“Beyond the Clinic Door”: Examining healthcare status and access challenges of persons experiencing street homelessness in the city of Johannesburg, South Africa

This study explores the health conditions, service barriers, and coping mechanisms of people experiencing homelessness in the urban context of Johannesburg. Guided by Andersen’s Behavioural Model of Health Services Use and situated within a transformative research paradigm, the study used a qualitative phenomenological design to capture the lived experiences of 10 homeless adults recruited by purposive sampling. Data were generated through in-depth interviews and thematically analysed using the Braun and Clarke (2006) framework. The findings reveal a complex interplay between poverty, illness, stigma, and systemic exclusion. Participants reported high rates of HIV/AIDS, tuberculosis, respiratory infections, and substance-related illnesses, compounded by poor sanitation and exposure to violence. Structural barriers, including a lack of identification documents, discriminatory treatment in clinics, and fragmented service delivery, significantly hindered healthcare access and continuity of care. Despite these adversities, participants displayed resilience through informal networks, support from non-profit and faith-based organisations, and personal spirituality. A recurring theme was the longing for dignity, family reconnection, and reintegration into society. The study concludes that homelessness in Johannesburg is both a health and human rights issue, necessitating coordinated, multi-sectoral interventions. Recommendations include mobile outreach health services, removal of administrative barriers, expanded mental health and addiction programs, and family reunification initiatives to promote inclusive and equitable healthcare for the city’s most marginalised populations.