Upon coming to power in 1994, South Africa’s first postapartheid government
launched its ambitious Reconstruction and Development Programme with several major
primary health care initiatives. Two years later, it adopted a macroeconomic policy
that put neoliberal reforms ahead of redistributive goals. Based on ethnographic
research in one urban health district, this article examines the consequences of
this discordant national policy configuration as manifested in the micropolitics of
four community clinics. The article examines contrasting experiences of
desegregation in two formerly ‘White’ facilities, and
contrasting community responses to two newly built township clinics. The article
finds that, in general, South Africa’s neoliberal shift undermined its
health policy objectives. However, in exceptional cases where strong nurse
leadership combined with relatively uncontentious local class relations, some
community clinics did succeed in becoming sites for the local pursuit of health and
development goals.
African National Congress
(1994) A National Health Plan for South Africa.
Johannesburg: African National Congress
.
2.
Beinart, William
(1994) Twentieth-Century South Africa.
Oxford and New York: Oxford University Press
.
3.
Bond, Patrick
(2000a) Cities of Gold, Townships of Coal: Essays on South
Africa’s New Urban Crisis.
Trenton, NJ, and Asmara, Eritrea: Africa World
Press, Inc.
4.
Bond, Patrick
(2000b) Elite Transition: From Apartheid to Neoliberalism in
South Africa.
London: Pluto Press
.
5.
Bonner, Philip L.
,
Peter Delius
and
Deborah Posel
(1993) ‘The Shaping of Apartheid: Contradiction,
Continuity, and Popular Struggle’, in
P.L. Bonner
,
P. Delius
and
D. Posel
(eds) Apartheid’s Genesis, 1935-1962, pp.
1-41.
Johannesburg: Ravan Press
.
6.
Brodwin, Paul E.
(1997)
‘Politics, Practical Logic, and Primary Health Care in Rural Haiti’
, Medical Anthropology Quarterly11(1):
69-88
.
7.
Crankshaw, Owen
(1993)
‘Squatting, Apartheid and Urbanisation on the Southern Witwatersrand’
, African Affairs92(366):
31-51
.
8.
Delius, Peter
and
Clive Glaser
(2002)
‘Sexual Socialisation in South Africa: A Historical Perspective’
, African Studies61(1):
27-54
.
9.
Department of Health
(1997)
‘White Paper for the Transformation of the Health System in South Africa’
, Government Gazette383(17910): notice 667.
10.
Department of Health
(2000) Primary Health Care Progress Report.
Pretoria: Republic of South Africa
.
11.
Desai, Ashwin
(2002) We are the Poors: Community Struggles in
Post-Apartheid South Africa.
New York: Monthly Review Press
.
12.
Donahue, John M.
(1989)
‘International Organizations, Health Services, and Nation
Building in Nicaragua’
, Medical Anthropology Quarterly3(3):
258-269
.
13.
du Toit, Andries
(1993)
‘The Micro-Politics of Paternalism: The Discourses of Management
and Resistance on South African Fruit and Wine Farms’
, Journal of Southern African Studies19(2):
314-336
.
14.
Evian, Clive R.
(1986) ‘A Rural Primary Health Care Nurse
Training Program in South Africa’, in
Committee for Health in Southern Africa
(ed.) Health Activism in Southern Africa: Nurses and Primary Health
Care. Proceedings of the First Workshop of the Project on Poverty, Health and
the State in Southern Africa, November 1985.
New York: Institute of African Studies,
Columbia University
.
15.
Foucault, Michel
(1978) The History of Sexuality: An Introduction,
1st American edn, vol. 1.
New York: Pantheon Books
.
16.
Frederickson, George M.
(1981) White Supremacy: A Comparative Study in American and
South African History.
Oxford and New York: Oxford University Press
.
17.
Green, Linda Buckley
(1989)
‘Consensus and Coercion: Primary Health Care and the Guatemalan State’
, Medical Anthropology Quarterly3(3):
246-257
.
18.
Gwagwa, Thembeka
and
June Webber
(1995)
‘Striking Nurses: Trapped in Frustration’
, South African Labor Bulletin19(6):
79-82
.
19.
Habib, Adam
and
Vishnu Padayachee
(2000)
‘Economic Policy and Power Relations in South Africa’s
Transition to Democracy’
, World Development28(2):
245-263
.
20.
Harrison, David
, ed. (1995) South African Health Review 1995.
Durban: Health Systems Trust
.
21.
Harrison, David
,
Peter Barron
and
Jane Edwards
, eds (1996) South African Health Review 1996.
Durban: Health Systems Trust and the Henry J.
Kaiser Family Foundation
.
22.
Jewkes, Rachel
,
Naeemah Abrahams
and
Zodumo Mvo
(1998)
‘Why do Nurses Abuse Patients? Reflections from South African
Obstetric Services’
, Social Science and Medicine47(11):
1781-1795
.
23.
Johnson, Krista
(2003)
‘Liberal or Liberation Framework? The Contradictions of ANC Rule
in South Africa’
, Journal of Contemporary African Studies21(2):
321-340
.
24.
Khalfani, Akil Kokayi
and
Tukufu Zuberi
(2001)
‘Racial Classification and the Modern Census in South Africa, 1911-1996’
, Race and Society4:
161-176
.
25.
Kuper, Hilda
(1965) ‘Nurses’, in
L. Kuper
(ed.) An African Bourgeoisie: Race, Class, and Politics in South
Africa.
New Haven, CT and London: Yale University Press
.
26.
Lodge, Tom
(2002) Politics in South Africa: From Mandela to Mbeki.
Bloomington and Indianapolis: Indiana
University Press
.
27.
McIntyre, Diane
and
Lucy Gilson
(2002)
‘Putting Equity in Health Back onto the Social Policy Agenda:
Experience from South Africa’
, Social Science and Medicine54:
1637-1656
.
28.
Marks, Shula
(1993) ‘The Nursing Profession and the Making of
Apartheid’, in
P.L. Bonner
,
P. Delius
and
D. Posel
(eds) Apartheid’s Genesis: 1935-1962.
Johannesburg: Ravan Press
.
29.
Marks, Shula
(1994) Divided Sisterhood: Race, Class and Gender in the
South African Nursing Profession.
New York: St Martin’s Press
.
30.
Mashabela, Harry
(1988) Townships of the PWV.
Braamfontein: South African Institute of Race Relations
.
31.
Morgan, Lynn M.
(1989a)
‘The Importance of the State in Primary Health Care Initiatives’
, Medical Anthropology Quarterly3(3):
227-231
.
32.
Morgan, Lynn M.
(1989b)
‘“Political Will” and Community Participation
in Costa Rica Primary Health Care’
, Medical Anthropology Quarterly3(3):
232-245
.
33.
Morgan, Lynn M.
(1993) Community Participation in Health: The Politics of
Primary Care in Costa Rica. Cambridge Studies in Medical Anthropology.
New York: Cambridge University Press
.
34.
Municipal Demarcation Board
(2003) ‘Municipal Profiles’,
Municipal Demarcation Board, URL (consulted 20 Jan. 2004): www.demarcation.org.za
35.
Nattrass, Nicoli
(2001)
‘High Productivity Now: A Critical Review of South
Africa’s Growth Strategy’
, Transformation45:
1-24
.
36.
Office of the President
(1994)
‘White Paper on Reconstruction and Development’
, Government Gazette353(16085).
37.
Packard, Randall M.
(1989a)
‘The “Healthy Reserve” and the
“Dressed Native”: Discourses on Black Health and the
Language of Legitimation in South Africa’
, American Ethnologist16(4):
686-703
.
38.
Packard, Randall M.
(1989b) White Plague, Black Labor: Tuberculosis and the
Political Economy of Health and Disease in South Africa. Comparative Studies of
Health Systems and Medical Care.
Berkeley and Los Angeles: University of
California Press
.
39.
Pelupessy, Wim
and
J.C. Slabbert Tielman
(2001)
‘Creating Jobs in South African Townships’
, Africa Insight31(4):
34-42
.
40.
Posel, Deborah
(2001)
‘Race as Common Sense: Racial Classification in Twentieth-Century
South Africa’
, African Studies Review44(2):
87-113
.
41.
Price, Max
(1986)
‘Health Care as an Instrument of Apartheid Policy in South Africa’
, Health Policy and Planning1(2):
158-170
.
42.
Rispel, Laetitia
and
Helen Schneider
(1991)
‘Professionalization of South African Nursing: Who Benefits?’
, International Journal of Health Services21:
109-126
.
43.
Rosenthal, Tanya
(1997) ‘Steel in South Africa:
ISCOR’, in
N.S. Jennings
(ed.) Steel in the New Millennium: Nine Case Studies, Working
Paper SAP 2.62/WP.112, Sectoral Activities Programme Working Papers.
Geneva: International Labor Office
.
44.
Smith, Laila
(2004)
‘The Murky Waters of the Second Wave of Neoliberalism:
Corporatization as a Service Delivery Model in CapeTown’
, Geoforum35:
375-393
.
45.
Sparks, Allister
(2003) Beyond the Miracle: Inside the New South Africa.
Chicago, IL: University of Chicago Press
.
46.
Statistics South Africa
(1998a)
‘1996 Population Census: Emfuleni District (GT421) and Midvaal
District (GT422)’
, Statistics South Africa. URL (consulted 24 March 2005): www.statssa.gov.za/census01/census96
47.
Statistics South Africa (1998b) The People of South Africa: Population
Census 1996, Census in Brief. Pretoria: Statistics South Africa
Report No. 03-01-11 [1996]. Statistics South Africa (2003) ‘2001
Population Census: Emfuleni District (GT421) and Midvaal District
(GT422)’, Statistics South Africa. URL (consulted 27 March 2005): www.statssa.gov.za/census2001/digiAtlas/index.html
48.
Stevens, Lucy
and
Stephen Rule
(1999)
‘Moving to an Informal Settlement: The Gauteng Experience’
, South African Geographical Journal81(3):
107-118
.
49.
Susser, Mervyn
(1993)
‘A South African Odyssey in Community Health: A Memoir of the
Impact of the Teachings of Sidney Kark’
, American Journal of Public Health83(7):
1039-1042
.
50.
Susser, Mervyn
and
V.P. Cherry
(1982)
‘Health and Health Care under Apartheid’
, Journal of Public Health Policy12:
455-475
.
51.
Suttner, Raymond
(2003)
‘Culture(s) of the African National Congress of South Africa:
Imprint of Exile Experiences’
, Journal of Contemporary African Studies21(2):
303-320
.
52.
Tollman, Steve M.
(1994)
‘The Pholela Health Centre: The Origins of Community-Oriented
Primary Health Care (COPC)’
, South African Medical Journal84(10):
653-658
.
53.
Urban Dynamics Vaal
and
Emendo
(1997) The Composite Land Development Objectives for the
Lekoa Vaal Region.
Vanderbijlpark: Urban Dynamics Vaal and Emendo
.
54.
van Rensburg, H.C.J.
and
A. Fourie
(1994)
‘Inequalities in South African Health Care’
, South African Medical Journal84:
95-99
.
55.
Walker, Liz
and
Lucy Gilson
(2004)
‘“We are Bitter But We are Satisfied”: Nurses
as Street-Level Bureaucrats in South Africa’
, Social Science and Medicine59:
1251-1261
.
56.
Webber, June (1999) ‘Fragmented, Frustrated and Trapped: Nurses in
Post-Apartheid Transition at King Edward VIII Hospital, Durban’,
unpublished PhD thesis, University of Natal.
57.
Weeks, John
(1999)
‘Stuck in Low GEAR? Macroeconomic Policy in South Africa, 1996-1998’
, Cambridge Journal of Economics23(6):
795-811
.
58.
Yach, Derek
and
Steve M. Tollman
(1993)
‘Public Health Initiatives in South Africa in the 1940s and
1950s: Lessons for a Post-Apartheid Era’
, American Journal of Public Health83(7):
1043-1050
.
