A qualitative approach to examining health care access in rural South Africa

Using a combination of documentary analysis, a household survey, and in-depth interviews, we examine instances when people access healthcare outside of the standard, government protocol in Harry Gwala District, KwaZulu-Natal to better understand barriers to access. South Africa's healthcare system is organized according to a spatial hierarchy, where specialty care is concentrated in urban areas and basic care is disbursed throughout the country. Livelihoods and family life are shaped by South Africa's political and economic history and current day. The tensions between everyday life and national healthcare policy are evident when people access care outside of official policy. Our research reveals that resource scarcity, transportation, and kinship networks, all rooted in South Africa's economy and long history of racial segregation, have the biggest influence on access. This finding adds to scholarly literature by bringing in the experiences of rural residents to reveal that the healthcare system is inextricably linked to the country's political-economy and that access models focused on distance break down when faced with poverty, transportation, and family networks in rural areas. Further, by focusing on examples of access outside of the prescribed pathways, we examine in depth what is happening on-the-ground. At the same time, we examine the broader political and economic context that has shaped both the healthcare system and the people who access it. As a result of this qualitative research, we open up possibilities for improving access to the healthcare system by highlighting factors outside of the system.