Wits public health professor and former Gauteng MEC of health Laetitia Rispel has written about why South Africa's health system underperforms despite the country spending 8% of its gross domestic product on health.
Rispel's research was published in the 2016 edition of the SA Health Review. South Africa's spending on health compares with that of Brazil, but with less favourable results and fewer health workers.
While Rispel praises the health minister as "charismatic" and says the department is full of competent hard-working staff, she says there is a "failure of leadership and incompetence at all levels of the health system exacerbated by a general lack of accountability".
Regulatory bodies such as the Nursing Council and Health Professions Council are in disarray, while the Council for Medical Schemes has no permanent head.
Rispel points to a 2009 study that concluded South Africa had 10 health departments - a national one and nine provincial departments - as opposed to "one strong national health system". This remains today.