As of 1992, the South African government increased its spending in the public and private sectors of health care. South Africa's governmental policy has been directed toward a more streamlined and equitable public health service to bridge the country's social and ideological divisions. Emphasis on better health care resulted in numerous projects to expand and modernize existing hospitals and clinics, as well as build new ones. There was also emphasis on preventive health care, as well as a greater demand for laboratory analysis and therapeutic equipment and disposables. Most electronic and high-tech equipment is imported. Provincial administrations maintain most major hospitals and receive subsidies from the national government. Hospital care is free for those unable to bear the costs, but medical treatment is generally conducted on a private basis.
About 80% of doctors take care of urban citizens. Large sectors of the population live in conditions nearer to those of a developing country. In 1990, there were 684 hospitals, with Baragwanath Hospital near Johannesburg the largest in southern Africa (nearly 3,000 beds). In 1989, there were 143,519 hospital beds (4.8 per 1,000 people). The nurse to doctor ratio in 1990–97 was 4.5, and in 1996, the population per physician was 1,673. As of 1999, there were an estimated 0.6 physicians per 1,000 people. Chains of independent hospitals have been established. As of 1999 total health care expenditure was estimated at 7.2% of GDP.
There are medical schools at the universities of Cape Town, Stellenbosch, Witwatersrand, Pretoria, Natal, and the Orange Free State. Between 1959 and 1994, most black medical students attended the medical school at the University of Natal. In addition, the Medical University of Southern Africa (near Pretoria) was opened for black students in 1978. Following the introduction of democracy in 1994, the government sought to reverse the discrimination against blacks by building 780 community clinics by the year 2000. However, the money to fund these clinics comea from the medical school budgets funded publicly. The South African Institute for Medical Research in Johannesburg is well known for its studies of silicosis and other diseases to which mine workers are subject.
The HIV/AIDS epidemic in South Africa is among the worst in the world. At the end of 2001 the number of people living with HIV/AIDS was estimated at 5 million (including 20% of the adult population) and deaths from AIDS that year were estimated at 360,000. HIV prevalence in 1999 was 19.9 per 100 adults. An increasing percentage of those infected are infants and young children and it is estimated that nearly one-fourth of pregnant women are HIV positive, although the rate of infection varies widely among provinces. In some hospitals more than one-third of the beds are occupied by AIDS patients.
Aside from HIV/AIDS, other prevalent infectious diseases reported in South Africa include tuberculosis, measles, typhoid, malaria, and viral hepatitis. By 1990, leprosy had been reduced to less than 1 per 100,000, but malaria and tuberculosis still cause serious problems. About 52% of the male and 16% of the female populations over age 15 smoked in 1995. Between 1983 and 1992, there were about 15,000 deaths due to political and ethnic violence.
As of 2002, the crude birth rate and overall mortality rate were estimated at, respectively, 20.6 and 18.9 per 1,000 people. Average life expectancy was 48 years in 2000. Infant mortality in 2000 was 63 per 1,000 live births and the maternal mortality rate in 1995 was estimated at 340 per 100,000 live births. Children up to one year of age were immunized in 1997 against tuberculosis, 95%; diphtheria, pertussis, and tetanus, 73%; polio, 73%; and measles, 76%.