Essay Writing Help on Country with High Mortality Rates: South Africa

Country with High Mortality Rates: South Africa

Name of country: South Africa

            This paper is based on the nursing practice in South Africa. The reason why South Africa has been chosen is because there is documented evidence of high levels of maternal and adult mortality rates in this country (Cockerham, 2010).


            South Africa is located at the base of the African continent, at 24 00 E, 29 00 S, geographic coordinates. The country’s land size is 1,219,090 sq km. In terms of climate, South Africa is predominantly semiarid, while the east coast is predominantly subtropical. This climate is characterized by cold nights and sunny days. With regards to terrain, there are vast interior plateau in South Africa. They border a narrow coastal plain, and rugged hills (The World Factbook, 2015).   


            The latest population estimates carried out by the National Statistical Agency of South Africa in mid-2013 estimates the country’s population to be 52,981,991 (The World Factbook, 2015). Majority of the South African population fall under the 25- 54 years age bracket (38.2%) (The World Factbook, 2015).


            South Africa is a republic state. The capital is in Pretoria, which also doubles as the administrative capital. The judicial capital is in Bloemfontein, while the legislative capital is in Cape Town (The World Factbook, 2015). The country is divided into 9 administrative divisions, or provinces. It terms of legal system, South Africa has a mixed legal system that encompasses English common law, Roman-Dutch civil law, and customary law (The World Factbook, 2015). There are three branches of the government: the executive, headed by the president, the legislative branch ( a bicameral Parliament made up of the National Assembly and the National Council of Provinces), and the judicial branch (made up of the Constitutional Court and the Supreme Court) ( The World Factbook, 2015).


            South Africa is richly endowed with natural resources, and has a well-developed legal, communications, transport, energy, and financial sectors (The Worldfactbook, 2015). As of 2014 estimates, South Africa’s gross domestic product (GDP) stood at 1.4%, while GDP-per capita was estimated at $ 12,700.  On the other hand, the country’s gross national saving was estimated at 13.6% (The Worldfactbook, 2015). The services sector accounts for more than two-thirds of the country’s GDP (69.1%), followed by industry and agriculture, at 28.5% and 2.4%, in that order.

State of Health (Diseases/Violence/Accidents)         

            There is a high level of diversity in health care in South Africa. On the one hand, we have the basic primary health care that the state provides for free. On the other hand, there are also the hi-tech, and highly specialised health services available in the private and public sector (Harrison, 2009). However, it is important to note that the public health sector in South Africa is under-funded, and hence over-stretched. In the last few decades, South Africa’s healthcare system has made tremendously progress. For example, adult mortality rate in the country has been on the decline from 1995 to-date. The World Bank Group defines adult mortality rate as “the probability of dying between the ages of 15 and 60” (2015, n.p.). In other words, this is the probability of a teenager aged 15 years of age dying prior to their 60th birthday.

            Between 1995 and 1999, South Africa had an adult mortality rate of 495 for every 1,000 live births. However, between 2010 and 2014, this had reduced to 464 (The World Bank Group, 2015).  In the last five years, the infant mortality rates in South Africa have only improved modestly. The World Bank Group defines infant mortality rate as “the number of infants dying before reaching one year of age, per 1,000 live births in a given year” (2015, n.p.). In 2010, South Africa had an infant mortality rate of 35 for every 1,000 live births. Between 2011 and 2012, it reduced slightly to 34, and in 2013, it stood at 33 (The World Bank Group, 2015). Statistics in 2010, South Africa had an under-1 infant mortality rate of 41 deaths for every 1,000 live births. On the other hand, the under-5 mortality rate was estimated at 57 deaths for every 1 000 live births (The World Bank Group, 2015).

            Even as the state caters for nearly 40% of all the health expenditures, the public health sector still remains under a lot of pressure to offer services to nearly 80% of the country’s population (Cockerham, 2010). In contrast, the private sector is, for the most part, operated based on commercial lines. As such, it mainly attends to the high-income and middle-income earners, majority of whom belong to medical schemes. Majority of the country’s health professional are also attracted to the private health sector, as it is highly paying.   This has led to the evolving of a two-tiered system that is both inaccessible and inequitable to majority of the South Africans. In addition, public health institutions have suffered underfunding, poor management, and deteriorating infrastructure. Even as there has been an improvement in access to health care, quality has on the other hand, deteriorated (South Africa, 2012). This has been worsened by various public health challenges, such as the burden of diseases like tuberculosis (TB) and HIV/AIDS, and lacking key health personnel.

            While South Africa is a signatory to the UN’s MDGs (Millenium Development Goals), which aims to attend to the health needs of children and women, the plight of children and  others in the country remains poor. AIDS, along with cholera and tuberculosis have in recent years put a real strain on the health care system in South Africa. In 2011, the country had an overall HIV prevalence of 1.6% (South Africa, 2012). Nearly one in every five women in South Africa within the reproductive age bracket were HIV positive. However, by May 2012, the government of South Africa noted that new HIV Infections had reduced to 0.8%   from 1.4 among youths aged between 18 and 24 years of age.

Culture/Traditional Medicine 

            Nearly 80% of South Africans are thought to consult the general medical practitioners alongside the traditional healers (Cockerham, 2010). In 1997, a traditional medicines research unit was founded by the South Africa’s MRC (Medical Research Council). This research unit would be tasked with the responsibility of integrating the use of conventional medicines with modern research methodologies (WHO 2006). In addition, the unit intends to develop various patents for promising novel entities that have been gotten from medicinal plants. 

Healthcare System and Delivery:

i) Governmental Health-Related Agencies (such as Ministry of Health), and Health Regulatory organizations

            The Department of Health is charged with the responsibility of overseeing the health care system and delivery in South Africa. The Department of Health has in turn delegated its authority at the provincial level to the provincial health departments that manage and provides comprehensive health services through public health care model that is based at the district level (South Africa, 2012). Operational issues like human resources and budget have in turn been delegated to the local hospital management, to cater for local health care needs. Public health in South Africa accounts for nearly 11% of the total government budget (Cockerham, 2010). The allocation of these resources differs from one province to another.

            There are over 110 registered medical schemes in South Africa, with nearly 3.4 million principle members.  Hundreds of NGOs have also made a significant contribution in the fights against HIV/AIDS and tuberculosis, cancer, disability, and mental health. South Africa has some 4 200 public health facilities. For every 13 718 South Africans, there is a clinic facility offering health care services to them (Department of National Treasury, 2011). This exceed the 10 000 people per clinic as recommended by WHO guidelines. On the other hand, figures released by March 2009 indicate that the average South African made 2.5 visits to a public health care facility a year. On the other hand, the rate of usable bed occupancy at hospitals stood at between 65 and 77 %.  Since 1994, the South African government has either upgraded or built over 1 600 clinics. In the mid-1990s, the South African government introduced free health care for breastfeeding or pregnant mothers, and children below the age of 6 years (Government Communication and Information Systems, 2014).  Health-related research and diagnostic services in South Africa are handled by the National Health Laboratory Service. It serves nearly 80% of the South Africans in its 265 laboratories.

ii) Healthcare personnel: Ex Number of Nurses and Doctors

             The number of nurses in the health sector in South Africa has increased tremendously over the past two decades. In 1998, the number of nurses registered with SANC (South African Nursing Council) stood at 91,011. By 2013, this number had increased to 129,015, representing a 29.45% increase. In addition, the number of qualified health practitioners in the private and public sectors registered with the South Africa Health Professional Council, stood at 165 371. Of these, 38 236 were doctors, while 5 560 were dentists.  In terms of patient-doctor ratio, this is estimated at 0.77 doctors this for every 1000 people. However, since most of the GPs are to be found in the private sector (73%), this means that each practising doctors has to attend to 4 219 people (South Africa, 2012). This has prompted the Department of Health to introduce mid-level health providers and clinical health associates to handle under-served areas.

iii) Nursing Education System and Accrediting Organizations

            The South African Nursing Council was incepted following the amendments in 1978 of the Nursing Act No. 50. This enabled the government of South Africa to task this body with the responsibility of maintaining and promoting standards in nursing education. The role of the SANC is to overseas nursing education in various institutions. In addition, it ensures that the nursing care given to the public is ethically sound, safe and of desired quality.

            In South Africa, nursing education began in 1899. Over the years various programmes have been modified or evolved in response to health care pressures and needs (Sekwa, n.d.). The programmes are categorised into two: pre-registration and post-registration. 

Pre-registration Programmes: 

  • A detailed four year Degree or Diploma qualification in Psychiatric, Community Health Nursing, General, and Midwifery, in line with the regulations by SANC.
  • Diploma in General Nursing (two years). This qualification results in registration as a psychiatric or general nurse in line with the regulations of SANC 
  • Certificate programme (two years) leading to the qualification of an enrolled nurse.


  • Post-basic degree resulting in a specialisation in Nursing Administration, Nursing Education, and Community Health Nursing.
  • Post-basic Diplomas resulting in qualifications in diploma programmes in any discipline covered by the four year programme in Nursing.  
  • Masters and Honours degrees, taken upon completion of basic degree programmes.

iv) Nursing Associations

            There are several recognised nursing association in South Africa. Established in 2009, ENSSA (Emergency Nurses Society of South Africa) aims to promote emergency nursing in the country through education, leadership, practice development, collaboration, and research (Emergency Nurses Society of South Africa, 2012).  ANASA (Association of Nursing Agencies of South Africa) was formed in 1994, as the umbrella body of nursing agencies, to represent their interests in the industry and enable them to speak collectively (ANASA, 2015).

Health Priorities Based

            The South African government is seeing to address the challenges to public health care in the form of increased cases of HIV/AIDS, tuberculosis, infant deaths, maternal and adult mortality rates. To do so, the government has developed far-reaching reforms aimed at restructuring and revitalising the health care system in the country. They include:

  • Speeding up the execution of a National Health Insurance schemes whose ultimate aim is to ensure that all South Africans are covered.
  • Enhancing the fight against TB and HIV, violence, injury, and as non-communicable diseases (Cockerham, 2010).
  • Enhancing human resource management at the various state hospitals, in addition to improving co-ordination between private and public health sector.
  •  Ensuring that “health teams” are deployed to school and communities  
  • Achieving the goal of increasing the country’s life expectancy to 58.5 in 2015, from 56.5 in 2009.

Implications for Nursing

            Nurses in practice can play a significant role in enabling the health care sector in South Africa to achieve its set priorities. They can do this by creating more awareness to the public on how the need to reverse and halt non communicable diseases such as high blood pressure and diabetes. They can also engage in government intervention programmes aimed at reducing the burden of non communicable conditions.  In addition, nurses can also play an active role in intervention programmes aimed at reducing the prevalence of malaria especially among pregnant mothers, infants, and others. Other intervention programmes in which nurses can play a key role includes the elimination of Measles, Neonatal Tetanus, and other tropical diseases. Others include Tuberculosis, and HIV/AIDS. They can do this by enlightening the populations concerned on how to eliminate the causative agents of these health conditions.   


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