Health inequality and healthcare policies’ efficacy across areas with different deprivation levels within South Africa.

Abstract

Despite South Africa's efforts to reduce socio-economic inequalities since 1994 through policies like the Reconstruction and Development Programme and the Broad-Based Black Economic Empowerment Act, significant disparities remain. While these policies aimed to improve access to services and provide economic opportunities for marginalised communities, their impact has been limited. As a result, health disparities persist, challenging the effectiveness of existing health policies. This thesis seeks to fill a research gap by assessing health inequalities and the efficacy of healthcare policies across regions with varying levels of deprivation in South Africa. It is structured around four interconnected analyses. The first analysis investigates the impact of localised deprivation on adult health across different areas (traditional authority, formal rural, and formal and informal urban regions) using ordered probit models and data from the National Income Dynamics Study (NIDS). The findings reveal significant health disparities, especially in informal urban areas, where increased deprivation is strongly correlated with poor self-rated health. This highlights the need for targeted health interventions in these regions. The second analysis explores socio-economic inequalities in chronic illnesses and disabilities among children utilising concentration indices, Oaxaca-Blinder Decomposition, and NIDS data from the 2008 and 2017 waves. The results show stark disparities, with children from wealthier households in formal urban areas benefiting from better health outcomes, while poorer children in informal urban areas are disadvantaged. The third analysis examines diabetes prevalence among South African adults using standardised concentration indices, decomposition techniques and NIDS data. It uncovers varying socio-economic disparities across regions, with some areas showing reduced inequalities while others show increasing disparities. The final analysis looks at the relationship between public health expenditure and health outcomes from 2005 to 2019 across South African provinces employing two-way fixed effects panel models data from multiple sources. It finds that higher per capita health spending is paradoxically associated with lower life expectancy, indicating inefficiencies in resource allocation. Overall, the study underscores the need for tailored, region-specific healthcare policies to address the diverse challenges and reduce health inequalities across South Africa.