Regressive realisation of the right to access health care services in South Africa High-res version

The South African Constitution is often referred to as ‘the foremost law of our land’.  It is a very important document because all SA legislation is drawn from the Constitution.  The objective of our legislation is to promote realisation of the human rights stipulated in the Constitution.  When it comes to health care, the Bill of Rights says that: “Everyone has the right to have access to health care services, including reproductive health care”.  This seems straight forward.  But you have to read on a few lines to find both the crux of this argument, and the caveat to realising this right.

Resources and Relaisation

The crux of the argument is that the state must realise the right to access health services progressively.  I think we’d all agree that this makes sense.  Healthcare comes at a cost and a new government needs time to find sufficient funds.  The caveat to this section states that realisation of rights need only take place within the resource pool available to the state.  Many NB people whom I’ve discussed this with say that the state often uses the concept of limited resources as an ‘escape clause’ to justify the non-realisation of human rights.

The reality

Working in SA health sector, what I see on a daily basis is in fact much more worrying than a simple lack of resources (some of which may be attributed to corruption – a topic not for this post).  It seems to me that we are in fact seeing ‘regressive realisation’ of the right to access health care in South Africa.  A colleague and I recently discussed this dire state of affairs in this article related to the provision of dialysis services.  We note that since the advent of democracy, the number of dialysis facilities available to wealthier private patients grew by 3820%.  The number of state facilities available to the rest of the population only grew by 8%.  However, the number of people accessing private healthcare in 1994 is about the same as now.  Whereas the number of people accessing state healthcare has grown from 31.7 million in 1994 to 47.9 million in 2017.  This is a population growth of 33%.  We would expect to see at least this same rate of growth in the number of dialysis facilities available to state patients, as this would at least be maintaining the status quo (though certainly not progressive realisation).


More and more often, patients are being turned away from state healthcare facilities in SA.  And dialysis is not the only example of regressive realisation.  Look at the sad state of oncology in KwaZulu-Natal, where all state-based oncologists resigned.  Look at the Life Esidimeni Scandal.  This is coupled with hellishly long waiting lists for investigations or surgery at hospitals (where patients die waiting for treatment), lack of drugs and (understandably) low morale amongst many healthcare staff.


Regressive realisation of the right to access healthcare in South Africa is undeniable, and unconstitutional.  I hope there is a committed human rights organisation out there willing to take up the baton, and take this matter to court.


The views published in this blog are entirely my own (informed) opinions.  They are open to debate, discussion and disagreement.