A lack of leadership has left South Africa's health system burdened by rampant HIV, poor maternal and child health services, and violent crime, doctors said in The Lancet.
"Although South Africa is considered a middle-income country in terms of its economy, it has health outcomes that are worse than those in many lower income countries," South African doctors said in the British medical journal.
The journal published a series of articles highlighting the challenges facing South Africa's health system, which has been transformed into a comprehensive national service 15 years after the end of apartheid.
But the country faces a collision of epidemics including AIDS and tuberculosis, as well as a high level of deadly violence and poor services for mothers and children, the articles said.
Health Minister Aaron Motsoaledi described the country's the health system as in trouble.
"Both the private and public sectors are in trouble. As government we take responsibility of the mistakes especially with regards to HIV/AIDS where wrong policies were adopted," he said at a press conference.
"However, some of the problems we have inherited from apartheid and colonialism," he added.
Motsoaledi met Monday with a team of international experts, including the articles' authors, in Johannesburg to discuss ways to battle South Africa's health challenges, which the articles blamed on weak leadership.
"Failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies," South African researchers said in one article.
Former president Thabo Mbeki for years denied the threat posed by AIDS, questioning whether HIV causes the illness and delaying the rollout of life-prolonging drugs.
Lancet editor Richard Horten said the election of President Jacob Zuma earlier this year offered an opportunity to redress the mistakes of the past.
"The catastrophic failure of previous leadership to address certain health issues has broken the trust of the South Africa public and betrayed the trust of the international medical community," he said.
The articles highlighted gaping differences in health care among South Africa's provinces, pointing to the lack of national coordination.
In the Western Cape, home to Cape Town, 80 percent of tuberculosis cases were cured in 2007. In KwaZulu-Natal, where the port city of Durban is located, the rate was as low as 40 percent.
Poor mother and child services mean South Africa was among just 12 nations that saw child mortality increase since 1990, the journal said.
AIDS remains the biggest challenge to South Africa's health system, with 5.5 million people living with HIV -- about 17 percent of the world total.
But many people with HIV also suffer from tuberculosis, while ailments like obesity, heart disease, substance abuse and anxiety and depression are also on the rise, the articles said.
South Africa's alarming crime rate poses another burden to the health system, the articles said, including the high incidence of homicide, domestic abuse and rape.
The violent death rate in South Africa is nearly five times the average worldwide, according to the report.
"Violence is profoundly gendered, with young men (aged 15-29 years) disproportionately engaged in violence both as victims and perpetrators," the researchers said.
"Half the female victims of homicide are killed by their intimate male partners and the country has an especially high rate of rape of women and girls."