Healthcare Policies and Access: A Behavioural-Ecological Model Analysis

Abstract

The legacy of apartheid systems continues to be felt, especially in the country’s healthcare systems. Existing policies contribute to the inequality and challenges confronted when navigating healthcare services. This study uses the behavioural-ecological approach to analyse healthcare policy challenges hindering patients from accessing healthcare services in peri-urban communities in Johannesburg, South Africa. In addition, the study examines how poverty, poor infrastructure, and geographic location contribute to challenges facing communities in accessing healthcare services. A mixed-methods research was adopted; semi-structured interviews and field notes were used for data collection. Data were collected from outpatients, administration, and medical personnel. 173 respondents participated in the surveys, 14 participants were interviewed, and 12 respondents for focus groups. Statistical Package for the Social Sciences (SPSS) was used for quantitative data analysis and Nudist Vivo (NVivo) for thematic analysis. The study established that poverty, costly medical services, inability to communicate with healthcare providers, and low literacy were significant hindrances. It was revealed that unemployment contributed significantly to poverty levels, thus impeding access to healthcare services. The study concluded that South Africa needs a comprehensive social security system that provides adequate and sustainable social protection for peri-urban communities. The above remedial actions were recommended, but the public sector health reforms were negatively perceived. Thus, a conceptual model was developed to catalyse behavioural change in the public and private healthcare systems to achieve affordable and sustainable improvement in access and usage of healthcare services.