A National Household Survey of Health Inequalities in .

Prepared by the Community Agency for Social Enquiry (CASE) for the Henry J. Kaiser Family Foundation.

Overview Chapter 1. Research Methodology. Chapter 2. Household Description. Chapter 3. Research Findings: Children Aged 5 Years and Younger. Chapter 4. Research Findings: Children Aged 6 to 15 Years. Chapter 5. Background Information: Adults Aged 16 to 64 Years. Chapter 6. Access to Health-Care: Adults Aged 16 to 64 Years. Chapter 7. Chronic Illnesses and Disabilities: Adults Aged 16 to 64 Years. Chapter 8. Mental Health: Adults Aged 16 to 64 Years. Chapter 9. Reproductive and Sexual Health. Chapter 10. Women's Health. Chapter 11. Research Findings: Adults Aged 65 Years and More. Chapter 12. Health Knowledge. Chapter 13. Provincial Comparisons. Appenices A-D. References.

A National Household Survey of Health Inequalities in South Africa

OVERVIEW CHAPTER

Overview Report. Summary of Key Survey Findings. Principle Survey Findings: Demographics, Public Health Environment, Site of Care, Barriers to Care, Quality of Care, Satisfaction with Services, Child Health, Reproductive Health, Chronic Health Conditions. Measures of Progress.

OVERVIEW REPORT

The first democratically elected government in South Africa has made improving health and health services for the historically underserved black majority a national prioity. As part of this process, in June 1995, the Minister of Health, Dr. Nkosazana Dlamini Zuma, outlined a plan designed to provide free primary health care to all South Africans. This plan aims to improve the health status of South Africans, as well as the quality of care, through increased emphasis on disease prevention and early intervention.

To establish a baseline from which to measure the impact of these improvements over time, the Henry J. Kaiser Family Foundation, in June 1994, commissioned this national household health survey, the first of its kind in South Africa. The Foundation plans to regularly repeat this survey to provide a reliable monitor of progress.

A nationally representative sample of 4,000 households was drawn and the data weighted to the universe of 7,594,000 households in South Africa and for the universe of each age category, taking into account the distribution of households within provinces, population groups and environment such as metro, urban or rural. The survey was coordinated by the Community Agency for Social Enquiry (CASE) and the questionnaire administered by Market Research Africa.

The questionnaire and data analysis were reviewed by a specially convened panel of reviewers in South Africa and the United States (see Appendix A and B). In addition, the questionnaire was pre-tested in a series of 10 focus groups, representative of different race groups and population categories, such as the elderly and disabled.

The questionnaire focused on the public health environment; barriers in access to health care; and perceptions of quality and satisfaction with the outcome of health care. In addition, a series of sentinel indicators of health status and health information were identified.

SUMMARY OF KEY SURVEY FINDINGS

The findings of this survey underscore how dramatically worse off the majority African population in South Africa is in almost every aspect of their lives when compared to other race groups. Poverty, combined with poor public health conditions--overcrowded housing, lack of accessible drinking water and sanitation--make Africans most vulnerable to ill health. Yet those who are at greatest risk also have the greatest difficulty accessing health services and are treated the most shabbily when they do.

Although nearly half of all respondents expressed dissatisfaction with the existing health service, predictably dissatisfaction is much higher among Africans. Approximately two thirds of Africans live in rural areas (in the former homelands or on white-owned farms) or in informa