Please note - this article was originally published on the id21 website which has now closed. This and other articles produced by id21 were archived by Eldis in 2009 and are not actively maintained. If you find links and references which are no longer valid please email eldis@ids.ac.uk.

Health-wealth unhappiness: healthcare inequalities in South Africa

South Africa has relatively abundant health sector resources, but national health status indicators are poor. How can resources be used more effectively to improve healthcare? How does the unequal distribution of resources contribute to the poor performance of health services?

A case study by the South African Universities of Cape Town and the Witwatersrand found that access to healthcare varies greatly across the country and favours wealthier urban areas. Redistribution of resources is needed to provide equal access to health services for all.

Household survey data suggest that South Africans have relatively good access to health services, with more than 80 percent of ill or injured people seeking care. Utilisation of prenatal services is also high. A good proportion of deliveries occur in a hospital or other health facility and nearly all births are attended by a trained health worker. However, the study also found that:

Access to health services is lower in rural than urban areas.
Many rural dwellers are not benefiting from the introduction of free primary care services as they have to travel long distances to access them.
As a result, more costly hospital services are used extensively in rural areas and, overall, 50 percent of South Africans use a hospital when ill.
Coverage of prenatal care could be improved. A relatively low proportion of women receive prenatal care during the first three months of their pregnancy.

Lower levels of reported illness in poorer households and rural areas in general are a particular concern, as mortality and morbidity trends suggest higher levels of ill-health among low income groups. Poor rural dwellers appear to tolerate more serious illness before they can afford to ‘recognise’ being ill. This may be due to limited access to healthcare in rural areas and the relatively high costs of taking time off. However, advanced illness requires more expensive treatment and so failure to seek care earlier may aggravate poverty. Poor households in urban areas have similar problems, but have greater access to doctor-provided services.

A reliance on tax to fund public services and the cost of servicing the large national debt place serious constraints on the government health budget. Improvements will largely entail a redistribution of resources within the public health sector. The report identified priorities for policy change, including:

improving access to health services, particularly high quality primary care, in rural regions and urban areas with high poverty levels
addressing unequal distribution of healthcare resources and personnel between rural and urban areas and between public and private sectors
redistributing resources, particularly financial and human, towards primary care services
undertaking research into the reasons for the late initiation of prenatal care.

Ultimately, however, promoting human development will require policy interventions to reduce the vast socio-economic inequities in South Africa, legacies of the apartheid era.

Source(s):
‘Equity of Health Sector Revenue Generation and Allocation’ by D. McIntyre L. Gilson, N. Valentine and Neil Soderland, Report prepared for Partnerships for Health Reform (1998) Full document.

Funded by: US Agency for International Development

id21 Research Highlight: 05 February 2001

Further Information:
Lucy Gilson
Centre for Health Policy
University of Witwatersrand
PO Box 1038
Johannesburg 2000
South Africa

Tel: +27 11 489 9941
Fax: +27 11 489 9900
Contact the contributor: lucyg@mail.saimr.wits.ac.za

University of the Witwatersrand, South Africa

Views expressed on these pages are not necessarily those of DfID, IDS, id21 or other contributing institutions. Articles featured on the id21 site may be copied or quoted without restriction provided id21 and originating author(s) and institution(s) are acknowledged. Copyright © 2009 IDS. All rights reserved.

id21 is funded by the UK Department for International Development. id21 is one of a family of knowledge services at the Institute of Development Studies at the University of Sussex. id21 is a www.oneworld.net partner and an affiliate of www.mediachannel.org. IDS is a charitable company, No. 877338.