In 2008 the South African health sector was in crisis with an estimated 300,000 deaths from a delayed response to HIV, increasing health inequities, and a public sector unable to cope with the huge burden of disease. Three major reviews of the South African health system were separately commissioned: by the development bank of Southern Africa, by the Lancet journal, and by the ministry of health. The findings of these reviews, published in 2009, provided a baseline for major new policy initiatives launched that year. Under the leadership of the minister of health, the government laid out a ten point plan for transforming the health sector, announced a massive scaling up of the response to HIV, and set ambitious targets with the presidency for improving health and the health system. By 2013, the country had seen unprecedented improvements in life expectancy, major reductions in some aspects of child and adult mortality, and had started implementing an ambitious set of health reforms to achieve universal coverage of high quality, accessible health services.
In this book, we describe how this turn-around in health policy is being achieved, the challenges that have had to be overcome, and the many challenges that remain. As a case study of an emerging power's efforts to deliver on the expectations brought by the onset of democracy, it will be of interest to students of social and public health practice and policy nationally and around the globe.