Country with High Mortality Rates: South Africa
Many countries struggle to achieve better health outcomes. Improving the health of a nation can be reflected through the reduced mortality rates, low levels of poverty, high levels of gender equality, and low disease prevalence levels among many other indicators (Skolnik, 2015). However, some countries like South Africa have the worst indicators of health. Therefore, it is of great importance to investigate various issues concerning South Africa because it has high levels of HIV/AIDS and a multiracial population. More than 6.8 million people out of its total 55.91 million live with HIV (“SA continues to monitor”, 2016). This proportion is huge for the country that comprises of more than 45 million Africans, four million whites, one million Asians, and 4.8 million other colored races (Stats SA, 2016). Given its multiracial nature, it is interesting to understand its health system, including the organizations that take active part in enhancing the education of health professionals and the overall health of locals.
South Africa is located on the tip of the African continent in the south. Its coastline stretches for more than 2,500km from the desert border with Namibia on the coast of the Atlantic Ocean southwards to the tip of the African continent; then, it stretches north to the border with the subtropical parts of Mozambique on the Indian Ocean (Tibane & Honwane, 2015). South Africa country shares borders with Botswana, Namibia, Zimbabwe, Mozambique, and finally, Swaziland (Tibane & Honwane, 2015). Lesotho is a country that is surrounded by South Africa. Chilling in winter, the Kalahari Desert and the Karoo plateau are dry and hot in summers, while the eastern part of this country experiences tropical climate, and the western part has a Mediterranean climate. The Fundudzi Lake is the only natural lake in the country; South Africa has three major rivers the Orange, Limpopo, and Vaal.
The country has a slightly higher number of females than males. Of the 55.91 million people, 28.53 million are women, and 4.47 (8%) are at least 60 years of age, while 30.1% are children below 15 years (Stats SA, 2016). At the same time, life expectancy by mid-2016 was 65.1 years for females and 59.7 years for males, with infant mortality rate of 33.7 per 1,000 live births; about 12.7% of the country’s population lived with HIV, representing a whole 7.03 million people (Stats SA, 2016). These demographic figures show that the health status of the nation is in jeopardy.
The South African government is divided into three governmental arms. The President is the head of the government, and he forms the executive arm together with the cabinet and deputy ministers (Government of South Africa, n.d.b). The other two are the legislative and the judicial arms respectively. The constitutional democracy rules it, with the national, provincial, and local government levels having their legal and executive authorities in their spheres. The Ministry of Health carries out all government health functions in the country.
The country enjoys a huge workforce between 15 and 64 years of age. This accounts for more than 65% of the population with more than half of the workforce being 25 years and below (The World Bank, 2015). Areas that power South Africa’s economy are agriculture, mining, manufacturing, construction, commerce, transport, and finance among many others. The World Bank ranks South Africa as an upper middle-income country with the second largest economy after Nigeria (SAinfo Reporter, 2015). In 2014, its GDP was $350.1-billion and with a per capita of $6 483 (SAinfo Reporter, 2015). Such a thing shows how the African economic giant thrives as compared to other countries in the continent.
State of Health (Disease/Violence/Accidents)
The health status of people in South Africa is worse because numerous diseases and other causes of death kill many people every year. The median time from the time of HIV infection to death is 11.5 years for women and 10.5 years for men, while the death crude rate is down from that of 2002, which was 12.9 deaths per 1,000 people to 9.9 death per 1,000 in 2016 (Stats SA, 2016). This shows that HIV kills men faster than women, and although mortality rate reduces, it is still high. Injuries cause more than 60,000 deaths every year, with 46% being homicides, while self-inflicted and road traffic injuries account for 9.1% and 26.7% of injury-related mortality respectively (The World Health Organization, n.d.). Therefore, homicides are the leading cause of injury deaths in South Africa followed by road accidents. However, HIV kills more people than all the injuries combined. Other common health problems that kill many people every year in the country include malaria, respiratory infections, prematurity and birth asphyxia, diarrhea, congenital abnormalities, neonatal sepsis, and many non-communicable diseases as well as cardiovascular conditions.
Traditional medicine is a deeply rooted among the South African population, especially the native blacks. It is the oldest form of health care system in the country, and it has existed as an ancient and culture-bound healing method for various diseases for many centuries (Abdullahi, 2011). Thus, herbal medicines utilized by traditional healers include herbs, finished herbal products, containing parts of plants, plant materials as active ingredients, and herbal preparations. Furthermore, the Southern Bantus of the African continent believe in the ancestors who direct and influence affairs of the living, and ill health as well as misfortunes is thought to come from ritual pollution, witchcraft, or ancestral wrath (Sobiecki, 2014). People also believe in curses as the cause of some problems brought about on some people or their families because of their evil deeds. South Africans have two types of traditional health practitioners – the diviner (Zulu isangoma) and the herbalist (Zulu inyanga) (Sobiecki, 2014). Diviners are spiritual specialists who communicate with ancestral spirits to diagnose problems of their patients before counseling, instructing on ritual ceremonies, or prescribing herbal medicine to treat the problem. Herbalists do not communicate with the spirits to diagnose but they use herbal medicines to treat illnesses.
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Healthcare System and Delivery
The healthcare system of South Africa is comprised of a large public sector, a small but fast-growing private sector, and finally, the non-governmental (NGO) sector. The state funds the public sector, with more than 40% of the health system expenditure coming from the national treasury, and 11% of the entire government budget is spent on health, which is more than the 5% GDP recommendation of the World Health Organization (Jobson, 2015). The reason for such expenditures is the significant burden posed by tuberculosis and HIV among other diseases. Additionally, the country experiences high levels of poverty and unemployment, compelling the state to bear the burden of financing the healthcare system (Jobson, 2015). The private sector comprises of private healthcare practitioners, and NGO focus mostly on HIV and tuberculosis.
Government health-related agencies and health regulatory organizations. The Ministry of Health of South Africa has a sole responsibility of regulating the health of citizens. It is aided by the legislative arm of the government that formulates the laws, through which it operates, and the Medicines Control Council (MCC), a medicine regulatory body. The MCC applies standards of the Medicines and Related Substance ACT that governs functions of manufacturing, distribution, sale, and marketing (Medicines Control Council, n.d.). The Ministry of Health regulates all areas of health provision in the country, including financing and ranking of healthcare facilities from the national to the local level (Government of South Africa, n.d.a). Therefore, the MCC and the Ministry of Health are the main government agencies influencing health care.
Healthcare personnel and hospitals. Although South Africa has many healthcare facilities, it suffers from acute shortage of both physicians and nurses. It has 5,560 dentists and 38,236 doctors with 1 doctor serving 4,219 people, which means that 23.7 physicians serve 100,000 people (Jobson, 2015). Furthermore, South Africa has 270,437 registered nurses, serving the population of 55.91 million people, meaning that around 483.7 nurses serve 100,000 people (MedicalBrief, 2016). The country has 4,200 public health facilities, 376 public hospitals, and 143 of them are located in urban places, while the remaining ones are in rural areas (Jobson, 2015). Therefore, South Africa suffers from an acute shortage of both physicians and nurses.
The nursing education system and accrediting organizations. The South African Nursing Council has the sole responsibility of accrediting nursing education institutions as well as the offered training programs. South Africa has 129 public schools of nursing education and extra 101 from the private sector (South African Nursing Council, n.d.). The Council has accredited many institutions to offer nursing education from public and private colleges and universities. It further investigates and takes legal action against the non-accredited institutions of nursing.
Nursing associations. Nurses in South Africa can join various nurse professional organizations. According to Sigma Theta Tau International (n.d.), the country has two professional nursing associations that include the DENOSA (Democratic Nursing Organization of South Africa) and the South African Society of Occupational Health Nurse Practitioners. DENOSA is the largest one, with more than 84,000 member nurses; it was created in 1996 (DENOSA, n.d.). Other than bringing unity, DENOSA advocates the rights and welfare of nurses all over the country. South African nurses are also members of the International Council of Nurses (ICN), in which DENOSA is an influential member (ICN, 2015). In fact, South Africa hosted the 2016 Annual Meeting of the ICN.
Together with international organizations, the government works hard to ensure that the health status of the country is improved. According to the Government of South Africa (n.d.a), the Department of Health has four priorities: increasing the life expectancy of people, reducing maternal-child mortality, decreasing the burden of tuberculosis and combating HIV and AIDS, and strengthening the effectiveness of the health system. Other organizations also work hard to help the government achieve its health priorities, given that mortality rates in the country are high, with many people living with HIV and AIDS, and tuberculosis. Mothers2mothers is an organization that trains South African mothers with HIV on how to prevent maternal to child transmission of this infection as well as how to live healthy lives (Rosenkranz, 2012). The Southern African AIDS Trust funds partners who work to reduce the prevalence of HIV and AIDS as well as tuberculosis to enhance programs of prevention, treatment, support, and impact mitigation among others (Rosenkranz, 2012). Therefore, the South African nation is committed to achieving its health priorities, with the government and non-governmental organizations taking the lead.
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Conclusion: Nursing Implications
The nursing profession can play a huge role in helping the country achieve its health priorities. Nurses can help increase life expectancy though offering quality care to limit hospital caused infections that kill many people. In addition, nursing professional organizations can contribute to reducing maternal-child mortality rates by encouraging the public to seek perinatal services from healthcare facilities. This can further reduce maternal to child transmission of HIV, which is a priority for the nation. Provision of quality care to different people, including primary, secondary, and tertiary prevention services are enough to realize improved health of the South African population. Therefore, nurses, together with their professional bodies, can play a huge role in the achievement of health-related goals because they are the ones who implement proper healthcare by meeting the needs of people.