The politics of exclusion: Health policy in South Africa, 1910-1990

The problems with the South African health system in the early 1990s is remarkably similar to the problems documented by the Gluckman Commission in 1944. Although the nature of the problems and potential solutions were known to successive Governments, political and economic imperatives resulted in the death of the more progressive recommendations of the Gluckman Commission and its successors.;This tragic story of health policy development in South Africa is captured in the following anecdote. In 1960 Gluckman wrote to George Gale to ask the latter's opinion on how he should respond to journalists who requested his (Gluckman's) response to the Government's appointment of the Snyman Commission of Inquiry into the High Cost of Medicine. Gale wrote back to Gluckman suggesting that he advise the Government to read the 1944 Report of the Gluckman Commission! Almost thirty-four years later, the author was a member of a group of health professionals who were mandated to create a macro health plan for the province of KwaZulu-Natal when one member of the group suggested that we revisit Gluckman's 1944 Report.;Commentators have described the South African health system as two tiered, i.e., composed of a public health system and a parallel private health system. In addition it has been the common wisdom that it was the policy of successive governments to increase the size of the private sector and decrease the public health sector. This dissertation, illustrates that both the description of the health system and the description of the health policy of successive governments are simplistic.;In attempting to understand the development of health policy in South Africa the roles played by various sectors of society were explored. While the State/Government was understood to be the mechanism through which legislation was passed and distribution of social goods were achieved, these activities occurred within a context. This context was the political economy of the country.;The neo-marxist approach adopted in this dissertation provides a broad framework within which one can begin to understand the roles played by a variety of forces in society in shaping health policy in South Africa. Specifically, the roles played by capital and its allies on the one hand and the black working class and its allies on the other were focussed on.;The analysis in this dissertation, it is hoped, would help in understanding the current health system in South Africa and provide valuable insights into what opportunities for change exist in the 'new' South Africa.