Inequality in health care services in urban and rural settings in South Africa

Nnabuike C. Ngene, Olive P. Khaliq, Jagidesa Moodley

Abstract

In low- and middle-income countries, urban and rural settings are distinct communities with the latter being more likely to have limited resources, particularly in health care services. We assessed the inequality in health care services in urban and rural settings in South Africa, highlighting the disparities between public and private health services, given that the latter are located mainly in urban settings. Rural settings suffer the highest inequality in the availability of drugs and supplies, overcrowding of health care facilities, delays in transporting patients, inadequate emergency medical services, and lack of experienced health care professionals. Rural settings also preferentially have a shortage of various levels of health care services, and increased security threats by criminals. In addition to specific remedies, the overarching key to solving these challenges is socio-economic growth, as well as visionary and compassionate leadership with integrity and accountability, which ensures policy development, implementation, monitoring, and evaluation. (Afr J Reprod Health 2023; 27 [5s]: 87-95).

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References

Statistics South Africa. Mid-year population estimates 2020.

Accessed on May 9, 2022.

http://www.statssa.gov.za/publications/P0302/P030

pdf

World bank. New World Bank country classifications by

income level: 2022-2023. Accessed on April 27,

https://blogs.worldbank.org/opendata/newworld-bank-country-classifications-income-level2022-2023

World Population Review. Wealth Inequality by Country

Accessed on March 11, 2022.

https://worldpopulationreview.com/countryrankings/wealth-inequality-by-country

Booysen F le R. Urban–rural inequalities in health care

delivery in South Africa. Development Southern

Africa, 2003, 20(5), 659-674.

https://doi.org/10.1080/0376835032000149298

Mahlathi P and Dlamini J. African Institute for Health and

Leadership Development and WHO. 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. Accessed May 20,

https://www.who.int/workforcealliance/031616sout

h_africa_case_studiesweb.pdf

Statista. Share of individuals who are members of medical

aid schemes in South Africa in 2018, by population

group. Accessed April 27, 2023.

https://www.statista.com/statistics/1115752/shareof-medical-aid-scheme-members-in-south-africaby-population-group/

Naidoo S. The South African national health insurance: a

revolution in health-care delivery! Journal of Public

Health, 2012, 34(1), 149-150.

https://doi.org/10.1093/pubmed/fds008

Ngene NC, Onyia CO, Moodley J and Titus MJ. Needlestick

injury in a pregnant inpatient in an overcrowded

hospital. Southern African Journal of HIV Medicine,

, 15(2), 66-68.

https://doi.org/10.4102/sajhivmed.v15i2.23

International Citizens Insurance. Understanding South

Africa’s Healthcare System. Accessed on May 20,

https://www.internationalinsurance.com/health/syst

ems/south-africa.ph 10. Canadian Council on Social Determinants of Health

(CCSDH). A Review of Frameworks on the

Determinants of Health. Accessed on January 9,

https://nccdh.ca/images/uploads/comments/CCSDH

_A-review-of-frameworks-on-the-determinants-ofhealth_EN.pdf

Reid, PP, Compton WD, Grossman JH and Fanjiang G.

Building a better delivery system: A New

Engineering/Health Care Partnership. Accessed on

May 20, 2022.

https://www.ncbi.nlm.nih.gov/books/NBK22832/pd

f/Bookshelf_NBK22832.pdf

Ferlie EB and Shortell SM. Improving the Quality of

Health Care in the United Kingdom and the United

States: A Framework for Change. The Milbank

Quarterly, 2001, 79(2), 281-315.

https://doi.org/10.1111/1468-0009.00206

Gaede B and Versteeg M. The state of the right to health in

rural South Africa. South African Health Review,

, 2011(1), 99-106.

https://hdl.handle.net/10520/EJC119080

Kok P and Collinson M. Migration and urbanization in

South Africa. Statistics South Africa. Accessed on

May 22, 2022.

http://www.statssa.gov.za/publications/Report-03-

-02/Report-03-04-02.pdf

Day C, Gray A and Budgell E. Health and related

indicators. South African Health Review, 2011,

(1), 119-148.

https://hdl.handle.net/10520/EJC119078

National Committee on Confidential Enquiry into Maternal

Deaths (NCCEMD). Saving Mothers and Babies

-2019: Executive Summary, Plus Final Report

the Effect of the First Wave of Covid-19 on Use of

Maternal and Reproductive Health Services and

Maternal and Perinatal Deaths in South Africa.

Pretoria: National Department of Health South

Africa; 2020, pp 56.

Ataguba JE, Akazili J and McIntyre D. Socioeconomicrelated health inequality in South Africa: evidence

from General Household Surveys. International

Journal for Equity in Health, 2011, 10:48.

https://doi.org/10.1186/1475-9276-10-48

Cane RM, Melesse DY, Kayeyi N, Manu A, Wado YD,

Barros A and Boerma T. HIV trends and disparities

by gender and urban–rural residence among

adolescents in sub-Saharan Africa. Reproductive

Health, 2021, 18(Suppl 1), 120.

https://doi.org/10.1186/s12978-021-01118-7

Moyo S, Ismail F, Van der Walt M, Ismail N, Mkhondo N,

Dlamini S, Mthiyane T, Chikovore J, Oladimeji O,

Mametja D, Maribe P, Seocharan I, Ximiya P, Law

I, Tadolini M, Zuma K, Manda S, Sismanidis C,

Pillay Y and Mvusi L. Prevalence of

bacteriologically confirmed pulmonary tuberculosis

in South Africa, 2017–19: a multistage, clusterbased, cross-sectional survey. Lancet Infectious

Disease, 2022, 22(8), 1172-1180.

https://doi.org/10.1016/S1473-3099(22)00149-9

Ataguba JE, Day C and McIntyre D. Explaining the role of

the social determinants of health on health inequality

in South Africa. Glob Health Action, 2015, 8:28865.

https://doi.org/10.3402/gha.v8.28865

Maphumulo WT and Bhengu BR. Challenges of quality

improvement in the healthcare of South Africa postapartheid: A critical review. Curationis. 2019, 42(1),

e1-e9. https://doi.org/10.4102/curationis.v42i1.1901

Cheteni P, Khamfula Y and Mah G. Gender and poverty in

South African rural areas. Ricart Casadevall S, ed.

Cogent Social Sciences, 2019, 5(1), 1586080.

https://doi.org/10.1080/23311886.2019.1586080

Ly DP, Blegen MB, Gibbons MM, Norris KC and Tsugawa

Y. Inequities in surgical outcomes by race and sex in

the United States: retrospective cohort study. British

Medical Journal, 2023, 380, e073290.

https://doi.org/10.1136/bmj-2022-073290

Kluge H, Azzopardi-Muscat N, Figueras J and McKee M.

Trust and transformation: an agenda for creating

resilient and sustainable health systems. British

Medical Journal. 2023, 380:651.

https://doi.org/10.1136/bmj.p651

Econex. Reform note 1: The role of primary healthcare in

health reform. Accessed on March 27, 2023.

https://econex.co.za/wpcontent/uploads/2015/04/econex_health-reformnote_1.pdf

Gumede DM, Taylor M and Kvalsvig JD. Engaging future

healthcare professionals for rural health services in

South Africa: students, graduates and managers

perceptions. BMC Health Services Research, 2021,

(1), 220. https://doi.org/10.1186/s12913-021-

-w

Macrotrends LLC. South Africa Rural Population 1960-

Accessed on March 24, 2023.

https://www.macrotrends.net/countries/ZAF/southafrica/rural-population

MC Alexander. Infographic: South Africa’s rural and urban

population from 1960 to 2016. Accessed on March

, 2023. https://southafricainfo.com/infographics/infographic-south-africasrural-urban-population-1960-2016/

van Rensburg HC. South Africa’s protracted struggle for

equal distribution and equitable access – still not

there. Human Resources for Health, 2014, 12(1), 26.

https://doi.org/10.1186/1478-4491-12-26

Schoeman S, Smuts C, Faber M, Van Stuijvenberg M,

Oelofse A, Laubscher JA, Benade AJS and Dhansay

MA. Primary health care facility infrastructure and

services and the nutritional status of children 0 to 71

months old and their caregivers attending these

facilities in four rural districts in the Eastern Cape

and KwaZulu-Natal provinces, South Africa. South

African Journal of Clinical Nutrition, 2010, 23(1),

-27.

https://doi.org/10.1080/16070658.2010.11734254

Moyimane MB, Matlala SF andKekana MP. Experiences

of nurses on the critical shortage of medical

equipment at a rural district hospital in South Africa:

a qualitative study. Pan African Medical Journal,

, 28, 100.

https://doi.org/10.11604/pamj.2017.28.100.11641

Health Systems Trust. The national health care facilities

baseline audit: National summary report 2012.

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