South Africa


Matisetso and her daughter Mtsoaki talk with the care worker Matseleng Mofokeng. Mtsoaki is 12 years old and lives in rural Qwa Qwa. She is one of five children living with their mother, who’s suffering with AIDS-related illnesses.
Credit: Ilan Godfrey/Save the Children

In South Africa more than 2.5 million children have been orphaned by AIDS and face a future of poverty and neglect. Nearly 410,000 children under 15 are living with HIV and most can’t get the treatment they need. Many children like Mtsoaki have to become adults too early and care for their ill parents.

Save the Children’s community workers visit homes and find children who need support. We’ve identified 80,000 children living in these situations in rural Qwa Qwa alone, and are helping them by providing support networks, education, food and medicines, help to register for child-support grants, and recreational activities that, for a short time, allow them to just be children. We also work with home-based carers like Matseleng who can support people living with HIV and relieve a young carer of their responsibilities on a regular basis.

Having the support of a community-based health worker has really helped Mtsoaki. She says: “My life has changed for the better. I’ve been able to play with other children. “I am able to attend school every day. At school we get taught. After lessons, we go and eat. Once we’ve finished eating, we go back to class for more lessons. “I want to study to become a teacher. So that I can teach children who haven’t had the opportunity to go to school.”

Neonatal mortality rate  (per 1,000 live births) (2011) 19
Under-five mortality rate (per 1,000 live births) (2011) 47
Maternal mortality ratio (per 100,000 live births) (2010) 300
Number of doctors, nurses and midwives per 10,000 people (2010) 7.6
Births attended by skilled personnel (2011) n/a
Total expenditure on health as a percentage of gross domestic product (2011) 8.5%
General government expenditure on health as a percentage of total expenditure on health (2011) 47.7%

The South African health system comprises a public-private mix, characterized by entrenched maldistribution of resources, and with inefficiencies and inequities that contribute to falling short of the health MDGs. Steps have been taken to put the country on a trajectory of achieving UHC through a National Health Insurance (NHI) system. The focus on HRH has increased as part of a 2011 strategic plan, driven by the very high burden of HIV, tuberculosis and maternal and child diseases.

The ratio of nurses to physicians is above the OECD average and the percentage of female physicians is 30%. Mechanisms for accreditation, regulation and licensing of the health workforce are in place and there is some evidence of their efficiency. Despite some good progress, availability and accessibility still present challenges. Density of physicians is well below OECD standards, with a great variation in density of physicians between regions. Migration flows to high-income countries are important, partially compensated by inflows from poorer neighbouring countries. Recently these flows have been reduced significantly, especially for nurses.

Download the full country profile here.