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Exploring the interaction of activity limitations with context, systems, community and personal factors in accessing public health care services: A presentation of South African case studies

Gubela Mji, Stine H. Braathen, Richard Vergunst, Elsje Scheffler, Janis Kritzinger, Hasheem Mannan, Marguerite Schneider, Leslie Swartz, Surona Visagie

African Journal of Primary Health Care & Family Medicine; Vol 9, No 1 (2017), 9 pages. doi: 10.4102/phcfm.v9i1.1166

Submitted: 19 February 2016
Published:  08 February 2017


Background: There are many factors that influence access to public health services, such as the context people live in, the existing health services, and personal, cultural and community factors. People with disabilities (activity limitations), through their experience of health services, may offer a particular understanding of the performance of the health services, thus exposing health system limitations more clearly than perhaps any other health service user.
Aim: This article explores how activity limitations interact with factors related to context, systems, community and personal factors in accessing public health care services in South Africa.
Setting: We present four case studies of people with disabilities from four low-resource diverse contexts in South Africa (rural, semi-rural, farming community and peri-urban) to highlight challenges of access to health services experienced by people with activity limitations in a variety of contexts.
Methods: One case study of a person with disabilities was chosen from each study setting to build evidence using an intensive qualitative case study methodology to elucidate individual and household experiences of challenges experienced by people with activity limitations when attempting to access public health services. In-depth interviews were used to collect data, using an interview guide. The analysis was conducted in the form of a thematic analysis using the interview topics as a starting point.
Results: First, these four case studies demonstrate that equitable access to health services for people with activity limitations is influenced by a complex interplay of a variety of factors for a single individual in a particular context. Secondly, that while problems with access to public health services are experienced by everyone, people with activity limitations are affected in particular ways making them particularly vulnerable in using public health services.
Conclusion: The revitalisation of primary health care and the introduction of national health insurance by the Health Department of South Africa open a window of opportunity for policy makers and policy implementers to revisit and address the areas of access to public health services for people with activity limitations.

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Author affiliations

Gubela Mji, Centre for Rehabilitation Studies, Stellenbosch University, South Africa
Stine H. Braathen, SINTEF, Norway
Richard Vergunst, Psychology Department, Stellenbosch University, South Africa
Elsje Scheffler, Centre for Rehabilitation Studies, Stellenbosch University, South Africa
Janis Kritzinger, Psychology Department, Stellenbosch University,, South Africa
Hasheem Mannan, School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin,, Ireland
Marguerite Schneider, Alan J Flisher Centre for Public Mental Health, University of Cape Town, South Africa
Leslie Swartz, Psychology Department, Stellenbosch University, South Africa
Surona Visagie, Centre for Rehabilitation Studies, Stellenbosch University, South Africa


disabled people; equitable access to health care services; vulnerable groups; vulnerable factors and access to public health care services


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ISSN: 2071-2928 (print) | ISSN: 2071-2936 (online)

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