Is access to health services universal? What are the potential barriers? Are there specific geographical areas or population groups for which access to health care is problematic? | South Africa Is access to health services universal? What are the potential barriers? Are there specific geographical areas or population groups for which access to health care is problematic? | South Africa

13 Aug 2022

The South African healthcare sector is characterised by inequality in terms of access to care services and resources (human, financial and technologies) between provinces, with more facilities and services concentrated in more urban areas (Competition Commission SA, 2018; Department Planning Monitoring and Evaluation, 2017; Mahlathi & Dlamini, 2015), despite the majority of the population (64.7%) living in provinces that are largely characterised as more rural (Mahlathi & Dlamini, 2015). Most patients access health care via the Public District Health System where healthcare is free, however overburdened by catering for the service needs of 84% of the population (Mahlathi & Dlamini, 2015), and further characterised by:

  • Poor management and governance;
  • Shortages of key health care professionals, and skewed between the public and private sector;
  • Weak service delivery platform with poor quality of care and delivery of healthcare services;
  • Lack or inconsistent supply of medical products and health technologies;
  • Fragmented and unequal healthcare financing; and
  • Poor information management (Department Planning Monitoring and Evaluation, 2017).

The legacy of Apartheid perpetuates the racial disparities and inequitable access to care, despite active redresses of the past. Ninety percent (90%) of South Africans are said to live within 7 kilometres from a public healthcare facility, and about two-thirds live within 2 kilometres (Fusheini & Eyles, 2016). However, for most South Africans the cost in time and money to travel to the nearest healthcare facility poses a significant barrier (Fusheini & Eyles, 2016). With regards to population groups, it is estimated that 15% of black South Africans live more than 5km away from the nearest healthcare facility, as compared to 7% coloureds and 4% whites (Mclaren et al., 2013). Poorer South Africans live furthest from facilities and are characterised by poorer health, with a tendency for men to utilise health care facilities less than women (Mclaren et al., 2013).

Barriers in accessing care within the private sector relates to the escalating costs of care, despite having medical insurance. Medical scheme coverage rates often have to be supplemented by out-of-pocket payments, decreasing the range and depth of services accessed (Competition Commission SA, 2018). There are 8 million South Africans that are currently covered by a medical aid scheme (Abraham et al., 2012). More so, 21.3% of households in the metropolitan areas have some form of medical health insurance, compared to only 5.4% of households in more rural areas (DOH, 2011). Access to private health care services in rural areas is limited.


Abraham, M., Dreyer, K., Giuricich, M., & Ramjee, S. (2012). Healthcare Expenditure in the Last year of Life: The Experience of South African Medical Schemes. (Issue 5). Available from: https://www.actuarialsociety.org.za/convention/convention2012registration/assets/pdf/papers/Kathryn%20Dreyer,%20Shivani%20Ramjee%20-%20HEALTHCARE%20EXPENDITURE%20IN%20THE%20LAST%20YEAR.pdf

Competition Commission SA. (2018). Health market injuiry. Available from:  http://www.compcom.co.za/wp-content/uploads/2018/07/Executive-Summary.pdf

Department Planning Monitoring and Evaluation. (2017). Socio-Economic Impact Assessment System (SEIAS) Final Impact Assessment (Phase 2): White Paper on National Health Insurance (Issue May).

DOH. (2011). HUMAN RESOURCES FOR HEALTH SOUTH AFRICA (HRH) Department of Health. Available from: http://www.hst.org.za/publications/NonHST Publications/hrh_strategy-2.pdf

Fusheini, A., & Eyles, J. (2016). Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision. BMC Health Services Research, 16(1), 1–11. https://doi.org/10.1186/s12913-016-1797-4

Mahlathi, P., & Dlamini, J. (2015). MINIMUM DATA SETS FOR HUMAN RESOURCES FOR HEALTH AND THE SURGICAL WORKFORCE IN SOUTH AFRICA’S HEALTH SYSTEM: A rapid analysis of stock and migration. Available from: http://www.prographic.com/wp-content/uploads/2016/07/0316-south-africa-case-studies-web.pdf

Mclaren, Z., Ardington, C., & Leibbrandt, M. (2013). Distance as a barrier to health care access in South Africa.