New Histories of South Africa's Apartheid-Era Bantustans

Shireen Ally, Arianna Lissoni

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351970686
• Edition: 1
• Topic: History
• Subtopic: World History
• Index: History

The bantustans – or 'homelands' – were created by South Africa's apartheid regime as ethnically-defined territories for Africans. Granted self-governing and 'independent' status by Pretoria, they aimed to deflect the demands for full political representation by black South Africans and were shunned by the anti-apartheid movement. In 1972, Steve Biko wrote that 'politically, the bantustans are the greatest single fraud ever invented by white politicians'. With the end of apartheid and the first democratic elections of 1994, the bantustans formally ceased to exist, but their legacies remain inscribed in South Africa's contemporary social, cultural, political, and economic landscape. While the older literature on the bantustans has tended to focus on their repressive role and political illegitimacy, this edited volume offers new approaches to the histories and afterlives of the former bantustans in South Africa by a new generation of scholars. This book was originally published as various special issues of the South African Historical Journal.

‘The Bandwagon of Golden Opportunities’? Healthcare in South Africa’s Bantustan Periphery

ANNE DIGBY

Oxford Brookes University, Oxford, UK

ABSTRACT

The article discusses the aspirations and achievements of 10 Bantustan departments of health in trying to develop integrated district healthcare for their African populations from the 1970s to 1990s. These aimed to prioritise preventive and promotive rather than curative medicine, and to decentralise healthcare in an expanding network of clinics. The departments were both helped and hindered in their innovative work by their relationship with South Africa which, whilst aiding them with resources, at the same time caused growing problems because of a migrant labour system in which many people worked in South Africa but were forced to reside in the Bantustans. In addition the article suggests that, within a wider South African context, Bantustan healthcare provided a hidden link between the progressive but abortive proposals for a national health service proposed in the Gluckman Report (1944) and attempts by the democratic government half a century later to provide a district system of primary healthcare.

Reluctance to give political or moral legitimacy to Bantustans, more particularly in the immediate post-apartheid years, has restricted the scope of academic analysis, with recent work focusing mainly on political or socio-economic aspects of their origins, character and legacy.¹ A cohesive analytical focus on Bantustan healthcare has been rare.² But re-historicizing the homelands is now beginning.³ Within this context the article argues that re-centring attention on medicine in such marginal terrain is worthwhile in leading to new knowledge and insights because – despite impoverishment and underdevelopment – innovative, integrated healthcare policies were attempted in the Bantustans from the 1970s to the 1990s. Through extending the boundary of public services into remote, rural areas and focusing on primary healthcare (PHC), efforts were made to develop comprehensive services similar to those later pursued by the ANC government after 1994.

This article discusses both the ambitious aspirations and the more limited achievements of these largely forgotten policies and places them within the wider framework of evolving healthcare in South Africa. Historians have been reluctant to use Bantustan-generated sources because of anxiety over both omissions and self-promoting bias. Used with critical discrimination, however, these sources can give coverage within acceptable limits of credibility to defined areas such as policy intention. In addition, whilst Bantustan health reports might be assumed to be less reliable on delivery failure, their extensive discussion of key aspects – such as chronic medical shortage or deficiencies in infrastructure – indicated an unexpected degree of self-criticism, and so have also been utilised below. Other sources have been employed as a ‘reality check’ in assessing the Bantustans’ record of healthcare, including post-apartheid financial audits, as well as independent verification of such important topics as clinics and health workers. Statistical information given by the South African Institute of Race Relations (SAIRR) Reports has been used as the key source for tables on institutional growth and disease, whilst figures on comparative expenditure draw on research at the Health Economics Unit of the University of Cape Town.

Context

Bantustans in the Republic of South Africa (RSA) arose from the National Party government’s grand apartheid policy of transforming the old African Reserves (the only places where Africans could own land) into ‘homelands’ for people of different African ethnicities. The Promotion of Bantu Self-Government Act (1959) aimed to create a governmental structure of institutionalised ethnicity based on these Bantustans. Ten so-called ‘homelands’ were set up, of which four allegedly became ‘self-governing’ or ‘independent territories’ (see Table 1). The Bantustans comprised about 13 per cent of RSA and formed a broken geographical chain of 91 blocks of territory stretching from the Northern Cape, through the Transvaal, Zululand and Natal to the Transkei and Ciskei. Nearly seven out of a total of 15 million Africans lived there in 1970, and this had swelled to almost 13 million by 1985.⁴ This growth was caused both by natural increase and by the RSA’s policies of forced removal, resettlement and territorial consolidation.⁵ The density of Bantustan population – already three and a half times greater than that of South Africa in 1970 – thus became ever larger.⁶ In his definitive study of apartheid, David Welsh has assessed as ‘chimerical’ the apartheid vision that poor and dependent ‘homelands’ ‘could be translated into viable, credible and legitimate’ states, concluding that they were dumping grounds for RSA’s surplus labour, and dormitories for labour migrants.⁷ In creating colonial labour reservoirs for the settler economy South Africa thrust on to Bantustan health and social welfare departments the responsibility for ameliorating its outcomes in deprivation and ill health. And, as Anthony Zwi has convincingly suggested, the ‘homelands’ enabled Pretoria to manipulate health statistics so that it appeared that health in the RSA was improving.⁸

All Bantustan Departments of Health and Social Welfare aimed to implement comprehensive, integrated healthcare based on health wards delivering community-based services. In key respects these decentralised services – prioritising preventive and promotive medicine – gave new life to policies advocated in South Africa’s National Health Services Commission Report of 1944, under the chairmanships of Henry Gluckman, which had advocated social medicine in an integrate...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Citation Information
• Notes on Contributors
• Preface: ‘Let’s Talk About Bantustans’
• Introduction – Beyond ‘Homelands’: Some Ideas about the History of African Rural Areas in South Africa
• 1. ‘The Bandwagon of Golden Opportunities’? Healthcare in South Africa’s Bantustan Periphery
• 2. The Renewal of Community Health under the KwaZulu ‘Homeland’ Government
• 3. Bantustan Education History: The ‘Progressivism’ of Bophutatswana’s Primary Education Upgrade Programme (PEUP), 1979–1988
• 4. Witchcraft and the South African Bantustans: Evidence from Bushbuckridge
• 5. Ethnic Separatism or Cultural Preservation? Ndebele Radio under Apartheid, 1983–1994
• 6. Rural Reggae: The Politics of Performance in the Former ‘Homeland’ of Venda
• 7. Bophuthatswana and the North-West Province: From Pan-Tswanaism to Mineral-Based Ethnic Assertiveness
• 8. ‘If you are hungry, and a man promises you mealies, will you not follow him?’ South African Swazi Ethnic Nationalism, 1931–1986
• 9. South Africa’s Bantustans and the Dynamics of ‘Decolonisation’: Reflections on Writing Histories of the Homelands
• 10. Autobiography of an Underground Political Activist
• 11. KaNgwane: A Life in and Beyond
• 12. Bophuthatswana and the North-West Province: The Role of the Joint Administrators
• Index