Healthcare in South Africa, public healthcare, in particular, has been compromised by various issues that impact negatively on quality. Our constitution, chapter two which is the bill of rights, entrenches the right to quality healthcare as a basic right every south African citizen is entitled to. Therefore, our government is obligated to meet such a requirement.

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There have been efforts to improve the quality, however, reports from the media and various studies point to the fact that the basic standards of quality healthcare are not being met and the public has lost trust in the healthcare system. Many of the problems can be traced back to our not so recent history, 1948-1993, a period in which the healthcare system was highly fragmented. Efforts have been made to correct such problems but they seem to have only worsened. Amongst the plethora of issues our healthcare system has been the following:

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1. Prolonged waiting time because of shortage of human resources
2. Adverse events
3. Poor hygiene and poor infection control measures
4. Increased litigation because of avoidable errors
5. Poor record-keeping
6. Increased disease burden

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Prolonged waiting time because of shortage of human resources
A major weakness in sub-Saharan African health systems is inadequate human resources. Africa is said to have less than one health worker per 1000 population compared to 10 per 1000. Health problems in South Africa are worsened by unequal distribution of health professionals between the private and public sectors, coupled with unequal distribution of public sector health professionals among the provinces.

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Adverse events
Other incidents reported were patients who developed complications, and in some cases died, because they were turned away from the public healthcare facility or denied access to healthcare services.

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Poor hygiene and poor infection control measures
Public healthcare facilities exhibit numerous shortcomings such as long waiting times, poor-quality healthcare delivery, old and poorly maintained infrastructure, and poor disease control and prevention practices. Most facilities have problems such as poor waste management, lack of cleanliness and poor maintenance of grounds and equipment. 

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Increased litigation because of avoidable errors
There has been a proliferation of medical negligence litigation against the Department of Health, leading to large pay-outs which have put further strain on the health budget.  

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Poor record-keeping
Poor record-keeping causes unnecessary delays for patients. Sometimes, patients’ folders go missing or lost, and instead of healthcare workers explaining this to the patient, they simply let the patient wait. In worst scenarios, the medical history of the patient is lost, which can create further complications leading to incorrect diagnosis and in some cases death of the patient. 

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Increased disease burden
South Africa currently faces a multiple burden of disease, with the HIV and AIDS epidemic coinciding with high burden of tuberculosis, high maternal and child mortality, high levels of violence and injuries and a growing burden of non-communicable diseases (e.g. cardiovascular diseases, diabetes, chronic respiratory conditions and cancer).

Another major cause of morbidity and mortality in the public sector in South Africa is healthcare-associated infections. Approximately one in seven patients entering South African hospitals is at risk of acquiring an HAI because of poor infection prevention and control measures, such as poor waste management and poor handwashing techniques.