'Vision and Vested Interests': National Health Service Reform in South Africa and Britain during the 1940s and Beyond

Digby, Anne

doi:10.1093/shm/hkn061

Cited by 8 publications

(18 citation statements)

References 4 publications

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“…The Gluckman report acknowledged that the proposals "may, perhaps be described as revolutionary for those who look to tradition and precedent as their guide" while the Beveridge report stated that "a revolutionary moment in the world's history is a time for revolutions, not for patching" [57]. 5 Thus, when Gluckman was appointed Minister of Health in 1945 [54,58] health system transformation may well have seemed, if not inevitable, imminently possible. However, unlike in Britain, a host of factors conspired to prevent health system transformation in South Africa.…”

Section: S and 1950s: Health System Reform Is Nearly Achieved But Pre...mentioning

confidence: 99%

“…With the poor black majority unjustly disenfranchised, those who stood to gain the most from the implementation of the NHS lacked political power to vote for it [58]. The death of Gluckman's successor, Minister Stals, intensified government opposition to the health centre concept [37,54]. Most health centres were closed or converted to curative, outpatient departments [37].…”

Section: S and 1950s: Health System Reform Is Nearly Achieved But Pre...mentioning

confidence: 99%

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A socio-political history of South Africa’s National Health Insurance

Whyle,

Olivier

2023

Preprint

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Background. Spurred by the WHO’s endorsement of universal health coverage as a universal goal of health systems, many countries are undertaking health financing reforms. The nature of these reforms, and the policy processes by which they are achieved, will depend on context-specific factors, including the history of reform efforts and the political imperatives driving reforms. South Africa’s pursuit of universal health coverage through a National Health Insurance is the latest in a nearly 100-year history of health system reform efforts shaped by social and political realities. Methods. We conducted an interdisciplinary, retrospective literature review to explore how these reform efforts have unfolded, and been shaped by the contextual realities of the moment. We began the review by identifying peer-reviewed literature on health system reform in South Africa, and iteratively expanded the search through author tracking, citation tracking and purposeful searches for material on particular events or processes referenced in the initial body of evidence. Data was extracted and organised chronologically into nine periods. Results. The analysis suggests that in South Africa politics; the power of the private sector; competing policy priorities and budgetary constraints; and ideas, values and ideologies have been particularly important in constraining, and sometimes spurring, health system reform efforts. Political transitions and pressures, including the introduction of apartheid in 1948, anti-apartheid opposition, the transition to democracy, and corruption and governance failures, have alternately created political imperatives for reform, and constrained reform efforts. In addition, the country’s political history has given rise to dominant ideas, values and ideologies that imbue health system reform with a particular social meaning. While these ideas and values increase opposition and complicate reform efforts, they also help to expose the inequities of the current system as problematic and re-emphasise the need for reform. Conclusion. Ultimately, this analysis demonstrates the context-specific nature of health system reform processes and the influence of history on what sorts of reforms are politically feasible and socially acceptable, even in the context of a global push for universal health coverage.

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Section: S and 1950s: Health System Reform Is Nearly Achieved But Pre...mentioning

confidence: 99%

Section: S and 1950s: Health System Reform Is Nearly Achieved But Pre...mentioning

confidence: 99%

A socio-political history of South Africa’s National Health Insurance

Whyle,

Olivier

2023

Preprint

View full text Add to dashboard Cite

show abstract

“…These also raised important issues about the terms on which doctors provided service in hospitals, and on patients' free choice of doctor. 123 Some practitioners magnified these provincial ordinances as constituting a watershed between a free, liberal profession and a publicly-controlled, socialised one. 124 In the face of the magnitude of these projected post-war changes the earlier progressive stance of the profession towards healthcare reforms waned.…”

Section: From Idealistic Recommendations To Practical Outcomesmentioning

confidence: 99%

Evidence, Encounters and Effects of South Africa's Reforming Gluckman National Health Services Commission, 1942–1944

Digby

2012

South African Historical Journal

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The progressive recommendations of the National Health Service Commission of 1942Á1944 have attracted historical attention but the three and a half million words of evidence given to it have hardly done so. This article reviews this testimony, which gave unrivalled detail on the fragmented state of South Africa's healthcare structures and on the variety of its personnel. In addition it supplied insights into social attitudes and prejudices related to health and medicine in a racially segregated society on the eve of apartheid. The paper analyses the problems that this ground-breaking commission encountered, and explores whether there were 'lions in the way' of its reforms, as was suggested in an encounter with an influential witness. The article probes whether there was a tangential relationship between the evidence, and the commission's conclusions on new health centres as the basis of a radical new national health system. In evaluating whether these reforms were stultified by the election of an apartheid government in 1948 (as others have argued), it concludes that the Gluckman recommendations had already failed before this because they ignored political and professional interest groups. The article also assesses reasons for the contrast between the commission's grandiose recommendations and its modest effects.

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“…Britain's landmark Beveridge report -which described a 'radical,' 'utopian,' and 'visionary' plan for the introduction of a universal [8] welfare state funded through general taxation -was released in 1942 to euphoric popular reception, and prompted global interest in welfare state-building, including in South Africa [41,54,55]. Gluckman was appointed as chair of the o cial National Health Services Commission, which released a detailed report on the potential for a state-run health service in South African in 1944 [53].…”

Section: Introductionmentioning

confidence: 99%

A socio-political history of the South African National Health Insurance

Whyle

Olivier

2023

Preprint

View full text Add to dashboard Cite

Background Health policy processes are invariably shaped by social, political and historical realities. Spurred by the WHO’s endorsement of universal health coverage as a universal health system goal, many countries are undertaking health financing reforms. The nature of these reforms and the process by which they are achieved will depend on context-specific factors, including the history of reform efforts and the political imperatives driving contemporary reforms. South Africa’s pursuit of universal health coverage through a National Health Insurance is the latest in a nearly 100-year history of health system reform efforts shaped by social and political realities. Methods We conducted an interdisciplinary, retrospective literature review to develop an account of how health system reform efforts have unfolded, shaped by the contextual realities of the moment. We began the review by identifying peer-reviewed literature on health system reform in South Africa and iteratively expanded the search through author tracking, citation tracking and purposeful searches for material on particular events or processes referenced in the initial body of evidence. Data was extracted and organised chronologically into nine periods. Results The analysis suggests that in South Africa politics; the power of the private sector; competing policy priorities and budgetary constraints; and ideas, values and ideologies have been particularly important in constraining, and sometimes spurring, health system reform efforts. Political transitions and pressures, including the introduction of apartheid in 1948, anti-apartheid opposition, the transition to democracy, and corruption and governance failures, have alternately created political imperatives for reform, and constrained reform efforts. In addition, the country’s political history has given rise to dominant ideas, values and ideologies that imbue health system reform with a particular social meaning. While these ideas and values increase opposition and complicate reform efforts, they also help to expose the inequities of the current system as problematic and re-emphasise the need for reform. Conclusions Ultimately, this analysis demonstrates the context-specific nature of health system reform processes and the influence of history on what sorts of reforms are politically feasible and socially acceptable. In addition, the analysis reveals the value of a historical perspective to understanding the challenges facing contemporary reforms.

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'Vision and Vested Interests': National Health Service Reform in South Africa and Britain during the 1940s and Beyond

Cited by 8 publications

References 4 publications

A socio-political history of South Africa’s National Health Insurance

A socio-political history of South Africa’s National Health Insurance

Evidence, Encounters and Effects of South Africa's Reforming Gluckman National Health Services Commission, 1942–1944

A socio-political history of the South African National Health Insurance

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