The public healthcare system in South Africa is built on the principle of universal access; however, in places like Gauteng, which has high migration rates and a dense population, this accessibility remains a challenge (Abrahams et al., 2022; Moeti et al., 2023). Gauteng is the smallest province in South Africa, yet it has the highest population, housing over 15 million people (Census, 2022). The dense population and poverty conditions cause a strain on the quality of public healthcare; thus, the supply is highly outpaced by the demand (Abaerei et al., 2017; Moeti et al., 2023). Marginalized and vulnerable communities often have limited access to quality healthcare services (Abrahams et al., 2022). Social tensions worsen spatial inequalities, especially for undocumented migrants who encounter both geographic and political obstacles to accessing care (Abaerei et al., 2017; Janse van Rensburg et al., 2021).

The heatmap (Figure 1) shows a high concentration of healthcare facilities in City of Johannesburg and City of Tshwane, but sparse coverage in peri-urban areas like Merafong City and Rand West City. This highlights spatial inequities in relation to physical location of healthcare facilities.

Figure 1 shows heatmap of the healthcare facilities distribution concentrations in Gauteng’s local municipalities.

To understand spatial distribution of healthcare facilities in relation to the communities they are intended to serve, the Two-Step Floating Catchment Area (2SFCA) approach is applied. This method applies a 5 km travel distance to estimate access, assuming each public healthcare facility can serve 100 people. Figure 2 shows disparities in access, with some regions having more access to healthcare in relation to their population size and others having large gaps. Higher accessibility (0.000107-0.00044) is indicated by lighter green color in Merafong City and Rand West City which means that these municipalities have more healthcare capacity within a 5-kilometre radius in comparison to their local population. Lower accessibility (0.000000-0.000025) is shown in light blue color in areas such as City of Tshwane, Lesedi and City of Johannesburg which may indicate that there are fewer facilities nearby in relation to the population they are intended to serve.

While Figure 1 highlights the uneven geographic distribution of healthcare facilities, Figure 2 reveals how this distribution translates into real access for communities. Together, the maps show that areas with many facilities can still have poor access when demand is high, while areas with fewer facilities can sometimes offer better access relative to their population. This underscores the importance of considering both facility location and population needs in healthcare planning.

Figure 2 shows how healthcare accessibility is distributed geographically throughout Gauteng’s local municipalities using the Two-Step Floating Catchment Area (2SFCA) approach.

References

Abera Abaerei, A., Ncayiyana, J. and Levin, J. (2017). Health-care utilization and associated factors in Gauteng province, South Africa. Global Health Action, 10(1), 1305765. DOI:https://doi.org/10.1080/16549716.2017.1305765.

Abrahams, G.L., Thani, X.C. and Kahn, S.B. (2022). South African Public Primary Healthcare Services and Challenges. Sabinet: African Journals, 30(2). DOI:https://doi.org/10.10520/ejc-adminpub_v30_n2_a7.

Janse van Rensburg, G.H., Feucht, U.D., Makin, J., le Clus, N. and Avenant, T. (2021). Healthcare without borders: A cross-sectional study of immigrant and nonimmigrant children admitted to a large public sector hospital in the Gauteng Province of South Africa. PLOS Medicine, 18(3). DOI:https://doi.org/10.1371/journal.pmed.1003565.

Moeti, T., Mokhele, T., Weir-Smith, G., Dlamini, S. and Tesfamicheal, S. (2023). Factors Affecting Access to Public Healthcare Facilities in the City of Tshwane, South Africa. International Journal of Environmental Research and Public Health, 20(4), 3651. DOI:https://doi.org/10.3390/ijerph20043651.

For more information, contact:

Thabiso Moeti (tmoeti@hsrc.ac.za) or Regina Mabokachaba (rmabokachaba@hsrc.ac.za)