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.

Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia

“…14,47 A significant component of OOP payments for people residing in rural areas and remote settings is the cost of travel to access health services. Clearly, OOP payments increases with increasing remoteness.…”

“…Furthermore, studies have shown that even when user fees have been abolished, individuals and households still incur costs when they visit health facilities. 9,14,15 When patients turn up at a health facility to seek treatment, they often face uncertain OOP charges. In such a system, the implications for health service utilisation and health expenditure associated with visits to a health provider remain unclear.…”

Health-seeking behaviours of older black women living with non-communicable diseases in an urban township in South Africa

“…Such access to healthcare may be limited for older women in light of their multi-tasking roles and perhaps, cultural restrictions. Lack of income and limited transportation to hospitals within the continent are additional barriers which may be faced by elderly people with NCDs in their quest for proper healthcare [18, 19]. We hypothesize that these challenges may prompt older women in a South African peri-urban/township area to seek readily accessible treatment options to take care of their health conditions.…”

Treatment-seeking behaviour in low- and middle-income countries estimated using a Bayesian model

“…1). The geographical barrier to utilisation, manifested as a distance decay, is a well-known phenomenon in studies of healthcare utilization [37, 38, 49] and occurs when usage of health facilities declines with increasing distance [50, 51]. This feature motivates the use of probit models to characterise treatment-seeking behaviour (section 2.4).…”