There are substantial differences in the equity of health services in South Africa, by race, geographic distribution and between the private and public sectors. Despite this, research indicates that there has been progress in several areas. These are some of the findings of the 1998 South African Health Review, an annual publication of the Health Systems Trust, which seeks to provide a comprehensive, authoritative and independent review of South Africa’s health system. Although only part of the publication focuses directly on Pharmacy, it is surely important that pharmacists increasingly see themselves as one cog in the whole health system, and a publication such as this serves to place several of the components in context of the bigger picture of health care delivery. Another important issue is to understand the successes and problems of both the private and public sectors, as neither is actually independent of each other, and better health care can only be achieved through co-operation between the sectors, as well as between different health care professionals.

The full text of the publication, and the associated research technical reports is available from the HST web site: http://hst.org.za/sahr

In 1998 the greatest inequity remains the difference between those who predominantly use private sector health care and those who do not. Just under one fifth of South Africa’s population belong to a medical aid scheme, yet this group has access to 85% of pharmacists and 60% of medical specialists working in South Africa.

With regard to the distribution of health sector personnel, disparities tend to occur between the more urbanised and historically better funded provinces and those which are predominantly rural. For example Gauteng has 2000 people to every pharmacist while the comparable figure in the Northern Province is 16000.

A survey of 294 clinics and 84 regional and district hospitals provides information about service delivery and indicates the variations that exist between provinces and between rural and urban facilities. While 100% of clinics in the Northern Cape have all TB drugs available this is true for only 20% of clinics in the Northern Province.

A quick search on Medline ( http://www.ncbi.nlm.nih.gov/PubMed/ ) reveals that equity is a key issue in the USA and UK too, for example the article "An examination of the concept of equity and the implications for health policy if equity is re-asserted as one of the key government objectives for the National Health Service." In J Nurs Manag 1998 Jul;6(4):215-21.

One should be careful not too confuse "equity" with "equality" as a press article about the SAHR has in the title - http://www.inc.co.za/online/star/headlines/1999/01/290199/healthcare.html .

HealthLink maintains a page on health legislation that attempts to provide links to the full text of all major legislation affecting health, and commentary documentation thereon. You can find it from http://www.healthlink.org.za   under "Info Resources". Note also the new Government web site ( http://www.gov.za ) and new Parliament site ( http://www.parliament.gov.za ) that have some information on the health department and a very good interface to most legislative material.

The PHILA program of the NPPHCN has commentaries on health legislation (including for example the SAMMDRA bill) at http://www.healthlink.org.za/pphc/phila/

• SA has a shortage of pharmacists compared to the WHO recommendations
• The greatest inequity is between the public and private sectors