“Our multivariate analysis shows that despite government efforts to make health care more
accessible by expanding the facility network and abolishing user fees, rural households and
vulnerable subgroups such as black South Africans, the less educated, the unemployed and the
poor tend to be less likely to have adequate access to health care. Whereas there is clearly room for
more reforms and greater vigilance regarding access constraints, our analysis shows that, in many cases, problems with affordability and availability are due to remoteness – the vulnerable groups have to travel further to the health facilities and pay more to do so. These problems are rooted in South Africa’s apartheid legacy of underdeveloped homelands and are therefore not simple to solve.
The homelands system constrained migration to urban areas and promoted and legislated settlement in underdeveloped rural areas thus preventing more organic migration patterns coinciding with regional develop-ment dynamics. The high coefficient on the rural indicator in our study’s LPM provides further confirmation of the strong role of geography in constraining health care access.
Adding to the geographical constraint is South Africa’s underdeveloped public transport network, whose deficiencies and shortcomings increase travel times and costs.”