When 60-year-old Nolamethe Ntintili from Nombanjana, a village in Centane in the Eastern Cape first fell ill in January the family did not think much of it. But her health soon deteriorated.  

“Two weeks after she complained about body aches, she couldn’t walk and was in pain. She went quiet and could not eat. The closest hospital from Centane is Butterworth which is about 60km from here. Getting there with public transport costs about R220. She was too sick to use public transport. But to hire private transport costs around R1,500,” Harvey Tshoko, a family member, tells Health-e News.

The family was out of options: nobody in the household of five children and two adults was employed. They relied on Ntintili’s old age grant of R2,180 as the children’s grants were used to pay for transport to school. By the time she needed to get to a hospital, the money had already been spent. 

“From her government pension grant, she had to buy groceries, pay funeral policies, pay her debts and take care of her unemployed 39-year-old daughter. The money was not enough to last them through the month,” Tshoko explains.

Ntintili’s condition was getting worse, and in February her daughter made a tough choice. They would forego the month’s provisions and use the money to take her mother to a hospital.

Millions of South Africans live in poverty, which makes it difficult for them to access healthcare, even though services are provided for free. A 2023 paper looking at health access in the Eastern Cape highlights how the cost of transport and the distances from health facilities pose major barriers to medical care.  

Dr Chriselda Pillay, Public Health Medicine Registrar at the University of Cape Town (UCT), tells Health-e News that limited resources are some of the socio-economic factors that prevent families from disadvantaged backgrounds from accessing healthcare services. 

“As the cost of living rises, it becomes harder to prioritise spending time and money on long-term health benefits over immediate needs like income or food security,” she says.

Delayed diagnosis and transport

Ntintili was diagnosed with colorectal cancer in early February. It was at an advanced stage. 

Hannes Steinberg, Associate Professor of Family Medicine at the University of Free State, says early diagnosis, especially in illnesses like cancer, is key to better health outcomes. 

“South Africa is full of examples where people from disadvantaged communities take longer to present to health services for diagnosis and treatment. This is a result of socio-economic factors preventing them from accessing healthcare facilities. These people have more advanced disease, which in turn is more difficult and expensive treatment,” he says.

Research shows that rural cancer patients experience longer delays for screening, greater financial hardship, and higher travel costs to access care.

Ntintili was discharged from the hospital after a few days in hospital. Tshoko says Ntintili was given another date for her cancer treatment. However, two weeks later her condition became worse and the family could not afford to take her back to the hospital in East London. 

“We called an ambulance that took two days to arrive. Ntintili left in an ambulance with her daughter. For the week she was in hospital her daughter had to stay at a friend’s place to be closer to the hospital and be able to visit her mother,” he says. 

Ambulance challenges in the Eastern Cape can lead to delays in critical medical assistance. It takes longer for emergency services to respond to calls because of poor road infrastructure and a shortage of ambulances in the province.

Ntintili passed away in the last week of February.  Tshoko says the family is left with many regrets. 

“We have seen people dying in their homes due to lack of finances. While death cannot be prevented, if there had been money to take her to the hospital when she first complained of body pains, maybe her life could have been spared,” he says.

Competing needs 

Dr Wanga Zembe, a specialist scientist in the Health Systems Research Unit at the South African Medical Research Council (SAMRC), says their studies on tuberculosis and childhood malnutrition show how the lack of basic necessities and income to pay for transport to get to the facility prevent people from presenting at health facilities in a timely fashion.

“They sit with symptoms and delay seeking healthcare until they are too ill to stay at home,” Zembe says. 

Zembe explains that social determinants of health refer to the non-medical conditions in which people are born, grow, live, and make a living; thus, living conditions, income, public infrastructure, and access to services play a significant role in determining access to healthcare.

“These can be integrated into public health planning by building accessible, high-quality health services near where people live and improving living conditions and public infrastructure,” she says.

For many South Africans living in disadvantaged areas, the fight for health is not just about medical treatment but about survival itself. – Health-e News