Inequities in access to health care in South Africa
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Achieving equitable universal health coverage requires the provision of accessible, necessary services for the entire population without imposing an unaffordable burden on individuals or households. In South Africa, little is known about access barriers to health care for the general population. We explore affordability, availability, and acceptability of services through a nationally representative household survey (n=4668), covering utilization, health status, reasons for delaying care, perceptions and experiences of services, and health-care expenditure. Socio-economic status, race, insurance status, and urban-rural location were associated with access to care, with black Africans, poor, uninsured and rural respondents, experiencing greatest barriers. Understanding access barriers from the user perspective is important for expanding health-care coverage, both in South Africa and in other low- and middle-income countries.
Keywordsout-of-pocket payments access health-care utilization inequities household survey South Africa
For their highly valued contribution to the data collection, management and analysis, we would like to thank our colleagues, including Vanessa Daries, Veloshnee Govender, Okore Okorafor, Robert Moeti, Adelaide Maja, Natasha Palmer, Anne Mills, and Olufunke Alaba. For conceptual guidance, we would like to thank Duane Blaauw and Laetitia Rispel. SACBIA survey was a collaborative initiative between Health Economics Unit, University of Cape Town; Centre for Health Policy, University of the Witwatersrand; South African National Department of Health (NDoH); and the London School of Hygiene and Tropical Medicine. NDoH funded the survey through a European Union grant. The Community Agency for Social Enquiry collected the data. Diane McIntyre is supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation.
- World Health Organization. (2010) The World Health Report – Health Systems Financing: The Path to Universal Coverage. Geneva: World Health Organisation.Google Scholar
- Constitution of the Republic of South Africa. (No. 108 of 1996). Statutes of the Republic of South Africa – Constitutional Law 38: 1241–1331, http://www.info.gov.za/documents/constitution/1996/a108-96.pdf, accessed 4 May 2011.
- Frenz, P. and Vega, J. (2010) Universal Health Coverage with Equity: What We Know, Don’t Know and Need to Know. Background paper for the global symposium on health systems research. Montreux, Switzerland: First Global Symposium on Health Systems Research, http://www.hsr-symposium.org/images/stories/9coverage_with_equity.pdf, accessed 4 May 2011.Google Scholar
- Penchansky, R. (1977) The Concept of Access: A Definition. Hyattsville, MD: National Health Planning Information Centre.Google Scholar
- McIntyre, D. et al (2007) A Critical Analysis of the Current South African Health System. Cape Town, South Africa: Health Economics Unit, University of Cape Town and Centre for Health Policy, University of the Witwatersrand.Google Scholar
- Ataguba, J. and McIntyre, D. (2009) Financing and Benefit Incidence in the South African Health System: Preliminary Results. Cape Town: Health Economics Unit. Report No. 09-1.Google Scholar
- McIntyre, D., Goudge, J., Harris, B., Nxumalo, N. and Nkosi, M. (2009) Prerequisites for national health insurance in South Africa: Results of a national household survey. South African Medical Journal 99 (10): 725–729.Google Scholar
- McIntyre, D., Gilson, L., Valentine, N. and Soderlund, N. (1998) Equity of Health Sector Revenue Generation and Allocation: A South African Case Study. Washington DC: Partnerships for Health Reform.Google Scholar
- Saksena, P., Xu, K., Elovaino, R. and Perrot, J. (2010) Health Services Utilization and Out-of-Pocket Expenditure at Public and Private Facilities in Low-income Countries. Geneva: World Health Organisation. Background paper no. 20.Google Scholar
- African National Congress. National Health Insurance. (2010) ANC National General Council, Additional Discussion Documents. 24–28 September; Durban, South Africa: African National Congress. pp. 1–48.Google Scholar
- Nkosi, M., Govender, V., Erasmus, E. and Gilson, L. (2008) Investigation the Role of Power and Institutions in Hospital-level Implementation of Equity-oriented Policies. Johannesburg, South Africa: Centre for Health Policy, University of the Witwatersrand; Health Economics Unit, University of Cape Town and London School of Hygiene and Tropical Medicine.Google Scholar
- Gilson, L. and Erasmus, E. (2005) Supporting the Retention of HRH: SADC Policy Context. Johannesburg: Centre for Health Policy. Equinet Discussion Paper No. 26.Google Scholar