Investigation into deaths of healthcare workers in South Africa reveals systemic problems in the healthcare system

Despite the common perception among South Africans that the public healthcare system is deteriorating, recent data suggests a more complex picture: improvements in medical capacity are evident, although problems remain unresolved.

Contrast Between Perception and Statistics

Many citizens encounter long queues, overcrowded facilities, overworked staff, and uneven service provision, leading them to believe in the continuous decline of the system. However, empirical data paints a different, more multifaceted picture.

Improvements in Medical Indicators

According to the 'Health in South Africa' report by the Inclusive Society Institute, key indicators of medical capacity have indeed increased. The number of people served by public sector doctors decreased from 4,143 in 2002 to 2,795 in 2023. Similarly, the ratio of people per nurse improved from 496 to 446 over the same period. Pharmaceutical capacity also grew significantly: the number of patients per public sector pharmacist dropped from 40,263 in 2000 to 10,436 in 2023. Furthermore, emergency services expanded, increasing from 713 ambulance providers in 2019 to 834 in 2024.

Reasons for the Feeling of Overcrowding

At first glance, these improvements are difficult to reconcile with the experiences of many patients. If the proportion of healthcare workers per capita has risen, why does the system still feel overloaded? Part of the answer lies in the significant population growth of South Africa. Since 1994, the country's population has increased by over 50%, and today every clinic, hospital, ambulance service, and healthcare worker serves a much larger population than at the beginning of the democratic era.

Limitations and Citizen Expectations

It is important to understand that simply matching capacity to population growth is not enough. Although the availability of medical personnel has improved, the country still faces serious limitations. These include immense pressure on public sector doctors, shortages and uneven distribution of nurses, and access issues in several communities. Compared to many upper-middle-income countries, South Africa is still far from solving its healthcare workforce challenges.

This explains the discrepancy between official statistics and public opinion. Patients evaluate the system not based on national averages, but on the quality of care at a specific clinic or hospital. The system may have more doctors than twenty years ago, but it can still force patients to wait for hours, and improved nurse availability may be accompanied by management issues and staff shortages in certain areas.

New Focus for the Political Agenda

The report's findings point precisely to this reality: capacity constraints have eased in various aspects but have not disappeared entirely. Progress has been made, yet the gap between the current situation and reasonable citizen expectations remains significant. This difference is critically important because it changes the direction of political discussions. If the system were collapsing, the priority would only be to stop the decline. But since the system has expanded while remaining under strain, the task becomes more complex: policymakers must continue to build capacity while simultaneously improving management, efficiency, distribution, and patient care quality.

South Africans have every right to demand better healthcare, and they must continue to do so. However, these demands must be based on an honest assessment of the country's current state. The data does not support the narrative of a 'washed out' system; rather, it points to a system that has expanded key elements of its capacity under difficult conditions but lags significantly behind citizen expectations for a country of this level of development. The problem is not that South Africa failed to build a large healthcare system, but that it needs to build a better one.

Foreign nationals were housed in camps near the Epping repatriation center in Cape Town because the closure of the facility left them without support.

Long-Term Migration Issues

South Africa has long ignored its border security. For over thirty years, the country has faced the problem of illegal immigration, forcing civil organizations to take responsibility for repatriating undocumented foreigners. This complex situation has led to criticism of South Africa at the continental level.

Societal and Governmental Reaction

By law, only government officials have the authority to enforce immigration legislation. Nevertheless, many citizens take to the streets in protest, expressing dissatisfaction with what they perceive as a crisis caused by the presence of illegal immigrants. Although vandalism is condemned, critics argue that the South African government should be held accountable for its insufficient approach over many years.

It is estimated that more than three million undocumented immigrants reside in the country due to porous borders. The government may have had the resources to deport these individuals for years, but its efforts have been inadequate given the scale of the problem, which is exacerbated by allegations of corruption in the police and the Department of Home Affairs. Only recently is it being observed that the crisis is beginning to be addressed with due urgency.

International Response and Appeals

Various nations have been forced to evacuate their citizens from South Africa under pressure from anti-immigration groups. While some countries struggle with their citizens stranded in transit camps, Ghana organized charter flights for the repatriation of its nationals. Furthermore, the West African nation advised its youth political groups to refrain from any retaliatory actions.

Recognizing the issue of illegal immigration, Ghana's Deputy Minister of Foreign Affairs, James Gyakye Kwesi, recently called on African countries to support South Africa in resolving this crisis. There are approximately 200 South African businesses and registered companies operating in Ghana. Conflict over this issue is likely to cause both countries more economic damage than benefit.

Economic Ties and the Continent's Future

Despite over 100 South African companies investing significant funds in Nigeria, the West African country threatened countermeasures against South Africans due to the consequences of immigration. Business proponents should not exchange their interests for human rights, but revenge is not the solution—much is at stake. It must be recognized that continued hostility will result in no winners.

In early 2026, South African investors invested about $1 billion in Nigeria. African governments must view the continental immigration crisis as a starting point, focusing collective efforts on finding solutions and determining necessary steps.

Many have concluded that South Africa's public healthcare system has collapsed, and this conclusion is understandable given the personal experiences of many citizens. However, available data suggests a more complex picture.

Problems and Service Reality

It cannot be argued that South Africa's healthcare system functions perfectly. In fact, the quality of services provided in many institutions remains unacceptably low. Every day, millions of South Africans face serious problems such as long waiting times, overcrowding, staff shortages, and administrative failures. At the same time, the disappointment and humiliation often accompanying such experiences cannot be underestimated.

The Difference Between Struggle and Collapse

However, there is a fundamental difference between a system that is struggling and a system that is in complete collapse. The question is not whether patients experience frustration—it is obvious that they do. The main question is whether the population's health indicators are deteriorating. On this metric, the evidence points convincingly in the opposite direction.

Significant Health Improvements

Consider the trend in child mortality over the last two decades. In 2002, approximately 57 infants died per 1,000 live births in South Africa. By 2024, this figure had dropped to less than 23. A similar trend was observed regarding the mortality of children under five: it fell from nearly 80 deaths per 1,000 live births to less than 30 over the same period. These figures reflect the survival of hundreds of thousands of children who might not have survived to adulthood a generation ago.

A similar positive trend is visible in life expectancy. At the peak of the HIV/AIDS crisis, South Africans lived and died sooner than at any point in the democratic era. In 2002, the average life expectancy was less than 55 years, whereas today it exceeds 66 years. This means that the average resident of South Africa can expect to live more than a decade longer than twenty years ago. Life expectancy is one of the most comprehensive indicators of a nation's health status, and in this aspect, South Africa has made significant progress.

Epidemic Control

Part of this can be explained by the country's response to the most serious public health challenges. For example, the number of new HIV cases decreased from over 380,000 per year at its peak in the late 2000s to approximately 142,000 in 2024, representing a decrease of more than 60%. Furthermore, tuberculosis prevalence declined after peaking at about 857 cases per 100,000 people, which was reached after rising from approximately 475 cases per 100,000 in 1990. These changes rarely become the central topic of public discussion, but they are among the most important achievements in public health during the democratic period.

The Paradox of Quality and Outcomes

Critics rightly argue that these statistics do not align with their personal experiences, pointing to overcrowded hospitals, drug shortages, and facilities that seem unable to cope with the load. They assert that patients experience healthcare through the lens of the quality of the service received, rather than through national averages and long-term trends. This observation is absolutely correct.

However, this does not negate the existing evidence. On the contrary, it highlights an important distinction: service quality and health outcomes are related, but they are not the same thing. A patient may face unacceptable waiting times in a clinic but still benefit from a system that has proven more effective in preventing child mortality than twenty years ago. A hospital may suffer from managerial failures but nevertheless contribute to increased life expectancy and improved disease outcomes. These realities do not exclude each other.

Conclusion on the Healthcare System

This may be the central paradox of South Africa's healthcare: the system delivers better results than many realize while providing a level of service that often falls short of reasonable expectations. The mistake of government supporters is focusing exclusively on positive indicators while ignoring daily patient dissatisfaction. The mistake of pessimists is concentrating only on these frustrations and neglecting the measurable improvements that have occurred over time. Neither approach serves the public interest.

Sound policy begins with accurate diagnosis. If we assume everything is collapsing, we risk missing interventions that have proven effective and abandoning approaches that have saved lives. Conversely, if we become complacent due to positive trends in some indicators, we risk entrenching an unacceptable level of service provision. The evidence points to a more nuanced conclusion: South Africa's healthcare system is under significant pressure, often inefficient, and regularly causes dissatisfaction among those who depend on it, but it is not in a state of collapse.