerations for the country.
Although efforts have been made to improve, sanitation has not registered significant development. Nevertheless, progress continues being made. According to the WHO, sanitation improved from 71% to 79% in 2008. The value of clean water and sanitation is evident in the role they play towards mitigating illnesses, such as diarrhea and cholera.
South Africa ranks among the countries with the worst rates of tuberculosis worldwide. The epidemic is largely driven by its rapid spread and infections related to HIV/AIDS. The incidence of the ailment rose from 300 in 100,000 persons in the early 1990s to over 600 in 100,000 people in the 2000s. By 2010, the incidence had risen to 950 per 100,000 persons. Regardless of measures aimed at improving treatment, the tuberculosis problem remains a challenge. The emergence of Multidrug-resistant (MDR) tuberculosis further complicates the problem.
Conclusion: Nursing Implications
The delivery of health care must align with the needs of people who are the beneficiaries. In the case of South Africa, poverty is an issue of concern because social and economic problems pose ramifications on health care in the country. Other aspects border on governance and shortages in nursing/health professionals. It also emerges that the public sector is lagging behind in terms of attracting such professionals.
Given that the role of nursing fraternity is to contribute to the delivery of care, it has a big role to play. Through practice and research, the profession can make a difference in the South African context. In case of shortages, nursing professionals can conduct research so that they can advise policymakers on how to redress the situation. Regarding the issue of socioeconomic inequalities, nurses need to focus on delivering care to the poor given that the rich segment of the society is capable of catering for its care needs.
Based on the finding that race/ethnic differences exist in South African society, the use of a culturally competent framework would also be desirable. In this regard, nurses would be at the forefront of designing and guiding the implementation of such frameworks. Through communication skills, nurses must build rapport and trust in order to come up with an acceptable approach to mitigating the discrepancies in health care access in the country.