IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v230y2019icp214-221.html
   My bibliography  Save this article

A qualitative approach to examining health care access in rural South Africa

Author

Listed:
  • Neely, Abigail H.
  • Ponshunmugam, Arunsrinivasan

Abstract

Using a combination of documentary analysis, a household survey, and in-depth interviews, we examine instances when people access healthcare outside of the standard, government protocol in Harry Gwala District, KwaZulu-Natal to better understand barriers to access. South Africa's healthcare system is organized according to a spatial hierarchy, where specialty care is concentrated in urban areas and basic care is disbursed throughout the country. Livelihoods and family life are shaped by South Africa's political and economic history and current day. The tensions between everyday life and national healthcare policy are evident when people access care outside of official policy. Our research reveals that resource scarcity, transportation, and kinship networks, all rooted in South Africa's economy and long history of racial segregation, have the biggest influence on access. This finding adds to scholarly literature by bringing in the experiences of rural residents to reveal that the healthcare system is inextricably linked to the country's political-economy and that access models focused on distance break down when faced with poverty, transportation, and family networks in rural areas. Further, by focusing on examples of access outside of the prescribed pathways, we examine in depth what is happening on-the-ground. At the same time, we examine the broader political and economic context that has shaped both the healthcare system and the people who access it. As a result of this qualitative research, we open up possibilities for improving access to the healthcare system by highlighting factors outside of the system.

Suggested Citation

  • Neely, Abigail H. & Ponshunmugam, Arunsrinivasan, 2019. "A qualitative approach to examining health care access in rural South Africa," Social Science & Medicine, Elsevier, vol. 230(C), pages 214-221.
    • Handle: RePEc:eee:socmed:v:230:y:2019:i:c:p:214-221
    DOI: 10.1016/j.socscimed.2019.04.025
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953619302254
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2019.04.025?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Ager, Alastair & Iacovou, Melina, 2014. "The co-construction of medical humanitarianism: Analysis of personal, organizationally condoned narratives from an agency website," Social Science & Medicine, Elsevier, vol. 120(C), pages 430-438.
    2. Iannantuono, Adele & Eyles, John, 1997. "Meanings in policy: A textual analysis of Canada's "Achieving Health for All" document," Social Science & Medicine, Elsevier, vol. 44(11), pages 1611-1621, June.
    3. Atinga, Roger A. & Agyepong, Irene Akua & Esena, Reuben K., 2018. "Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation," Social Science & Medicine, Elsevier, vol. 201(C), pages 27-34.
    4. Towne, Samuel D. & Probst, Janice C. & Hardin, James W. & Bell, Bethany A. & Glover, Saundra, 2017. "Health & access to care among working-age lower income adults in the Great Recession: Disparities across race and ethnicity and geospatial factors," Social Science & Medicine, Elsevier, vol. 182(C), pages 30-44.
    5. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance?: findings from an exploratory household survey in Senegal," LSE Research Online Documents on Economics 55820, London School of Economics and Political Science, LSE Library.
    6. Srivastava, Divya & McGuire, Alistair, 2015. "Patient access to health care and medicines across low-income countries," Social Science & Medicine, Elsevier, vol. 133(C), pages 21-27.
    7. Gilbert, Leah & Walker, Liz, 2002. "Treading the path of least resistance: HIV/AIDS and social inequalities--a South African case study," Social Science & Medicine, Elsevier, vol. 54(7), pages 1093-1110, April.
    8. Trani, Jean-Francois & Browne, Joyce & Kett, Maria & Bah, Osman & Morlai, Teddy & Bailey, Nicki & Groce, Nora, 2011. "Access to health care, reproductive health and disability: A large scale survey in Sierra Leone," Social Science & Medicine, Elsevier, vol. 73(10), pages 1477-1489.
    9. Geoffrey Fatti & Ashraf Grimwood & Peter Bock, 2010. "Better Antiretroviral Therapy Outcomes at Primary Healthcare Facilities: An Evaluation of Three Tiers of ART Services in Four South African Provinces," PLOS ONE, Public Library of Science, vol. 5(9), pages 1-10, September.
    10. Kehinde Omotoso & Steven F. Koch, 2017. "South African trends in medical aid coverage and stated healthcare-seeking preferences: 2004–14," Development Southern Africa, Taylor & Francis Journals, vol. 34(5), pages 575-592, September.
    11. Yach, Derek, 1992. "The use and value of qualitative methods in health research in developing countries," Social Science & Medicine, Elsevier, vol. 35(4), pages 603-612, August.
    12. Thiede, Michael, 2005. "Information and access to health care: is there a role for trust?," Social Science & Medicine, Elsevier, vol. 61(7), pages 1452-1462, October.
    13. Miteniece, Elina & Pavlova, Milena & Rechel, Bernd & Groot, Wim, 2017. "Barriers to accessing adequate maternal care in Central and Eastern European countries: A systematic literature review," Social Science & Medicine, Elsevier, vol. 177(C), pages 1-8.
    14. Kim, Tae Jun & Vonneilich, Nico & Lüdecke, Daniel & von dem Knesebeck, Olaf, 2017. "Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries," Social Science & Medicine, Elsevier, vol. 176(C), pages 158-165.
    15. Cantor-Graae, Elizabeth & Chak, Thida & Sunbaunat, Ka & Jarl, Johan & Larsson, Charlotte A., 2014. "Long-term psychiatric consequences of exposure to trauma in Cambodia: A regional household survey," Social Science & Medicine, Elsevier, vol. 123(C), pages 133-140.
    16. Mohseni, Mohabbat & Lindstrom, Martin, 2007. "Social capital, trust in the health-care system and self-rated health: The role of access to health care in a population-based study," Social Science & Medicine, Elsevier, vol. 64(7), pages 1373-1383, April.
    17. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal," Social Science & Medicine, Elsevier, vol. 107(C), pages 78-88.
    18. Yao, Jing & Murray, Alan T. & Agadjanian, Victor, 2013. "A geographical perspective on access to sexual and reproductive health care for women in rural Africa," Social Science & Medicine, Elsevier, vol. 96(C), pages 60-68.
    19. Beinart, William, 2001. "Twentieth-Century South Africa," OUP Catalogue, Oxford University Press, edition 2, number 9780192893185.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Nomaxabiso Mildred Mooi & Busisiwe Purity Ncama, 2020. "Perceived needs of patients and family caregivers regarding home-based enteral nutritional therapy in South Africa: A qualitative study," PLOS ONE, Public Library of Science, vol. 15(2), pages 1-14, February.
    2. Yuan, Yaqi, 2021. "Public satisfaction with health care system in 30 countries: The effects of individual characteristics and social contexts," Health Policy, Elsevier, vol. 125(10), pages 1359-1366.
    3. Nathanael Ojong, 2019. "Healthcare Financing in Rural Cameroon," Societies, MDPI, vol. 9(4), pages 1-12, November.
    4. Hartley, Sarah & Ledingham, Katie & Owen, Richard & Leonelli, Sabina & Diarra, Samba & Diop, Samba, 2021. "Experimenting with co-development: A qualitative study of gene drive research for malaria control in Mali," Social Science & Medicine, Elsevier, vol. 276(C).
    5. Noah Kaiser & Christina K. Barstow, 2022. "Rural Transportation Infrastructure in Low- and Middle-Income Countries: A Review of Impacts, Implications, and Interventions," Sustainability, MDPI, vol. 14(4), pages 1-48, February.
    6. Buhle Lubuzo & Khumbulani W. Hlongwana & Themba G. Ginindza, 2022. "Improving Timely Access to Diagnostic and Treatment Services for Lung Cancer Patients in KwaZulu-Natal, South Africa: Priority-Setting through Nominal Group Techniques," IJERPH, MDPI, vol. 19(4), pages 1-12, February.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Nshakira-Rukundo, Emmanuel & Mussa, Essa Chanie & Gerber, Nicolas & von Braun, Joachim, 2020. "Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda," Social Science & Medicine, Elsevier, vol. 245(C).
    2. Panda, P. & Chakraborty, A. & Raza, W.A. & Bedi, A.S., 2015. "Renewing membership in three community-based health insurance schemes in rural India," ISS Working Papers - General Series 608, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    3. Bocoum, Fadima & Grimm, Michael & Hartwig, Renate & Zongo, Nathalie, 2019. "Can information increase the understanding and uptake of insurance? Lessons from a randomized experiment in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 220(C), pages 102-111.
    4. Boutin, Delphine & Petifour, Laurene & Allard, Yvonne & Kontoubré, Souleymane & Ridde, Valéry, 2024. "Comprehensive Assessment of the Impact of Mandatory Community-Based Health Insurance in Burkina Faso," IZA Discussion Papers 17094, Institute of Labor Economics (IZA).
    5. David Mark Dror, 2018. "What Factors Affect Voluntary Uptake of Community-based Health Insurance Schemes in Lowand Middle-Income Countries? A Systematic Review and Meta-Analysis," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 14, pages 271-306, World Scientific Publishing Co. Pte. Ltd..
    6. Agier, Isabelle & Ly, Antarou & Kadio, Kadidiatou & Kouanda, Seni & Ridde, Valéry, 2016. "Endorsement of universal health coverage financial principles in Burkina Faso," Social Science & Medicine, Elsevier, vol. 151(C), pages 157-166.
    7. Shigute, Zemzem & Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2017. "Uptake of health insurance and the productive safety net program in rural Ethiopia," Social Science & Medicine, Elsevier, vol. 176(C), pages 133-141.
    8. Thomas Rouyard & Yukichi Mano & Bocar Mamadou Daff & Serigne Diouf & Khadidiatou Fall Dia & Laetitia Duval & Josselin Thuilliez & Ryota Nakamura, 2022. "Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal," Post-Print halshs-03641124, HAL.
    9. Mladovsky, Philipa, 2020. "Fragmentation by design: Universal health coverage policies as governmentality in Senegal," Social Science & Medicine, Elsevier, vol. 260(C).
    10. Petro G. Nzowa & Felix A. Nandonde & Somo M. L. Seimu, 2023. "Mediation effect of trust on willingness to pay for health insurance among co-operative members in Tanzania," Future Business Journal, Springer, vol. 9(1), pages 1-15, December.
    11. Shi, Xiaojun & Du, Baorui, 2024. "Decomposition of social networks and household purchase of insurance as knowledge products," Research in International Business and Finance, Elsevier, vol. 69(C).
    12. Wood, Anna, 2023. "Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal," Social Science & Medicine, Elsevier, vol. 319(C).
    13. Chen, Bingzheng & Feng, Frank Y. & Powers, Michael R. & Qiu, Joseph, 2019. "Risk-revealing contracts for government-sponsored microinsurance," Pacific-Basin Finance Journal, Elsevier, vol. 57(C).
    14. Dao, Amy, 2020. "What it means to say “I Don't have any money to buy health insurance” in rural Vietnam: How anticipatory activities shape health insurance enrollment," Social Science & Medicine, Elsevier, vol. 266(C).
    15. Rabbani, Atonu & Mehareen, Jeenat & Chowdhury, Imran Ahmed & Sarker, Malabika, 2022. "Mandatory employer-sponsored health financing scheme for semiformal workers in Bangladesh: An experimental assessment," Social Science & Medicine, Elsevier, vol. 292(C).
    16. Eichengreen, Barry & Aksoy, Cevat Giray & Saka, Orkun, 2021. "Revenge of the experts: Will COVID-19 renew or diminish public trust in science?," Journal of Public Economics, Elsevier, vol. 193(C).
    17. Maxmillan Martin & Yi hyun Kang & Motasim Billah & Tasneem Siddiqui & Richard Black & Dominic Kniveton, 2017. "Climate-influenced migration in Bangladesh: The need for a policy realignment," Development Policy Review, Overseas Development Institute, vol. 35, pages 357-379, October.
    18. Arne H Eide & Hasheem Mannan & Mustafa Khogali & Gert van Rooy & Leslie Swartz & Alister Munthali & Karl-Gerhard Hem & Malcolm MacLachlan & Karin Dyrstad, 2015. "Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-13, May.
    19. Anooj Pattnaik & Diwakar Mohan & Amy Tsui & Sam Chipokosa & Hans Katengeza & Jameson Ndawala & Melissa A Marx, 2021. "The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-16, November.
    20. Barış Alpaslan & Julide Yildirim, 2020. "The Missing Link: Are Individuals with More Social Capital in Better Health? Evidence from India," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 150(3), pages 811-834, August.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:230:y:2019:i:c:p:214-221. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.