Endurance, resistance and resilience

Lessons from patients and healthcare providers in a constrained South African health system

Despite positive developments in recent years such as better leadership and an improved response to the major challenge of HIV/AIDS and tuberculosis (TB), providers and patients alike often experience South Africa’s health system as a very constrained environment.

The issues that weigh on providers include strained relationships with their managers, too few staff, high workloads, resource shortages, dissatisfaction with how the system works, and wanting to do more to increase its responsiveness. Patients face challenges such as poor quality care, services and treatments that are unacceptable for cultural or other reasons, and negative staff attitudes.

Indeed, suspicion, blame and mistrust in the provider-patient relationships significantly constrain the functioning of the health system and make it all the more challenging to deliver the caring, efficient, effective and equitable services that so many desperately need (Figure 1).

Although there are many examples of positive provider-patient relationships, mistrust, when it occurs, can lead to negative outcomes that include a tense working environment in health facilities, as well as patients interrupting their treatment, withholding information about side effects or treatment complications, and experiencing feelings of being unwanted and less than human.

Against the backdrop of a challenged system, this brief highlights selected strategies that providers and patients use to cope with their circumstances in order to access services and provide care in a meaningful way. Click here