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Government, Health and Social Services

white figure, Social grants, contagious diseases, Social welfare services, great differences

The right to adequate health care has been enshrined in the constitution, but provision represents a major challenge. Private health facilities can meet the demands of those who can afford to pay, although the cost of hospitalization, treatment, and medical aid subscriptions is soaring. For the majority who cannot afford to pay, current government plans emphasize primary health care that provides a comprehensive package of health care services. Payment for treatment in provincial hospitals is based on a patientís financial means. A proposed national health insurance program is being developed for the first time. Since 1994 free health treatment has been available to children under six years old and some mothers before and after birth.

The countryís infant mortality rate was categorized by the United Nations (UN) in 1991 as twice the rate expected for a country with South Africaís level of income. In 2002 the rate was 62 deaths per 1,000 live births, but this figure conceals great differences between racial groups because the white figure is less than one-fifth the national average.

Tuberculosis (TB) is currently the most prevalent disease in South Africa, followed by malaria and measles. Much of the black and Coloured population suffers high incidences of TB, measles, and other infectious and contagious diseases such as gastroenteritis and respiratory infections. Malaria is endemic in the low-altitude areas of Northern Province, Mpumalanga, and eastern KwaZulu-Natal. For whites the main causes of death are stroke, heart disease, and cancer. Acquired immunodeficiency syndrome (AIDS) threatens to become a problem of epidemic proportions. In 1999 an estimated 4,200,000South Africans were infected with the human immunodeficiency virus (HIV) that causes AIDS.

Social welfare services are provided by government agencies and the private sector, sometimes working in cooperation. Private sector initiatives like Operation Hunger and child welfare societies make a major contribution. The government proposes to create a more integrated welfare system that will harness state and private sector resources more effectively. It is committed to affirmative action to address inherited racial inequalities. Children are a particular focus, with programs under way to resolve the plight of homeless street children and legislate against child abuse and child labor.

Social grants and allowances, including retirement pensions, cost the state around $4 billion from 1995 to 1996, and were paid out to 3 million recipients. Although the levels of such payments are low, those receiving pensions often support dependents who are unemployed and have no other means of support.

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