Learning from our apartheid past: human rights challenges for health professionals in contemporary South Africa

Central to South Africa's democratic transformation have been attempts to understand how and why human rights abuses were common under apartheid. In testimony to the Truth and Reconciliation Commission evidence has emerged of a wide range of past complicity in human rights abuses by health professionals and their organisations. This has presented a major challenge to the health sector to develop ways to operationalize a commitment to human rights in the future. This paper argues that only after a process of self-reflection, both personal and institutional, which enables a thorough and accurate analysis of why things went so wrong, can the health sector effectively move forward. The authors' perspective draws on the submission to the TRC Health Sector Hearings by the Health and Human Rights Project in 1997, which provides a systemic and case-based analysis of the health sector's role in human rights abuses under apartheid. However, human rights responses have to take account of a changing national and global terrain in which human rights issues are no longer as morally absolute as previously encountered, and in which seemingly insuperable resource constraints, inimical economic policies, and the demobilization of civil society, are serious obstacles. Moreover, the politics of transformation has generated expediencies that threaten to rewrite history in ways that fundamentally cheapen human rights. To address this contradiction, the authors propose a set of objectives that places accountability of health professionals in a human rights framework. These objectives are intended to give substance to the main tasks facing the health sector--to develop and infuse the capacity to recognise and integrate both the 'new' and traditional human rights dilemmas, and to effect personal and institutional transformation. A matrix is presented, linking these objectives to key role players in the health sector and identifying activities specific for each role player. As the health sector in South Africa grapples with the challenges framed in this model, key lessons for the international community may emerge that further our understanding of the complex relationship between health and human rights and how best to implement strategies for the attainment of human rights in health.