This chapter seeks to introduce the topic of accessing health care services in
townships, using the case study of Bram Fischerville, will give an outline of the problem
statement as well as the structure of this report.
1.1. Introduction
The post-Apartheid government had made strides to promote land redistribution in
terms of the Reconstruction and Development Programme (RDP1
) which was
implemented in 1994. According to Todes et al (2015) the redistribution mechanism
was focused on the provision of housing for the previously disadvantaged, especially
the non-white citizens who were considered to be low income earners (earning a
monthly income of R3 500 or less), as well as the delivery of basic services such as
water, electricity and sanitation. The RDP houses provided were to help redress the
land issue in the country as well as to promote secure land tenure through free-hold
tenure for the previously disadvantaged among other major goals.
Housing policy and programmes adopted principles from the RDP programme such
as understanding housing as a basic need. For example, the Housing White Paper of
1994 gave its interpretation of “adequate housing” as a basic need through its vision
that housing is a:
viable, socially and economically integrated communities, situated in areas allowing
convenient access to economic opportunities as well as health, educational and social
amenities, within which all South Africa's people will have access to:
o A permanent residential structure and with secure tenure, ensuring privacy and
providing adequate protection against the elements; and
o Potable water, adequate sanitary facilities including waste disposal and
domestic electricity supply. (Department of Housing, 1994, p. 12 in
Huchzermeyer, 2011).
In order to implement and deliver on the above vision there was financial assistance
through a capital subsidy. The subsidy initially delivered houses which were said to have fallen short of what could be deemed as a dignified house, especially with
regards to size and privacy (Huchzermeyer, 2011).
The initial RDP house underwent various changes, especially with regards to an
increase in size as well as internally subdivision of the structure. However, what
became prevalent in most of the RDP housing developments was the replication of
Apartheid spatial layouts such as distant locations, insufficient delivery of services and
facilities such as schools and places of employment, a characteristic which a number
of scholars were scrutinising and critical of (Govender, 2011; Poulsen, 2010). This
distant location was argued to be due to limited access to cheaper land which was
closer to urban centres (Turok and Borel-Saladin, 2015).
From this vision, the notion of “adequate housing” would further promote settlements
that offered a range of amenities and facilities although it fell short and rather focused
on only the delivery of houses. This background thus sheds light on why the provision
of health services is considered in relation to settlements, with a particular focus to
post-apartheid low income settlements. This background then leads to the introduction
of this research, accessing health care services in townships.
In 2004, the housing policy and programme was then revised through the introduction
of the Breaking New Grounds (BNG) programme. This programme intended to
address the loopholes of former housing policies in terms of new settlement
developments. This new programme aimed to promote settlements that were
integrated, that promoted social and economic infrastructure and facilities as well as
to offer mixed use developments (Govender, 2011; Department of Housing, 2004).
In the midst of such strides and developments within the housing policy sphere, there
still exist housing settlements that lack basic social facilities, physical infrastructure
and are located on urban peripheries, further from economic opportunities. However,
many of these settlements are still residential areas of the growing urban population
as they offer cheaper rental accommodation, mainly through backyarding and offer
better access to transportation modes and other vital urban services that are in limited
availability in “informal” settlements (Todes et al, 2015). Hence these new settlements
could be deemed to be experiencing better living conditions than “informal”
settlements (Todes et al, 2015). According to Gardner (2015), what has characterised
these housing developments has been the promotion of sprawl which is due to their
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peripheral locations, increasing densities as well as the under development of public
infrastructure.
Theoretically, housing or housing developments offer access to better economic
opportunities, social infrastructure and other public and private facilities (Turok and
Borel-Saladin, 2015). This can be argued to be offered to some extent in post1994 low
income housing development, especially with regards to the improvement of access
to public services such as water and sanitation, especially in the South African context.
However, some of these settlements do not seem to anticipate the amount of growth
in terms of population which could take place over a period of time, especially
population growth through “informal” mechanisms such as backyarding. According to
Turok and Borel-Saladin (2015), the “informal” housing trend has been a growing
phenomenon in townships where township densities are increasing due to lower rental
rates and offerings of better and affordable services such as water, electricity and
sanitation.