One of the earliest priorities of the new government of the country in 1994 was to remedy the past inequalities of healthcare delivery and also to provide much-needed institutional support for public health. The idea to create a national public health institution specifically for communicable diseases, which accounted for some 70 per cent of the health burden of sub-Saharan Africa, was first raised in 1995. Some six years later it was the establishment of the more broadly encompassing NHLS which finally enabled the creation of the NICD, in 2001. Again, meddlesome, unproductive political interference threw obstacles onto the pathway of its development.

The proposed new national health plan was contained in a document entitled ‘A National Health Plan for South Africa’ and was published in May 1994. The document set out a comprehensive health programme with the express goal of providing health benefits to all South Africans. The elements of the plan were directed at strengthening health systems over a broad spectrum of healthcare. In particular, there was a focus on redressing the past inequities of health delivery. This included the building of capacity in the health sector and improving the effectiveness and efficiency of all components of the health system for all sectors of the population. Laboratory services were singled out as being one component of healthcare delivery that needed to be remedied, as it was ‘plagued by gross fragmentation and duplication with serious disparities in laboratory service provision, especially along racial and geographic lines’. Not surprisingly, the national health plan included a section on laboratory services and called for the establishment of a national health laboratory service.

THE NATIONAL HEALTH LABORATORY SERVICE (NHLS)

Soon after April 1994, the newly appointed minister of health, Dr Nkosazana Zuma, appointed a task team under the chairmanship of Professor Jan van den Ende, previously director of the SAIMR and head of medical microbiology at the universities of the Free State and Natal, to address the challenge of establishing an effective and comprehensive national laboratory service for the country. The team was tasked with creating a plan to consolidate all public-sector medical laboratories. Following the release of the Van den Ende report, a project implementation team was created to put into effect the restructuring of the public health laboratory services of the country.