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The Catholic church in Southern Africa was very slow to evangelise the indigenous peoples. The first clergy were sent out to minister mainly to the settler population, and so they remained in the settler towns and villages along the coast. It was only in the middle of the Nineteenth Century that Catholic missionaries from France, Belgium, Germany and Ireland began to move into the Interior and began evangelising work. The Oblates of Mary Immaculate, a French congregation but with a strong Irish contingent, began to preach to the Zulu and Sotho peoples, and others soon followed them. Gradually churches, schools and hospitals were built, so that by the middle of the twentieth century, there was a network of Catholic hospitals and clinics right across the country.  By 1950, there were 41 St Marys Hospital 1925. Catholic hospitals and 29 clinics in South Africa, and Catholic nurses and health professionals, mainly religious, cared for a large part of the population. In some cases, Catholic hospitals were the first health care institutions to be built, as in the case of the Johannesburg hospital, which was founded by the Holy Family sisters a few years after gold was discovered in 1886.

The Years of Apartheid 1948-1994

But there were clouds on the horizon.  In 1948 the Afrikaner National Party won the Whites-only general election, and began to implement a policy of apartheid or separation of the races.  Any institutions which catered for Black people and which were in private hands immediately came under suspicion.  By the early 1970s there was immense pressure on Catholic and other Church schools, and many of them succumbed and handed over to the government.  There was similar pressure on health institutions.  Many Catholic hospitalsForced removals under apartheid were situated in the rural areas where they served mainly Black people, and some of these areas were earmarked to become "homelands" or areas for the sole occupation of Black people of certain ethnic backgrounds.  In 1973 the government made the decision to confiscate all mission hospitals, and by 1976 this was complete.  Only one hospital, St. Mary's in Mariannhill outside Durban, survives to this day. 

Catholic hospitals in the cities too, came under pressure, but of a different kind.  Many of them served mainly the White community, but as the financial climate became more difficult, and hospitals and medicine more and more expensive to run, they too began to feel pressure.  One by one they closed, until by the 1980s there were only a handful of Catholic hospitals left in the cities as well.  It was a crisis point for Catholic health care in South Africa.

The formation of CATHCA

In this climate, Sister Shelagh Mary Waspe, Provincial of the Holy Family Congregation which ran a number of hospitals and clinics, saw the need to act.  She realised that with the declining number of religious, Catholic health care institutions would have to be run more and more by lay people.  In 1986 she began to explore the possibility of writing a constitution for one of their large hospitals and of creating a Board of Management.  Then she began to think of other hospitals, and soon a number of other Catholic hospitals in Johannesburg joined in.  The new organisation began as the Catholic hospitals and clinics Board but soon adopted the name "Catholic Health Care Association".

The first meetings were held in 1988 and soon after a Director and secretary were appointed.  The organisation ran as a very small enterprise for many years.  There still existed separately, a Catholic Nurses Guild, a Catholic Doctors Guild, and there was a Health Desk at the Catholic Bishops' Conference.

Official recognition

In 1997 the Catholic Bishops wanted to unify the Catholic health care entities.  In October of that year the Bishops asked the Catholic Health Care Association to transform itself into a national body dealing not only with rural clinics and hospitals, but also with all the health care interests of the Catholic church in South Africa.  A meeting of stake holders was held on the 12th January 1998 at which it was resolved to transform the old Catholic Health Care Association into a new body called Catholic Health Care and using the same acronym CATHCA.  A constitution was approved by the Bishops and at the Plenary session of the Bishops' Conference in January 1999 CATHCA was recognised as an Associate body of the Conferene, and as the official voice of Catholic health.

The new era: Democracy 1994

Meanwhile of course big things were happening on the political front.  In 1990 Nelson Mandela was released from prison and negotiations began towards establishing a democracy in South Africa.  On the 27th April Nelson Mandela1994 South Africans elected the first democratic government in its history, and all the old apartheid institutions were abolished.  This meant that private institutions like schools, churches and hospitals were free to operate as they had before apartheid, though by now of course many of them had ceased to exist.

The new government was faced with enormous challenges: on the fronts of health, housing, education, water, electricity, and infrastructure.  They inherited a deeply divided country, with First world standards in the cities, and abject poverty in the countryside.  They did not know how to start, and although they developed ambitious projects like the Reconstruction and Development Programme (RDP), it took them a long time to begin implementing these.  In the field of health too, they inherited a very divided system, with First world health standards in the cities, and Third world conditions in the countryside.

The Challenge of AIDSAIDS ribbon

The worst challenge was however still to come.  By 1985 it had been reported that 500 people had died of AIDS in South Africa, but since everyone was concerned with the political agenda, it was largely overlooked.  By 1990, however the situation was becoming serious, and may health organisations were beginning to mobilise.  After 1994, Nelson Mandela himself took the lead, but his Department of Health was slow to get organised.

The Church’s response too, was slow.  In 1993 there had been an AIDS office at the Bishops' Conference, but it did little apart from promoting the use of condoms.  Several abortive attempts failed.  Finally in 1999, CATHCA together with several other agencies set up the AIDS office with proper financing, and things began to move.  The AIDS office received finance from the USA and Europe and projects were soon underway.  The AIDS office now finances about 170 projects countrywide, most of them Catholic.  Most Dioceses have now created AIDS teams, with responsibility for home based care, for prevention, and for the care of orphans and vulnerable children.  Many of these are now member organisations of CATHCA, and so we work together to fight this epidemic, which affects nearly 20% of our total population.

Tim Smith