Have public health spending and access in South Africa become more equitable since the end of apartheid?

Abstract

This study investigates whether health spending and access to services in South Africa has become more or less pro-poor over time. We find that over the post-apartheid period health spending has become significantly more pro-poor. In addition to the rising share of the health budget allocated to public clinics, there has been an increase in the share of public clinic and hospital spending going to the poor and a rising share of the health budget allocated to public clinics. In addition, between 1993 and 2008 there were improvements in both financial access to public health servicesas measured by the incidence of catastrophic costsand physical access to public health facilitiesas measured by reduced travel time. Given that substantial progress has been made with fiscal equity and access to health, problems that users complain aboutrude staff, long queues and lack of medicinehave moved higher on the policy agenda.

Access to human immunodeficiency virus testing services in Cape Town, South Africa: a user perspective

“…This finding is in agreement with previous studies showing that mobile services are conveniently situated in communities, 14 providing users with the immediate opportunity to test, 13 and that physical proximity of health care is no longer a problem for reaching public facilities. 19 Findings may be different in rural settings, where the service may be further from the user.…”

“…Levels of dissatisfaction with waiting times at public health care facilities in South Africa have been widely reported. 18,19,23,24 Longer waiting times are expected at public facilities due to high patient loads and because of the number of services offered (i.e., not only HTS), but they may be a barrier to service uptake. Addressing staff shortages and improving patient flow 25 may reduce waiting times.…”

Inequity in inpatient healthcare utilisation 10 years after Apartheid

“…For example, Burger et al (2012) examined the effect of the post-Apartheid policies on the targeting of public spending on health and the consequent access to public hospitals and clinics between 1993 and 2008. They found an increase in the poorest quintile's share of utilisation in both public hospitals and clinics.…”

The S’Khokho ‘bushcan’ initiative: Kick a bush and condoms fall out

“…[2][3][4][5] Referring to 'distance decay' , Tanser et al [3] found that there was a significant decline in public health facility use with increasing travel time (p<0.0001), individuals living within 30 minutes of a clinic utilising clinic services 10 times more often (adjusted odds ratio 10; 95% confidence interval 6.9 -14.4) than those whose travel time to the clinic was in excess of 90 minutes.…”