Hazel Friedman=20
TWO-THIRDS of South Africa’s black population are=20 subject to poor health conditions. This is among=20 the startling findings of South Africa’s first=20 national household health survey.=20
A 200-page report, released by the Community Agency=20 for Social Enquiry (Case) on behalf of the Kaiser=20 Foundation this week, sketches an appalling picture=20 of continued racial imbalance in the conditions=20 that make for healthy living. The list goes on: 80=20 percent of African households have no tap indoors,=20 16 percent have no toilet of any kind and nearly 60=20 percent are without electricity, while 67 percent=20 live below the poverty line. =20
The report, based on the scientific sampling of 4=20 000 households across the country, concludes that=20 black South Africans, particularly those from rural=20 areas, are worse off in every aspect of their lives=20 compared to other segments of the population.=20
This inevitably makes them more prone to ill health=20 and poverty-related diseases. Yet they have the=20 greatest difficulty in getting access to health=20 services, because of the cost of health care and=20 excessive distances.=20
The principal victims of this imbalance are African=20 children under the age of five, of which 75 percent=20 live in rural ares. Of these, 76 percent live in=20 households with incomes below the poverty line, and=20 23 percent of families are too poor to properly=20 feed their pre-school children. =20
But the survey’s prognosis for health care in South=20 Africa is not entirely bleak. Divided into three=20 components, it presents health reforms in an=20 historical context, describes the critical elements=20 needed to transform health care in South Africa,=20 and offers a research and implementation agenda=20 geared towards shifting the emphasis of health care=20 from a curative approach towards a primary health=20 care system based on the principle of equal health=20 care for all.=20
The obvious conclusion is that the government’s=20 primary school feeding programme is not reaching a=20 substantial number of chidren from rural households=20 living below the minimum level.=20
From=20the start of this mammoth undertaking in June=20 1994, research was hampered by a lack of=20 demographic data and by the fact that over 65% of=20 African births are unregistered, throwing the=20 accuracy of any research into health-related issues=20 seriously into qestion.=20
Despite these problems, the survey has succeeded in=20 providing a barometer for measuring the impact of=20 improvements in health and health services for=20 South Africans in the future. It also gives a=20 comprehensive analysis of policy developments in=20 the health sector and attempts to formulate a=20 research agenda towards addressing and clarifying=20 unclear policy issues.=20