Insufficient Community Health Care Centres: A Nightmare of Poor Black Women in South Africa


Mental health care is regarded and treated as a luxury service for poor black communities in South Africa –and it simply does not exist. The understanding that black communities are primarily suffering from mental health disorders escapes the South African health care policy makers. They do not grasp that comprehensive health care, constituted of mental and physical wellbeing is essential and primary to education for poor communities.

And mental health care is an essential in health care but a non-existent service in all black communities. Ironically, poverty begins with the state of the mind before it manifests as a physical reality. Arguably, black communities are poor because they lack the essential service of mental health care.

A comprehensive health care system of a country is an essential asset for economic development and growth –and for nation building. A healthy population thrive on creative imagination, expansive vision and a desire to build healthy communities –with originality and selflessness. Even by the stretch of the imagination, it is inconceivable that a healthy population can be dependent on the state or be criminally inclined and ridden by corruption, unemployment and poverty. These are qualities of a mentally unhealthy nation. Mentally healthy people are active citizens who focus their energies on creating and maintaining physically healthy communities. Their physical environments are a reflection of the state of their mental health and self-imagination –and by that logic, they invest in them. And a comprehensive health care system will at least consist of both mental and physical care.

A country that wants to create a thriving economy and build a happy nation has to prioritise, and primarily, invest in a comprehensive health care system for all its citizens. To create a thriving economy and build a happy nation rest on mental health care as a prioritised public good. A privatised mental health care, like higher education, is exclusionary and result in the creation and perpetuation of Karl Marx’s dialectical social classes. This is because it all begins in the mind, and a healthy mind disposition has to be the priority.

In its historical, and particularly post-apartheid economic and political development, South Africa adopted and maintained a gendered, racially biased, class creating and perpetuating mixed economic system. Over time, the system changed heavily towards market orientation with the GEAR policies, and eventually, a patrimonial system as things stand. With the 2017 poverty data release, by Statistics South Africa, that thirty million South Africans live in extreme poverty, the country’s mental health underdevelopment trajectory show that the country is in a dreadful state –and alarming unemployment and crime statistics support this view.

The historical ‘whites only’ policies were designed and rested on the backward twisting of the natural functioning of the mental abilities and capabilities of the black nation. Its architect, Hendrik Verwoed, was a psychology professor, who went to Germany to study psychology during the time Adolf Hitler was crafting his Nazi government campaign. He then proceeded to the United States of America during the period when black Americans were fighting for civil rights, under the administration of the Republican president, Calvin Coolidge. By this time, W.E.B Du Boise had written and published his book, The Souls of Black Folk, in 1903. In it, he argued that the challenge of the 20th century was the creation and institutionalisation of racial policies. And he subsequently became a civil rights activist advocating for the inclusion ofblack Americans in American civil liberties.

Hendrik Verwoed was aware of the economic challenges faced by Germans and white Americans during these times. Germanswere being prepared for a Nazi government while white Americans were developing and implementing racial extermination policies. As a psychology professor from Stellenbosch University, Verwoed studied and emulated them, and drafted his own separate development policies in South Africa. The apartheid government survived as long as it did, largely, because of the success of the psychologically implemented separate development policies of Hendrik Verwoed.

Logically then, it would take psychologically designed policies to reverse the mental retardation created by Hendrik Verwoed’s policies on black people. This was and still is the complete failure of the African National Congress’s administrations to date. From the late Nelson Mandela to President Jacob Zuma, policies have primarily focused on the material conditions than the mental retardation black people are suffering from, created by the apartheid policies of Verwoed and his successors. And black women are the most affected of black people as we still remain the most marginalised group in our society.

Mental retardation is an environmental condition illness that causes people to behave outside of their natural character. Criminal, alcohol dependency and other social conditions, for example, are consequences of mental retardation, arguably, caused by extreme material and other deprivations. To improve the conditions then, one has to look at the policies causing the material deprivation suffered by the people.

However, with paternalistic policies, and a racially maintained and patriarchal society, poor black women are kept on a raw end of a now collapsing political economy. Each day we suffer multiple blows with each collapsing institution in the economic and governance systems. Primarily, insufficiently serviced community health care centres are institutions through which black women remain in seriously compromised socio-political and economic conditions. The community health centres in South Africa do not have psychological and psychiatric personnel and services for black communities. As the ANC administrations have failed to recognise this dire need as a primary driving force in the material deprivation of black people, they continue neglecting the need for an institutionalisation of mental health care in black communities. As a result, black women continue to carry the burned of the effects of the mental retardation in the black communities. The burden is supposed to trickle down to the community health care centres, if, they were comprehensively conceptualised and established. But they are solely focused on physical well-being even as they are failing in adequately providing it.

As things stand, the South African government does not regard mental health care as an essential service needed in poor black communities although history shows otherwise. The community health care centres’ focus on the physical wellness only is misplaced and need to be corrected if there should be improvement in the living conditions of black women and communities.

And the government will have to revise the country’s health policies and consider this reality to truly effect change for black women. When people are sick, they cannot attend to their activities with clear minds. The apparent lack of education in black communities is founded on the deteriorating mental health conditions suffered by black people. And primarily, black communities suffer from mental health conditions that disable the majority black communities from imagining different and improved living conditions.

Lindiswa Jan Researcher & Masters Candidate Department of Social Anthropology University of Cape Town