Gauteng City-Region Observatory Research Articles

Health services satisfaction and medical exclusion among migrant youths in Gauteng Province of South Africa: A cross-sectional analysis of the GCRO survey (2017-2018).

Medical xenophobia of migrant (either in-migrants or immigrants) youths is an ongoing problem in contemporary South African society. Medical mistreatment by healthcare workers and social phobia from migrant youths have been attributed to major obstacles to healthcare utilization as well as health services satisfaction. This study aimed to determine the prevalence and factors contributing to health services satisfaction and medical exclusion among migrant youths in Gauteng province in South Africa. The Round 5 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) survey was conducted in 2017‒2018, a nationally representative survey piloted every two years in South Africa, was utilized in this study. A 2-year cohort study of 24,889 respondents aged 18 to 29 and a baseline data consisted of 4,872 respondents, comprising non-migrants, in-migrants and immigrants, from where 2,162 in-migrants and immigrants were utilized as the sample size. The data was analysed using descriptive statistics, Chi-Square analysis and logistic regression. A total of 2,162 migrants, comprising 35.4% in-migrants and 9.0% of immigrants, from the 4,872 respondents, were included in the analysis. The prevalence of medical exclusion of in-migrant and immigrant youths were 5.5% and 4.2%, and the majority of them reported the use of public health facilities (in-migrants ‒ 84.3% vs. immigrants ‒ 87.1%). At the bivariate level, demographic (age, sex, and population group), economic (employed and any income) and health-related (no medical aid and household member with mental health) factors were significantly associated with medical exclusion (ρ≤0.05). The adjusted odds ratio showed that only female gender (AOR: 1.07, 95% CI: 0.678, 1.705), no medical aid cover (AOR: 1.23, 95% CI: 0.450, 3.362), and neither (AOR: 1.59, 95% CI: 0.606, 4.174) or dissatisfied (AOR: 4.29, 95% CI: 2.528, 7.270) were independent predictors of medical exclusion. Having no medical aid cover, being a female and dissatisfied, or neither satisfied nor dissatisfied with health services significantly increased the odds of medical exclusion among migrant youths. To increase healthcare utilization and ensuring adequate medical care of migrant youths, opting for medical aid insurance without increasing costs should be guaranteed. Therefore, there should be no consequences for lack of residence status or correct documentation papers when accessing healthcare services among migrant youths in South Africa.

Determinants of life satisfaction among migrants in South Africa: an analysis of the GCRO’s quality of life survey (2009–2021)

BackgroundMigrant populations in any country are a vulnerable group, and psycho-demographic research measuring life satisfaction has been used to assess migrants’ well-being in developed and developing countries. However, South Africa, with its high influx of migrant populations, has investigated these topical concerns from the perspective of xenophobia, with mixed findings. However, no, or very few studies have examined life satisfaction among migrants in South Africa. This study, therefore, extends previous literature by examining the determinants of life satisfaction among South Africa’s internal and international migrant populations.MethodsWe conducted a cross-sectional study from the 2009 to 2021 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) surveys among migrant populations in two ways: a full sample and a gender-stratified sample. A sample of male and female migrants ranging from 15 to 49 years of age were recruited into this study. Cantril’s Self-Anchoring Ladder Life Satisfaction scale captured their life satisfaction alongside relevant social demographic factors. Descriptive statistics were applied for the data analysis of the demographic factors. Bivariate and multivariate logistics regression analyses were conducted to assess the associations and the predictive factors of life satisfaction among migrants, both internal and international.ResultsThe key findings were the gender distribution of life satisfaction, showing that more international (male – 66.0% and female – 67.1%) migrants reported having a thriving life satisfaction than internal migrants (male – 61.7% and female – 61.5%). Findings from the Pearson correlation coefficient revealed a significant association between the individual, household, and community factors by migrant status (ρ < 0.05). However, the probit coefficients revealed that individual factors (age 48+: AOR = 2.18, 95% CI: 1.13, 3.23, and secondary/higher education: AOR = 1.1., 95% CI: 0.01, 1.19) and household factors (two persons living in households (H/H): AOR = 1.05, 95% CI: 0.50, 1.10), and community factors (international migrant status: AOR = 2.12, 95% CI: 0.08, 2.16) significantly increase the prediction of higher odds of life satisfaction by gender among migrants. The ordered logit coefficients also showed that individual factors (middle and high income and having health insurance) and household factors (receiving SASSA social grant) predicted the highest life satisfaction among migrants (internal and international).ConclusionWe found substantial evidence that individual-, household-, and community-level factors were associated with life satisfaction among migrants. In particular, the pattern of life satisfaction varied slightly between male and female migrants, as well as with migrant status in South Africa. These findings collectively may provide helpful information for policymakers and practitioners to optimise interventions for migrant populations to improve their life satisfaction. Evidence from this study also calls on the government of South Africa to begin tracking the life satisfaction of its nationals, whether migrants or not.

A Geographically Weighted Regression Analysis of Barriers to Youth’s Participation in Local Development Planning in Gauteng Province, South Africa

With South Africa having a history of youth activism and a predominantly youthful population, this paper investigates why the youth (18-34 years) do not participate in local development planning in Gauteng Province. The main source of data used in this study was the 2015/2016 QoL data of the Gauteng City-Region Observatory (GCRO). Results across Gauteng show that the majority of the youth do not participate in ward committee (WC), community development forum (CDF), and integrated development planning (IDP) meetings. The geographically weighted regression (GWR) approach proved important in allowing us to investigate the spatial variation in non-attendance at WC meetings and the heterogeneity role of the predictor variables over the study area. The GWR results show that the percentage of employed youth, average household income, the percentage of youth who have never interacted with government, the percentage of youth dissatisfied with the local councillor, and the average educational level of the youth emerged as barriers to participation in WC meetings. While results for non-participation in CDF meetings had no significant localised GWR results, compared to those for WC meetings, common barriers (as in the ordinary least squares (OLS) model) to participation in CDF meetings were, for instance, the youth’s educational level and the lack of interaction with local government. Even according to the OLS model, the results of IDP meetings were not robust, and could not therefore be interpreted. Overall, however, these results are useful in spurring spatially-targeted – either region-wide or localised – policies.

Factors Affecting Access to Public Healthcare Facilities in the City of Tshwane, South Africa

Access to healthcare services is largely determined by socioeconomic factors, with economically well-off individuals obtaining healthcare services more efficiently than those who are disadvantaged. This paper aims to assess the effects of socioeconomic and other related factors on access to healthcare facilities in the City of Tshwane, South Africa, during the COVID-19 pandemic. Data were sourced from the Gauteng City-Region Observatory (GCRO) quality of life survey (2020/2021). Multivariate logistic regression was applied. Results showed that 66.3% of the respondents reported that they had access to public healthcare facilities within their area. Furthermore, results showed that those who lived in informal houses were significantly (OR = 0.55, 95% CI [0.37-0.80], p < 0.01) less likely to report that they had access to public healthcare facilities in their area compared to those who lived in formal houses. More efforts need to be undertaken to ensure that all citizens have access to public healthcare facilities, especially among those who are disadvantaged, such as informal dwellers. In addition, future research should encompass locality in relation to the factors that affect access to public healthcare facilities, especially during pandemics such as the COVID-19 pandemic, in order to have geographically targeted interventions.

Construction of a Reflective Quality of Life Index for Gauteng Province in South Africa

This paper demonstrates a simple methodological sequence for the statistical calculation of a context-sensitive quality of life index especially suitable for use in the Global South, i.e. lower and middle income countries. We draw on the large (n = 24,889), area-sampled, survey dataset of the fifth Quality of Life Survey (QoL V, 2017/18) of South Africa’s Gauteng province, conducted by the Gauteng City-Region Observatory. Using overtly exploratory analysis, and a fully reflective conception of indicators, we apply exploratory factor analysis (EFA) in two stages to generate our model, while defending our approach methodologically and empirically and indicating its philosophical foundations. We contrast this approach to previous analyses using the QoL I (2010) data, which defined their dimensions and assign their indicators in advance, drawing on literature and indexes largely from the Global North. We ran series of EFAs on 60 longitudinally available variables from the QoL V data set. This allowed us to determine the optimal number of factors/dimensions, guided by established criteria and the interpretability of the grouped indicators. Each dimension score is calculated arithmetically, using the indicators’ factor loadings as weights. Then the dimensions, weighted by their eigenvalues, are aggregated into the composite index, scaled to run from 0 to 100. The resulting seven-dimension, 33-indicator model was validated through confirmatory factor analysis (CFA) on the QoL V data; and its configural invariance, i.e. whether the pattern of indicators amongst the factors holds over time, was checked against the two previous QoL datasets and confirmed. This validates the ability of the approach outlined to generate a stable index. Analysis of the resulting quality of life index by race and municipality reveals trends consistent with the South African context. Overall, the White population group has the highest measured quality of life index, followed in turn by the Indian/Asian, Coloured and Black African population groups. Changes in the quality-of-life ranking of the nine municipalities comprising Gauteng province may be observed over time, using the validated previous models. The value of the exploratory approach in enabling context to influence the index construction is highlighted by the emergence of a distinct dimension of bottom-up political voice, which is relevant for democratic governance.

The invisible crisis: the determinants of local food insecurity in Gauteng municipalities, South Africa

PurposeThe purpose of this study is to estimate the determinants of household food insecurity in the Gauteng City-Region, South Africa. This is motivated by the fact that food insecurity remains a key challenge at the household level in South Africa. Furthermore, the Gauteng Province has been rapidly urbanising due to a migrant influx, both locally and internationally. The findings will assist the country in achieving its mandate on the local economic development policy, Agenda 2063 and the Sustainable Development Goals 1 and 2.Design/methodology/approachThe study adopted a quantitative cross-section design, utilising the binary logistic regression technique, drawing on the Gauteng City-Region Observatory Quality of Life 2020/2021 data, consisting of 13,616 observations, randomly drawn from nine municipalities in Gauteng City-Region.FindingsThe main findings of the study highlight unemployment, health status, education, household size, indigency and income as the main determinants of food insecurity in Gauteng City-Region. Policies towards sustainable urban agriculture, improving access to education, increasing employment and income, and health for all can help improve the food insecurity status of households in the Gauteng City-Region.Research limitations/implicationsFurther studies would require an in-depth assessment of household coping mechanisms, as well as the influence of household income (notably government social grants) and access to credit on household food security status, to better understand the dynamics of food security in the Gauteng City-Region.Practical implicationsDeterminants of food insecurity should be considered when developing and implementing policies to reduce food insecurity in urban municipalities.Social implicationsThe study is of interest as it interdicts food insecurity issues, which have an effect on socio-economic well-being.Originality/valueThe study adds value by providing evidence on the determinants of food insecurity in an urban setting in a developing country. Gauteng is the richest of all provinces in South Africa and is also at the receiving end of internal and international migration. Factors affecting food insecurity have changed in the nine cities. This compromises nutrition safety and calls for targeted policy interventions.

Factors Correlated with Home Gardening in Gauteng Province, South Africa.

Background: In addition to increasing access to fresh and affordable produce, home gardening enhances food security. This notwithstanding, there is no evidence of studies that have investigated factors correlated with home gardening in Gauteng Province (GP), South Africa. The present study investigated home gardening across the GP. Methods: Retrospective data of residents of GP (n = 30002) collected by the Gauteng City Region Observatory were used. A binary logistic regression was employed to determine factors correlated with home gardening. Results: Overall participation in home gardening was low (12.37%). If a respondent was a resident of the poorest areas, resided in a house received under the Rural Development Programme, had a borehole/well as the main source of water, belonged to a social club, received a social grant, was >65 years, and rated his/her health as poor, then they were more likely to participate in home gardening. Factors that were negatively correlated with home gardening included if the respondent rented from private individuals and if the respondent’s health status prevented him/her from doing daily work. Conclusion: The low participation levels in home gardening observed suggest the failure of the current policies geared at fostering home gardening in the province. Policy makers and relevant authorities should target identified groups to improve participation in home gardening.

Mobilising knowledge for urban governance: the case of the Gauteng City-region observatory

ABSTRACT The capacity to derive, analyse and communicate urban knowledge is increasingly essential for decision-makers managing the complex pressures of rapidly expanding cities. This paper examines the importance of transdisciplinary boundary organisations in generating and mobilising this knowledge. It introduces ‘urban observatories’ as an example of institutions catalysing information that can shape urban governance, considering in detail the experience of the Gauteng City-Region Observatory (GCRO) in South Africa. Insights drawn from GCRO’s recent work illustrate key operational considerations for these types of boundary institutions, highlighting opportunities and challenges in shaping the knowledge systems that underpin contemporary policymaking in and for cities.

Internet access and its relationship to subjective well-being in a developing region

Internet access has been shown to play an important developmental role and Internet access to all people has become an international goal. This is also true for South Africa where the ‘South Africa Connect’ policy was introduced in 2013. The question arises whether Internet access goes beyond meeting developmental goals to improving the subjective well-being of people. Furthermore, if the association between Internet access and subjective well-being vary between different race and age groups. Previous research was performed in developed countries at a national level or for specific small subsamples, like the elderly; however, this study contributes to the literature by analysing a substantial sample, at sub-national level, in a heterogeneous, unequal society, in a developing country. The benefit is that heterogeneities masked in studies at a national, macro level are highlighted in a study at a sub-national, micro level. This article investigated the relationship between subjective well-being and Internet access within a developing region with a heterogeneous, unequal society. The article used a data set representative of the Gauteng population, the economic centre of South Africa, which was collected in 2013 by the Gauteng City Region Observatory. To analyse the data, ordered probit, ordinary least square and instrumental variable regression techniques were used. The results show that Internet access is positively related to subjective well-being and this relationship holds across all race groups and all age groups, from 18 years to over 65 years of age. In addition, it seems that the stark inequalities between race groups present in South Africa are fading among younger generations. Based on the results, the ‘South Africa Connect’ policy, which aims to give Internet access to all people, including those in Gauteng, the region analysed, is supported, as it not only contributes to the development of the region but also to the life satisfaction of the citizens.

Doing more with less (data): complexities of resource flow analysis in the Gauteng City-Region

Urban metabolism is a growing field of study into resource flows through cities, and how these could be managed more sustainably. There are two main schools of thought on urban metabolism—metabolic flow analysis (MFA) and urban political ecology (UPE). The two schools remain siloed despite common foundations. This paper reflects on recent research by the Gauteng City-Region Observatory (GCRO) into urban sustainability transitions in South Africa’s Gauteng City-Region, a large and sprawling urban formation that faces a host of sustainability challenges including water deficits, erratic electricity supply, stretched infrastructure networks and increasingly carbon-intensive settlement patterns. Three GCRO research projects are reviewed. Each project began with the assumption that data collection on the region’s metabolism could enable an MFA or MFA-like analysis to highlight where possible resource efficiency and sustainability gains might be achieved. However, in each case we confronted severe data-limitations, and ended up asking UPE-style questions on the reasons for and implications of the chronic paucity of urban metabolism data. We have been led to conclude that urban metabolism research will require much more than just assembling and modelling flows data, although these efforts should not be abandoned. A synthesis of MFA and UPE is needed, which simultaneously builds a deeper understanding of resource flows and the systems that govern these flows. We support the emerging approach in political-industrial ecology literature which values both material data on and socio-political insight into urban metabolism, and emphasises the importance of multi-disciplinary and multi-dimensional analysis to inform decision-making in urban sustainability transitions.

Health-care utilization and associated factors in Gauteng province, South Africa

ABSTRACT Background: More than a billion people, mainly in low- and middle-income countries, are unable to access needed health-care services for a variety of reasons. Possible factors influencing health-care utilization include socio-demographic and economic factors such as age, sex, education, employment and income. However, different studies have showed mixed results. Moreover, there are limited studies on health-care utilization. Objective: This study aimed to determine health-care utilization and associated factors among all residents aged 18 or over in Gauteng province, South Africa. Methods: A cross-sectional study was conducted from data collected for a Quality of Life survey which was carried out by Gauteng City-Region Observatory in 2013. Simple random sampling was used to select participants. A total of 27,490 participants have been interviewed. Data were collected via a digital data collection instrument using an open source system called Formhub. Coarsened Exact Matching (CEM) was used to improve estimation of causal effects. Stepwise multiple logistic regression was employed to identify factors associated with health-care utilization. Results: Around 95.7% reported usually utilizing health-care services while the other 4.3% reported not having sought health-care services of any type. Around 75% of participants reported reduced quality of public health services as a major reason not to visit them. Higher odds of reported health-care utilization were associated with being female (OR = 2.18, 95% CI: 1.88–2.53; p < 0.001), being White compared to being African (OR = 2.28, 95% CI: 1.84–2.74; p < 0.001), and having medical insurance (OR = 5.41, 95% CI: 4.06–7.23; p < 0.001). Lower odds of seeking health-care were associated with being an immigrant (OR = 0.61, 95% CI: 0.53–0.70; p < 0.001). Conclusions: The results indicated that there is a need to improve the quality of public health-care services and perception towards them as improved health-care quality increases the choice of health-care providers.

Spatial statistical analysis of dissatisfaction with the performance of local government in the Gauteng City-Region, South Africa

South Africa in general, and the Gauteng City-Region in particular, are grappling with rising service delivery protests and increasing levels of dissatisfaction with government performance. Besides internal government performance measures, citizen satisfaction surveys are useful in providing citizen-based measurement of satisfaction with service delivery and the performance of government. With 27 490 respondents across Gauteng, the 2013 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) survey provides an interesting snap shot of attitudes towards government. A spatial statistical approach is applied to the 2013 QoL survey data to analyse patterns of dissatisfaction with the performance of local government. The analysis reveals spatial clustering in the level of dissatisfaction with the performance of local government. It also reveals percentage of respondents dissatisfied with dwelling, mean sense of safety index, and percentage agree the country is going in the wrong direction, as significant predictors of the level of local dissatisfaction. Other predictors include the percentage of respondents that think lack of maintenance is the biggest problem facing the community, and percentage agree that politics is waste of time. These results imply the need for incorporating spatial analysis and targeting in the formulation of policy aimed at improving government performance.

Mobility patterns in the Gauteng City-Region, South Africa

A key factor in understanding a city-region is the daily flows of people between its constituent parts. Mapping of the commuter field may help delineate the functional extent of the region, clarify challenges of transport efficiency, access and affordability, and reveal the impact of key transport interventions over time. It may also elucidate social dimensions of life in the region, notably patterns of inequality between groups. Data from the Gauteng City-Region Observatory’s (GCRO) 2013 Quality of Life Survey were used to map trips to work made by white and (separately) African respondents. The maps illustrate the functional extent of the city-region as well as ongoing racial disparities in geographic access-to-work opportunities in a region historically patterned by apartheid spatial forms. While there is significant continuity from the past, there are also some surprising new trends.

Nation-Building, Africanism and the 2010 Fifa World Cup: what did they do for social cohesion in post-apartheid South Africa

This paper addresses issues of nation-building and Africanism as seen through the lens of South Africa’s hosting of the 2010 FIFA World Cup. It discusses the challenges posed to social cohesion and critically examines the shift in South Africa’s national identity toward Africanism through the World Cup. The paper draws upon some findings from the Gauteng City-Region Observatory’s (GCRO) 2010 FIFA World Cup longitudinal study as reference points for the paper. The research was conducted amongst a sample of small and micro-entrepreneurs in Gauteng in order to gauge the expectations and impact of the FIFA World Cup on small business in the province. Such key findings from the research include the contention amongst 92 per cent of respondents that Ghana’s performance in the World Cup ‘brought (us) together as Africans’, while 62 per cent of respondents responded positively to the statement that ‘foreigners are taking our benefits’. This data is indicative of South Africa’s ambivalent relationship with the African continent and allows a critical perspective on the prospects for social cohesion in a post-apartheid society. The paper concludes by reflecting on the impact and meaning of the World Cup for South Africa and its ambitions to unite South Africans behind both a nation-building project and an Africanist agenda which looks to mobilise the African continent.

Deepening Non-Racialism in South Africa

Through an analysis of the Kathrada Foundation/GCRO (Gauteng City-Region Observatory) focus groups transcript pack on non-racialism, it is shown that prevailing conceptions of non-racialism are tied to being ‘colour-blind’ and to being opposed to racial prejudice and discrimination. Such conceptions, it is revealed, are too contradictory and shallow to have any meaningful transformative effect. The article argues that a deeper, more sociologically valid conception of non-racialism can be constructed if attention is turned to critically relating non-racialism to the phenomenon of systemic racism, whereby racism is read as being structurally embedded in contemporary South African society.

‘We can't really say what the future holds for us’: Non-Racialism in a Transitional Democracy

This article reflects on a set of focus group transcripts from a joint research project by the Ahmed Kathrada Foundation and the Gauteng City-Region Observatory. Casting South Africa as a transitional democracy uncovers a number of ambiguities in this context. For instance, a selection of South Africans who were respondents in various focus groups around the country, cutting across various divides, articulated a sense of uncertainty about who needs to bear the responsibility for building a cohesive society, and who will bear the cost. Various citizens attempt to assert a claim on belonging or entitlement in this transitioning society, some vocalising fears that their place may be threatened, others vocalising the fact that their needs are being overlooked. The article concludes that at this juncture in South Africa's democracy, where there is growing individual ambiguity/uncertainty, it is critical to bring issues of equality centre-stage. The imperative of research on non-racialism is to (re)cast economic redress and the economic uplifting of disenfranchised South Africans as the new challenge that requires non-racial intervention and support.

The Possibilities of Researching Non-Racialism: Reflections on Racialism in South Africa

Using as a starting point the research conducted by the Gauteng City-Region Observatory for the Ahmed Kathrada Foundation in 2011 to explore the status of non-racialism in South Africa, we conclude that in nearly all of the focus groups the participants and moderators find it impossible to define the notion of non-racialism—at least, not in a way that distinguishes it from non-racism, multi-racialism or ‘good/better race relations’. We initiate the discussion of non-racialism by highlighting the ubiquity of the term, despite there being only rare indications of its actual meaning. One of the obstacles to imagining and giving meaning to non-racialism is the binding together of essentialist notions of culture and race to form unbridgeable divides between constructed groups. The prevalence of multi-racial notions of society, resonating closely with ideas of multiculturalism, means the task of critically discussing non-racialism still lies ahead, but demands that existing practices be critically analysed.

Leaving it to the Children: Non-Racialism, Identity, Socialisation and Generational Change in South Africa

Although a critical value of the anti-apartheid movement and within the democratic Constitution, there is a lack of national consensus on the meaning of non-racialism in South Africa and how best it can be achieved, particularly given the continued use of historically defined race categories for redress. In response, the Ahmed Kathrada Foundation and Gauteng City-Region Observatory conducted a series of qualitative focus groups exploring the understanding of non-racialism among South Africans, and found widespread ambiguity about its meaning among research participants. Results suggest that while many continue to associate strongly with identity groups based on apartheid race categories, integration and engagement has increased within public life. Less change has occurred within private spaces, where stereotypes and racism remain firmly intact. Participants view non-racialism as more likely to be achieved by future generations than present ones. However, the research findings cast doubt on whether children will be able to reject stereotypes within families and at home.