Does the country have a public long-term care system? If so, please provide a description of its coverage: is it universal, or residual? What are potential barriers to access? | South Africa Does the country have a public long-term care system? If so, please provide a description of its coverage: is it universal, or residual? What are potential barriers to access? | South Africa

14 Jun 2022

Yes.  South Africa provides old-age pensions to individuals who are financially needy (WHO, 2017).  All older persons are entitled to free primary healthcare, while access to hospital care is only free for those who do not have the means to pay for these services – including long term care services such as residential care services. Long-term care in South Africa reflects the legacy of Apartheid whereby availability and access to residential care services (usually in the more affluent, urban areas) cater primarily for the older white population, while promoting family care for black South Africans and positioning care for the older persons as primarily a family responsibility (Lloyd-Sherlock, 2019a).

Long-term care services in South Africa are characterised with much variation in services available between the public and private sector. The South African government funds public long-term care for older persons, for which the majority of care is through residential facilities (WHO, 2017). Public services cater only for a small portion of the older population and are largely confined to urban areas (WHO, 2017). Persons who seek residential care, need to undergo a rigorous assessment process in which only those eligible will be admitted (i.e., frail and destitute). Demand for these services is beyond what the public sector can cater for and long waiting lists are significant barriers for eligible individuals accessing long-term care (WHO, 2017). Private care limits access to services for those who can afford it, and as a typical feature of the private sector in South Africa, it is expensive and inaccessible to most South Africans. Another barrier refers to the lack of training among nurses at primary healthcare level that undermines an integrated health and social care system for older persons, especially in rural areas (Lloyd-Sherlock, 2019a).

All registered facilities can apply for subsidies for individual residents, with eligibility restricted to the frail and destitute (South African Government, 2019). Reductions in subsidy amounts paid out by the Department of Social Development have in itself become a barrier to care as they have led facilities to fail to provide services for the poor and frail individuals (who are eligible), while opting to admit more wealthier persons (who are able and can pay themselves) (Lloyd-Sherlock, 2019a). Currently DSD subsidies cover 51.9% of costs of care for frail care, with non-profit organisations left to cover the remaining costs amounting to R3800 per person (TAFTA, 2019b).

Furthermore, historical racial discriminatory practices and cultural preferences in admissions restrict racial transformation and the care of all population groups at facilities. An audit of residential care homes in 2010 revealed that: (1) Only 4% of residents across 405 homes were black; (2) 10 homes physically separated residents between white and black with clear evidence that residents were not receiving the same standard quality of care; (3) in some instances family members threatened to remove older persons should homes be integrated; and (4) that there were evidence of very little sensitivity and knowledge displayed of different religions and cultural practices (e.g., language and food preferences) (Department of Social Development, 2010; Lloyd-Sherlock, 2019a; WHO, 2017).


Department of Social Development. (2010). Audit of Residential Facilities. April, 1–87. Available from: https://social.un.org/ageing-working-group/documents/FINAL%20REPORT%20DSD%20Audit%20of%20Residential%20Facilities%20April2010.pdf

Lloyd-Sherlock, P. (2019a). Long-term Care for Older People in South Africa: The Enduring Legacies of Apartheid and HIV/AIDS. Journal of Social Policy, 48(1), 147–167. https://doi.org/10.1017/S0047279418000326

South African Government. (2019). Old age pension. 1–7. http://www.services.gov.za/services/content/Home/ServicesForPeople/Socialbenefits/oldagegrant/en_ZA#Cost

TAFTA. (2019b). The Care “Gap.” https://www.gov.za/services/retirement-and-old-age/admission-older-persons-residential-facilities

WHO. (2017). Towards long-term care systems in sub_Saharan Africa: WHO series on long-term care on healthy ageing. Available from: https://www.who.int/publications/i/item/9789241513388