Abstract
BackgroundIn South Africa, human geographic mobility is high as people engage in both permanent and temporary relocation, predominantly from rural to urban areas. Such mobility can compromise healthcare access and utilisation. The objective of this paper is to explore healthcare utilisation and its determinants in a cohort of internal migrants and permanent residents (non-migrants) originating from the Agincourt sub-district in South Africa’s rural northeast.MethodsA 5-year cohort study of 3800 individuals aged 18 to 40 commenced in 2017. Baseline data have been collected from 1764 Agincourt residents and 1334 temporary, mostly urban-based, migrants, and are analysed using bivariate analyses, logistic and multinomial regression models, and propensity score matching analysis.ResultsHealth service utilisation differs sharply by migrant status and sex. Among those with a chronic condition, migrants had 0.33 times the odds of non-migrants to have consulted a health service in the preceding year, and males had 0.32 times the odds of females of having used health services. Of those who utilised services, migration status was further associated with the type of healthcare utilised, with 97% of non-migrant rural residents having accessed government facilities, while large proportions of migrants (31%) utilised private health services or consulted traditional healers (25%) in migrant destinations. The multinomial logistic regression analysis indicated that, in the presence of controls, migrants had 8.12 the relative risk of non-migrants for utilising private healthcare (versus the government-services-only reference category), and 2.40 the relative risk of non-migrants for using a combination of public and private sector facilities. These findings of differential utilisation hold under statistical adjustment for relevant controls and for underlying propensity to migrate.ConclusionsMigrants and non-migrants in the study population in South Africa were found to utilise health services differently, both in overall use and in the type of healthcare consulted. The study helps improve upon the limited stock of knowledge on how migrants interface with healthcare systems in low and middle-income country settings. Findings can assist in guiding policies and programmes to be directed more effectively to the populations most in need, and to drive locally adapted approaches to universal health coverage.
Highlights
In South Africa, human geographic mobility is high as people engage in both permanent and temporary relocation, predominantly from rural to urban areas
The study helps improve upon the limited stock of knowledge on how migrants interface with healthcare systems in low and middle-income country settings
Descriptive results The socio-demographic and health characteristics of the study participants are presented in Table 1, with Health and Demographic Surveillance Systems (HDSS) residents contrasted with migrants
Summary
In South Africa, human geographic mobility is high as people engage in both permanent and temporary relocation, predominantly from rural to urban areas. Such mobility can compromise healthcare access and utilisation. Circular migration was historically connected with the Apartheid system of movement control, where black South Africans, who were recruited to work in mines and urban centres, were restricted from permanently settling in these areas [7]. South and Southern Africa’s economic foundation was built on both internal and cross-border labour migration, with migrant remittances providing significant support to origin households and communities [9] These interconnections between urban and rural areas have persisted post-Apartheid. It is important to gain a better understanding of the levels and trends of internal mobility in the country, as well as the impacts of such mobility on productivity, health and wellbeing
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