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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa

Authors: Veloshnee Govender, Jana Fried, Stephen Birch, Natsayi Chimbindi, Susan Cleary

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

In South Africa, HIV/AIDS remains a major public health problem. In a context of chronic unemployment and deepening poverty, social assistance through a Disability Grant (DG) is extended to adults with HIV/AIDS who are unable to work because of a mental or physical disability. Using a mixed methods approach, we consider 1) inequalities in access to the DG for patients on ART and 2) implications of DG access for on-going access to healthcare.

Methods

Data were collected in exit interviews with 1200 ART patients in two rural and two urban health sub-districts in four different South African provinces. Additionally, 17 and 18 in-depth interviews were completed with patients on ART treatment and ART providers, respectively, in three of the four sites included in the quantitative phase.

Results

Grant recipients were comparatively worse off than non-recipients in terms of employment (9.1 % vs. 29.9 %) and wealth (58.3 % in the poorest half vs. 45.8 %). After controlling for socioeconomic and demographic factors, site, treatment duration, adherence and concomitant TB treatment, the regression analyses showed that the employed were significantly less likely to receive the DG than the unemployed (p < 0.001). Also, patients who were longer on treatment and receiving concomitant treatment (i.e., ART and tuberculosis care) were more likely to receive the DG (significant at the 5 % level). The qualitative analyses indicated that the DG alleviated the burden of healthcare related costs for ART patients. Both patients and healthcare providers spoke of the complexity of the grants process and eligibility criteria as a barrier to accessing the grant. This impacted adversely on patient-provider relationships.

Conclusions

These findings highlight the appropriateness of the DG for people living with HIV/AIDS. However, improved collaboration between the Departments of Social Development and Health is essential for preparing healthcare providers who are at the interface between social security and potential recipients.
Appendix
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Footnotes
1
The Social Assistance Act (No. 13 of 2004) defines a disable person as an adult who is ‘owing to his or her physical or mental disability, unfit to obtain, by virtue of any service employment or profession, the means needed to enable him or her to provide for his or her maintenance’.
 
2
Overall, there are currently seven types of social grants including not only the Disability Grant but also Older Persons Grant, Child Support Grant, Care Dependency Grant, Foster Child Grant, War Veterans Grant and the Grant-in-Aid (Department of Social Development in South Africa 2010).
 
3
People living with HIV/AIDS qualify for and receive a temporary DG, based on an assessment of the disability by a state-doctor. The assessment of disability rests with the doctor who is usually guided by the person’s CD4 count (less than 200) and/or TB/pneumonia related illness. People with a CD4 count of below 200 will usually qualify for the DG. At the same time, some people with CD4 counts of less than 200 may still be assessed as fit enough to work. Equally some people with CD4 counts above 200 who are very sick with TB or may qualify for the grant.
 
4
If the person’s CD4 count increases above 200 with ART and he/she is judged as fit for work by the doctor, they will no longer qualify for the DG.
 
5
The study was conducted between 2008 and 2010
 
6
In this study, expenditure is used as proxy for household income
 
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Metadata
Title
Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa
Authors
Veloshnee Govender
Jana Fried
Stephen Birch
Natsayi Chimbindi
Susan Cleary
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0870-8

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