Module 3

About the Eastern Cape

About seven million people live in the Eastern Cape, representing 16% (third largest) of the South African population. The non-urban population amounts to nearly 4,100,000, located in dense concentrations of rural and peri-urban settlements. 

The Eastern Cape is located on the east coast of South Africa between the Western Cape and KwaZulu-Natal provinces. Inland, it borders the Northern Cape and Free State provinces, as well as Lesotho. The region boasts remarkable natural diversity, from the desert of the Karoo, to the forests of the Wild Coast and the Qoboqobo Valley under Intaba ka Ndoda, to the fertile land of the Langkloof up to the citrus farms along Sunday’s River, and the mountainous southern region on Iintaba Zokhahlamba. The Eastern Cape’s main feature is its spectacular coastline stretching from eMampondweni to the Kouga area and westwards. 

The beauty of nature does not exist outside human interaction and the stories told of these interactions.  The interaction of indigenous people of the Khoi to Nguni (amaXhosa) people, the invasion of colonialists, and the political and social movement struggles for survival over centuries. The people in this part of the world are attached to their land and nature; they are known for their clicks in tongue, song, and dance of umngqungqo accompanied by musical instruments.

Below is a map of the key towns, a map of the district and local municipalities:

The Eastern Cape continues to be one of the provinces with the highest levels of poverty, underdeveloped infrastructure, backlogs and unemployment.  Historically this is because it contained two former homelands, Ciskei and Transkei – the apartheid government’s legal deportation of black communities into deprivation. Today, the failures reside in poor governance and corruption.

The Eastern Cape represents amongst the worst marginalisation and exclusion of rural communities. It is the province that contains a relatively large number of the most deprived districts and displays the most vulnerable communities in South Africa. It surfaces the SSDOH in a way that is unimaginable for those living comfortably and protected by their class, race and location.

Sometimes the Eastern Cape is spoken of as experiencing it’s ‘second round’ of  exclusion, following on from the historical marginalisation of communities under conditions of colonial segregation, and apartheid capitalism, and now neoliberal capitalism.

The Eastern Cape demonstrates the absence of Section 27 of the Constitution being upheld in any meaningful way – the right of “everyone to have access to health care services” and the duty on the government to “progressively realise” this right. In 2013/14 the Treatment Action Campaign (TAC) and Section 27 released a very grim report on the collapse of the Health System in the  Eastern Cape. Titled ‘’Death and Dying in the Eastern Cape” it chronicled the scale of the health system crisis in the Eastern Cape and its adverse impact on patients and health providers: redacted.pdf.

Marije Versteeg, the former Director of the Rural Health Advocacy Project (RHAP), sets this out well in her argument on how rural areas in the Eastern Cape are more deeply affected by the problems of the public health care system in the province. She observes (2013):

“Of the 10 most deprived districts in South Africa, three are rural districts based in the Eastern Cape: Chris Hani, OR Tambo and Alfred Nzo districts. A failing healthcare system compounds the many socio-economic hardships these communities face on a daily basis, such as high rates of unemployment, lack of clean water and sanitation, inadequate education, and poor nutrition. What makes the failing healthcare system for all residents of the Eastern Cape a double disgrace for its rural people, are two fundamental barriers to care: The difficulties in accessing public health care in the first place, and the challenges to bring people back into the system after service failures have driven them away, and the lack of healthcare alternatives.”

A few statistics on the Eastern Cape. 

  1. Where the Xhosa, Dutch and British had their first encounters, leading to frequent clashes with the colonial empires.
  2. The poorest province in the country in terms of GDP per capita.
  3. The province where it is estimated that over 72% of its population lives below the poverty line
  4. The province where more than half of poor households in rural areas have no access to piped water, electricity and health-care facilities. 
  5. The province with the highest youth unemployment rate in the country, with the expanded unemployment rate for Quarter 1 in 2022 (including those who have given up looking for work) for youth between the ages of 15 and 24 at 80.7%, and for those aged 25 to 34, at 62.7%.
  6. A province where the agricultural sector plays a crucial role in the economy, including through providing employment and livelihoods.
  7. The province that has the highest rate of permanent out-migration of any province in the country.
  8. The province cited as having the highest level of food insecurity at 36.2% of the population.
  9. The province with the widest coverage of social assistance in the country, receiving the highest disbursements for Child Support and Old Age Grants.
  10. The province where 63% of the province scored a rank of 1 (most deprived) in the SA Index of Multiple Deprivation study
  11. The Province demonstrating increasing maternal mortality – with deaths occurring in health facilities only—in the Eastern Cape deaths having tripled from 45.9 deaths per 100,000 live births in 1998 to 138.7 in 2007.
  12. The province that accounts for 45% of schools in the country which rely solely on pit latrine toilets.