Poverty blocks many rural South Africans from accessing health-care services

Life has never been easy for Siphamandla Magodla, a 35-year-old man from Ncwane village in Tsomo, but in recent years, survival itself has become an exhausting negotiation. Living in deep rural Eastern Cape, he cannot even afford the most basic health care.

His only income is South Africa’s social relief of distress (SRD) grant of R350 a month, meant to support unemployed individuals with no financial safety net.

According to Stats SA, South Africa’s official unemployment rate stood at 32.9% in the first quarter of 2025, leaving 8.2-million people actively seeking work. For many, like Magodla, the economic devastation that followed Covid-19 destroyed any remaining stability.

He once survived on seasonal contract jobs in Cape Town, “and life was just fine. I could keep the wolf from the door,” he said. “I don’t remember the last time I went to the hospital when I’m sick. Even the clinic in the next village is too far. I simply cannot afford the transport. I must choose between buying food and going hungry.”

Magodla’s story is painfully common. While South Africa’s public health services are free at the point of care, rural poor households continue to face barriers so severe that free care is still effectively inaccessible.

The gap between government promises and rural reality

In his medium-term budget policy statement (MTBPS), finance minister Enoch Godongwana spoke of the need to stabilise health budgets, strengthen primary health care and improve the prevention and management of non-communicable diseases (NCDs) such as diabetes, hypertension and cardiovascular illnesses.

But for people like Siphamandla, the announcements changed nothing.

These speeches don’t reach us. They tell us clinics are free, but what good is that when you can’t get there?

—  Siphamandla Magodla, 35

The MTBPS acknowledged rising pressure on the public health system, yet no new significant allocations were made to expand rural clinic infrastructure, improve transport availability or address health worker shortages — the exact obstacles that keep NCD care out of reach for millions.

For rural communities, Godongwana’s commitments remain policy on paper, not a lived reality.

‘The speeches don’t reach us’

Surrounded by hills and scattered plantations, Magodla lives in a small rondavel with no proper windows. Inside is a single bed, battered cupboards and a few boxes holding what little he and his uncle own. They cook outside. They have been without electricity for years.

“These speeches don’t reach us,” he said. “They tell us clinics are free, but what good is that when you can’t get there?”

He spends most of his R350 grant on basics: mealie meal, flour, rice. Whatever little he earns from piece jobs, he buys cabbage or soap. Health care is the last thing on the list, not because he doesn’t value it but because he must choose between eating and being healthy.

Poverty is fueling South Africa’s NCD crisis

A 2023 study on access to health care in the rural Eastern Cape found that poverty, unemployment, long distances, poor roads and lack of transport are the main reasons people delay seeking care, especially for chronic illnesses.

For NCDs, this delay is dangerous. Without early detection and consistent treatment, conditions like hypertension, diabetes and asthma silently worsen.

Health experts have repeatedly warned that South Africa’s NCD crisis is most severe among the poor, who:

• eat cheaper, starch-heavy diets;
• cannot afford transport to clinics;
• go years without screening;
• collect medication irregularly; and
• often present late with complications.

Earlier this year, Dr Hannes Steinberg, associate professor of family medicine at the University of the Free State, said South Africa has “a large population of disadvantaged people who present late for diagnosis and treatment due to socio-economic barriers”.

Why the MTBPS fails families like Siphamandla’s

Godongwana’s budget speech reiterated the government’s commitment to fighting NCDs, but did not allocate any new targeted funding to:

• fix or expand rural clinics;
• recruit more community health workers;
• subsidise patient transport;
• improve medicine availability at village-level points; and
• ensure screening programmes reach remote communities.

Instead, the health budget remains strained, with provinces warning of possible cuts to staff and outreach services, the very tools needed to manage NCDs in rural populations.

Siphamandla said he does not even think about going to the clinic when he has to hustle for food.

A health crisis that is also an economic crisis

South Africa’s growing NCD burden mirrors its economic reality. Poverty drives poor diets and poor health; poor health worsens poverty. People like Siphamandla are trapped in a cycle no policy speech has yet broken.