Spatial analysis of perceived health system capability and actual health system capacity for COVID-19 in South Africa

Peoples confidence in the health system's capability in managing the COVID-19 pandemic can determine public support, risk perceptions, and compliance to the required behaviors during the pandemic. Therefore, this paper investigated peoples perception of health system capability to manage the COVID-19 pandemic in different spatial areas across the country using data from an online survey. Multivariate logistic regression models were used to examine factors associated with peoples perception of the health system capability to manage the COVID-19 pandemic at the national and provincial levels. Spatial comparative analysis was conducted to contrast spatial density indicators of the number of hospitals, hospital beds, and ICU beds per given population across various provinces. Findings showed that South Africans had low confidence in the health system capability, with only two in five (40.7%) reporting that they thought that the countrys health system was able to manage the COVID-19 pandemic. Sex and knowledge on COVID-19 were significantly associated with the peoples perception of the health system capability to manage the pandemic at the national level and in four of the nine provinces. Overall, the findings of this study clearly highlight challenges facing the countrys health system, both perceived or real, that needed to be addressed as part of the preparation for the COVID-19 pandemic. Timeous implementation of a countrywide National Health Insurance (NHI) system is now more critical than ever in improving healthcare outcomes of the South African population beyond the existence of the COVID-19 epidemic.