Access to health care in post-apartheid South Africa: availability, affordability, acceptability

Abstract

We use a reliable, intuitive and simple set of indicators to capture three dimensions of access - availability, affordability and acceptability. Data are from South Africa's 2009 and 2010 General Household Surveys (n=190,164). Affordability constraints were faced by 23% and are more concentrated amongst the poorest. However, 73% of affordability constraints are due to travel costs which are aligned with findings of the availability constraints dimension. Availability constraints, involving distances and transport costs, particularly in underdeveloped rural areas, and inconvenient opening times, were faced by 27%. Acceptability constraints were noted by only 10%. We approximate acceptability with an indicator measuring the share of community members bypassing the closest health care facility, as we argue that reported health care provider choice is more reliable than stated preferences. However, the indicator assumes a choice of available and affordable providers, which may often not be an accurate assumption in rural areas. We recommend further work on the measurement of acceptability in household surveys, especially considering this dimension's importance for health reform.

Catastrophic health expenditures arising from out-of-pocket payments: Evidence from South African income and expenditure surveys

“…Importantly, health expenditure calculations do not consider foregone earnings or travel costs. In the case of travel costs, nearly 3/4 of those, who felt that public health care was unaffordable in South Africa, felt that was because of travel costs [13]. For poor South Africans, who may be working either informally or with limited access to sick or family leave to care for sick family members, seeking health care would have the additional cost of reducing earnings.…”

“…However, there is evidence that households in 1995 who had experienced an illness did seek health care, and there is further evidence that the reduction in user fees that occurred in 1994 and 1996 had only a limited impact on facility usage [9,10,48]. Despite that, there are also concerns that South Africans do not believe they can afford to use the public health care system [13]. While the literature does not have a benchmark against which to compare CHE results for the years 2000 and 2010-11, our findings for the years 1995 and 2005-06 are consistent with those previously documented for those data sets [30,49].…”

Understanding Critical Concepts in Engaged Research: The Case of a Rural Health Development Project in South Africa

“…Currently, physical access to health care affects a multitude of health outcomes, especially for those patients residing in rural communities which are reliant on the continuity of healthcare services (Burger & Christian, 2018;McIntyre & Ataguba, 2014;McLaren et al, 2013;Tanser et al, 2006). This is specifically so for high-risk patients and for those with chronic diseases.…”

Asthma in South African adolescents: a time trend and risk factor analysis over two decades

“…[9,10] From 2002 onwards, South Africa experienced profound changes in society and policies with strengthening of health care provision, rapid urbanisation and improved access to basic amenities such as water, sanitation and electricity as well as basic education. [11,12] However, challenges such as poverty, unemployment, socioeconomic inequity and sub-optimal health systems continued to negatively impact on health. [11,13] The aim of this study was to investigate time trends in the prevalence of asthma in South African adolescents from 2002 to 2017, and to identify risk factors associated with asthma or asthma severity.…”