Gender disparities in disability persist while healthcare access shows no net improvement in South Africa: a general household survey trend analysis, 2020-2024.

OBJECTIVES

To examine trends in disability prevalence by sex and province in South Africa between 2020 and 2024, and to test whether the reported gender gap and changes in healthcare access indicators are consistent with genuine population characteristics rather than sampling variation.

METHODS

A descriptive cross-sectional trend analysis was conducted using five consecutive General Household Survey (GHS) statistical releases (2020-2024). Disability was measured using the Washington Group Short Set. Because the releases report population counts alongside percentages, two-proportion z-tests and binomial trend models were used to test whether the sex differential in disability prevalence and year-to-year changes in disability and medical aid coverage were statistically distinguishable from sampling variation.

RESULTS

National disability prevalence fluctuated between 4.5 and 5.0%, with no significant linear trend (p = 0.49). Females recorded significantly higher prevalence than males in every survey year (p ≤ 0.007). Northern Cape recorded the highest prevalence in both 2020 and 2024; Eastern Cape recorded the largest descriptive increase in female prevalence (provincial-level significance testing was not possible). Public facilities remained the dominant first point of consultation (72-73%). Medical aid coverage showed no significant overall linear trend (p = 0.72) but was not flat throughout: coverage rose significantly in 2021 and subsequently declined significantly to 2024 (p = 0.004).

CONCLUSION

The female excess in disability prevalence is a statistically consistent, year-on-year finding, robust under design-effect sensitivity analysis, while overall prevalence and medical aid coverage showed no statistically detectable linear trend despite visible fluctuation. Provincial patterns remained uneven, and most households continued to rely on public facilities. These findings support disability-inclusive, gender-responsive, equity-oriented health policy, with attention to public-sector rehabilitation and primary healthcare in high-burden provinces.