Access to Healthcare
Motivated by disappointing health outcomes, stubborn health inequalities, and the global and national prioritisation of universal coverage, we investigate access to healthcare in post-apartheid South Africa. Following Thiede, Akweongo & McIntyre (2007), the study concentrates on three underlying dimensions of access: availability, affordability and acceptability. The initiatives have paid off: our analysis of the General Household Surveys of 2009 and 2010 show that while a number of individuals still struggle with physical access to clinics, this is associated with remote and rural communities and innovative solutions may be required to improve the availability of healthcare for such communities in a cost effective way.
Affordability does not appear to be a significant impediment to access. Turning to user acceptability, the analysis shows that a considerable proportion of public sector facility users complain about long waiting times, rude nurses and drug stock outs, but then proceed to report that they are satisfied with the service they had received. This tension may be attributed to expectations adapting to circumstances and are flagged as a potential concern to be researched in more depth to better understand whether low expectations may present an obstacles to initiatives seeking to strengthen local accountability and monitoring systems.
Over the last few years there has been an increasing recognition of the importance of demand-side constraints and specifically, health system responsiveness and clinical quality, amongst South African policy makers. Demand-side aspects of healthcare have often not received the attention it deserves and is arguably one the most significant remaining obstacles to enhancing health-seeking behaviour and improving health outcomes in post-apartheid South Africa.
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