Spaces, Places, and Migration: Understanding and Strengthening Public Health-Care Provision in South Africa

Abstract

Given South Africa’s historical and contemporary realities of both internal mobility and migration from other countries, this paper argues that engaging with space, place, and migration is pivotal to understanding and strengthening public health-care provision in South Africa. This paper views place as emerging from and relating to space. A mutually reinforcing and reciprocal relationship between people and place over time shapes health-care delivery and health outcomes in South Africa. Therefore, this paper argues that engaging with a place-based approach is required to understand the local context in which diverse groups are situated. There is, however, a lacuna in studies situating South(ern) African public health-care challenges within such a place-based approach. This paper presents findings from a mixed-methods study that was designed to fill this gap. The research team conducted fieldwork in six health-care facilities across two provinces in South Africa – four in Gauteng and two in the Vhembe district of Limpopo province – representing urban, peri-urban, and rural settings. The study included exploratory in-depth interviews with 77 health-care providers (including nursing and administrative staff), a survey conducted with 229 health-care users, and site visits. The findings show how diverse spaces shape and are shaped by different migrant profiles, producing diverse places, which in turn present particular demands to the public-health system. It is crucial to understand the pathways, behaviors, and meanings associated with such mobility if we are to strengthen the provision of health-care services in South Africa.