Migrants’ perceptions of health system responsiveness and satisfaction with health workers in a South African Province

Abstract

Background : There is global emphasis on quality universal health coverage (UHC) that is responsive to the needs of vulnerable communities, such as migrants. Objective : Examine the perceptions of migrants on health system responsiveness (HSR) and their satisfaction with health workers in public health facilities of a South African Province. Method : We conducted a cross-sectional study in 13 public health facilities. Following informed consent, we used a semi-structured questionnaire to collect sociodemographic information, patient perceptions of HSR and their satisfaction with health workers. Two open-ended questions gave patients the opportunity to comment on the health facility visit. We applied descriptive and multivariate analyses to our data, and thematic analysis to the qualitative responses. Results : A total of 251 migrant patients participated in the study, giving a response rate of 80.7%. The majority of patients were female (81.1%), and the mean age was 31.4 years. 30.0% of patients reported that they waited too long; 94.3% that the consulting nurse or doctor listened to them; and 89.4% that they received information about their condition. However, 81.7% said they did not know the name of the consulting nurse or doctor. The mean scores on patients’ satisfaction with health workers ranged from 7.0 (95% CI 6.42–7.63) for clerks, 7.7 (95% CI 7.4–8.0) for security guards, 7.4 (95% CI 7.1–7.6) for nurses and 8.3 (95% CI 7.93–8.63) for doctors. The predictors of patient satisfaction with nurses were being given information about their condition; polite treatment, time spent in facility, whether they received prescribed medicines; and stating that they would refer the health facility to family/friends. Four overlapping themes emerged: health workers’ attitudes; time waited at the health facility, communication difficulties; and sub-optimal procedures in the health facility. Conclusion : UHC policies should incorporate migrant patients’ perceptions of HSR and the determinants of their satisfaction with health workers.

Experiences of migrant mothers attending vaccination services at primary healthcare facilities

“…The study aimed to explore the experience of migrant mothers attending vaccination services at PHC facilities. Healthcare utilisation studies among migrant patients are useful to explore migrants’ satisfaction with the health system (White, Levin & Rispel 2020 ). The Constitution of South Africa stipulates that all people are entitled to utilise healthcare services, regardless of citizenship (White et al 2020 ).…”

“…Healthcare utilisation studies among migrant patients are useful to explore migrants’ satisfaction with the health system (White, Levin & Rispel 2020 ). The Constitution of South Africa stipulates that all people are entitled to utilise healthcare services, regardless of citizenship (White et al 2020 ). This practice was also supported by Makandwa ( 2014 ) from a study conducted in sub-Saharan Africa.…”

“…Child immunisation for immigrant society and refugee resettlement is required, more especially where they experience a lower immunisation coverage and a higher burden of vaccine-preventable childhood illness (Tankwanchi et al 2021 ). White et al ( 2020 ) report that migrants compare their expectations with practices in their home country, and may become dissatisfied if the time spent waiting is longer than what they have been used to. Chu et al ( 2019 ), Egbujie et al ( 2018 ) and Karat et al ( 2022 ) highlight that informing patients beforehand of the possibility of waiting for healthcare services may reduce stress and frustration and promote tolerance.…”

“…Most study participants mentioned that they were treated fairly and equally to local citizens. White et al ( 2020 ) report that few participants mentioned being treated fairly during the healthcare visits.…”

Global health (security), immigration governance and Covid-19 in South(ern) Africa: An evolving research agenda

“…South Africa already faces a range of intersecting challenges associated with migration and communicable diseases, including pervasive anti-foreigner sentiments and xenophobia ( Misago, 2017 ) that can lead to non-citizens being unfairly blamed – scapegoated - for the failings of the country's public services ( Hiropoulos, 2020 ; Riemsdijk et al., 2021 ), including public healthcare systems ( Vearey, 2021 ). Whilst everyone in South Africa who is reliant on the public healthcare system, both citizens and non-citizens alike, face a range of challenges in accessing care ( Coovadia et al., 2009 ; Mayosi et al., 2012 ; Vearey, 2021 ), some non-citizens - especially those on short-term visitors visas, asylum seekers and undocumented migrants - may face additional challenges associated with their nationality, the language they speak, and the documents they hold ( Chekero and Ross, 2018 ; Crush and Tawodzera, 2014 ; Makandwa and Vearey, 2017 ; Vearey, 2021 ; Vearey et al., 2016 ; White et al., 2020b , 2020a ).…”