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Social History of Medicine Advance Access originally published online on October 17, 2008
Social History of Medicine 2008 21(3):485-502; doi:10.1093/shm/hkn061
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© The Author 2008. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. All rights reserved.

NHS at 60: Perspectives on Health Care Systems

‘Vision and Vested Interests’: National Health Service Reform in South Africa and Britain during the 1940s and Beyond

Anne Digby*

* Centre for Health, Medicine and Society, Oxford Brookes University, Gipsy Lane, Oxford OX3 OBP, UK. E-mail: adigby{at}brookes.ac.uk


  Abstract

Both Britain and South Africa considered major health reforms during the 1940s and there was mutual interest in the ideas being generated. In South Africa, the Report of the National Health Services Commission of 1944 advocated a national health service based on health centres that would integrate curative, preventive and promotive work. Parallel with this were plans by the provinces for free hospital treatment. Scarce finance, together with political and medical vested interests, meant that the health centre ideal only survived in minor form. In Britain, a free national health service was created in 1948, in which a reformed structure of hospitals was central, and early plans for health centres were marginalised. In each country, limited financial resources and vested interests—in the form of powerful medical professional associations or (in the case of South Africa) of provincial administrations—delayed, scaled down or reshaped the original reforming vision.

Keywords: free treatment; health centre; hospital reform; national health service; medical professional association; social medicine; South Africa; Britain


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