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The Church’s contribution to health care in South Africa has been enormous. In many parts of South Africa, the Catholic and other churches were the first to build hospitals and clinics and to provide modern medical care. Often that service was heroic, because of the difficulties of the environments in which these missionaries served, or because they cared for people in the front lines of violent conflict. Many times they defied the racial discrimination that was a norm in the region long even before the policy of apartheid was imposed.

In the late nineteenth century, missionaries fanned out over the subcontinent preaching the gospel to the local peoples. They built churches, schools and hospitals and clinics. Missionaries were often the first to set up hospitals long before anyone else where successive white rulers did not bother to do so. By 1950, there were 73 Catholic hospitals in South Africa, Namibia, Zimbabwe, Swaziland (now eSwatini) and Lesotho. Ten per cent of all the mission hospitals in the world were located in Southern Africa at that time. They provided not only medical services, often at nominal fees, but also trained African nurses. Over 500 African nurses were in training at several nursing colleges established by the church in 1951.

As a result, for much of the 20th century, the vast majority of South Africans received health care not from the government, but from Catholic mission hospitals—until the apartheid regime expropriated almost all of them in the 1970s. In many areas, the Catholic health mission continued with increasingly lay-run clinics.

In the 1990s, the appearance of HIV/AIDS changed the whole landscape. Suddenly the nation was faced with the most important health crisis in its history. The new government struggled to face it and to handle it and was beset by denialism and obfuscation.

Catholic clinics became again the centres of new action, and now the activity spread also into Catholic parishes, as caregivers, mostly women but also including some men, took up the challenge of caring for the sick and the orphans. Home based care became the tool with which the church tackled the problem, and together with many of the churches and with many civic groups, the Catholic church was in the forefront of the fight against AIDS.

Catholic Health Care in Southern Africa has changed in several ways over the past few decades. One trend is clear and documented: the inexorable decline of formal health care facilities controlled by Catholic institutions in the form of hospitals and clinics. These have either been taken over by the government or have been closed due to lack of funds. Patients can neither seek nor secure care in a Catholic health facility anymore. Another trend is the aging of religious health care providers, especially those whose membership is predominantly European. As members of such orders grow older and retire, the health care institutions they managed lose previously assured sources of funding and gradually reduce the scope of work before they finally close. No longer do any Catholic doctors serve institutions within the CATHCA network, with the exception of a single hospital in eSwatini. Even the number of nurses is slowly but surely dwindling. These trends started many years ago and will continue because of the reality of reducing numbers of Catholics who take up religious vocations and engage in health care.

Today, CATHCA is mostly made up of members belonging to small community-based organizations (CBOs) who provide community-based services which start and stop depending on the availability of funding. Few, if any, have any independent sources of funding. Almost all are dependent on grants from government or from national and international donors in order to function. They are skilled in providing specific services to community members which no one else provides such as home-based care and HIV counselling and adherence support. For this reason, they form the backbone of community-based health care services along with trained government community health workers. Without these cadres of grassroots workers, mortality and morbidity in South Africa would soar. Their services are increasingly appreciated and acknowledged by government, especially because access to formal health care is still quite low for the poor and marginalized.

CATHCA’s support is generally well appreciated by its members. Its periodic provincial and national conferences are appreciated by all as is the training it has provided in areas such as home-based care, Maternal and Child Health, HIV, TB and pastoral care. Much of this was made possible by grants from Catholic donors. Unfortunately, their support is slowly dwindling with some moving away from supporting health care and some away from supporting funding to South Africa which is considered better-off than other countries needing aid. This is a major risk to CATHCA since it has been reliant on funding from such Catholic donors since it was founded. Without assured funding streams, services such as capacity building for a Catholic health care network and pastoral care for health care workers, including psycho-social support, will be under threat. 

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