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This paper was first published on the NIDS-CRAM website, where all papers are available for download at

Authors: Ronelle Burger, Candy Day, Nicola Deghaye, Lungiswa Nkonki, Russell Rensburg, Anja Smith, and Cari van Schalkwyk


This paper considers how access to public sector healthcare in South Africa have been affected by the COVID-19 pandemic using three sources of evidence: the NIDS-CRAM (Coronavirus Rapid Mobile Survey) and MatCH (Maternal and Child Health) SMS survey together with routine health care utilisation data from the District Health Information System (DHIS). Our analysis shows that across almost all districts in the country there was a reduction in primary healthcare utilisation, especially in HIV testing and health visits by children under 5 years of age, irrespective of the actual district-level incidence risk of COVID-19 at the time. Preventive services such as immunisation and contraception were still below expected levels in 75% of districts in August 2020. These unmet needs are corroborated by survey results for the uninsured segment of the population where 23% reported not seeking acute care when needed and inability to access medication, contraceptives or condoms. HIV testing is climbing again in some areas, and early access to antenatal care was only slightly lower than expected, recovering quite quickly since April 2020. COVID-19 fears may have disproportionately affected the poorest and most vulnerable groups, and impacted access especially to preventive services, where the negative consequences may unfold over an extended period if interventions to ‘catch up’ are not urgently prioritised and closely monitored.

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