REPUBLIC OF SOUTH AFRICA COMBINED SECOND PERIODIC REPORT UNDER THE AFRICAN CHARTER ON HUMAN AND PEOPLE`S RIGHTS and INITIAL REPORT UNDER THE PROTOCOL TO THE AFRICAN CHARTER ON THE RIGHTS OF WOMEN IN AFRICA Article 16: Right to health (including the right to food and water and sanitation) Measures to improve the provision of health care services 168 272. The right to have access to health care, food and water are enshrined in section 27 of the Constitution.168 South Africa's health system consists of a large public sector and a smaller but fast growing private sector. Health care in South Africa varies from the most basic primary health care, offered free by the state, to highly specialised, hi-tech health services available in the both the public and private sector. 273. While the state contributes about 40% of all expenditure on health, the public health sector is under pressure to deliver services to about 80% of the population. The private sector, on the other hand, is run largely on commercial lines and caters to middle- and high-income earners who tend to be members of medical aid schemes. It also attracts most of the country's health professionals. The situation is compounded by public health challenges, including the burden of diseases such as HIV and tuberculosis (TB), and a shortage of key medical personnel. 274. However, government is responding with a far-reaching reform plan to revitalise and restructure the South African health care system, including:  Fast-tracking the implementation of a National Health Insurance scheme, which will eventually cover all South Africans.  Strengthening the fight against HIV and TB, non-communicable diseases, as well as injury and violence.  Improving human-resource management at state hospitals and strengthening coordination between the public and private health sector.  Deploying health teams to communities and schools.  Regulating costs to make health care affordable to all.  Increasing life expectancy from 56.5 years in 2009 to 58.5 years in 2014. 275. Before South Africa's first democratic elections, hospitals were assigned to particular racial groups and most were concentrated in white areas. With 14 different health departments, the system was characterized by fragmentation and duplication. Transformation is now under fully under way. 276. The Department of Health holds overall responsibility for health care, with a specific responsibility for the public sector. Provincial health departments provide and manage comprehensive health services, via a district-based, public health-care model. Local hospital management has delegated authority over operational issues, such as the S 27 “(1) Everyone has the right to have access to – (a) health care services, including reproductive health care; (b) sufficient food and water; and (c) …” 80