No Place to Park the Clinic: Accountability, Expropriation, and the Social Function of Property in Pursuit of Health Equity in South Africa

As South Africa moves toward implementing the National Health Insurance scheme, the promise of universal health coverage remains constrained by material and legal obstacles to land access. Mobile clinics, vital for underserved communities, are undermined by tenure insecurity, fragmented land governance, and exclusionary property regimes. These obstacles expose an accountability gap: the state’s failure to use available constitutional tools to dismantle entrenched spatial inequalities. This paper conceptualizes accountability through three interlinked features—monitoring, review against human rights standards, and remedial action—and uses this framework to examine the case of South Africa. We argue that equitable health care delivery requires transforming the property relations that structure spatial access. At the heart of this claim is the recognition that property is a social institution whose legitimacy depends on serving broad societal goals. Reframed in this way and coupled with expropriation as a constitutionally sanctioned remedial tool, land acquisition for health care infrastructure becomes a decisive test of accountability. Doing so repositions expropriation not as an exception but as a necessary instrument of social repair and redistributive justice, particularly where historical dispossession and spatial apartheid have left deep scars in access to health care.