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Country with High Mortality Rates

The main challenge for dealing with high mortality rates in South Africa is HIV/AIDS. The paper presents a review of South Africa’s health care outlook. Most of the country’s population lacks the necessary importance of registering deaths. Culture and traditions also interfere with the accurate reporting of the cause of death. Only after the year 2000 did the country significantly increase its number of registered adult deaths (Garrib, et al., 2006).

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The country is located in the southern part of Africa. It covers more than 1.2 million square kilometers. It has nine provinces and shares a border Botswana, Namibia, Zimbabwe, and Swaziland. The country experiences a varied climate and has a diverse topography with a vast coastline (GCIS, 2011).


South Africa has a total population of fifty million people. Sixty-one percent, of the population, lives in urban areas. The country has a life expectancy of fifty-four years for men and fifty-five years for females. It has an adult mortality rate of 496 and a child mortality rate of 62. The country reported a 410 maternal mortality rate in 2009.


The right-wing National Party ruled the county from 1948 to 1994. During this period, the party excluded the black population from political participation. Moreover, it practiced a policy of economic marginalization. Other anomalies included social separation and racial injustices. The government has a policy of decentralization that distributes state resources through the provinces.


South Africa has a gross national income of about US $10,050. It is a middle-income country. Before the discovery and mining of diamonds and gold started in 1886, the county used to be an agricultural economy. The total expenditure on health accounts for 8.7 percent of the GDP. The figure translates to the US $16.7 billion. The per-capita expenditure on health is the US $300. Due to decentralization, the distribution of state resources to the different provinces is not exact. The inter-provincial inequality affects most rural areas, which suffer from inadequate resource allocation.

State of Health (Diseases/Violence/Accidents)

South Africa suffers from four major sources of health problems and mortality. It faces natural disasters and interpersonal violence as threats to health. It has to deal with residual infectious diseases like cholera and tuberculosis.

Furthermore, there are emerging epidemics like HIV/AIDS, drug resistance to TB and malaria as well as new infections such as avian flu. Lastly, the country also has epidemiological transition problems from chronic diseases and injuries, mental health, obesity, and tobacco-related illness. HIV and tuberculosis have the highest prevalence rate in South Africa. The rates are 178 and 808 per 1000 people respectively. Skilled health personnel attends to eighty-five percent of rural childbirths and ninety-four percent of urban childbirths. However, for measles immunization, rural areas lead with sixty-eight percent compared to only fifty-nine percent in city areas (WHO, 2011).

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Culture/Traditional Medicine

South Africa has herbalists who are known as Inyangas. They have extensive knowledge about curative herbs. In addition, they also offer medicines of animal origin (Kale, 1995). The Health Act of 1974 banned the practice of traditional healers (Scott, Springfield, & Coldrey, 2004). However, the state allows various organizations throughout the country to register traditional healers. Some of them are the Southern African Traditional Healers Council.

Another one is the Association of Traditional Healers of South Africa. Other organizations are the African Skilled Herbalists Association and the African Dingaka Association (Kale, 1995). The government notes the importance of customary healers. It is constantly working on ways to make a formidable collaboration between non-conventional medicine and mainstream medical practice. The challenge of the successful integration of traditional medicine remains the enforcement and differentiation of certification for healers (Kale, 1995).

Healthcare System and Delivery

The country funds its health care system from taxes. The system covers eighty-five percent of the population. The private sector covers the remaining gap. Most coverage from the private sector occurs as direct out-of-pocket payments or medical aid contributions. South Africa does not rely on donor aid to fund its health care system. The Federal Department of Health is responsible for health policy and coordination in the country. There are nine provinces and 284 municipalities that carry out the implementation and delivery of health services. Curative hospital services are in the province. On the other hand, local and municipal governments provide primary health care and environmental health services. There are 400 private hospitals and 4100 private clinics throughout the country.

Health-care reforms began in 1994 after the attainment of independence. In the first five years, they focused on increasing universal access to health care. Thus, the policies during the time focused mostly on the rural areas. There was a reorganization of the public finding system to improve equitability. The addressing of quality issues in the healthcare provision among state facilities began in 1999 and lasted over five years. During the period, the government also introduced legislative reforms to enable it to play an interventionist role in the private sector. Presently, the government continues to consolidate the health care system and resolve human-resource challenges.

Government Health-Related Agencies and Health Regulatory Organizations

The South African Nursing Council (SANC) is responsible for serving and protecting health care users in the country. It regulates the nursing and midwifery profession through advocacy, care, quality, expertise innovativeness, and relevance (South African Nursing Council, 2011). The constitution of South Africa and the National Health Act of 2003 gives the Department of Health the mandate of overseeing the health policies of the country and coordinating them (Coovadia, et al., 2009). However, defense forces and prisoners receive their health care services from their respective ministries. The SANC regulates new cadres of nurses. It coordinates the scopes of practice for nurses. Moreover, it manages the codes of conduct for nurses and their professional conduct within its practice regulation (Makhanya, 2009).

Healthcare Personnel

There are about seven physicians for every ten thousand people in the country. Moreover, forty-one nurses and midwives are catering for every one thousand people. The private health sector employs 240,000 people. Of all the health care employees in the private sector, 137,000 are professionals. There are 98,740 professional nurses in South Africa (Makhanya, 2009). The number of enrolled nurses is 35, 366 as of 2009. In the same year, auxiliary nurses were 50,703 (Makhanya, 2009).

South Africa has an active policy for addressing the brain drain It keeps on raising concerns, in international forums. Some notable achievements include WHO and bi-laterals agreements with developed countries. Other measures include the provision of push and pull factors to manage brain drain It is increasing the production numbers of health professionals. These factors include the improvement of health care facilities and the working conditions for workers. The government is also increasing the number of health professionals in the sector by increasing training, facilities, and enrolments.

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Nursing Education System and Accrediting Organization

The South Africa Nursing Council (SANC) promotes and maintains the nursing standards in the country. It monitors the process of nursing education through institutions and programs. In 1985, the SANC revised its regulation to make all nursing colleges associate with universities (Ehlers & Litt et Phil, 2002). Now, nursing education is the same as any other higher education and therefore, receives a similar status as the education of other professionals (Mekwa, n.d.).

Universities associated with colleges approve their respective curriculums. The same institutions also moderate the examinations compiled and administered by the colleges (Ehlers & Litt et Phil, 2002). There are no national examinations for nurses. The results obtained by a successful candidate determine their fate of registration with the SANC (Ehlers & Litt et Phil, 2002).

The SANC comes up with the goals of nursing education. It sets the standards and assures the quality of education meets the population’s needs. A four-year training course at a college or university leads to the registration as an overall nurse. The registration of a general nurse, midwife or psychiatric nurse, community health nurse by SANC, depends on the majors of the successful student. Admission to the four-year basic national nursing education program requires the completion of 12 years of formal schooling. Colleges and universities are free to add additional requirements to their admissions.

The difference between university and college education is the diploma got at the latter and degree obtained at the former. Nurses can also pursue post-basic education to specialize in certain fields such as ophthalmology. The post-basic education could happen as of a master’s or postgraduate degree at any university.

Nursing Association

The Association of Nursing Agencies of South Africa (ANASA) provides a means for all nursing agencies under its banner to conduct themselves professionally and ethically (ANASA, 2005). The association has a membership of more than fifty nursing-related agencies. All practicing nurses had to be registered with SANC and South African Nurses Association (SANA). In 1996, a new association called the Democratic Nursing Organization of South Africa (DENOSA) became the universal union for all nurses, irrespective of their background and political affiliation. Other than representation, DENOSA also undertakes professional development programs, for its members.

Health Priorities

The HIV epidemic will make it more difficult to deal with TB. Government estimates show that over 50 percent of HIV-infected persons will contract TB. The contraction rates will increase the rate of TB infections and erode previous successes in containing the epidemic. The government continues to address the emigration of registered nurses to the UK, US, and Canada as well as other developed countries. Moreover, SANC explores avenues of increasing the relevance of nursing education to meet international standards and meet the healthcare needs throughout the country (Ehlers & Litt et Phil, 2002).

Nursing Implications

The high rate of HIV infection throughout the country continues to increase the patient load for nurses. Furthermore, infections among nurses also increase the burden on the available human capital to take care of patients. Occupational health hazards facing nurses continue to rise as infectious diseases like TB continue to spread. The demand for non-conventional medicine and health care persists despite its ban. Nurse education institutions should look into ways of incorporating traditional and cultural certifications into their curricula.


ANASA. (2005). Association of nursing agencies of South Africa. Web.

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Coovadia, H., Jewkes, R., Barron, P., Sanders, D., & Mdntyre, D. (2009). The health and health system of South Africa: historical roots of current public health challenges. Health in South Africa 1, 1-18.

Ehlers, V. J., & Litt et Phil, R. N. (2002). Nursing Education in the Republic of South Africa. Nurse Educator, 27(5), 207-209.

Garrib, A., Jaffar, S., Knight, S., Bradshaw, D., & Bannish, M. L. (2006). Rates and causes of child mortality in an area of HIV prevalence in rural South Africa. Tropical Medicine and International Health, 11(12), 1841-1848.

GCIS. (2011). South Africa Government Online. Web.

Kale, R. (1995). South Africa’s health: Traditional healers in South Africa: a parallel health care system. BMJ, 310.

Makhanya, N. J. (2009). Regulation ofnursing within the South Africa’s health system. Web.

Mekwa, J. (n.d.). Transformation in nursing education. Web.

Scott, G., Springfield, E. P., & Coldrey, N. (2004). A pharmacognostical of 26 South African plant species used as traditional medicines. Phamaceutical Biology, 42(3), 186-213.

South African Nursing Council. (2011). Mission of South African Nursing Council. Web.

WHO. (2011). South Africa: health profile. Web.

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