Transport issues that underpin access to a tiered government health system in the context of the HIV/AIDS and tuberculosis epidemics : a study of referral and emergency service transport in greater Pietermaritzburg.

Abstract

There is a very limited literature examining transport and access to health care, especially in the South African context. The existing literature does not provide an analysis of the influence of transport on access to health care and the utilisation of referrals by the patients. In the context of the HIV/AIDS and Tuberculosis epidemics which have already increased the demand for health care and utilisation of referrals, transport is a critical issue to take into account with regard to access to health care. The case study presented in this dissertation examines the influence of transport (either public or private) on patient's access to health care facilities, particularly the referrals and Emergency Medical services (EMS). The findings are based on a sample of 30 EMS providers, 15 clinic and hospital nurses, doctors and senior administrators, as well as 200 patients (clients) seeking health care in the three clinics which were chosen as study sites. Using qualitative and quantitative methods, this study focuses on patients seeking health care as well as those who provide health care routinely at clinics and hospitals and in emergencies. The focus of interest was transport needs and services and its role in patient access in the context of HIV/AIDS and TB epidemics. Findings of this study confirm research undertaken in other developing contexts. They show that in rural and some remote urban settlements, transport is a serious barrier to equitable access to health care. Race and locality combine to generate a hierarchy of access to care in South Africa. The study concludes that there is a need to reallocate resources in the health sector in order to increase access. Transport needs have to be taken into account when access to services is planned. And alternative models of health care provision in the context of the epidemics have to be conceived, emphasising the provision of well-equipped and resourced primary health care facilities.