Understanding the New Study on Healthcare-Seeking Patterns
A groundbreaking study published in the South African Journal of Public Health has shed light on how race, gender, and internal migration profoundly influence whether South Africans consistently seek primary healthcare. Led by Tyler W. Myroniuk from the University of Kansas, with data from the University of Cape Town's Southern Africa Labour and Development Research Unit (SALDRU) National Income Dynamics Study (NIDS), the research analyzes longitudinal data from 2008 to 2015. This nationally representative panel survey tracks thousands of households, providing rare insights into long-term behavior trends in a country grappling with health inequities rooted in its apartheid legacy.
The findings reveal stark disparities: Black South Africans, particularly men who have migrated internally, are the least likely to regularly access care, even as South Africa boasts Africa's most advanced healthcare infrastructure per the World Health Organization. Women overall seek care more frequently, often driven by reproductive health needs, but migration disrupts these patterns for all groups. These revelations come at a pivotal time as South Africa advances its National Health Insurance (NHI) scheme, aiming for universal coverage by addressing such barriers.
South Africa's Healthcare Landscape: Progress and Persistent Gaps
South Africa's public health system serves over 80% of the population, with free primary care at clinics for vulnerable groups like children under six and pregnant women. Yet, utilization remains low—only about 60% of adults visit facilities when ill, per recent Stats SA reports. Private medical aid covers just 16% but consumes 48% of health spending, exacerbating divides.
Racial inequities linger: Black Africans, 81% of the population, face overcrowded facilities and longer waits. Recent 2025 data shows life expectancy at 64 years for men and 70 for women, with non-communicable diseases like hypertension rising amid an epidemiological shift from infectious ailments. Gender plays a role too—women report higher chronic illness rates but better preventive care uptake. Internal migration, affecting 2.5 million annually (Stats SA 2024), complicates access as people move from rural areas to urban hubs like Gauteng for jobs.
Internal Migration: A Double-Edged Sword for Health
Internal migration rates in South Africa hover at 10-15% lifetime prevalence, with 28% citing employment as the driver (Stats SA 2026). Rural-to-urban flows dominate, peaking among young Black men seeking mining or construction work. This mobility severs ties to familiar clinics, leading to delayed care.
The NIDS data shows migrants 20-30% less consistent in seeking services, as routines break and new locales present navigation hurdles. For instance, a migrant from Limpopo to Johannesburg might forgo checkups due to transport costs (R50-100 per trip) or unfamiliarity. Studies from Wits University echo this, noting migrants' higher untreated illness rates.
Racial Disparities Rooted in History
Post-apartheid, racial gaps persist. Coloured South Africans (mixed ancestry) show 15-20% higher consistent seeking rates than Black Africans, per the study. Legacy effects include spatial inequality—Black communities in townships far from facilities—and trust issues from segregated pasts.
2025 Stats SA figures indicate Black households contribute R40 billion to medical aid but underutilize public options due to stigma or perceived quality. University of Cape Town researchers link this to socioeconomic factors: 55% poverty rate among Blacks vs 27% for Coloureds.
Stats SA Provincial Healthcare ReportGender Dynamics in Care-Seeking
Women are 1.5 times more likely to seek care consistently, driven by maternal programs like road-to-health cards. Men, socialized against vulnerability, delay until emergencies—Black men especially, with odds 40% lower. UKZN studies attribute this to 'machismo' culture and work pressures.
Yet, migrant women face unique risks: family separation increases stress-related illnesses, but migration boosts urban access for some.
Photo by Hush Naidoo Jade Photography on Unsplash
Intersectionality: The Plight of Black Migrant Men
The study's core insight: Black internal migrant men have the lowest odds (OR ~0.6 vs Coloured non-migrants). Migration amplifies racial/gender barriers—job instability, hostel living, no family support. NIDS tracks show they skip 25% more checkups.
Implications? Higher chronic disease burdens, straining NHI rollout.
Unpacking the Methodology
Using NIDS waves 1-4 (28,000 respondents), researchers employed logistic regression on 'consistent seekers' (care when needed across waves). Controls included age, income, education. Longitudinal design captures causality better than cross-sections.
SALDRU at UCT ensures data quality, enabling robust findings. Myroniuk: "No direct migration effect, but conditional on race/gender."
Full Study in SAJPHKey Statistics from the Research
- Black residents: 25% lower odds vs Coloured.
- Men: 30% lower than women.
- Black migrant men: Least consistent (lowest OR).
- Overall consistency: ~65% population.
Aligns with 2024 Stats SA: 40% Blacks report unmet needs vs 20% Coloureds.
Policy Implications and NHI Synergies
As NHI phases in (2024 Bill signed), targeting migrants via mobile clinics and media campaigns could boost uptake 20-30%, per Wits models. Integrate migration data into planning—Gauteng absorbs 40% inflows.
Universities like UCT advocate community health workers for townships.
Stakeholder Perspectives
Myroniuk urges radio/social media pushes: "Promote checkups now insurance expands." SALDRU's Murray Leibbrandt notes data's role in equity. SA Medical Association calls for gender-sensitive services.
Photo by Hennie Stander on Unsplash
University Research Driving Change
SA universities lead: UCT's NIDS powers policy; Wits examines migration-health links; UKZN gender studies. Global ties, like KU collaboration, amplify impact. Amid NHI, academic input vital for inclusive design.
Future Outlook and Actionable Insights
With migration rising (Stats SA projects 3M+ annually), proactive strategies essential. Recommendations: migrant-friendly apps, workplace screenings, targeted ads. Universities can expand public health training—demand surges.
Optimism: NHI could equalize access if disparities addressed. Researchers call for NIDS wave 6 to track post-NHI shifts.
