School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Centre for Health Policy & South African Research Chairs Initiative, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Glob Health Action. 2024 Dec 31;17(1):2422192. doi: 10.1080/16549716.2024.2422192. Epub 2024 Nov 5.
Notwithstanding the global goal of inclusive universal health coverage, and the notion of migrant-sensitive health systems, limited healthcare access or the exclusion of migrants from national health systems persists. South Africa has a rights-based constitution, but there is an inability or a failure of the health system to recognise and address the health needs of migrants.
To explore the intersection of the environment of healthcare provision for migrants and the everyday practices and behaviours of health workers and patients in the Gauteng province of South Africa.
The conceptual frameworks of health system responsiveness and social exclusion informed this institutional ethnographic study at 13 healthcare facilities in Gauteng province. We developed an observation guide to explore the intersection of culture and environment and its influence on healthcare provision to patients, especially migrants. Following ethics approval, we observed the facilities for 234 person-days. We used thematic analysis to analyse the data.
Busy, frantic or nervous spaces, and contestations between patients and health workers, and among health workers formed part of the social and cultural environment of healthcare provision. The presence of migrant patients during busy periods served as a detonator for rude or discriminatory remarks, exacerbated by staff shortages and language barriers. Simultaneously, migrants exercised their agency by rebutting or confronting rude health workers. We also observed encouraging examples of kindness, caring and professionalism of health workers.
The study has implications for achieving a migrant-sensitive health system in South Africa.
尽管全球目标是实现包容的全民健康覆盖，并提出了移民敏感型卫生系统的概念，但移民获得医疗保健的机会有限，或移民被排除在国家卫生系统之外的情况仍然存在。南非有一部基于权利的宪法，但卫生系统无法或未能承认和满足移民的健康需求。
探讨南非豪登省为移民提供医疗服务的环境以及卫生工作者和患者的日常实践和行为之间的交叉点。
本机构民族志研究借鉴了卫生系统响应性和社会排斥的概念框架，在豪登省的 13 家医疗保健机构进行。我们制定了一个观察指南，以探讨文化和环境的交叉点及其对向患者（特别是移民）提供医疗服务的影响。在获得伦理批准后，我们对这些设施进行了 234 个人日的观察。我们使用主题分析来分析数据。
繁忙、紧张或紧张的空间，以及患者与卫生工作者之间、卫生工作者之间的争执，构成了医疗服务提供的社会和文化环境的一部分。在繁忙时期出现移民患者时，会引发粗鲁或歧视性言论，而工作人员短缺和语言障碍则加剧了这种情况。同时，移民通过反驳或面对粗鲁的卫生工作者来行使自己的代理权。我们还观察到卫生工作者表现出的令人鼓舞的善良、关怀和专业精神的例子。
该研究对在南非实现移民敏感型卫生系统具有启示意义。
