Doing with, not doing to or doing for

The continuing challenge of transforming the institutions and practices of the South African health system.

Historically, South Africa’s health system was, in part, a site of injustice. After its hearing into the apartheid health sector (1960-1994), the Truth and Reconciliation Commission (TRC) found "millions of South Africans were denied access to appropriate, affordable healthcare...Healthcare workers, through acts of commission and omission, ignorance, fear and failure to exercise clinical independence, subjected many… to further abuse".

Across this time, healthcare was broadly delivered in authoritarian (doing to patients) and paternalistic (doing for patients) ways, especially for black South Africans. Since the advent of democracy in 1994, laws and policies have sought to protect human rights, address disparities in health and wealth, and encourage the delivery of care in more restorative, participatory (doing with patients) ways. Alongside the TRC, itself a vehicle for restorative justice, we find the Constitution’s Bill of Rights, Batho Pele (People First) Principles, Patients’ Rights Charter, and proposed National Health Insurance system.

However, those who suffered most under apartheid still struggle most to access care and continue to experience the poorest health outcomes. Mistrustful provider-patient relationships and provider hostility, neglect, sometimes even abuse, remain part of the health system.

This brief shows how authoritarian and paternalistic practices persist in the new democratic context. Click here......