Figure 25: Means of transport to health facility by geographic location (total households=17.2m

Figure 25: Means of transport to health facility by geographic location (total households: 17.2m) Source: GHS 2019

The geographical bias in access to care also emerges when analysing travel times to health facilities. While just over one in two households in urban areas reported travel times to healthcare facilities in less than 15 minutes in 2019, only one in five households could report the same in rural areas (see Figure 25 above). In rural areas, almost 80% of households take from 15 to 89 minutes to travel to a facility, while only about half of urban households reported the same travel time.

Even if care is accessed and received, it is important to ensure that quality standards are upheld. The government implemented an Ideal Clinic benchmark for clinics in 2015 and only 9.2% of clinics achieved this status at the time.41 It improved to 55.4% in 2018, but decreased slightly to 54.9% in 2019, indicating the challenge to ensure the sustainability of quality assurance initiatives.41 Basic patient-centric conduct may improve the perceived quality of care by patients. These include being greeted by staff and having their condition adequately explained to them.36 When simulated (mystery) pre-hypertensive patients were used in a study assessing the quality of care at primary healthcare facilities in South Africa, the latter was poorly performed. Among these standardised patients, 39% received no lifestyle counselling, and 25% did not receive a diagnosis or follow-up appointment.35 Similarly, among standardised TB patients, only 43% were offered an HIV test and 54% did not have any contact tracing.34 It is inevitable that demand-side proxies for poor healthcare quality, such as bad experiences or negative perceptions of healthcare services, will negatively impact health-seeking behaviours.

More evidence of how client experiences at healthcare services feed into health-seeking behaviour is illustrated in Figure 26 below. According to GHS data, in 2019 the main reasons why households reported bypassing their closest healthcare facility was based on their preference for private healthcare, long waiting times and a lack of required medication. Although the reported proportion was almost twice as high in urban areas as in rural areas (46% vs. 23%), the preference for private healthcare ranked as the top reason for bypassing, irrespective of the household’s geographical location. This finding has financial implications for the poor, who need to pay out of pocket for private healthcare – and are prepared to do so, even when ‘free’ public healthcare is available.