Spatial Analysis of Perceived Health System Capability and Actual Health System Capacity for COVID-19 in South Africa

Abstract

Introduction: People’s confidence in the health system's capability in managing the COVID-19 pandemic can determine public support, risk perceptions, and compliance to the required behaviors during the pandemic. Therefore, this paper investigated people’s perception of health system capability to manage the COVID-19 pandemic in different spatial areas across the country using data from an online survey. Methods: Multivariate logistic regression models were used to examine factors associated with people’s perception of the health system capability to manage the COVID-19 pandemic at the national and provincial levels. Spatial comparative analysis was conducted to contrast spatial density indicators of the number of hospitals, hospital beds, and ICU beds per given population across various provinces. Results: Findings showed that South Africans had low confidence in the health system capability, with only two in five (40.7%) reporting that they thought that the country’s health system was able to manage the COVID-19 pandemic. Sex and knowledge on COVID-19 were significantly associated with the people’s perception of the health system capability to manage the pandemic at the national level and in four of the nine provinces. Conclusion: Overall, the findings of this study clearly highlight challenges facing the country’s health system, both perceived or real, that needed to be addressed as part of the preparation for the COVID-19 pandemic. Timeous implementation of a countrywide National Health Insurance (NHI) system is now more critical than ever in improving healthcare outcomes of the South African population beyond the existence of the COVID-19 epidemic.

Factors Affecting Access to Public Healthcare Facilities in the City of Tshwane, South Africa

“…Together with the fact that the public healthcare system supports around 84% of the South African population (those who are uninsured), these findings point to the fact that more needs to be done in terms of universal health care access. In comparison, the private healthcare sector supports only 16% of the country’s population (those with medical insurance) but has an annual per capita healthcare expenditure of almost 10 times more than that of the public sector [ 24 , 31 ]. The NHI seeks to guarantee that everyone living in South Africa, regardless of SES, has access to high-quality healthcare services offered by the public and private sectors [ 32 ].…”

“…There is a need to investigate the effects of socioeconomic and other factors on access to public healthcare facilities during the COVID-19 pandemic. The COVID-19 pandemic has dramatically highlighted the necessity for a more integrated healthcare system, and it presented a significant opportunity for NHI to be piloted in real-time [ 23 , 24 ]. Therefore, the current study is aimed at assessing the effects of socioeconomic and other related factors on access to public healthcare facilities in the City of Tshwane, South Africa, during the COVID-19 pandemic.…”

A breath of relief: High-flow nasal oxygen in a resource-limited setting

“…Between March 2020 and February 2022 there were 58 774 ICU admissions [2] in a health system with just over 3 300 ICU beds. [3] Bearing in mind that only a third of these beds were in the public sector, which serves the majority of the population, the paucity of ICU resources is glaring. Reserving this precious resource for those who need it most can save lives.…”

The geography of COVID-19 misinformation: using geospatial maps for targeted messaging to combat misinformation on COVID-19, South Africa

“…In South Africa, geospatial analysis has been applied in mapping the capability and capacity of health system in response to COVID-19. This identified at a provincial-level, the need to increase intensive care unit bed capacity in response to increasing severe COVID-19 cases [ 6 ]. In Cape Town, geospatial analysis showed how difficult it was to achieve social distancing in two high density informal settlements highlighting the need for implementing lockdown at a community rather than household level [ 7 ].…”