The aim of this mini-thesis is to investigate the factors linked to access in the South African
public health sector - using General Household Survey Data - in order to contribute to a better
understanding of the role of access in achieving the National Department of Health’s primary
goal of universal coverage.
Even though the multi-dimensional interpretation of health system performance has gained
acceptance and traction in recent years, much of the research linked to it remains supplyfocused.
The implicit truth is that demand-side health issues are largely ignored, underresearched
and ominously absent from health policies. This is particularly true with regard to
the access dimension of health performance, where research and policy focus almost
exclusively on availability and affordability perspectives of access while neglecting demandside
aspects of health-seeking behaviour, such as acceptability.
The study, therefore, pursues an in-depth exploration of access across its three dimensions -
availability, affordability and acceptability - in the South African public health sector and aims
to empirically investigate access to public health care from 2002 to 2012. It also identifies the
underlying reasons for the observed trends, supplementing and reorienting the current
understanding of access to public health care.
The empirical findings reveal mixed results: it supports current literature by suggesting that
equity has been achieved in terms of making public health care services more affordable,
especially for the most vulnerable groups of South African society. However, acceptability and
availability issues persist. It is safe to say that the availability of public health care – mainly a
supply-side issue – is being addressed in the South African context with Government taking
steps to address it. Unfortunately the same attention has not been given to issues of acceptability
on the demand-side.