The quality of primary care received by foreign migrants in South Africa. A standardised patient audit
1
Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
2
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
3
Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A2738
ABSTRACT
BACKGROUND:
Studies report that foreign migrants experience negative attitudes, abuse and sub-standard care when attending South African (SA) public health facilities. However, citizens also report negative experiences and poor-quality care, and few studies have rigorously compared the experiences of migrants and citizens. We exploit a natural experiment to evaluate the quality of acute care provided to foreign and SA patients by different primary health care (PHC) providers.
METHODS:
We used a standardised patient (SP) audit survey to evaluate the effort, quality and efficiency of PHC providers. Our SP audit included five different clinical cases. We trained three SA SPs and one foreign SP for each case. The SPs were sent to 33 public clinics, 75 private doctors and 19 private nurse clinics in an urban township. 793 consultations were completed: 589 by SA SPs and 204 by foreign SPs. Visits were randomised so each provider received at least one foreign SP visit. Later we completed interviews with 237 providers which included asking about attitudes to foreigners. We used hierarchical regression models to compare the care received by migrants and citizens from different PHC providers.
RESULTS:
Public PHC providers expressed more negative attitudes towards migrants in the survey. In the audit, foreign SPs attending public facilities were more likely to receive comments about their citizen status. Foreign SPs had significantly shorter consultations than SA patients from both public and private providers. The technical quality of care received by SPs in the study was sub-optimal but there was no significant difference between foreigners and citizens. For example, the proportion of cases managed correctly in the two groups was equivalent, in public as well as private facilities.
CONCLUSIONS:
This more rigorous comparison indicates that foreign patients are as well treated and managed as their SA counterparts, in both the public and private sectors.
Studies report that foreign migrants experience negative attitudes, abuse and sub-standard care when attending South African (SA) public health facilities. However, citizens also report negative experiences and poor-quality care, and few studies have rigorously compared the experiences of migrants and citizens. We exploit a natural experiment to evaluate the quality of acute care provided to foreign and SA patients by different primary health care (PHC) providers.
METHODS:
We used a standardised patient (SP) audit survey to evaluate the effort, quality and efficiency of PHC providers. Our SP audit included five different clinical cases. We trained three SA SPs and one foreign SP for each case. The SPs were sent to 33 public clinics, 75 private doctors and 19 private nurse clinics in an urban township. 793 consultations were completed: 589 by SA SPs and 204 by foreign SPs. Visits were randomised so each provider received at least one foreign SP visit. Later we completed interviews with 237 providers which included asking about attitudes to foreigners. We used hierarchical regression models to compare the care received by migrants and citizens from different PHC providers.
RESULTS:
Public PHC providers expressed more negative attitudes towards migrants in the survey. In the audit, foreign SPs attending public facilities were more likely to receive comments about their citizen status. Foreign SPs had significantly shorter consultations than SA patients from both public and private providers. The technical quality of care received by SPs in the study was sub-optimal but there was no significant difference between foreigners and citizens. For example, the proportion of cases managed correctly in the two groups was equivalent, in public as well as private facilities.
CONCLUSIONS:
This more rigorous comparison indicates that foreign patients are as well treated and managed as their SA counterparts, in both the public and private sectors.
| eISSN: | 2654-1459 |
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