UCT study reveals surgical care access challenges in peri-urban Cape Town

A new study by researchers at the University of Cape Town has revealed significant barriers to accessing timely surgical care in peri-urban communities, with nearly one in three residents reporting delays in receiving appropriate treatment — despite living close to healthcare facilities.

The research, published in the South African Medical Journal, surveyed 432 adults across 10 neighbourhoods in the Klipfontein subdistrict, including Gugulethu, Nyanga, Manenberg and areas governed by the former Klipfontein Transitional Council. It is the first comprehensive assessment of surgical care experiences from a community perspective in peri-urban South Africa.

The study found that 60% of respondents had undergone at least one surgical procedure in their lifetime, with 45% of those procedures taking place within the past five years. Caesarean deliveries accounted for the largest share of surgeries at 27%, highlighting the continued importance of safe and timely access to obstetric surgical care.

Using the internationally recognised Three Delays framework, researchers identified barriers at every stage of the surgical care pathway. Twenty percent of participants delayed seeking care, 26% experienced delays in reaching a healthcare facility, and 32% faced delays in receiving appropriate treatment once at a facility. Only 22% reported no delays throughout their surgical care journey.

The study also found that 10% of surgical patients experienced postoperative disability — substantially higher than the 3% to 7% typically reported in high-income countries. These disabilities were mainly linked to persistent pain, functional impairment and reduced mobility.

“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 kilometres of a healthcare facility, yet significant barriers persist,” said Dr Moses Isiagi, a senior lecturer in UCT’s Division of Global Surgery and lead author of the study.

“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.”

Researchers also identified a high burden of chronic disease in the community, with 56% of participants reporting at least one chronic condition. Hypertension was the most prevalent, affecting 37% of respondents overall and 42% of women. Women were also found to have higher overall rates of chronic disease than men, as well as higher average body mass index levels.

Professor Bruce Biccard, Nuffield Professor of Anaesthetic Science at the University of Oxford, said the findings had important implications for surgical outcomes, noting that chronic conditions increase surgical risk and the likelihood of postoperative complications. Biccard is a former second chair of UCT’s Department of Anaesthesia and Perioperative Medicine and a director of Global Surgery Research.

The research team identified three priority interventions: improved community education on chronic disease management and primary healthcare; increased capacity for elective surgery to reduce delays; and the introduction of structured programmes to strengthen surgical care delivery in resource-limited settings.

Professor Salome Maswime, head of UCT’s Division of Global Surgery and the study’s senior author, said the findings provided critical evidence to guide policy and healthcare planning.

“These results provide crucial evidence for policymakers 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,” she said.

The study was conducted by researchers from UCT’s Division of Global Surgery and the WHO Collaborating Centre on Integrated Clinical Care, in partnership with the African Partnership for Perioperative and Critical Care Research. Funding was provided in part by the National Institute for Health and Care Research Global Health Group on Perioperative and Critical Care and The Gabrielle Foundation.

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