Researching Equity in Access to Health Care (REACH)
Background
REACH started in May 2007 and was initially planned to run over four years, but following an extension for an additional year, the project ended in April 2012. Funded by a Teasdale-Corti Team Grant, which is administered by the IDRC (International Development Research Center, Canada), the project had three phases located in four study sites:
• Mitchells Plain – an urban sub-district in Cape Town in the Western Cape Province
• Region D – an urban sub-district in Johannesburg/Soweto in the Gauteng Province
• Hlabisa – a rural sub-district in Northern KwaZulu-Natal; part of Hlabisa is included in the Africa Centre Demographic Surveillance Site
• Bushbuckridge – a rural sub-district in Mpumulanga; part of Bushbuckridge is included in the Agincourt Demographic Surveillance Site
Objectives
The Researching Equity in Access to Health Care Project (REACH) explored access barriers to health care in South Africa, where health inequities continue to persist despite democratic reforms. Although achieving equitable access is a central goal of health systems, there has been relatively little research into access and appropriate policy responses to inequities in access. This project aimed to better understand the complexities and nuances of access, defined as the ‘degree of fit’ between users/populations and providers/health system in the availability, affordability and acceptability of health services.
By focusing on three health interventions (“tracers”) – maternal health deliveries, tuberculosis care and anti-retroviral therapy for HIV - the research mapped inequities in utilisation and access nationally, conducted in-depth studies in four health ‘sub-districts’ (rural and urban), and identified relevant responses in the policy and practice environment. The project sought to integrate research, capacity strengthening and knowledge translation through methodologies that included utilisation-incidence and secondary data analyses, health services assessments, qualitative research, policy analyses and research-to-action processes at several levels.
Partnerships
The project began as a collaboration between one Canadian (McMaster) and two South African (CHP, Wits University and HEU, University of Cape Town) universities. Subsequently, two additional South African research units were added to the team of research collaborators in order to assist with the research in specific sites (ACHPS, University of KwaZulu Natal and RADAR, Wits University) (although the funding remains centrally disbursed through CHP, HEU and McMaster).
The project was also run in conjunction with representatives of various strategically placed groups of actors (‘research users’) in the South African health system, including the Departments of Health (nationally, provincially and locally) and the Midwives Society.
Capacity Development
The research team comprised of a multi-disciplinary set of researchers drawn from the fields of health -economics, -systems, -policy and the social sciences and the research team involved a mix of genders within each stage of the research programme and within each level of responsibility (Principal Investigators, researchers etc). A postdoctoral research fellow, two registered PhDs and two potential doctoral candidates were embedded within the project to benefit from research training opportunities, as part of the project’s aim was to strengthen the capacity to respond to health inequities in the health sector more widely.
Publications related to the project:
2014
Harris B, Eyles J, Penn-Kekana L, Fried J, Nyathela H, Thomas L, Goudge J. (2014) Bringing Justice to Unacceptable Health Care Services? Street-Level Reflections from Urban South Africa. International Journal of Transitional Justice;8 (1):141-61.
Harris B, Eyles J, Penn-Kekana L, Thomas L, Goudge J. Adverse or acceptable: negotiating access to a post-apartheid health care contract. Globalization and Health. 2014;10(1):35.
2012
Fried J, Harris B, Eyles J. Hopes interrupted: accessing and experiences of antiretroviral therapy in South Africa. Sexually Transmitted Infections. 2012 88:147-151.
Schneider H, Govender V, Harris B, Cleary C, Moshabela M, Birch S. Gender differences in experiences of ART services in South Africa: a mixed methods study. Tropical Medicine and International Health. 2012 doi:10.1111/j.1365-3156.2012.03009.x: 1-7
Silal SP, Penn-Kekana L, Harris B, Birch S, McIntyre D. Exploring inequalities in access to and use of maternal health services in South Africa. BMC Health Services Research. 2012 12(120).
Technical Report:
Schneider H, McIntyre D, et al. (2012). Researching Equity in Access to Health Care (REACH) Final Technical Report, Centre for Health Policy/RADAR, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, McMaster University, African Centre for Health and Population Studies, University of KwaZulu-Natal, School of Public Health, University of the Western Cape: 169 Pages.
REACH research results meeting, Ottawa
Over 200 global health researchers gathered in Ottawa in November 2012 to discuss research results from the 7-year Teasdale-Corti Global Health Research Partnership. Canadian and South African researchers reported on the factors that make it difficult for poor people to take advantage of publicly funded health care. Click here to read more about this meeting.