MPH COHORT 2
PRINCIPLES OF PUBLIC HEALTH
Dr. F.N.N MUKORA-MUTSEYEKWA
23 MARCH 2013
Discuss the evolution of the health care delivery system in an African country of your choice, from the pre-colonial, colonial through to the post- independence era. In your discourse, highlight the associations between political, social, cultural and economic climates and provision of public health service. The essay will highlight the evolution of the health care delivery system in South Africa. The development of the system will be outlined from the dependence on traditional medicine in the pre-colonial era, through an imbalanced system during the apartheid period to a two-tiered system being offered at the moment. Coovadia H, Jewkes R, Barron P, Sanders D and McIntyre D (2009), pointed out that South Africa’s history which was characterized by racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities have affected health and health services. WHO indicated that "a health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities”. This will shape the discussion taking into consideration that healthcare delivery has always been a transnational practice and health care planning has been described as often evolutionary rather than revolutionary.
The healthcare delivery system evolved from the pre- colonial era, through Dutch colonialism 1652- 1800, British colonialism 1800- 1910, period of segregation 1910- 1948, the apartheid years 1948-1994 to post-apartheid democracy in 1994 to date. The social, cultural and economic climate of the country was different through all these phases and the impact to health care delivery system was not the same during the various political periods. The quality of health service delivery differs in terms of race and era in which the country was. In this discussion, health will be defined “as a complete state of physical, mental and social wellbeing and not merely the absence of disease or infirmity” (WHO 1946). Some considerations will also be made to the other definitions of health that is the biological model, functional theory of health, social model and traditional view.
The health delivery system in the pre-colonial South Africa was largely through the traditional medicine including herbalists, divine healers, mid wives and spiritualists. Khoisan practices included the delivery of pregnant women and healing through the use of methods like poultices, lancing, and incisions (Kolben, 1738). The traditional healers performed a variety of functions for African communities which included bringing rain, detecting witches and criminals, doctoring armies, negotiating with ancestors, and using herbs and surgical procedures to cure and mend the body. The number of indigenous traditional healers in SA was estimated to be around two hundred thousand (Chester, 2001). The existence of diseases was explained in relation to sin or evil doing where it was believed that poor health was as a result of sin or evil doing. This was the starting point as no any other service was available during the pre-colonial period.
The traditional medicine was accessible regardless of class or levels of wealth in the community and the referral system existed in the system where the traditional practitioners would refer their clients to other traditional healers when they could not deal with the issue. Under the system, payment was in the form of livestock or other family possessions. The system was non-discriminatory, effective, affordable, culturally acceptable and accessible. The communities had ways of preventing diseases and curing infections although it was not...
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