Some economic and philosophical dilemmas facing medicine in South Africa

Growth of the population in South Africa is not being matched by appropriate expansion of our health care services. Inadequate development of primary health care and community hospitals is placing an increasing burden of clinical service on teaching hospitals, which in turn have not been allocated sufficient resources to cope with both these service demands and academic activities. The current policy, whereby a greater percentage of health care funding is being directed towards preventive medicine, is appropriate, but the coupling of this with a progressive reduction in the relative amount of total expenditure on health (as a percentage of the gross national product) is short-sighted and not in the best interests of academic medicine or health care services in the country. The public and the medical profession in South Africa should recognize these adverse trends and actively participate in reversing them. The profession also needs to re-evaluate its priorities and objectives in relation to economic and sociological developments and prospects. An enlightened approach with adequate financial backing is needed to prevent further erosion in medical standards, to protect academic teaching centres of excellence and to ensure an adequate health care service in the future. Social, economic and political advancement of all people in our country is necessary to allow achievement of these objectives.