Table Of ContentCOMMUNITY HEALTH NEEDS IN SOUTH AFRICA
The Making of Modern Africa
Series Editors: Abebe Zegeye and John Higginson
Growth or Stagnation? South Africa heading for the year 2000
Mats Lundahl
Sudan's Predicament
Civil war displacement and ecological degradation
y
Edited by Girma Kebbede
Doctors and the State
The struggle for professional control in Zimbabwe
Dorothy Mutizwa-Mangiza
Class Formation and Civil Society: The Politics of Education in Africa
Patrick M. Boyle
The Social Services Crisis of the 1990's
Edited by Anna Kajumulo Tibaijuka
Oil and Fiscal Federalism in Nigeria
Augustine A. Ikein and Comfort Briggs-Anigboh
Environment, Health and Population Displacement
Andrew E. Collins
International Banking and Rural Development
Pade Badru
Structural Adjustment and Mass Poverty in Ghana
Kwabena Donkor
Contemporary Issues in Socio-economic Reform in Zambia
Edited by Herrick C. Mpuku and Ivan Zyuulu
The State and Organised Labour in Botswana
Monageng Mogalakwe
Community Health Needs in
South Africa
NTOMBENHLE PROTASIA KHOTI TORKINGTON
Director of The Applied Research Centre and
Executive Dean of Hope in the Community,
Liverpool Hope University College
First published 2000 by Ashgate Publishing
Reissued 2018 by Routledge
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Copyright © Ntombenhle Protasia Khoti Torkington 2000
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A Library of Congress record exists under LC control number: 00132591
ISBN 13: 978-1-138-71627-8 (hbk)
ISBN 13: 978-1-315-19713-5 (ebk)
Contents
List of Figures and Tables vi
Preface viii
Introduction xii
Submission to the Truth and Reconciliation Commission
Concerning Forced Removals xxii
Glossary xxxi
1 The Historical Development of South African Society 1
2 The Development of Health Services in South Africa 6
3 The Structure of the Present Health System 15
4 Children and Health 38
5 Women and Health 73
6 Women Making 'Herstory' 98
7 Care for Elderly People 142
8 Black People and Mental Illness 151
9 HIV/AIDS Epidemic 168
10 Care for Terminally 111 People - The Role of Hospices 176
11 The Orange Farm Study 185
12 Quantitative Research 203
13 Action Research 220
Conclusion 225
V
List of Figures and Tables
Table 2.1 Distribution of GPs in the nine 11
provinces
Table 2.2 Geographical distribution of resources in 12
the 1993-94 health budget
Table 3.1 Primary school entrants with low 15
anthropometric indices by racial groups
Table 3.2 Health personnel practising in the 27
private sector
Table 4.1 Infant mortality rate per 1000 live births 39
Table 4.2 Types of disabilities among children 61
aged between two to nine years
Table 6.1 Women's organisations in the nine 99
provinces
Table 6.2 Creches in the Vulamehlo 138
Table 11.1 Number of patients who have used 202
equipment in Dr. Nta's surgery
Figure 12.1 Age of respondents 208
Figure 12.2 Length of time waited 209
Table 12.1 Priorities in health needs 210
Figure 12.3 Employment status 215
VI
List of Figures and Tables vii
Figure 12.4 Ability to provide adequate subsistence 215
for the family
Figure 12.5 Things that would have a big impact on 216
health
Figure 12.6 What do you do when your child has 217
diarrhoea?
Figure 12.7 Where children are taken for medication when ill 218
Preface
Three weeks before I left for South Africa to undertake this research a
friend came to wish me a good and fruitful sabbatical. She asked me a
question which enabled me to voice the deep fears and anxieties I had had
since it became evident that I was going to take a year off to conduct
research on the health needs of black people in South Africa:
Last summer I cycled from John O'Groats in Scotland to Land's End in
Cornwall. I have always wanted to do this. It has been my lifelong
ambition. Before I began my journey all my friends were saying how
wonderful and exciting it was going to be and how brave I was to
undertake such a journey. I shared in the feelings of excitement they had
for me, but deep down there was the anxiety and the fear of moving from
the known to the unknown. I remained anxious even when my friends in
different parts of the country told me that they were going to come and
spend some time with me when I cycled past their localities. What about
you, how do you really feel about this project?
I admitted that underneath all the excitement and the anticipation of
doing something I have always wanted to do, there was fear and anxiety. A
number of factors contributed to my unease. South Africa is my home
country and in that sense I was not going to a totally unknown situation. I
knew for example, that I would not have major language difficulties, as I
am fluent in two African languages and can understand and can make a
good attempt at speaking a third. I am familiar with the norms and values
that permeate black culture irrespective of where one is in South Africa.
My first anxiety was around accommodation. I chose to have a base in the
University of Cape Town rather than in a Durban University, closer to my
family. Two reasons were influential in my decision. One was that I have
always wanted to visit Cape Town but had not been able to do so whilst I
lived in South Africa. Secondly, I wanted to be far enough from my family
to ensure that the temptation to see the sabbatical as a year's holiday was
minimised. I reasoned that a two-hour flight from Cape Town to Durban
was a sufficient barrier in terms of both time and expense. Nevertheless,
however valid these reasons might have been, I began to question my
viu
Preface ix
decision when four weeks before I was due to leave I had no
accommodation arranged in Cape Town. The University offered me all
academic facilities but no living quarters were available. My attempts to
find a place to live by phoning estate agencies in Cape Town were not
fruitful. This left me with a lot of anxiety.
The second anxiety was about the research itself. When asked to do a
piece of research, it is usually well defined in terms of scope and
parameters. It is true that in the life of a project one might be drawn into
areas beyond the initial boundaries because of issues that emerge in the
course of the research process, but in general, the boundaries are quite clear
in the beginning in terms of the geographical area, the groups of people to
be involved in the study and the methodologies to employ in the
investigation. With a country as big as South Africa, and a topic as wide as
health needs, anxiety is inevitable. I was excited about the opportunity to
do the work but I also found the whole thing daunting. Where do I start?
Will I be able to do it? Will people want to talk to me about their
experiences? If they do, how will the research benefit them?
A year later, I was able to report I need not have had all those anxieties
and fears, and for that I have a lot of people to thank. My accommodation
problem was resolved three days before I flew to Cape Town. A close
friend rang to inform me that she had not only found a place for me but that
she was flying from Durban to Cape Town and with my landlady, was
going to meet me at the airport.
Many other people contributed in different ways to make my sabbatical
in South Africa enjoyable and fruitful. I wish to express my heartfelt
gratitude to them all. I also want to explain that if some of the names do
not appear in the acknowledgement it is not because I do not value their
support and help, but if every name was included there would be no space
left to write anything else. Also, my use of the pronoun 'we' in some areas
reflects the strength of my feeling that this was a collective rather than an
individual project. I would like, however, to mention a few people who
played a critical role in reducing anxiety levels. I would like to thank Jane
Moores who commissioned the research, for having enough trust in me to
do the work. My many thanks to Professor Simon Lee, Rector and Chief
Executive in Liverpool Hope University College, who trusted my ability to
carry out the research and allowed me to have a year's sabbatical. My
year's absence meant that my colleagues had to subsume my duties under
their already heavy workload. I thank them all. In particular, I want to
