Figure 18: Trends in the under-five mortality rate in South Africa
Under-five mortality has declined dramatically over the last 30 years, with the 2020 rate at almost half of what it was in 1990. Source: MacDonnell and Low, 2019
Some researchers suggest that poorer municipalities benefited more from ART during the first five years of the roll-out, despite reports of poorer provinces lagging.83 Widespread ART availability has also been associated with larger decreases in AIDS-mortality for women than men, in part because of higher infection rates among women, but also because of poor testing and delayed health-seeking among men. ART has had a dramatic impact on recovering mortality in South Africa: between 2000-2014, ART is estimated to have saved 1.72 million lives, and 6.15 million life years.87 However, the delay in rolling out treatment constituted a devastating loss of life. Researchers suggest that as many as 8.8 million life years might have been saved if South Africa had more readily taken up WHO guidelines and moved more quickly in scaling ART uptake.87 3.3.2 Health interventions to tackle inequality and harness population dynamics People-centred, high-quality universal health coverage South Africa’s health system is starkly unequal: a small proportion (27%) of South Africans is enabled, through medical scheme contributions and those who pay out of pocket, to access expensive private healthcare services. Meanwhile, the majority (71%) is reliant on the public health system, which is notoriously under-resourced and under-staffed.88 To advance health equity, and expand access to affordable quality care, South Africa has initiated a pathway to universal health coverage. Because of the bi-directional relationship between poverty and ill-health, removing the financial burden of accessing quality care is critical to alleviating poverty and facilitating social mobility in South Africa. Universal health coverage must include: Non-judgemental, accessible sexual and reproductive health services South Africa’s population is constituted by a growing proportion of young people. Safeguarding the Sexual and Reproductive Health (SRH) rights of these young people is a prerequisite to them achieving their potential, and the country’s ability to reap the benefits of their contribution. Expanded SRH services should empower young people to make choices in their sexual lives. They should enable them to avoid, delay or space pregnancies and seek out healthcare. Young people who are empowered to stay healthy also do better in school, acquire more skills, and take on a life course that is both more productive, and more fulfilling. With expanded access to SRH, young people usually delay their first birth, and choose to have fewer children, which can contribute to a demographically induced economic upswing.89 More so, because they are more likely to stay healthy, and in school, the children they do have also inherit greater human capital.
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INEQUALITY AND DEMOGRAPHY
