A National household survey of health inequalities in South Africa

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.