Perspectives on surgery in the new South Africa.

Radical changes have occurred in the health care system since the democratization of South Africa in 1994, with the emphasis on improving previously neglected community-based primary health care. Because of the resultant financial constraints, funding of tertiary academic centers has been drastically cut which has compromised their proud record of service, teaching, and research excellence. Tertiary surgery has been particularly affected and now lags in the acquisition of new technologies which form an integral part of teaching and modern day practice. The acute shortage of full-time surgeons in regional public hospitals has prompted the government to fill vacancies with surgeons from foreign countries. In stark contrast, an abundance of surgeons in the relatively small private sector enjoy the benefits of the very best of First World medicine. The ultimate goal is a seamless progression of effective health care at all levels. It behooves the main role players to ensure that the high standard of training of South African doctors, which has international recognition, is maintained during this transition period.