The cost of travelling to and from clinics or hospitals place even free health services out of reach of many poor South Africans, especially from remote areas of the country, Professor Di McIntyre said in a presentation on inequality in healthcare at the Carnegie III Conference focussing on Strategies to Overcome Poverty and Inequality at the University of Cape Town (UCT).

A study by UCT’€™s Health Economics Unit on two South African communities, investigated the costs involved in accessing health services. They found that on average TB patients had spent R100 and HIV-positive patients on antiretroviral treatment (ART) R81 on travel each month to access treatment, while pregnant women paid R321 to access obstetrics services during their pregnancy.

‘€œWhile these amounts may appear to be ‘€˜small’€™, they are in fact considerable relative to many households’€™ ability to pay,’€ said McIntyre. ‘€œFor example, direct costs exceeded 10 percent of total household expenditure in two’€thirds of households using obstetric services, in one’€third of households with a member receiving TB treatment and in 23 percent of households with a member on ART.

‘€œHouseholds were reliant on financial support from family, friends and other social networks to cover these costs, but 20 percent of households had to borrow money or sell assets to cope with the direct costs of TB treatment and ART and 10 percent in the case of obstetric care. It is particularly concerning that about 40 percent of TB and ART service users in the one rural site had to borrow money or sell assets to cope with health care costs.’€

Transport costs to health facilities accounted for the majority of direct costs, and are particularly high for TB patients who, in some areas, are expected to visit a health facility on a daily basis for directly’€observed treatment.

Poverty is not only linked to health in the sense that health care costs impoverish households, but there is evidence that proves that due to socio-economic conditions, the poor become sick more often too.

‘€œIn South Africa the poor carry by far the greatest burden in most of the major causes of ill health,’€ said McIntyre. ‘€œAnd not just infectious disease such as TB or HIV, also some chronic illness such as hypertension and diabetes.’€

Poor health also translates into absenteeism and lower productivity which also leads to less income (indirect costs), which, according to McIntyre, is often greater than the direct costs incurred by patients.

‘€œWhile it is necessary to address the social determinants of health (e.g. improve living conditions such as housing and access to potable water and sanitation) it is equally important to ensure access to needed health care and to provide protection against the financial risks associated with illness,’€ said Mcintyre.