Part II. Health and economic context

This overview of South Africa’s demographic profile, economic development and health system provides the context in which to view the situation of antibiotic access and resistance. It presents information on national health policy and governance, infrastructure and human resources. The presence and utilisation of these features within the health system are discussed in relation to access to essential medicines, with a particular focus on antibiotics. Demographics and economy Demographic and social context With an estimated population of 49.9 million, South Africa is a nation of diverse cultures, languages and religious beliefs. 1 Approximately 61% of the population live in urban areas (2008) compared with the regional urbanisation levels of 37%. The median age is a relatively young 24 years (2008), similar to that of other middle-income countries such as Mexico (26) and Brazil (29). Population growth has declined, dropping from 2.4% in 1994 to 1.06% in 2009. This reflects the decreasing total fertility rate in the country, which went from 6.7 births per woman in the late 1960s to about 2.4 in 2010, and was among the lowest total fertility rates reported for the whole of sub-Saharan Africa. Decreasing fertility levels are also mirrored in the age profile of the population. Unlike most countries in the region, South Africa faces a high ageing index, defined as the number of people aged 65 and over per 100 youths under the age of 15. The index varies considerably, however, when disaggregated by population group: it is highest among whites, moderate among Indians and lowest among the black population. South Africa instituted a ‘no-fee’ school system in the last decade. As a result, the percentage of adults without any schooling has dramatically fallen from 18% in 2001 to 7% in 2010. There remains, however, a high degree of inequality in access to education by region and racial group. Housing conditions vary as well. Although 83% of households are connected to electricity nationally, households relying on wood or paraffin remain high in Limpopo (54%) and the Eastern Cape (41%). Most households have access to piped water, with the national average at 89% in 2009. The Eastern Cape, however, lags with only 75% access. Economic context South Africa has achieved a high level of economic stability since the transition to a constitutional democracy in 1994. It has the largest economy in Africa, contributing 40% of the continent’s gross domestic product (GDP) and exerting significant influence on trade and investment on the continent. 2