Distance decay and persistent health care disparities in South Africa

Abstract

BackgroundAccess to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa’s apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health.MethodsUsing newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, we use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth.ResultsNinety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation (p < 0.01) and 47 percentage points less likely to use private facilities (p < 0.01). Respondents in the poorest income quintiles live 0.5 to 0.75 km further from the nearest health facility (p < 0.01). Racial differentials in the likelihood of having a health consultation or an attended birth persist even after controlling for confounders.ConclusionsOur results have two policy implications: minimizing the distance that poor South Africans must travel to obtain health care and improving the quality of care provided in poorer areas will reduce inequality. Much has been done to redress disparities in South Africa since the end of apartheid but progress is still needed to achieve equity in health care access.

Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia

“…Second, some patients incur considerable expenses in travel costs. These costs would be invariably significantly greater for the poorest sections who tend to live farther from health facilities [ 20 ]. A third possibility is informal charges whereby health workers could have sold drugs or received bribes to perform medical tests.…”

“…Similarly, findings in Burkina Faso show that poor quality of available TB treatment resulted in patients incurring cost in the private sector [ 19 ]. A study in South Africa showed that long distance to facilities represented a financial barrier and added a significant portion to the cost of seeking care [ 20 ]. These studies suggest that financial protection is closely related to the quality of the health-care system or the integrity of implementation of free health care policy [ 8 ].…”

Wealth-related inequality in early uptake of HIV testing among pregnant women: an analysis of data from a national cross-sectional survey, South Africa

“…There was a clear difference in uptake of HIV testing between those who owned cars and those who used public transport, leading to a high contribution to inequality. This result is impressive in that even though the poor rely on public transport and largely live further from health facilities, 34 uptake of HIV testing is better among them. This is a progress worth to note as other countries battle with accessibility to healthcare for their populations.…”

Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa

“…It is well known that early HIV testing and engagement with antiretroviral therapy (ART) reduces morbidity, mortality, and infectiousness of the virus (Anderson et al 2014; Coetzee et al 2004; Cohen et al 2011; Eaton et al 2014; Mills et al 2011; Smith et al 2013; Wouters et al 2007). Yet, many South Africans do not visit health facilities for regular checkups (McLaren et al 2014). Thus, community-based HTC has become an important strategy adopted by the South African government as it seeks to attain the first 90 target (diagnosing 90% of people with HIV who do not know their HIV status) (South African Department of Health 2015; World Health Organization 2015).…”