Social exclusion is a dynamic, multi-dimensional phenomenon. Driven by unequal power relationships, it works to exclude groups of people in particular contexts from engaging fully in community or social life. Many of South Africa's post-apartheid policies and programmes have been directed at correcting historical injustices responsible for social exclusion, yet inequalities remain rampant.Based on a review of local and international literature on the social determinants of health and on interviews with key individuals in civil society, academics and senior officials in national ministries, this study explores factors that enable or constrain the implementation of policies and programmes that address social exclusion.Three government programmes were investigated and analysed in detail: free health care, child support grants and the Gauteng Bana Pele (Children First) Programme. The insightful analysis and clear recommendations presented here are of particular interest to social scientists, international agencies and government ministries whose work concerns health equity.This study was done under the auspices of the World Health Organization's Commission on Social Determinants of Health, as part of the Social Exclusion Knowledge Network (SEKN). The research was conducted by the Social Aspects of HIV/AIDS and Health research programme of the Human Sciences Research Council.
Dr Laetitia Rispel is currently with the Centre for Health Policy in the School of Public Health at the University of the Witwatersrand. Boitumelo Molomo is a former intern in the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council. She is currently with ESKOM. Sellinah Dumela is a former Research Manager in the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council. She is currently with the Limpopo Department of Health.
The global and national context - global response to health inequities, South African case study, country profile; the current context - aims and methodology, aims and focus, methodology; social exclusion - constructs and policies - constructs of social exclusion, affected groups, the impact of social exclusion, social inclusion policies; appraising South African policies - free healthcare, cash transfers and support grants, bana pele, summary.