How race, internal migration and gender are associated with consistency in healthcare-seeking behaviour in South Africa: Nationally representative longitudinal evidence from 2008 to 2015
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Abstract
Background. In South Africa (SA), consistently seeking out primary healthcare is more important than ever as the country ages and undergoes epidemiological transition. SA’s most racialised individuals – those identifying as black and coloured – often need to migrate within the country to ensure their families’ economic stability, and internal migrants often experience difficulties in accessing healthcare compared with non-migrants. But gender matters too, as women tend to seek out healthcare more than men throughout the world, and internal migration affects women’s and men’s lives differently in SA.
Objectives. To examine differences in the consistency of healthcare-seeking behaviour between internal migrants and non-migrants, among black and coloured residents of SA, by gender. No study in SA to date has been able to examine all three of these elements, despite their important confluence stemming from apartheid and before.
Methods. To do so, this article uses data from the first four waves (2008, 2010 - 2011, 2012, and 2014 - 2015) of the National Income Dynamics Study. A total of 6 131 black and coloured men and women aged ≥18 years in 2008 form the analytical sample. Logistic regressions, with panel weights adjusted for respondent loss to follow-up, predict the likelihood that individual respondents will be consistent in seeking health consultations over the four waves as a function of their racialised identity, internal migrant status, and gender.
Results. Black residents (compared with coloured) and men (compared with women) have the lowest chances of consistently seeking out healthcare. There is no direct internal migration difference in seeking healthcare, but it is conditional upon racial and gender identity.
Conclusion. Black South Africans – especially, but not exclusively, migrant men – do not have the same chances of seeking primary care as their also-racialised coloured counterparts. For population health and clinical efforts, identifying who is at risk of not seeing a doctor is crucial, and this article provides a key update on earlier striking differences in healthcare access between SA’s most racialised groups.
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