From Friendly Society to Compulsory Medical Aid Association: the history of medical aid provision in South Africa in the public sector, 1905-70

"The provision of medical benefits developed as a function of mutual benefit associations operating on an informal basis amongst people of restricted financial means. In South Africa the frequent operation of ‘friendly societies’ led to legislation to regulate their actions in the Cape Colony. By the end of the Anglo Boer War, the British occupation of the former Boer republics led to the establishment of British administration in the areas and soon other social structures associated with it. One of them was the Civil Servants’ Medical Benefit Association (CSMBA), which was the first such formal medical benefit society in the Transvaal. This society moulded its operation on the example of earlier friendly societies and extended its membership amongst civil servants until it could lobby government to introduce a compulsory medical benefit association for civil servants. The CSMBA (with an changed name - Public Servants Medical Aid Association - PSMAA) became the first compulsory medical aid society in South Africa. This paper explores the incentives towards the establishment of such a medical benefit association, its operations and organisation in comparison to similar associations in other British colonies and late the British Commonwealth. How was provision made for medical needs as part of social security provision in colonial societies of the early twentieth century? South Africa was leading other members of the Commonwealth with respect to the payment of pension in the 1940’s, but how did it compare with other Commonwealth nations with respect to the provision of medical security?"