Access to health care in South Africa: an ethical and human rights obligation
Date
2010-10-15
Authors
Meyer, Ellenore Dorette
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Abstract
Access to health care is a constitutionally recognized right, under section 27
of the South African Constitution. Fifteen years post the first democratic
election in South Africa the realization of this right is the focus of this research
report. In 1997 the South African Human Rights Commission (SAHRC), a
statutory body assigned to evaluate the realization of access to health care,
held a public enquiry into the matter. The report was released in early 2009.
The public health care system was found to be in a „lamentable state‟. South
Africa faces a number of challenges that complicate the progressive
realization of access to health care . For example, the country is currently in
recession; the HIV / AIDS statistics is among the highest in the world placing a
huge burden on public health; South Africa has the highest income inequality
globally and the gap between public and private health care, with regards to
affordability and quality of service remains a great concern. A way of
addressing this problem is to engage ethical principles such as beneficence,
non-maleficence, autonomy and (distributive) justice. Each of these in
application can argue a case for the moral obligation to initiate a more
effective national health care system. Rawls1 (1999) emphasized the
centrality of justice in consideration of the bio-medical principles.
1 Rawls, J. 1999. A Theory of Justice. Revised edition. Cambridge, Mass.: Harvard
University Press., 1971. Oxford: Clarendon Press, 1972.
The principle of justice and its derivative, distributive justice, is of importance
when making a moral argument for equal access to health care for all. Farmer
and Campos (2004:28) rightly asks2: “What does it mean, for both bioethics
and human rights, when a person living in poverty is able to vote, is protected
from torture or from imprisonment without due process, but dies of untreated
AIDS? What does it mean when a person with renal failure experiences no
abuse of his or her civil and political rights, but dies without ever having been
offered access to dialysis, to say nothing of transplant?” There is a need for
ethicists to become more involved in arguments pertaining to the inequalities
in distribution of social goods.
Legislation and case law in South Africa also affirm the right to access health
care services and have as their grounding normative ethical tenets. The
recommendations made by the SAHRC, together with the planned national
health insurance aimed at addressing the gap between public and private
health care, can only become a reality through successful implementation of a
monitored process based on ethical principles. There is a need for a practical
implementation of current ethico-legal and human rights principles through
every phase of the health care system to serve as monitors to ensure the
success of this guaranteed right that so few people have genuinely seen
realized. The findings of the SAHRC, together with the response from the
Department of Health, serve as a basis for planning towards successful
2 Farmer, P. and Campos, N.G. 2004. Rethinking Medical Ethics: A view from below.
In: Developing World Bioethics, 4 (1), 17-41
implementation of an equitable health service system that is of an excellent
standard. To aid in this process an ethical framework could be of use to
assess the policies formed along the way as well as the practical
implementation thereof. This research report is an analysis of current
literature and data available on access to health care in South Africa in light of
human rights and ethical arguments for its provision. The aim is to reflect on
the realization of greater access to health care since 1994, identifying current
hampering factors in achieving this and proposing a broad set of guidelines
that can be applied to the reform process already underway in South African
health care.
Description
MSc (Med), (Bioethics and Health Law), Faculty of Health Sciences, University of the Witwatersrand
Keywords
health care, human rights