Percutaneous coronary intervention still not accessible for many South Africans

Abstract

IntroductionThe incidence of myocardial infarction is rising in Sub-Saharan Africa. In order to reduce mortality, timely reperfusion by percutaneous coronary intervention (PCI) or thrombolysis followed by PCI is required. South Africa has historically been characterised by inequities in healthcare access based on geographic and socioeconomic status. We aimed to determine the coverage of PCI-facilities in South Africa and relate this to access based on population and socio-economic status.MethodsThis cross-sectional study obtained data from literature, directories, organisational databases and correspondence with Departments of Health and hospital groups. Data was analysed descriptively while Spearman’s Rho sought correlations between PCI-facility resources, population, poverty and medical insurance status.ResultsSouth Africa has 62 PCI-facilities. Gauteng has the most PCI-facilities (n = 28) while the Northern Cape has none. Most PCI-facilities (n = 48; 77%) are owned by the private sector. A disparity exists between the number of private and state-owned PCI-facilities when compared to the poverty (r = 0.01; p = 0.17) and insurance status of individuals (r = −0.4; p = 0.27).ConclusionFor many South Africans, access to PCI-facilities and primary PCI is still impossible given their socio-economic status or geographical locale. Research is needed to determine the specific PCI-facility needs based on geographic and epidemiological aspects, and to develop a contextualised solution for South Africans suffering a myocardial infarction.

The proportion of South Africans living within 60 and 120 minutes of a percutaneous coronary intervention facility

“…For those living further away, 74% would be able to access a PCI facility with an additional drive of less than 30 minutes, 18 well within the recommendations. 4 There is currently one PCI facility for every 887 096 people in South Africa, 15 which would be sufficient if every patient could access this facility within 120 minutes of first medical contact.19 This is however only achievable for 71.53% of the population. More PCI facilities are therefore needed.…”

“…Access is not simply a product of proximity, but also of socio-economic status and other demographic factors. 3 , 15 , 20 - 22 Low-income patients living in rural areas and those without medical insurance experience the greatest barriers to accessing healthcare services. 20 In South Africa, 77% of all the PCI facilities are owned by the private healthcare sector and can therefore only be utilised by 18.1% of the population,15 unless upfront payment of up to $3500 (~R50 000) is made.…”

“… 20 In South Africa, 77% of all the PCI facilities are owned by the private healthcare sector and can therefore only be utilised by 18.1% of the population,15 unless upfront payment of up to $3500 (~R50 000) is made. 15 …”

“…PCI facility availability data from a previously published cross-sectional study were utilised. 15 We plotted public and private PCI facilities in turn, using the physical address of each. From here we used ArcGIS 10 and ArcGIS Online (Esri, California, United States) to plot a 60- and 120-minute drive-time polygon around each of the PCI facilities.…”

“…However, in practice most facilities (77%) are only accessible to the 18% of patients with medical insurance. 15 , 34…”