The South African healthcare system: a goal of quality healthcare for all

Abstract

The South African healthcare system has been evolving over the last four centuries. Prior to the arrival of Dutch colonialists en route to India via the Cape, the local population, i.e., the Khoisan and Africans, relied on indigenous healthcare. Even today, many continue to use this system. Jan van Riebeeck arrived in the Cape in 1652, carrying in his three ships sick, hungry, and poor Dutch sailors. The Dutch East India Company, an organization he served as an administrator, required him to establish a food station and medical care for the crew as well as other settlers. Van Riebeeck, a medical doctor turned merchant who brought white settlers to South Africa, converted his house into a hospital to care for the sick, using Dutch medically trained surgeon-merchants. This hospital was later used not only by settlers, but also by local people. This was the beginning of western medicine in South Africa, which also made great efforts to subordinate indigenous medicine. With trade between the East and Europe via the Cape growing, diseases came. One that played a pivotal role in formalizing medical care in South Africa was the smallpox epidemic of 1713, which brought by sailors who arrived from India with infected clothes to be washed by local people, the Khoisan. The disease spread and killed one-fourth of the European settlers and decimated the Khoisan workers. With increased demand for healthcare due to smallpox, health services were restricted to whites. Another smallpox outbreak that occurred in 1751 further decimated the local and the European population. The 1755 smallpox epidemic brought by a ship from Ceylon (now Sri Lanka) was responsible for racial segregation in healthcare, only providing care according to one's skin color.