Since the 1980s there has been a steep increase in the number of women migrating from rural to urban areas in search of economic opportunities. The movement of women to urban areas has affected children as they depend on their mothers for their primary care. The aim of this study is to shed insights into childcare arrangements among migrant mothers in an urban township in South Africa. Data was collected from in-depth interviews with 20 migrant mothers in Imbali. Mothers are concerned about the care and well-being of their children and as a result, they are opting to relocate with their children. Traditional methods of care that were provided by grandparents or extended family members in the past are no longer an option for many mothers. All the mothers relied on either formal or informal childcare facilities within the community. The mothers wanted their children to be cared for in early childhood facilities that they felt were conducive for their development. However, lack of finances were a major challenge and this had an impact on the type of care facility that the mothers used. Some of these facilities are not seen as suitable due to a number of factors including safety, limited play equipment, and an unhygienic environment. Therefore, it is recommended that community-wide efforts in providing childcare should be explored in order to support single mothers in urban areas who have migrated to improve their economic conditions.

Background: South Africa’s Referral Policy and Implementation Guidelines aim to ensure continuity of care, manage patient flow, and improve health system efficiency. However, in Mpumalanga province, a growing number of patients bypass Primary Health Care (PHC) clinics and seek hospital services without formal referral. This trend undermines the structured referral pathway and strains healthcare resources. Aim: This study sought to identify the key factors that influence patients to bypass PHC facilities in Mpumalanga province. Setting: The study was conducted across the three districts in Mpumalanga province. Methods: A qualitative exploratory design was employed to better understand the factors influencing patients to bypass PHC clinics from the perspective of healthcare workers (HCWs). Using purposive sampling techniques, key informant interviews were conducted with 20 HCWs from 10 selected hospitals. Thematic analysis of the qualitative data was conducted using an inductive approach, with NVivo® software facilitating systematic coding, theme development and data organisation. Results: Key factors that influenced patients to bypass included a lack of adherence to the referral system, perceptions of poor quality at PHC facilities, long waiting times, negative HCWs’ attitudes and concerns pertaining to stigma and confidentiality. Conclusion: Insights gained from this study contribute to the understanding of factors that lead patients to bypass PHC facilities. Contribution: By understanding the underlying reasons for such bypassing, policymakers and healthcare providers can develop targeted interventions to enhance the quality and utilisation of PHC services. Moreover, addressing these challenges is crucial for achieving equitable healthcare access.

Background/objective: The Immunisation Agenda 2030, led by the World Health Organization, aims to ensure that people of all ages benefit from vaccination. South Africa remains committed to these goals, strengthening childhood immunisation largely through the Expanded Programme on Immunisation. However, despite progress, the number of unvaccinated and partially vaccinated children continues to rise in some urban settings. This study sought to identify barriers to childhood immunisation in selected zero-dose urban communities in Gauteng Province. Methods: A qualitative exploratory–descriptive design was used to examine factors influencing childhood immunisation. Data were collected through seven focus group discussions and fifteen key informant interviews with purposively selected caregivers, community leaders, community health workers and healthcare workers involved in routine immunisation services at public healthcare facilities across the Cities of Johannesburg, Ekurhuleni, and Tshwane. Thematic analysis was conducted using NVivo^® software. Results: The study identified multiple demand-side and supply-side barriers. Demand-side barriers included limited parental knowledge, lack of trust in the government and immunisation services, religious beliefs, migration, and perceptions of caregiver substance use. Supply-side barriers involved distance to the facility, negative healthcare worker attitudes, long queues and waiting times, and frequent vaccine stock-outs. These barriers collectively contributed to missed opportunities and decreased uptake of immunisation services. Conclusions: Childhood immunisation remains a critical and cost-effective public health intervention. The findings demonstrate the complex interplay of individual and system-level factors influencing vaccine demand, uptake and persistent zero-dose status in urban Gauteng communities. Addressing these barriers requires a comprehensive approach that strengthens community trust, improves caregiver vaccine literacy, and ensures accessible, responsive, and respectful immunisation services.

In recent years family structures in South Africa have been drastically transformed, and this can be attributed to several factors (Bengesai and Nzimande 2020). Past laws, urban housing policy and ...