Health systems and quality of life: The situation of South Africans with spinal cord injury.

Background: Spinal cord injury (SCI) significantly impacts quality of life (QoL) through physical disabilities and reduced social participation. Objectives: This study compared health system indicators, social factors and self-reported QoL between individuals with SCI accessing public versus private healthcare in South Africa. Method: A cross-sectional survey using the International Spinal Cord Injury (InSCI) community survey questionnaire was conducted with 200 SCI individuals (156 public, 44 private sector) from Cape Town and Pretoria. Chi-square tests and correlation analyses were performed. Results: Significant disparities were observed between cohorts. Public sector participants reported higher rates of disability pension receipt (82.1% vs 54.5%) and greater challenges accessing various services. Overall, self-reported QoL was 56%, with the private cohort reporting significantly higher satisfaction (64% vs 52%). Private sector participants also reported higher satisfaction with living conditions and personal relationships. Access to disability pension and healthcare negatively correlated with QoL, while access to public spaces, medication, transport and nursing care positively correlated with QoL. Conclusion: This study reveals significant disparities in health system performance, social factors and QoL between SCI individuals accessing public versus private healthcare in South Africa. Clinical implications: Findings highlight the need to address systemic inequities in healthcare access and social support for individuals with SCI to improve QoL across sectors.