This study investigates whether health spending and access to services in South Africa has become more or less pro-poor over time. We find that over the post-apartheid period health spending has become significantly more pro-poor. In addition to the rising share of the health budget allocated to public clinics, there has been an increase in the share of public clinic and hospital spending going to the poor and a rising share of the health budget allocated to public clinics. In addition, between 1993 and 2008 there were improvements in both financial access to public health servicesas measured by the incidence of catastrophic costsand physical access to public health facilitiesas measured by reduced travel time. Given that substantial progress has been made with fiscal equity and access to health, problems that users complain aboutrude staff, long queues and lack of medicinehave moved higher on the policy agenda.

In order to achieve an 'optimal health system', health policies should not only be focused on the supply of health care, but also take cognisance of the demand for health care. Studies of health care demand in South Africa are scarce due to considerable data limitations. This analysis attempts to fill this gap by combining two data sets (specifically, the GHS 2004 and IES/LFS 2000) in order to be able to utilize the wealth of information regarding health care utilization in the General Household Survey. The aim is to inform and encourage debate on how to incorporate demand side considerations in order to arrive at improved public health care in South Africa. Copyright (c) 2007 The Authors; Journal compilation (c) Economic Society of South Africa 2007.

South Africa is one of the emerging market countries that have received a relatively large amount of foreign capital since the mid-2000s. In South Africa's case, these inflows were partly used to build the country's foreign exchange reserves, but more particularly to finance continued large current account deficits. During the course of the past two years, however, adverse domestic political developments, combined with the potential negative impacts of the unwinding of quantitative easing policies and the normalising of monetary policy in the United States on emerging markets in general, has raised the spectre of a sharp slowdown in foreign capital flows to South Africa and an associated reversal of the current deficit. This paper explores the potential impact of such a development on macroeconomic conditions in South Africa. The analysis consists of macroeconometric model-based alternative scenarios backed up by both the international evidence on the impact of such events and South Africa's own history. JEL Classification: F32, F41, F47, E1

Since 1994 there have been a number of radical changes in the public health care system in South Africa. Budgets have been reallocated, decision making was decentralised, the clinic network was expanded and user fees for primary health care were abolished. The paper examines how these recent changes have affected the incidence of spending and the accessibility and quality of health care.The paper finds that between 1995 and 2003 there have been advances in the pro-poor spending incidence of both clinics and hospitals. The increased share of the health budget allocated to the more pro-poor clinic services has contributed further to the improvement in the targeting of overall health spending. Also, it appears that the elimination of user fees for clinics and the expansion of the clinic network have helped to make health services more affordable and geographically accessible to the poor and were associated with a notable rise in health service utilisation for individuals in the bottom two expenditure quintiles. South Africa's spending on clinics and hospitals is well targeted and more progressive than other developing country public health systems. Unfortunately, it appears that to a considerable extent this result is driven by perceptions that services offered in public hospitals and clinics are of a low and variable quality. These perceptions seem to be encouraging most of those who can afford to pay more for health services to opt out of the public health system, thereby increasing the pro-poor incidence of public health spending. Complaints by users of public health facilities include long waiting times, staff rudeness and problems with drug availability. Dissatisfaction with health services is significantly higher in the public sector than in the private sector and the gap has expanded slightly over time. It is consequently not surprising that a substantial and increasing share of individuals -also including the very poorest -prefer to consult private providers.