Essays on healthcare quality in South Africa

Stacey, Nicholas (2024) Essays on healthcare quality in South Africa. PhD thesis, London School of Economics and Political Science.

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Abstract

Many low- and middle-income countries are pursuing universal healthcare coverage to prevent and treat ill-health and provide financial risk protection to households in need of care. However, while access to health services has expanded, there is growing concern about the quality of the services provided by governments and debates about the extent to which the private sector can offer solutions. How does one improve access to good quality care in the face of limited public financial and human resources, poor economic conditions, social cleavages, and rapid technological change? In this dissertation, I contribute to the literature on the quality of primary healthcare services in low- and middle-income countries (LMICs) through a series of empirical studies set in South Africa. South Africa’s health system reflects many of the challenges LMICs face in pursuing UHC and has seen significant changes and policy intervention which can be learned from, thus providing an ideal setting to study care quality. The essays making up the dissertation investigate (i) structural inputs to quality and their effect on provider process quality, (ii) the effects of a complex, national public-sector care quality improvement programme, and (iii) users’ demand for attributes of care quality (in-person versus telemedicine care, and shared identity and racial concordance with providers). In sum, this thesis underlines several challenges South African policymakers face as they strive to improve the quality of care of available health services. While I find structural inputs to care, like a reliable electricity supply, do influence provider behaviour, programmes to drive improvements in facility conditions more broadly are not guaranteed to improve clinical outputs and require careful consideration. Making the private sector’s resources more widely available will require consideration of the uninsured population’s demand constraints, both financial and otherwise.

Item Type:	Thesis (PhD)
Additional Information:	© 2024 Nicholas Stacey
Library of Congress subject classification:	H Social Sciences > H Social Sciences (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets:	Departments > Health Policy
Supervisor:	Lagarde, Mylène and Papanicolas, Irene
URI:	http://etheses.lse.ac.uk/id/eprint/4687

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