In a country striving for equitable healthcare access, statistics often highlight the challenges faced by its people. The 2023 Person General Household Survey (GHS) in South Africa revealed a stark reality: a significant 87% of respondents reported not having medical aid. This statistic underscores the urgent need for innovative solutions to bridge the healthcare gap and ensure all South Africans can access essential medical services without financial strain.

Geoscope is a pioneering organization that harnesses Geographic Information Systems (GIS) and advanced analytics to map and understand socio-economic issues. Using Circle Point Analysis (CPA), we have visualized how the National Health Insurance (NHI) initiative could potentially transform healthcare accessibility across South Africa. Our analysis begins with mapping healthcare deserts—regions where access to medical facilities and services is limited or non-existent. By overlaying data from the 2023 GHS with geographic information, we identify areas most in need of improved healthcare support & infrastructure. This spatial perspective helps prioritize resource allocation and infrastructure development under the NHI framework, effectively targeting townships and rural areas far from main cities.

Healthcare Deserts in South Africa

Municipalities like those shown on the map and listed for each province in Figure 1, have the lowest proportion of people with medical aid due to several interrelated factors. Economic challenges, such as high levels of poverty and unemployment and limit residents’ ability to afford medical aid. Many of these areas are rural or underdeveloped, with limited access to formal employment opportunities that offer medical aid benefits. There is also a lack of awareness and education about the benefits of medical aid, a heavy reliance on public health services, and poor infrastructure that makes accessing private healthcare facilities difficult.

Figure 1: According to the General Household Survey (GHS) 2023, the following municipalities have no residents with medical aid coverage.

Additionally, cultural, and social factors may contribute to a preference for traditional medicine over conventional medical aid. The implementation of the National Health Insurance (NHI) can help address these issues by providing universal health coverage, ensuring that all residents, regardless of economic status, have access to quality healthcare services, thereby reducing reliance on private medical aid and improving overall health outcomes in under-resourced areas.

Demographic Insights drive Future Service Utilization

Circle Point Analysis (CPA) of GHS data delves into demographic insights crucial for healthcare planning. Geoscope is able to examines factors such as:

• Age group: Individuals aged 20-29 show around 90% without medical aid, with a rise in coverage from age 35.
• Gender: There is little difference between males and females, with both having around 40% without medical aid and 10% having medical aid.
• Existing health conditions: Individuals with poor health conditions show the highest percentage without medical aid, whereas those in good/excellent health are more likely to have medical aid.

This data-driven approach enables policymakers to tailor healthcare services under NHI to meet specific community needs effectively. By analysing historical healthcare utilization data and socio-economic indicators, we can forecast how different communities might access and use healthcare services once NHI is fully implemented. This foresight helps optimize service delivery and resource allocation for maximum impact.

Transformative Potential of NHI in Addressing Healthcare Disparities

The insights derived from CPA paint a compelling picture of how NHI can potentially transform healthcare in South Africa. NHI aims to provide universal access to quality healthcare services, regardless of socio-economic status or geographical location. By identifying and addressing healthcare deserts, NHI can ensure no South African is left behind due to a lack of medical aid. With 87% of the population currently without medical aid, NHI offers financial protection by eliminating out-of-pocket expenses for essential healthcare services, reducing financial barriers, and promoting health equity across diverse communities.

The 2023 GHS data in KwaZulu-Natal highlights significant disparities in medical aid coverage in townships dominated by different population groups (Table 1). There are 78% of African/Black people living in townships in KwaZulu-Natal followed by 18.5% in Asian townships and only 3.4% in Coloured townships. The table shows that over 85% of people living in townships in the province do not having access to medical aid. The table also shows in relation to each race group living in townships the percentage that have no access to medical aid in the province, which equates to 86% of the African/Black population, 85.7% of Asians and 67% of Coloured people.

Table 1: Percentage of individuals with medical aid in Asian, African/Black and Coloured townships according to GHS 2023.

Race	No	Yes	Total
KwaZulu-Natal	85.37%	14.63%	100.00%
Asian	15.89%	2.64%	18.53%
Black	67.18%	10.86%	78.04%
Coloured	2.30%	1.13%	3.43%
Total	85.37%	14.63%	100.00%

 

Taking KwaMashu as an example, which is a populous area with high unemployment rates and limited access to healthcare facilities, medical aid coverage is very low. In contrast, the neighbouring Asian/Indian township of Phoenix has higher medical aid prevalence, likely due to the presence of local healthcare facilities and better access to economic opportunities (Figure 2).

Figure 2: Individuals in the 2023 GHS with medical aid (green circle) and individuals without medical aid (red) in KwaMashu & Phoenix townships.

Enhancing Healthcare Access and Equity in South Africa

Accessibility modelling is a vital tool in optimizing the location of hospitals and clinics in South Africa, ensuring equitable access to healthcare for all citizens, especially in the more rural healthcare deserts where there may be limited access to private health facilities. By integrating GIS and advanced spatial analysis, accessibility models evaluate factors such as population density, socio-economic status, and transportation networks. Geoscope specializes in building these sophisticated models, enabling planners to identify underserved areas and strategically locate new facilities to maximize coverage.

The implementation of NHI has raised concerns about potential negative impacts on the healthcare system. Critics argue that NHI could lead to an overburdened public healthcare sector, resulting in longer waiting times and reduced quality of care. Financial sustainability is also a concern, given South Africa’s economic challenges. Additionally, there is apprehension about potential mismanagement and corruption within a large, centralized system. Private healthcare providers fear that NHI could undermine their operations by imposing price controls and reducing their autonomy, possibly leading to a decline in the quality of private healthcare services.

As South Africa navigates the path towards implementing NHI, Geoscope’s CPA provides invaluable insights into how this initiative can reshape the healthcare landscape and help to address potential negative impacts. By leveraging data-driven strategies and geographic intelligence, stakeholders can collaborate effectively to ensure NHI’s success and its positive impact on the lives of millions. The integration of Circle Point Analysis underscores the transformative potential of NHI in South Africa. By visualizing data, mapping needs, and predicting outcomes, we pave the way towards a future where healthcare is accessible, affordable, and equitable for all. Together, we can build a healthier and more resilient nation, where every individual can access the healthcare, they need to thrive.