Racial and Ethnic Health Disparities in a Post Apartheid South Africa
Racial and Ethnic Health Disparities in a Post Apartheid South Africa
Introduction
Exploring health disparities in an effort to access health care is a subject of relevance to developing and developed nations. In South Africa, the issues of ethnicity and racism furnace by apartheid widen the health disparity between communities in the country. The blacks and colored are the most disadvantage groups in South African compared to whites. The blacks have higher chances of not accessing quality medical care compared to whites. The inaccessibility to quality care has left many blacks and colored individuals without appropriate access to healthcare.
This paper evaluates the accessibility of health care among communities in post apartheid South Africa. The paper also aims to look into ethic and racial issues that come to play in an effort to access health care services. The paper also reviews the role of history, power and privilege in enhancing health disparity in the country. The elements of professional ethics and cultural competency in the health industry will also be reviewed. A series of recommendation that aims to address healthcare as a human right will be discussed at the end of the paper. South Africa has come from an era of apartheid that favored the White over the Blacks. It is vital that the country reinforces its efforts and ensures that the ethnic and racial disparity in health care is non-existent.
History of Apartheid
Compared to the apartheid era South Africa has changed in the political and economic sector. The nations changed from apartheid ran system to a nation that operates through democracy. During the era of apartheid South Africans were categorized into four groups: the White, Asians, Blacks and Colored. The four groupings were used to determine the type of jobs that individuals can do, the medical care they can assess and who they can marry. In short, the categorization of South African into groups based on color furnace apartheid and allowed discrimination among many other injustices. Blacks were assigned homelands such as Venda, Lebowa and Ciskei where they were to live. The whites, on the other hand, dominated provinces such as Transvaal and Cape.
With regards to the health sector, the apartheid era results to two developments that affected the health care system in the country. First, the government engaged in racial fragmentation of health services. Using the division of the homelands and the provinces, the government segregated the blacks from accessing quality care. The blacks were no longer considered citizens of South Africa, but citizens of their homelands. Relocating to the homelands was compulsory and resulted to the involuntary designation of citizenship. The blacks were to seek any services from their homelands. Unfortunately, in the health care sectors for instance the homelands were poorly organized, poorly equipped and inefficient to serve the black community.
According to Kautzky & Tollman (2008), “many of the homelands health services struggled to offer proper medical and public health care”. With the failing government health care system, other partners such as the church attempted to provide health care services to the homelands. Missionary health services by the British, Swiss and Germany attempted to fill the gap left by the homeland health care services. However, the demand for proper health care in the homeland was overwhelming, and it was impossible for the missionary health facilities to cater for all their needs. In the 1980’s, for instance, there was one physicians to serve a population of 91000 Blacks. Infant mortality rates in the Black population stood at 20%, while in the white population, it was only 2.7%. The life expectancy also varied with blacks living up to 55years, 80 in the Asian population and 18 in the White populations (Kautzky & Tollman, 2008). The blacks suffered in the homelands with conditions such as trachoma, nutritional and infectious diseases being common. Diseases such as trachoma were an indicator that the blacks suffered in the social sector, for instance accessibility to clean water and similar social amenities.
The dire situation in health facilities, in the homelands, could not compare to heath facilities in the White, and Asian communities. The white and Asian communities enjoyed adequate health facilities that were fully equipped and with adequate trained health personnel. It was evident that there was racial fragmentation and politicization in South African health care system. The white were considered better citizens and more deserving than the blacks who were considered second class citizens. Differentiation of expenditures in the health sector was made on the basis of race/ethnic affiliations rather that the needs of each healthcare facility.
It is also during the apartheid period that the government of South Africa deregulated the health sector hence privatization. Privatization of the health sector was in an effort to manage the economic crunch and financial strain that the government was facing. Privatization of the private sector favored one community over another. The white community was able to access better medical services. Unfortunately, it was a grim situation for the blacks as the cost of health care rose. The introduction of financial barriers meant the Blacks, who comprised of the poor, were disadvantaged. The disparity of health care services between the white and Black communities widened (Kautzky & Tollman, 2008). In summary, the health care system in South Africa during the apartheid era was determined by factors such as race/ethnicity, income and location. Unfortunately in all the three factors, it is the Blacks community that turned out disadvantaged. The Blacks were considered second class citizens; they accessed lowly paying jobs and were enclosed in homelands.
Post-Apartheid South Africa
The end of apartheid in 1994 was seen as the beginning of a new dawn in South Africa. Racial/ethnic segregation came to an end, and the blacks could not move freely across the country. The government of National unity took over with the aim to restructure public sector policies and programs in the country. GNU embarked on a reconstructions and development program in various public sectors. The health care industry was one of the sectors that were restructured to benefit the public.
The government embarked on a strategy to build an elaborate health sectors that could serve all citizens regardless of color and economic capabilities. Policies such as free maternal and child health care were introduced. These services were free in all public health facilities. The government also made an effort to increase electrification and electrification of the country (Braverman & Gruskin, 2003). Proper hygiene was one of the ways to curb infectious and communicable diseases. With the availability of water, communities could engage in hygienic practices. The government also engaged in efforts to decentralize and build health systems that were managed at the district level. The unification of the health care system during the apartheid era proved unsuccessful as it increased the disparity between health care facilities among whites and Blacks. So far the government of South African has made significant improvement is sectors such as education and nutrition. However, many researchers note that the disparity in health care is still present in South Africa. Elements of discrimination and segregation may have been abolished, but their remnants are still present in the society.
The majority of Blacks have remained in disadvantaged regions that were previously reserved as Homelands. Large slums such as Soweto are home to many blacks. These areas remain disadvantaged in terms of accessibility of public health care services. Most of the Blacks still live in deplorable conditions putting the at the risk of acquiring diseases. The Blacks of South Africa continue to live as the disadvantaged group in the country.
Professional Ethics in Diverse Community Settings
Professional ethics refers to personal and corporate standards of professionals within their work setting. Professionals are expected to use their knowledge in an ethical manner when serving the public. The moral aspect of how professionals render their services determines whether a professional is upholding professional ethics. Professions must be capable of making informed judgments and apply their skills to make informed decisions in situations where the public cannot. In health care for instance the guiding principles for professionals who wish to adhere to ethics to guarantee the continuity of factors that help individual live healthier live.
In South Africa, unfortunately, the era of apartheid disregarded any form of ethics and moral responsibility. The Blacks, considered second class citizens lived in deplorable conditions, which put their health at a risk. After apartheid studies still indicate that the Blacks continue to live in less favorable conditions compared to Whites.
When discussing professional ethics, the element of public accountability cannot be ignored. Public accountability ensures that power is directed towards achieving efficiency, effectiveness and transparency in any operations. In 1996, the republic of South Africa adopted a new constitution that was aimed at leading the new South Africa through the transition process towards a democratic nation. The constitution aimed to provide South African with a government that is accountable to the communities. The government also aimed to ensure there is equitable of services, and that all its citizens live in a safe and healthy environment. Promising change is different from actually achieving the desired change. In South Africa, there is a need to adopt a culture that appreciates ethical behavior (Kautzky & Tollman, 2008). Ethics focuses on the aspect of character, conduct and morals. For instance, it unethical that one section of a population suffers in abject poverty without proper sanitation and health while another enjoys quality public amenities and services. Ethics also goes together with accountability in which individuals are answerable for their judgment and actions to society. In South Africa, the policy makers during the apartheid period showed no interest in enhancing health care in the rural homelands. After apartheid, the policy makers were slows to improve health care services and there was a variation of the Black population and White population.
Health care Disparity and Equity
When discussing the issues of health care and the existence of disparity, it is vital to determine whether there is equity across the different communities. For countries such as South Africa, it is not easy to establish an environment of total equality. This is attributed to the apartheid regime that favored the Whites against the Blacks. The regime of apartheid lasted for many years hence a long history of injustice and conflict between the communities. In terms of health care, there are two ways of looking at the aspect of equity. First, one should determine whether communities are able to access quality equal health services. Equal access to health services means equal health outcomes in areas such as life expectancy and mortality rates.
According to Braverman & Gruskin (2003) health equity “is lack of systematic discrepancies in health between groups in the society that experience different social advantages. In the absence of health equity, a population experiences differences in health care, which are unfair. In the absence of equity, one community may have gain over another with regards to accessibility of health care services. In South Africa, the cause of health inequalities is due to social determinants like income variations, education, gender and race. According to Kon & Lackan (2008) “equity is an issue that must be explored further in South Africa to ensure equal distribution of resources”. Kon & Lackan (2008) affirms that the Blacks still hold a disadvantaged position in South Africa as they lack adequate public health services. Government efforts to enhance equity in health care are not as successful as efforts such as allocation of funds still emphasizes on the private rather than the public sector.
Structural inequality still persists in South Africa with the majority of the Black population being poor. Most Blacks are still found in blue collar jobs. These are informal jobs with minimal pay. Without financial stability, the ability to access services such as health care is almost impossible. Other non-Black communities, on the other hand, are better in terms of financially stability as most have jobs in the formal sector. With adequate funds, these non-blacks communities can access quality health care services. Structural inequality is closely related to geographical inequality. Even in Post-apartheid, most of the Blacks are found in the rural underdeveloped regions.
The underdevelopment of rural areas means that there are minimal opportunities such as health care services compared to the towns. Public services such as clean water are also strained in the rural areas compared to the urban areas, which accesses tapped water. Health care refers to the provision of services, and provision of infrastructure to support a population’s health. In South Africa, these infrastructures are strained in the rural areas making the equitable distribution of health care difficult.
An assessment in 2003 by the World Health Organization on the distribution of health workers in South Africa Indicates that there is a wide disparity in health care institutions. Over 60% of health facilities in South Africa are understaffed with over 4000 vacancies for general health practitioners and over 32000 vacancies for nurses. This is evidence of a critical shortage in the public health sector. Unfortunately, it is this public health sector that the underprivileged communities such as the Blacks rely on for health services. With regards to the legacy of apartheid and the emphasis on separate development, the gap in the health sector continues to be felt today.
During apartheid, most medical professionals preferred to work in the urban medical facilities compared to the rural facilities. Unfortunately, the urban facilities served the upper class that included the white communities. The government also made efforts to construct numerous health care facilities across the towns. In the rural areas, the Blacks had to walk for kilometers so as to access health facilities. The discrepancies between the urban and rural health facilities in South Africa continue to be felt to-date. There is a strong preference for health care practitioners to work in private health facilities. The private zone is costly, and few citizens can afford the cost of seeking quality services from these private health care facilities.
In 1998, 53% of general medical professionals, 57% of nurse and 76% of specialist worked in the private health sectors (Kon & Lackan, 2008). This is ironical as the private sector covers the needs of less than 20% of the population. The preferences to work in the private over the public sectors has seen the number s rise as 63% of GP’s work in 2008 worked in the private sectors. This is almost twice the total number of general practitioners found in the public sector that serves over 80% of the population of South Africa. In terms of finance and national expenditure, the private sector has taken the lion’s share of 62% against services a population of approximately seven million people. The public sector, on the other hand, receives funding of approximately 38% to serve a population of approximately 35 million citizens. The distribution of funds and qualified personnel’s across the South African population is unethical (Braverman & Gruskin, 2003). The private sector, with the least population, attracts the highest number of health professionals and receives the highest amount of funding. The majority of the South African citizens are thus forced to struggle with the strained public health sector where quality health care delivery is not guaranteed.
The persistence of inequality in the delivery of health care is also seen in the countrywide distribution of HIV/ AIDS. According to Scrub (2011), the apartheid ideologies of supremacy and racial segregation continue to impede health care development in the country. With regards to HIV/AIDs, the disease bears the greatest brunt on the Blacks. According to a study by Scrubb (2011), the government has not succeeded to deal with the HIV/AIDs epidemic. The government’s lack of participation is an indicator of the existence of apartheid ideologies in the post-apartheid era. According to a study by UNAIDS (2011), there are over 5 million citizens living with HIV/AIDS. 3 million of the infected are women, whereas 250000 are children below 14 years. The findings also indicate that 17.8% of adults South African aged 15-49 years are living with HIV. An analysis of the apartheid health policies with the treatment and HIV/AIDs occurrence rates indicates that significant racial disparities. During the apartheid period, Blacks in South African became the target of exploitative laws that separated citizens on the basis of color.
However, studies by UNAIDS (2011) indicate there is a great health disparity between infection rates in urban areas like Cape Province and rural areas like KwaZulu-Natal. The urban areas record a HIV prevalence rate of 15.1% while the rural region records a prevalence rate of 39.1%. The prevalence rates of the rural area are twice that of the urban areas. The rural areas are coincidentally the under developed region that were considered the abode of the Blacks during the apartheid era. Factors such as understaffing go public health facilities and the presence of under qualified health professionals have compromised the ability of the country to manage pandemics like HIV/AIDS.
Under post-apartheid government agencies were established with the aim of providing primary health care, preventive intervention and educational initiative to minimize the spread of the disease. However, the government failed to provide efficient functional organizations and infrastructure to boost its efforts. The rural areas had been neglected during the apartheid era that it was impossible for the government to immediately intervene in areas such as minimizing the spread of HIV/AIDS. Without proper infrastructure, the government efforts failed, the levels of HIV/AIDS infections went up and, the South African health care system continued to be fragmented.
Health care across diverse populations in post apartheid South Africa
The elements of culture exist in every societal set up. It is vital that one reviews the complexities of culture in communities such as South Africa. The diverse cultural aspect of South Africa demonstrates the difference in, lifestyle between the White and Black communities. In the new post apartheid South Africa, however, the government is making efforts to embracing culture as a unifying system that communicates social order. Embracing culture in South Africa involves celebrating the differences while maintaining a high degree of homogeneity. One way the country has attempted to increase homogeneity is through the adoption of a new constitution that aims to protect the rights of South Africa citizens. The new constitution acknowledges the ethnic imbalances of the past with a focus on efforts to compensate these imbalances.
Cultural Competence and Health Disparity
Health care professionals have given much attention to the impact of cultural diversity in rendering healthcare services. According to Congress, (2004) cultural competency affects the diagnosis, treatment and the relation between a patient and a doctor. It is vital that health care professionals are skilled in handling diverse cultural groups as it improves the chances of efficient health care delivery. Cultural competencies is, however, not as simple as many would imagine. Cultural competence requires that health care professionals are familiar with the client’s ethnic background. This is, however, not entirely possible as they are many cultures within a community. Secondly, even if a health care professional is culturally competent, he may not entirely have the expertise to handle all the clients he meets. This is attributed to the fact that people have different cultural interpretations. Individuals from the same cultural background may have differing perceptions of different situations in life. Cultural competence is, however, vital in enhancing health care as the medical practitioner can incorporate cultural aspects of a community into practices and practices that will enhance health care and well being.
In South Africa, cultural competence is vital in ensuring that the Black community experience quality health care after decades of suffering under apartheid. Cultural competency ensures that the health care professional understand the ethnic influences that determine the lifestyle and perception of life of the Black community. It is by understanding the various cultural aspects that health care providers will successfully penetrate the Black community and help them overcome various health issues. For instance, a community may not view the need of proper hygiene as necessary. Such perception out the community at risk of illnesses compared to other communities that adopt hygienic practices (Congress, 2004). For a health practitioner, understanding the reason behind, and their lack of enthusiasm will help the health provider work with the community to establish a solution. The black community has strong ties to it cultural practices compared to other communities. The white community is more receptive of modern health practices. They are thus aggressive in adopting modern health strategies and seeking modern treatment in times of illness (Department of Health, 2005). The Black community, on the other hand, is tied to its cultural practices that dictate the lifestyle, and practices that they hold. An individual from a Black community may be inclined to religious practice such as a prayer to get cured instead of seeking treatment in health facilities.
Cultural competence also refers to the recognition that a majority of the Black community in the South African population is still reliant on traditional medicine. The Blacks will thus rely on traditional healers, herbalists, faith healers and prophets before considering the conventional treatment methods. Cultural competence means that a health care provider will consider the use of public allopathic services together with consultation of traditional healers. It is vital that a healthcare professional appreciates the strengths and weaknesses of each of the systems. It is by appreciating the different systems that one can achieve comprehensive care in a socially and culturally acceptable manner.
Scholars, however, indicate that cultural competence alone cannot address the health disparities issues in countries such as South Africa. There is a need for adequate training for health care practitioners. In South Africa, statistics indicate that health care provider in rural health facilities are not adequately training. This hampers effective health care delivery as the medical professional lack the knowledge of how to handle different medical scenarios presented to them (Congress, 2004). It is the responsibility of the government to ensure that there are not only adequate personnel in all health care facilities, but that the health care providers are adequately trained. Such a scenario will guarantee that the health disparity between communities in South Africa is reduced.
Cultural competence coupled with adequate infrastructure and equipment to render health care services will also reduce the health disparity in South Africa. There is a need to have adequate health care facilities across the country. The rural areas, where the Black communities are populated, have few health care facilities that cannot serve the entire population. There is thus a need to construct more health facilities in such regions. Equipments such as medical tools and medication and also infrastructure such as water, electricity, and roads need to be constructed deep into the rural areas. This will not only work towards minimizing the disparity gap, but it will motivate the health care professional to also work in the rural areas. The rural areas in South Africa experience low numbers of health care providers due to lack of incentive. Unfortunately, the majority of the Black community relies on these public health facilities to get health services.
Sustainable Diverse Health Workforce
Diversity in health professional is paramount to a country’s need to overcome inequalities inequities and guarantee available health care for underserved population. In South Africa, the underserved population refers to the Blacks and the colored communities. The government has put in place elaborate plans to help overcome the decades of ethnic and racial inequalities in the country. The white community has everything from education, to security to the health care facilities. The Black communities, on the other hand, were concentrated in homelands, had to struggle to access medical facilities and even if they were accessible, they lacked adequate professionals to serve them.
A sustainable diverse health workforce guarantees that the medical professionals can tap into the underserved populations and render their services. It also ensures that patients have a wider selection of health providers and health facilities to visit. During the apartheid era, facilities were separated into white zones and black zones. An individual from the Black community could not access health services from the white community. Doctors in facilities that served white communities lacked the cultural competency to serve the black community. This led to increased suffering and dissatisfaction of the Black community.
Reconstruction and Development Efforts
After apartheid, the South African government adopted a broad policy and structural framework that led to the restructuring of various public sectors. The health sectors was one of the areas that was in dire need of restricting to accommodate the majority public. The national department of health took over the health sector and was responsible for policy making and coordination functions in the sector. The central government also formed the local governments which focused on the provision of municipal health services. The municipal health services range from environmental health services to ensure that communities live in environments that are healthy and promote health.
The municipal services also included the provision of primary care facilities. Provision of primary care services under the municipal services guarantees that the facilities will run based on the immediate needs of the population. This ensures that the health care facilities in different geographical areas serve fully serve the populace. In other words, all communities, regardless of race or ethnic background will manage access quality health care services (Moodley, & Adam, 2000). This is a viable approach that the government of South Africa had in mind in an effort to overcome health disparities. However, there have been several obstacles relating to the implementation process. First, the government has so far, failed to provide a clear structure on the governance of the facilities on a district level. It is vital that the governance structure is determined. For instance, with the district health system, will there be de-concentration of authority to provincial health departments or devolution to local governments.
In an effort to regulate the private health care sector, the South African government introduced policies aimed to regulate its growth and also minimize most of the excesses in the private sector. During the apartheid era, private practitioners participated in dispensing drugs, a practice that contributed to poly-pharmacy and excessive medication. The passing of the 1998 act for instance was aimed at preventing practice such as private pre-payment schemes that undermined equity in the health sector. The government has also engaged in improved finance efforts with an increase of the gross Domestic Product to the health care sector by 8.8% (Kautzky, & Tollman, 2008).
Efforts of financing the health sector are, however, not adequate as health indicators have shown no significant improvement. Instead, there has been an increased in individual suffering from HIV/AIDS pandemic with the stagnation of governments financing of the health sector. The presence of NGO and community based organization (CBO) after apartheid was common. This was because these non government bodies had already witnessed the health disparity in South Africa. In an effort to close the gap, between different ethnic communities, the NGO’s and CBO’s established health care facilities in rural areas. After, the apartheid era, the NGO appeared to be an ideal structure with which the government can penetrate further into the underserved areas in an effort to reconstruct and develop the health sector further. Unfortunately, the government did not envision the NGO sector from the perspective of development and reconstruction. After the apartheid era, the government ignored NGO’s and did not receive any financial support (Moodley, & Adam, 2000). Instead of collaborating with the government, some NGO’s were forced to shut down having lacked funding from their sponsors or the South African government.
The way forward
Strategies to eliminate racial/ethnic health disparities bring to focus nations such as South Africa that experienced apartheid, which favored whites over people of color. Differentiating between the healths outcomes of racial minority groups with the health outcomes of majority groups can shed light on the extent of disparity. However, having health promotion models is one effective intervention that can be used towards achieving health. The comparative approach model, for instance, looks into ways of improving health care by reviewing the outcomes of the underserved with the outcomes of those who had available health opportunities (Bediako, & Griffith, 2007).
It is by determining the quality of health care that those with opportunities have that a government can work towards enhancing equitable distribution of services in the health sectors. In South Africa, for example, the white community enjoyed better health care services than their colored countered. One areas in which the white community enjoyed is adequate health personnel. With this in mind, the government can work towards increasing health personnel’s in health facilities, in the rural areas too. This ensures that the health disparity between the two communities is minimized. It is, however, impossible to achieve total health equity with the comparative approach as the process is not a guarantee towards development. There is a need, therefore, to adopt an elaborate approach towards steering the nations towards achieving health equity after the apartheid era.
With regards to overcoming epidemics such as HIV/AIDS, healthcare services must strive to accelerate the rolling-out of ARV therapy across the nation. ARV therapy must be accompanied by improved voluntary counseling and testing services. Unlike the white population, the blacks are falling victims of HIV/Aids at an alarming rate. This is attributed to ineffective HIV prevention services in black dominated areas. In the post apartheid era, improvement of primary health care in the country requires the establishment of a robust ARV delivery system coupled with services such as ARV and prevention of mother to child transmission services (Kahn, & Collinson, 2007).
Healthcare as a Human Right
In this post apartheid era, the South African government should be striving to establish a health care system that overcomes racial and ethnic barriers. Such a healthcare system would be one that is appealing to the poorest African and still appealing to the middle and upper class of whites and non-whites. According to the international Convention on the Prevention of All Forms of Racial Discrimination, states should strive to eliminate all form of discriminatory policies that favor one group of individual over another. The convention represents the most authoritative body of international law that strives to eliminate any forms of ethnic and racial discrimination across nations in the world.
Though South Africa has demonstrated the desire to overcome racial discrimination, it needs to work harder and ensure that it overcomes the years or racial discrimination that formed the basis of functioning in the country. South Africa needs to transform its health care system and reduce racial disparities in access and resource allocation. The health care system need to incorporate patients from diverse racial backgrounds. Unlike the apartheid period, where South Africa’s health system was divided based on class and race, post apartheid South Africa needs to establish a single health system. A single health system overrides any racial and ethnic considerations emphasizes on equitable distribution of funds and resources. The single healthcare system must also focus on administering health services in a coordinated and consistent manner across all racial classes (Department of Health, 2005). The South African government should strive to establish a health system that motivates the upper class, black or white, to adopt strategies that encourage equitable distribution of resources in health care. The ability to guarantee quality health care services to all citizens means that quality healthcare will not only be for the wealthy, but a right that all citizens can enjoy. The inclusion of persons from different ethnic backgrounds in the establishment of a unitary health system would garner mass support from the public. With support, the country would be able to adopt an integrated medical culture with reduced racial and regional variation.
Achieving a unitary health care system is not an easy task for a nation that embraced apartheid for decades. There is a need for the adoption of various market oriented and government mechanism based on the country ideological and political preference. In South Africa, the reduction of the racial disparity in health care system will require a complete overhaul of various activities that still favor the whites than the non-whites. For instance, there is continued support for tertiary services in white academic medical centers than the non-white centers. It is impossible to attain racial equity with activities such as excessive funding in white dominated sectors. The journey towards racial equity requires that there is extensive cost cutting in predominantly white centers and distribution of these funds to other non-white centers.
The government may define budgetary priorities with regards to ensuring equitable distribution of resource. However, this may be done in general terms. There is a need to engage in crucial detailing on how budgetary allocation and distribution of resources will occur. There is a need to establish administrative regulators and managers to reviews in details how the nations will engage in equitable distribution of resources. Unfortunately, the South African government as well as its agencies still has elements of authority that still hold the ideologies of the apartheid era. It may thus pose difficult to introduce a health care system that overlooks the racial differences (Kahn, & Collinson, 2007). It is up to the government to develop substantive guidelines to ensure equitable distribution to resources in the new post apartheid South Africa.
The legislature must also play an active role on ensuring that tendencies of ethnic and racial disparities in health care are erased in the new South Africa. The legislature can do this by passing into law stringent discipline and sanction on parties engaging in discriminatory treatment of patients in health care facilities. The laws should also provide sanctions against physicians and other health care providers who strive to uphold racial discrimination while rendering health care services. Such sanctions should be triggered by segregation of waiting rooms and treatment facilities in health care facilities. Health care facilities must portray an image of neutrality in terms of their preferred race. These public health services must be the channels of demonstrating to societies that they can overcome ethnic disparities and work together.
There is also a need for post-apartheid South Africa to have a robust affirmative action aimed at addressing the wide disparity on the racial distribution of South Africa’s population and the healthcare community. Affirmative action refers to the positive steps that a body, e.g. government can take in an effort to increase the representation of the minority or underserved groups in society (Moodley, & Adam, 2000). The black community suffered the most under the apartheid era. They lacked educational opportunities, access to quality health care services was impossible and financial support was impossible. In overcoming ethnic disparities, affirmative action focuses on giving special preference to Blacks when rendering health care services, offering financial support and admission to medical schools. These are efforts that indicate that a black man has equal potential like the white man. In health care facilities, there should no preferences and special treatment based on color.
Conclusion
South Africa is a nation that was for decades plagued by apartheid. In the era of apartheid, the nation witnessed the highest level of racial inequities in different sectors. The health sector stands out as one of the areas where racial disparity existed. The country was divided on racial distinctions with the Blacks and the White being treated differently. The Blacks were considered second class citizens and were declined basic rights such as healthcare. The Blacks suffered under deplorable conditions, with scarce health care facilities. The available health care facilities were under staffed and poorly equipped. After 1994, the government engaged in stringent efforts to eliminate racial and ethnic health disparities in post-apartheid nation. Eradicating racial disparity was a milestone task for the government to accomplish as the Blacks had been disadvantaged for decades. The government has made efforts to overcome the ethnic and race disparity in health care. Some of the strategies include increased funding of health care services, the abolition on homeland settlements, constructions of additional health facilities and ensuring that the rural community has adequate healthcare personnel. The country passed a new constitution that seeks to recognize all South African citizens and guarantee equal rights across ethnic and racial differences. These are positive efforts, but they are minimal as the Black community continues to live in deplorable conditions, plagued by diseases such as HIV/AIDs. There is a need for reinforcement of strategies to guarantee that the health care industry overcomes the effects of decades of apartheid.
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