Introduction

South Africa’s Constitution guarantees every person the right to have access to health care, to sufficient food and water and to social security. It also requires the state to take reasonable measures, within available resources, to progressively realise these rights.

Yet, persistent systemic failures continue to limit access to essential services. For this reason, the FW de Klerk Foundation’s latest Human Rights Report Card rated the enjoyment of these socio‑economic rights as very poor and continuing to deteriorate.

Inaccessible Healthcare

South Africa’s healthcare system continues to face serious strain. The National Health Insurance Act, 2023, (which is not yet operational) aims to provide Universal Health Coverage so that no one is denied care because of socio‑economic status. It proposes a single public fund to meet the health needs of the entire population. However, serious concerns over its constitutionality, feasibility and viability have result in it facing numerous legal challenges.

The country also faces a shortage of more than 2 200 ambulances. Mpumalanga, with a population of nearly 5 million people, only has 72 ambulances. Patients have reportedly died waiting for help. The ambulance shortage leads to preventable deaths.

In Gauteng, roughly 3 000 cancer patients had to go to court, after going without treatment for three years at Charlotte Maxeke Johannesburg Academic Hospital and Steve Biko Academic Hospital. Importantly, this happened despite the hospitals receiving ring‑fenced funding for this purpose.

Food Insecurity and Vulnerability

Food security for South Africans has improved slightly, but one in ten children still go to bed hungry. Stunting affects roughly a quarter of children under five. In the Eastern Cape at least 70 children died from severe acute malnutrition between January and July 2025.

Not a Drop to Drink

South Africa’s water systems show clear signs of collapse and chronic neglect. Public protests erupted in places like Westbury and Coronationville. The Auditor-General of South Africa’s first consolidated water sector audit report found, amongst other things, that 46% of municipalities had unsafe drinking water and 99% of wastewater treatment discharged sewage did not meet legal standards. This creates serious risks for public health, agriculture and the environment.

Social Security Gaps

Social grants remain a lifeline for millions. Yet thousands of beneficiaries experienced payment issues or unexplained suspensions, creating uncertainty for families who depend on these grants. The Report Card also points out a widening structural imbalance: The number of social grant recipients, estimated at 28 million, far exceeds the number of taxpayers, which is only about 7,8 million. To cover the gap between shrinking revenue and rising social spending, the government relies on borrowing roughly 22 cents of every rand raised in revenue, more than the budget for health, police or basic education. The need for faster and broader job creation has never been more urgent.

Conclusion

Without urgent, sustained action, millions of South Africans will continue to struggle to access healthcare, food, water and social security. The failure to meet these basic needs undermines dignity, deepens inequality and weakens the foundations of our constitutional democracy.