An Empirical Investigation on the Provision of Non-Emergency Patient Transportation Services in South Africa (A Case Study of Mafikeng Provincial Hospital)

Accessibility to health care is one of the critical global developmental concerns. In this regard, the lack of provision of effective and efficient non-emergency patient transportation is one of the many access barriers to health care with multiple implications on the medium to long-term wellbeing of patients. This access to health challenge is even a bigger problem for individuals or group of individual with chronic medical conditions in socially vulnerable communities, as they are required to travel regularly to obtain treatment. In this view, it becomes necessary that health care system transformation initiatives that are aimed at improving accessibility and achieve universal access to health seek to address this need. This research study is warranted by inadequate academic research to inform the transportation planning approaches in support of healthcare reform programmes. In the context of South Africa, this is especially needed in the wake of the formulation of the National Health Insurance Policy (NHI) with a strategic goal to maximise universal access to healthcare. The study aim was to identify the non-emergency patient transportation needs and the extent to which such needs are being met in South Africa. The study further identified priority areas of interventions with the aim of contributing to the refinement of the objectives of the National Health Insurance Policy, and complementing its vision for universal access to health care. The research study adopted an empirical approach on the requirements for the provision of nonemergency patient transportation services in South Africa. The research study was case based and disease oriented. As one of the emerging chronic conditions that is considered have catastrophic implications on national health profile, and one that requires a high frequency of travel to obtain treatments, Chronic Kidney Disease was chosen for this research study. Given the structure of the research questions and literature discussions, a pragmatic research analysis was adopted. In this regard, a sequential, explanatory mixed methods approach was used to collect and analyse data. Semi-structured interviews and structured self-completed research questionnaires were used for primary data collection. The surveys were of a cross-sectional nature. Grounded theory was used for qualitative data analysis, while descriptive statistical analysis and IPA were used to determine the extent to which the identified renal dialysis patient travel needs have been met and to identify areas of potential intervention. The outcomes of the research study are presented as descriptive phenomenological-correlated findings. Accounts of patients, public transportation operators, treating doctors and hospital management are qualitatively and quantitatively analysed. Based on the research findings, this research study concludes that the lack of provision of effective and efficient non-emergency patient transportation services at Mafikeng Provincial Hospital is indeed a barrier to the accessibility of health care services. While the provision of non-emergency patient transportation has been established as a potential barrier in extant literature, the nature of this barrier is made clearer in this study within the South African context. Research findings shows that, unless non-emergency patient transport services are explicitly designed to cater for specific needs of patient travel, provisions for healthcare access remain critically incomplete, and may in fact, serve to worsen patient conditions. The research study recommends development of a robust, effective and efficient nonemergency patient transportation system as one of the many accessibility to health care factors that is required to achieve universal access to health in the country. In particular, transportation service design must take explicit account of operational needs of patient treatment requirements. On short to medium term interventions, provision of a dedicated renal dialysis patient travel financial subsidy and upgrading of the health services at MPH and other health facilities that serves as referring points to MPH were found to be the most desired in order to offset the considerable high travel costs, health and safety risks on the patient account. The research study also identifies areas of further research that are required to advance the incorporation of patient travel needs in non-emergency patient transportation service design