Distance decay and persistent health care disparities in South Africa

BMC Health Services Research

Murray Leibbrandt²  Cally Ardington¹  Zoë M McLaren³ 

[1] Southern Africa Labour and Development Research Unit (SALDRU), University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa;NRF Research Chair in Poverty and Inequality Research, Director of SALDRU, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa;Department of Health Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor 48109, MI, USA

关键词: Distance decay;    South Africa;    Inequality;    Health care utilization;   

Others  :  1092368
DOI  :  10.1186/s12913-014-0541-1

 received in 2013-12-23, accepted in 2014-10-20,  发布年份 2014

【 摘 要 】

Background

Access to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa’s apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health.

Methods

Using newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, we use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth.

Results

Ninety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation (p < 0.01) and 47 percentage points less likely to use private facilities (p < 0.01). Respondents in the poorest income quintiles live 0.5 to 0.75 km further from the nearest health facility (p < 0.01). Racial differentials in the likelihood of having a health consultation or an attended birth persist even after controlling for confounders.

Conclusions

Our results have two policy implications: minimizing the distance that poor South Africans must travel to obtain health care and improving the quality of care provided in poorer areas will reduce inequality. Much has been done to redress disparities in South Africa since the end of apartheid but progress is still needed to achieve equity in health care access.

【 授权许可】

   
2014 McLaren et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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