Access to surgical care limited in peri-urban areas

One in three residents who live in peri-urban areas in Cape Town struggle to access timely, high-quality surgical care even though they live a stone’s throw away from healthcare facilities – revealing significant challenges with its delivery to those in need.

These and other findings were highlighted in a new research study undertaken by clinicians at the University of Cape Town (UCT). Titled, “Community experiences of surgery in peri-urban Cape Town” and published in the South African Medical Journal, the study surveys 432 adults across 10 neighbourhoods in the Klipfontein district. These areas include Gugulethu, Nyanga, Manenberg and Klipfontein Transitional Council, and represents the first comprehensive assessment of surgical experiences from a community perspective in peri-urban South Africa.

The study was carried out by researchers from UCT’s Division of Global Surgery, the World Health Organization’s Collaborating Centre on Integrated Critical Care, and the African Partnership for Perioperative and Critical Care Research.

“This is not just about building more facilities – it’s about understanding the complex interplay of factors that prevent people from receiving timely, high-quality surgical care.”

“Our findings demonstrate that geographical proximity to healthcare facilities has improved but does not ensure optimal or timely access to surgical care. Nearly half of participants lived within 10 km of a healthcare facility, yet significant barriers persist,” said Dr Moses Isiagi, the study’s lead author and a senior lecturer in the Division of Global Surgery. “This is not just about building more facilities – it’s about understanding the complex interplay of factors that prevent people from receiving timely, high-quality surgical care.”

The study in brief

According to the research findings, 60% of community members have undergone at least one surgical procedure in their lifetime, and 45% of those who have undergone surgery, have done so in the past five years alone. Caesarean section deliveries comprised the largest share of procedures (27%) – emphasising the importance of safe and timely obstetric surgical services.

Using the internationally recognised Three Delays framework – a conceptual framework that identifies the underlying, non-medical factors that contribute to maternal mortality in low- and middle-income countries – researchers identified several systematic barriers at every stage of surgical care access: 20% of participants delayed seeking care; 26% experienced delays reaching healthcare facilities; and 32% faced delays in receiving appropriate treatment once they reached healthcare facilities. Only 22% of participants reported no delays in their surgical care journey.

The study also revealed that 10% of surgical patients experienced postoperative disability. This rate is significantly higher than the 3–7% reported in high-income countries. These disabilities primarily presented as pain, functional impairments and mobility limitations.

A high burden of chronic disease

Further findings also revealed a high burden of chronic diseases in the communities surveyed. More than 50% of respondents reported at least one chronic condition, with hypertension rated as the most common (affecting 37% of the community overall, and 42% of women).

Generally, women reported significantly higher rates of chronic diseases (60% of women versus 47% of men) and a higher average body mass index.

Commenting on the research findings, the former second chair of UCT’s Department of Anaesthesia and Perioperative Medicine and the director of Global Surgery Research, Professor Bruce Biccard, said the conclusions have important implications for surgical outcomes, as chronic diseases increase surgical risk and the likelihood of postoperative complications. Professor Biccard, who’s also Nuffield Professor of Anaesthetic Science at Oxford University, authored the book Safer Surgery for Africa: Challenges and Solutions.

Priority areas

To improve access to surgical care, the research team identified three priority interventions:

• improve community education on chronic disease management and primary healthcare
• increase capacity for elective surgery to address care delays
• implement structured programmes to improve surgical care delivery in resource-constrained settings.

“These results provide crucial evidence for policy makers and healthcare providers working to achieve universal surgical access in South Africa. Our findings can inform targeted interventions to improve surgical care access and outcomes in similar peri-urban settings across sub-Saharan Africa,” concluded Professor Salome Maswime, the head of the Division of Global Surgery and the study’s senior author.