Social Determinants Influencing Access to Home Delivery of Medication During the COVID-19 Pandemic for Cape Town Residents Living With Type 2 Diabetes.

OBJECTIVES

The COVID-19 pandemic disrupted routine healthcare services, disproportionately affecting people living with chronic conditions such as type 2 diabetes (T2D). In response, the Western Cape Government Health implemented home delivery of medication (HDM) via community health workers (CHWs) to maintain continuity of care. This study aimed to evaluate the association between socioeconomic factors and access to HDM among T2D patients in Cape Town, South Africa, during the pandemic, with a focus on equity and health system responsiveness.

METHODS

A descriptive cross-sectional survey was conducted via telephone interviews with 267 patients receiving care at 4 public primary care facilities. Sociodemographic, economic, and treatment-related variables were collected. Fisher's exact test and multivariable logistic regression were used to assess the associations between these variables and access to HDM.

RESULTS

Language, marital status, employment, access to piped water, distance from the clinic, and duration of diabetes were significantly associated with access to HDM. IsiXhosa-speaking and unmarried participants were less likely to receive HDM, while unemployed individuals and those with longer diabetes duration were more likely to benefit. Geographic and infrastructural barriers further limited access, suggesting that HDM implementation may have inadvertently excluded vulnerable groups.

CONCLUSION

While HDM was a valuable innovation during the pandemic, its uneven reach highlights the persistence of health inequities. Language, social support, and geographic location emerged as key barriers. These findings underscore the need for inclusive, community-informed service design and the critical role of CHWs in delivering equitable, person-centred care. Future interventions should prioritise co-design with communities and address structural barriers to ensure equitable access to healthcare during crises and beyond.