Healthcare in South Africa: What Determines Access to Medical Services – JOURNAL OF THE INSTITUTE FOR AFRICAN STUDIES

Author:

E.S. Bakhmeteva¹, A.K. Morozkina¹

Affiliation:

1. Higher School of Economics, Moscow, Russian Federation

Abstract:

This study investigates disparities in access to healthcare in South Africa. The first part of the study provides a detailed review of the existing literature, which highlights various demographic and socio-economic factors of access to healthcare. However, previous works on South Africa are based on surveys prior to 2012 and do not account for recent changes, including the shock caused by the COVID-19 pandemic and the worsening energy crisis in South Africa in 2022–2024. This study includes data from General Household Surveys of South Africa from 2002 to 2024. Factors such as gender and race, education level, place of residence (province and city/village), and income level are considered. The study presents the main results for assessing the physical accessibility of healthcare. Overall, there is a positive trend, although the values of 2024 still reflect the shock of the pandemic and the energy crisis, showing worse results than in 2019. The study also presents the assessment for inequality in financial affordability of healthcare. Socio-economic factors (race, education, and income level) have a much greater impact on financial accessibility. Comparison with previous literature shows that in 2024, the healthcare access landscape in South Africa remained largely similar to the situation in 2012: the same population groups remained vulnerable (black Africans, poor people, rural residents, and people with low education level), and the level of inequality in financial access to medicine remained high.

Keywords:

South Africa, inequality, healthcare, physical accessibility and financial affordability, income level, education level, racial discrimination

References:

1. Abrahams G.L., Thani X. C., Kahn S. B. (2022). South African Public Primary Healthcare Services and Challenges. Administratio Publica. Vol. 30. №. 2. Pp. 63–85.
2. Adu-Gyamfi S., Yakubu B., Nyaaba A.Y., Bempong E., Brobbey M.A. (2025). Traditional Healers and the State of Medical Integration in Asante: A 21st Century Dialogue with Practitioners and Residents in Aboabo. Journal of the Institute for African Studies. Vol. 11. № 2. Pp. 147–165. https://doi.org/10.31132/2412-5717-2025-71-2-147-165
3. Azad A.D., Charles A.G., Ding Q., Trickey A.W., Wren S.M. (2020). The Gender Gap and Healthcare: Associations between Gender Roles and Factors Affecting Healthcare Access in Central Malawi, June–August 2017. Archives of Public Health. Vol. 78. № 119. Pp. 1–11. https://doi.org/10.1186/s13690-020-00497-w
4. Bago d’Uva T., Lindeboom M., O’Donnell O., Van Doorslaer E. (2011). Education-Related Inequity in Healthcare with Heterogeneous Reporting of Health. Journal of the Royal Statistical Society Series A: Statistics in Society. Vol. 174. №. 3. Pp. 639–664. https://doi.org/10.1111/j.1467-985X.2011.00706.x
5. Balharith M., Alghalyini B., Al-Mansour K., Tantawy M.H., Alonezi M.A., Almazud A., Zaidi A.R.Z. (2023). Physical Accessibility, Availability, Financial Affordability, and Acceptability of Mobile Health Clinics in Remote Areas of Saudi Arabia. Journal of Family Medicine and Primary Care. Vol. 12. №. 9. Pp. 1947–1956. https://doi.org/10.4103/jfmpc.jfmpc_567_23
6. Banerjee S. (2021). Determinants of Rural-Urban Differential in Healthcare Utilization Among the Elderly Population in India. BMC Public Health. Vol. 21. № 939. Pp. 1–18 https://doi.org/10.1186/s12889-021-10773-1
7. Booysen F., Gordon T. (2020). Trends and Socio-Economic Inequality in Public Perceptions of Healthcare Delivery in South Africa. International Journal for Quality in Health Care. Vol. 32. № 2. Pp. 135–139. https://doi.org/10.1093/intqhc/mzz122

8. Bruce R., Firpo S., França M., Meloni L. (2020). Racial Inequality in Health Care during a Pandemic. SSRN. 13.09.2020. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3691313 (accessed: 07.05.2025)
9. Burger C., Burger R., Van Doorslaer E. (2022). The health impact of free access to antiretroviral therapy in South Africa. Social Science & Medicine. Vol. 299. № 114832. Pp. 1–7. https://doi.org/10.1016/j.socscimed.2022.114832
10. Burger R., Christian C. (2020). Access to Health Care in Post-Apartheid South Africa: Availability, Affordability, Acceptability. Health Economics, Policy and Law. Vol. 15. № 1. Pp. 43–55. https://doi.org/10.1017/S1744133118000300
11. Constante H.M., Marinho G.L., Bastos J.L. (2021). The Door is Open, but not Everyone May Enter: Racial Inequities in Healthcare Access across Three Brazilian Surveys. Ciência & Saúde Coletiva. Vol. 26. Pp. 3981–3990. https://doi.org/10.1590/1413-81232021269.47412020
12. Delobelle P. (2013). The Health System in South Africa. Historical Perspectives and Current Challenges. In: Wolhuter C. C. (Ed.). South Africa in focus: Economic, political and social issues. New York: Nova Science Publishers. Pp. 159–205.
13. Dos Santos A.M.A., Perelman J., de Andrade Jacinto P., Tejada C.A.O., Barros A.J.D., Bertoldi A., Matijasevich A., Santos I.S. (2019). Income-Related Inequality and Inequity in Children’s Health Care: A Longitudinal Analysis Using Data from Brazil. Social Science & Medicine. Vol. 224. Pp. 127–137. https://doi.org/10.1016/j.socscimed.2019.01.040
14. Dubey S., Deshpande S., Krishna L., Zadey S. (2023). Evolution of Government-Funded Health Insurance for Universal Health Coverage in India. The Lancet Regional Health-Southeast Asia. Vol. 13. № 100180. Pp. 1–14. https://doi.org/10.1016/j.lansea.2023.100180
15. Filatova I.I. (2016). The Republic of South Africa. In: Balezin A.S., Mazova S.V., Filatova I.I. (Eds.). Black Africa: Past and Present. Moscow: Publishing House of Dmitry Pozharsky University. Pp. 290–304. (In Russ.)
16. Gaede B., Versteeg M. (2011). The State of the Right to Health in Rural South Africa. South African Health Review. Vol. 2011. № 1. Pp. 99–106.
17. Gelders S., Ewen M., Noguchi N., Laing R. (2006). Background Report Prepared for the WHO Planning Meeting on the Global Initiative for Treatment of Chronic Diseases Held in Cairo in December 2005. World Health Organization. https://applications.emro.who.int/dsaf/dsa560.pdf (accessed: 06.05.2025).
18. Gordon T., Booysen F., Mbonigaba J. (2020). Socio-Economic Inequalities in the Multiple Dimensions of Access to Healthcare: The Case of South Africa. BMC Public Health. Vol. 20. № 289. Pp 1–13. https://doi.org/10.1186/s12889-020-8368-7
19. Gracheva M.V. (2019). Traditional Medicine in the Modern Healthcare System of South Africa. Humanitarian Accent. №. 1. Pp. 49–54. (In Russ.)
20. Grishina N.V. (2024). Western and Traditional African Medicine in the Fight Against Tropical Diseases in Africa. Journal of the Institute for African Studies. № 2. Pp. 186–196. https://doi.org/10.31132/2412-5717-2024-67-2-186-196
21. Harris B., Goudge J., Ataguba J.E., McIntyre D., Nxumalo N., Jikwana S., Chersich M. (2011). Inequities in Access to Health Care in South Africa. Journal of Public Health Policy. Vol. 32. Pp. 102–123. https://doi.org/10.1057/jphp.2011.35
22. Larson K., Halfon N. (2010). Family Income Gradients in the Health and Health Care Access of US Children. Maternal and Child Health Journal. Vol. 14. Pp. 332–342. https://doi.org/10.1007/s10995-009-0477-y
23. Leatt A., Shung-King M., Monson J. (2006). Healing Inequalities: The Free Health Care Policy. In: Monson J., Hall K., Smith C., Shung-King M. (Eds.). South African Child Gauge. Cape Town: Children’s Institute, University of Cape Town. Pp. 51–56.
24. Ma C., Song Z., Zong Q. (2021). Urban-Rural Inequality of Opportunity in Health Care: Evidence from China. International Journal of Environmental Research and Public Health. Vol. 18. №. 15. 7792. Pp. 1–13. https://doi.org/10.3390/ijerph18157792
25. Maphumulo W.T., Bhengu B.R. (2019). Challenges of Quality Improvement in the Healthcare of South Africa Post-Apartheid: A Critical Review. Curationis. Vol. 42. № 1. Pp. 1–9. https://doi.org/10.4102/curationis.v42i1.1901
26. McFarlane C. (2015). South Africa: The Rise of Traditional Medicine. Insight on Africa. Vol. 7. № 1. Pp. 60–70. https://doi.org/10.1177/0975087814554070
27. McLaren Z.M., Ardington C., Leibbrandt M. (2014). Distance Decay and Persistent Health Care Disparities in South Africa. BMC Health Services Research. Vol. 14. № 541. Pp. 1–9. https://doi.org/10.1186/s12913-014-0541-1
28. Mulyanto J., Kringos D.S., Kunst A.E. (2019). Socioeconomic Inequalities in Healthcare Utilisation in Indonesia: A Comprehensive Survey-Based Overview. BMJ open. Vol. 9. № 1. Pp. 1–9. https://doi.org/10.1136/bmjopen-2018-026164
29. Mutwali R., Ross E. (2019). Disparities in Physical Access and Healthcare Utilization among Adults with and without Disabilities in South Africa. Disability and Health Journal. Vol. 12. № 1. Pp. 35–42. https://doi.org/10.1016/j.dhjo.2018.07.009
30. Mvikweni M. (2024). Addressing Healthcare Access Inequalities in South Africa: Evaluating Legislative and Human Rights Obligations and Proposing Strategies for Improvement. Noyam (E-Journal of Humanities, Arts and Social Sciences/EHASS). Vol. 5. № 16. Pp. 3371–3382. https://doi.org/ 10.38159/ ehass.202451655
31. Naledi T., Barron P., Schneider H. (2011). Primary Health Care in SA since 1994 and Implications of the New Vision for PHC Re-Engineering. South African health review. Vol. 2011. №. 1. Pp. 17–28. https://journals.co.za/doi/epdf/10.10520/EJC119087
32. Ohonba A., Kirsten F., Mkhize B. (2023). Perceived Unmet Needs in Healthcare as Inequality Indicators: Evidence from South Africa. EDWRG Working Paper Number 05-23. Economic Development and Well-Being Research Group. https://www.uj.ac.za/wp-content/uploads/2022/01/ohonba-kirsten-mkhize-perceived-unmet-needs-in-healthcare-as-inequality-indicators-evidence-from-south-africa.pdf (accessed: 06.05.2025)
33. O’Donnell O., Van Doorslaer E., Wagstaff A., Lindelow M. (2008). Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. Washington: The World Bank.
34. Sambodo N.P., Van Doorslaer E., Pradhan M., Sparrow R. (2021). Does Geographic Spending Variation Exacerbate Healthcare Benefit Inequality? A Benefit Incidence Analysis for Indonesia. Health Policy and Planning. Vol. 36. № 7. Pp. 1129–1139. https://doi.org/10.1093/heapol/czab015
35. Samuel O., Zewotir T., North D. (2021). Decomposing the Urban–Rural Inequalities in the Utilisation of Maternal Health Care Services: Evidence from 27 Selected Countries in Sub-Saharan Africa. Reproductive Health. Vol. 18. № 216. Pp. 1–12. https://doi.org/10.1186/s12978-021-01268-8
36. Scheffler E., Visagie S., Schneider M. (2015). The Impact of Health Service Variables on Healthcare Access in a Low Resourced Urban Setting in the Western Cape, South Africa. African Journal of Primary Health Care and Family Medicine. Vol. 7. № 1. Pp. 1–11. https://doi.org/10.4102/phcfm.v7i1.820
37. Serván-Mori E., Meneses-Navarro S., García-Díaz R., Cerecero-García D., Contreras-Loya D., Gómez-Dantés O., Castro A. (2025). Ethnic and Racial Discrimination in Maternal Health Care in Mexico: A Neglected Challenge in the Search for Universal Health Coverage. International Journal for Equity in Health. Vol. 24. №. 1. 10. Pp. 1–17. https://doi.org/10.1186/s12939-024-02374-2
38. Simelela N., Venter F.W.D., Pillay Y., Barron P.A. (2015). Political and Social History of HIV in South Africa. Current HIV/AIDS Reports. Vol. 12. № 2. Pp. 256–261. https://doi.org/10.1007/s11904-015-0259-7
39. Staunton C., Swanepoel C., Labuschaigne M. (2020). Between a Rock and a Hard Place: COVID-19 and South Africa’s Response. Journal of Law and the Biosciences. Vol. 7. №. 1. lsaa052. Pp. 1–12. https://doi.org/10.1093/jlb/lsaa052
40. Wallace B.B., MacEntee M.I. (2012). Access to Dental Care for Low-Income Adults: Perceptions of Affordability, Availability and Acceptability. Journal of Community Health. Vol. 37. P. 32–39. https://doi.org/10.1007/s10900-011-9412-4
41. Willie M.M., Maqbool M. (2023). Access to public health services in South Africa’s rural Eastern Cape Province. Applied Sciences Research Periodicals. 2023. Vol. 1. №. 2. Pp. 35–54.

Received: 17.04.2025
Revised: 25.06.2025
Accepted: 15.08.2025

For citation:

Bakhmeteva E.S., Morozkina A.K. (2025). Healthcare in South Africa: What Determines Access to Medical Services. Journal of the Institute for African Studies. Vol. 11. № 3. Pp. 124‒147. https://doi.org/10.31132/2412-5717-2025-72-3-124-147

Full Text Article (ENG )

Appendix 1 (ENG)