South Africa is a middle-income country of around 55 million people, two thirds of whom live in urban areas. Public primary health care (PHC) is provided through a nurse-based, doctor-supported infrastructure of over 3500 clinics and community health centres, available within 5 kms to more than 90% of the population, and free at the point of use. It is supported by an emerging system of community-based outreach teams consisting of community health workers. This PHC system has enabled access to antiretroviral therapy (ART) to more than 3 million people, and reduced mother-to-child transmission of HIV to 1.5%. In parallel, primary care is also provided by private, fee-for-service general practitioners as well as traditional healers.
PHC progress has been achieved in South Africa despite a backdrop of significant health system, social and economic challenges. South Africa has one of the highest levels of income inequality in the world, with a Gini co-efficient of 0.69. In the health sector, these inequalities are visible as stark differences between two realities: A well-resourced, insurance-based private sector serving only 16% of the population, but consuming half the total funds flowing through the health sector in the country; and the tax-funded, public health system providing care for the remaining 84%.