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Refereed articles

Geography, marginalisation and the performance of the right to have access to health care services in Johannesburg – pg. 1.

Rights are not exercised in the abstract or in a vacuum, but are rather performed in a variety of physical contexts and settings, and through a variety of physical actions and interactions. It is therefore essential that laws and policies aimed at realising rights pay attention to their geographical and ‘performative’ dimensions. To illustrate this in relation to socio-economic rights, this article considers the performance and actualisation of the right to have access to health care services by different inhabitants of Johannesburg. It shows how a “performative” understanding of the right to have access to health care services dovetails with the international law approach to assessing compliance with the right to health, and points to certain features of South African socio-economic rights jurisprudence that enable such an understanding of the right. Thereafter, it considers some of the geographic aspects of access to health care services in Johannesburg, with a particular focus on the experiences of marginalised groups. Current health system reforms and urban development initiatives in Johannesburg, that relate to the geographical features of access to health care in the city, are then assessed. It is shown that, while many of these measures will have very positive consequences for the progressive realisation of the right to have access to health care services, the interaction of geographic factors with other determinants of access may nevertheless continue to frustrate access to care by certain marginalised groups. To show that this is not inevitable, two examples of target-group specific, place-aware interventions pertaining to access to sexual health services by marginalised groups in the city are discussed. Some cautionary notes for law and policy reform, particularly in relation to the rolling out of National Health Insurance, are offered in conclusion.

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