Close to hospitals, but far from care: UCT study shows surgical struggles in Cape Town

For many families in Cape Town’s peri-urban communities, getting surgery is not just about reaching a hospital but about surviving the wait.

A study by the University of Cape Town (UCT) has uncovered major barriers to surgical care in areas such as Gugulethu, Nyanga, Manenberg and the Klipfontein transitional council. The research, published in the South African Medical Journal, surveyed 432 adults in 10 neighbourhoods and is the first comprehensive look at surgical experiences from a community perspective in peri-urban South Africa.

The findings paint a troubling picture. Six out of 10 people said they had undergone surgery at some point in their lives, with almost half of those procedures taking place in the past five years.

Caesarean deliveries made up the largest share of operations (27%), showing the critical importance of safe obstetric care. Other common procedures included appendectomies and knee operations.

Despite the high demand, many patients faced obstacles at every stage of their surgical journey. Using the internationally recognised “Three Delays Framework”, researchers found:

• 20% of patients delayed seeking care, often due to fear, lack of awareness or financial constraints;
• 26% struggled to reach facilities, despite nearly half living within 10km of a clinic or hospital;
• 32% faced delays once in hospitals, waiting for treatment or surgery; and
• only 22% reported smooth access to care.

“Nearly half of participants lived within 10km of a healthcare facility, yet significant barriers persist. 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,” said lead author Dr Moses Isiagi, senior lecturer at UCT’s division of global surgery.

The study also revealed that “10% of patients experienced lasting disability after surgery”, a rate far higher than the 3% to 7% reported in high-income countries. These disabilities often meant chronic pain, functional impairments and mobility limitations that affected daily life.

Another concern was the high burden of chronic disease in the community. More than half of the participants (56%) reported at least one chronic condition, with hypertension being the most common.

Women were disproportionately affected, with 60% reporting chronic illness compared with 47% of men. Women also had a higher average body mass index, which increased the risk of surgery.

Prof Bruce Biccard, Nuffield professor of anaesthetic science at the University of Oxford and former UCT academic, said: “Chronic diseases increase surgical risk and the probability of postoperative complications.”

The study highlights how South Africa’s two‑tier health system, with most people relying on public hospitals, leaves peri‑urban communities vulnerable. Almost all participants (97%) depended on public facilities, while only 4% had medical aid.

Researchers say this reflects the socioeconomic profile of the area and the strain on public healthcare. The team has identified three priority interventions:

• better community education on chronic disease management and primary healthcare;
• increased capacity for elective surgery to reduce delays; and
• structured programmes to strengthen surgical care delivery in resource-limited settings.

“These results provide crucial evidence for policymakers and healthcare providers working to achieve universal surgical access in South Africa,” said head of UCT’s division of global surgery, Prof Salome Maswime.

“Our findings can inform targeted interventions to improve surgical care access and outcomes in similar peri‑urban settings across sub‑Saharan Africa.”

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