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Journal of Public Health Policy

, Volume 32, Supplement 1, pp S102–S123 | Cite as

Inequities in access to health care in South Africa

  • Bronwyn Harris
  • Jane Goudge
  • John E Ataguba
  • Diane McIntyre
  • Nonhlanhla Nxumalo
  • Siyabonga Jikwana
  • Matthew Chersich
Original Article

Abstract

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.

Keywords

out-of-pocket payments access health-care utilization inequities household survey South Africa 

Notes

Acknowledgements

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.

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Copyright information

© Palgrave Macmillan, a division of Macmillan Publishers Ltd 2011

Authors and Affiliations

  • Bronwyn Harris
    • 1
  • Jane Goudge
    • 1
  • John E Ataguba
    • 2
  • Diane McIntyre
    • 2
  • Nonhlanhla Nxumalo
    • 1
  • Siyabonga Jikwana
    • 3
  • Matthew Chersich
    • 1
    • 4
  1. 1.Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Private Bag X3, WitsJohannesburgSouth Africa
  2. 2.Health Economics Unit, School of Public Health and Family Medicine, University of Cape TownCape TownSouth Africa
  3. 3.National Department of HealthPretoriaSouth Africa
  4. 4.Department of Obstetrics and GynecologyInternational Centre for Reproductive Health, Faculty of Medicine, Ghent UniversityGhentBelgium

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