Healthcare Policies and Access: A Behavioural-Ecological Model Analysis

Authors

DOI:

https://doi.org/10.25159/2520-9515/10899

Keywords:

healthcare system, behavioural-ecological approach, healthcare policy, access to healthcare services, medical costs

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.

References

Ajzen, I. 1985. “From Intentions to Actions: A Theory of Planned Behaviour.” In Action-control: From Cognition to Behaviour edited by Julius Kuhl and Jürgen Beckman, 11–39. Heidelberg: Springer. https://doi.org/10.1007/978-3-642-69746-3_2 DOI: https://doi.org/10.1007/978-3-642-69746-3_2

Alexander, P. 2013. “Marikana, Turning Point in South African History.” Review of African Political Economy, 40(138): 605–619. https://doi.org/10.1080/03056244.2013.860893 DOI: https://doi.org/10.1080/03056244.2013.860893

Amundsen, I. 2009. Public Sector Ethics. Luanda: Catholic University of Angola.

Andersen, R.M. 1995. “Revisiting the Behavioural Model and Access to Medical Care: Does it Matter?” Journal of Health and Social Behaviour, 36(1): 1–10. https://doi.org/10.2307/2137284 DOI: https://doi.org/10.2307/2137284

Asante, A., Price, J., Hayen, A., Jan, S. and Wiseman, V. 2016. Equity in Health Care Financing in Low and middle-income countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses. PloS one.

https://doi.org/10.1371/journal.pone.0152866 (Accessed 15 November 2015). DOI: https://doi.org/10.1371/journal.pone.0152866

Ataguba, J. E. 2010. “Explaining Health Inequalities in South Africa: A Political Economy Perspective.” Social Science and Medicine, 70(3), 361–368.

Ataguba, J. E. and McIntyre, D. 2012. “Who Benefits from Health Services in South Africa?” Health Economics, Policy, and Law, 7(1), 21–46. https://doi.org/10.1017/S1744133112000060 DOI: https://doi.org/10.1017/S1744133112000060

Bateman, C. 2013. “Health Shambles. Continuing Medical Education.” South African Journal of Continuous Professional Development, 31(1): 32–34.

Berkman, L.F., Kawachi, I. and Glymour, M.M. eds. 2014. Social Epidemiology. London: Oxford University Press. https://doi.org/10.1093/med/9780195377903.001.0001 DOI: https://doi.org/10.1093/med/9780195377903.001.0001

Bonfrer, I., van de Poel, E., Grimm, M. and van Doorslaer, E. 2012. “Does Health Care Utilization Match Needs in Africa? Challenging Conventional Needs Measurement.” Health Policy Plan, (7): 921–937. https://doi.org/10.1093/heapol/czt074 DOI: https://doi.org/10.1093/heapol/czt074

Bronfenbrenner, U. 1979. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press.

Braun, V. and Clarke, V. 2006. “Using Thematic Analysis in Psychology.” Qualitative Research in Psychology, 3(2): 77–101. https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa

Bruner II, G.C. and Kumar, A. 2005. “Applying T.A.M. to Consumer Usage of Handheld Internet Devices.” Journal of Business Research, 58: 553–558. https://doi.org/10.1016/j.jbusres.2003.08.002 DOI: https://doi.org/10.1016/j.jbusres.2003.08.002

Burns, N. and Grove, S.K. 2010. Understanding Nursing Research - E-Book: Building An Evidence-based Practice. Elsevier Health Sciences.

Boulware, L. E., Cooper, L. A., Ratner, L. E., LaVeist, T. A., and Powe, N. R. 2016. “Race and Trust in the Health Care System.” Public Health Reports, 118(4), 358–365. https://doi.org/10.1016/S0033-3549(04)50262-5 DOI: https://doi.org/10.1016/S0033-3549(04)50262-5

Bowling, A., and Gabriel, Z. 2004. “An integrational Model of Quality of Life in Older Age. Results from the ESRC/MRC HSRC Quality of Life Survey in Britain.” Social Indicators Research, 69(1), 1–36. https://doi.org/10.1023/B:SOCI.0000032656.01524.07 DOI: https://doi.org/10.1023/B:SOCI.0000032656.01524.07

Chitiga, M., Sekyere, M., and Tsoanamatsie, T. 2015. “Determinants of Health Care Expenditure Growth Rate in South Africa.” Journal of Economics and Behavioral Studies, 7(4), 98–106.

Creswell, J.W. 2012. Collecting Qualitative Data. Educational Research: Planning, Conducting, and Evaluating Quantitative and Qualitative Research. 4th Edition. Boston: Pearson.

Creswell, J.W. and Clark, V.L.P. 2017. Designing and Conducting Mixed Methods Research. E-Book. Thousand Oakes, CA Sage Publications.

Coovadia, H., Jewkes, R., Barron, P., Sanders, D., and McIntyre, D. 2009. “The Health and Health System of South Africa: Historical Roots of Current Public Health Challenges.” The Lancet, 374(9692), 817–834. https://doi.org/10.1016/S0140-6736(09)60951-X DOI: https://doi.org/10.1016/S0140-6736(09)60951-X

Department of Planning, Monitoring and Evaluation. 2016. Annual Performance Plan 2016/17, Pretoria: Department of Planning Monitoring and Evaluation (DPME).

Gauteng Department of Health. 2016. Gauteng Department of Health Annual Report 2016/17. Gauteng Province Government, South Africa.

Goryakin, Y., Revill, P., Mirelman, A., Sweeney, R., Ochalek, J.M. and Suhrcke, M.E. 2017. Public Financial Management and Health Service Delivery: A Literature Review. London: University of York.

Grafström, A. 2010. “The Entropy of Unequal Probability Sampling Designs.” Statistical Methodology, 7(2): 84–97. https://doi.org/10.1016/j.stamet.2009.10.005 DOI: https://doi.org/10.1016/j.stamet.2009.10.005

Greer, S.L., Wismar, M., Figueras, J. and Vasev, N. 2016. “Policy Lessons for Health Governance.” Strengthening Health System Governance, Health Systems and Policy Analysis, 35: 1–24.

Hamilton, K., Spinks, T., White, K.M., Kavanagh, D.J. and Walsh, A.M. 2016. “A Psychosocial Analysis of Parents’ Decisions for Limiting Their Young Child’s Screen Time: An Examination of Attitudes, Social Norms and Roles, and Control Perceptions.” British Journal of Health Psychology, 21(2): 285–301. https://doi.org/10.1111/bjhp.12168 DOI: https://doi.org/10.1111/bjhp.12168

Harris, B., Goudge, J., Ataguba, J.E., McIntyre, D., Nxumalo, N., Jikwana, S. and Chersich, M., 2011. “Inequities in Access to Health Care in South Africa.” Journal of Public Health Policy, 32: 102-S123. https://doi.org/10.1057/jphp.2011.35 DOI: https://doi.org/10.1057/jphp.2011.35

Hassim, A., Heywood, M. and Berger, J. 2007. Traditional and Alternative Healthcare. Health and Democracy. Westlake Siber Inc.

Leibbrandt, M., Finn, A. and Woolard, I. 2012. “Describing and Decomposing Post-apartheid Income Inequality in South Africa.” Development Southern Africa, 29(1): 19–34. https://doi.org/10.1080/0376835X.2012.645639 DOI: https://doi.org/10.1080/0376835X.2012.645639

Lenders, C., Gorman, K., Milch, H., Decker, A., Harvey, N., Stanfield, L., Lim-Miller, A., Salge-Blake, J., Judd, L. and Levine, S. 2013. “A Novel Nutrition Medicine Education Model: The Boston University Experience.” Advances in Nutrition, 4(1): 1–7. https://doi.org/10.3945/an.112.002766 DOI: https://doi.org/10.3945/an.112.002766

Makhura, D. 2016. “Delivery Support Programme for Issues Facing Gauteng Citizens.” Daily Maverick, 26 February 2018. Johannesburg, South Africa: Daily Maverick Publishing.

Manning, E. 2009. Relationscapes: Movement, Art, Philosophy. Montreal: Mit Press. https://doi.org/10.7551/mitpress/9780262134903.001.0001 DOI: https://doi.org/10.7551/mitpress/9780262134903.001.0001

Mbeki, T. 1998. The African Renaissance: South Africa and the World. V.9. Speech. United Nations University.

Montano, D.E. and Kasprzyk, D. 2015. “Theory of Reasoned Action, Theory of Planned Behaviour, and the Integrated Behavioural Model.” Health Behaviour: Theory, Research and Practice, 70(4): 231.

Naidoo, K., Singh, J. and Lalloo, U. 2013. “Critical Analysis of ICU/HC Beds in South Africa: 2008–2009.” South African Medical Journal, 103(10): 746–750. https://doi.org/10.7196/SAMJ.6415 DOI: https://doi.org/10.7196/SAMJ.6415

National Department of Health. 2015a. National Health Insurance for South Africa: Towards Universal Health Coverage. http://www.gov.za/sites/www.gov.za/files/National_Health_Insurance_White_Paper 10 Dec 2015.pdf. (Accessed 16 December 2020).

National Department of Health. 2015b. Department of Health Annual Report 2015/2016. https://www.gov.za/documents/department-health-annual-report-20152016- 22-nov-2016-0000. (Accessed 16 December 2015).

National Department of Health. 2020. The Rapeutic Alternative for Cephalexin Suspension November 2019 final. https://doi.org/10.14202/vetworld.2020.2 (Accessed 13 February 2020). DOI: https://doi.org/10.14202/vetworld.2020.2

National Development Plan 2030. 2012. Pretoria: South Africa. http://www.section27.org.za/wp-content/uploads/2013/01/ndp2030_chap10.pdf

(Accessed 18 April 2020).

Netshitenzhe, J. 2013. “A Pan-African Renaissance in the Next 50 Years?” The Thinker, 20.

Peters, B.G. 2014. The Politics of Bureaucracy: In The Politics of Bureaucracy. Routledge. https://doi.org/10.4324/9780203879146 DOI: https://doi.org/10.4324/9780203879146

Ryvicker, M. 2018. “An International Perspective on Improving Occupational Conditions for Direct Care Workers in Home Health.” Israel Journal of Health Policy Research, 7(1): 1–4. https://doi.org/10.1186/s13584-018-0249-5 DOI: https://doi.org/10.1186/s13584-018-0249-5

Sofaer, S. 2009. “Navigating Poorly Charted Territory.” Medical Care Research and Review, 66(1): 75S–93S. https://doi.org/10.1177/1077558708327945 DOI: https://doi.org/10.1177/1077558708327945

Sheeran, P. 2002. “Intention – Behaviour Relations: A Conceptual and Empirical Review.” European Review of Social Psychology, 12(1): 1–36. https://doi.org/10.1080/14792772143000003 DOI: https://doi.org/10.1080/14792772143000003

StatsSA. 1999. South Africa Demographic and Health Survey 1998: Full Report. Statistics South Africa. http://www.statssa.gov.za/publications/Report-03-00-09/Report-03-00-09March2003.pdf

StatsSA. 1999. Provincial Profile 1999: KwaZulu-Natal. http://www.statssa.gov.za/publications/Report-00-91-05/Report-00-91-051999.pdf

(Accessed May 2020).

StatsSA. 2003. Annual Report 2003/04. Ten Years of Statistics. https://www.statssa.gov.za. (Accessed: 3 May 2017).

StatsSA. 2012. Bulletin of Statistics. https://www.statssa.gov.za/publications/Bulletin/BulletinJune2012.pdf

(Accessed 28 November 2019).

StatsSA. 2015. Mid-year Population Estimates. Statistical Release, 302.

StatsSA. 2016. Mid-year Population Estimates. https://www.statssa.gov.za/publications/P0302/P03022016.pdf. (Accessed 25 August 2016).

StatsSA. 2017. Non-financial Census of Municipalities. http://www.statssa.gov.za/?p=11199. (Accessed 4 June 2019).

StatsSA. 2018. General Household Survey. https://www.statssa.gov.za. (Accessed 18 May 2019).

StatsSA. 2018. Midyear Population Estimates 2018. http://www.statssa.gov.za/?p=11341. (Accessed 23 July 2018).

StatsSA. 2019. National Poverty Lines. http://www.statssa.gov.za/publications/P03101/P031012019.pdf. (Accessed 31 July 2019).

Teare, J., Kootbodien, T., Naicker, N. and Mathee, A. 2015. “The Extent, Nature and Environmental Health Implications of Cottage Industries in Johannesburg, South Africa.” International Journal of Environmental Research and Public Health, 12(2): 1894–1901. https://doi.org/10.3390/ijerph120201894 DOI: https://doi.org/10.3390/ijerph120201894

The Human Rights Watch. 2012. The World Report. DOI: https://doi.org/10.46692/9781447309925

World Bank. 2019b. South Africa’s Growth Prospects: Gini Coefficient. https://www.worldbank.org/cn/country/southafrica/overview. (Accessed 10 February 2020).

Legislation

Constitution of the Republic of South Africa, 1996. https://www.gov.za/sites/default/files/gcis_document/201409/act108of1996s.pdf (Accessed: 13 December 2019)

The Health Professions Amendment Act 29, 2007. https://www.gov.za. (Accessed 17 June 2018).

Published

2023-08-16

How to Cite

Sigamoney, Claudia. 2023. “Healthcare Policies and Access: A Behavioural-Ecological Model Analysis”. Journal of Law, Society and Development 10:24 pages. https://doi.org/10.25159/2520-9515/10899.

Issue

Section

Articles
Received 2022-03-15
Accepted 2023-07-05
Published 2023-08-16