The sentence “In a recent past, patients have had to walk for very long distances to seek medical services” uses “have to” in its past participle form “had to” to express an objective obligation or an obligation imposed by an outside agent or force. In this sentence, the first “have” functions as the auxiliary verb and the second “have” is actually the main verb or the verb that takes the tense. That particular sentence has the following basic form:
“Patients + have + had to + walk.”
Subject + “have” or “has” (as auxiliary verb) + “had to” (where “have” is the main verb in the past participle form “had”) + bare infinitive
Such sentences are perfectly grammatical constructions where the subject is forced or constrained to act not on its own accord but by a separate, external power.
Now let’s consider the particular sentence you presented (I took the liberty of replacing the article “a” with the more proper “the” to make the sentence unassailable by grammar purists):
“In the recent past, patients have had to walk for very long distances to seek medical services.”
Here, the intended sense is that until recently, the patients had no other means to get medical services but to walk for very long distances, presumably because there has been no other means of transport.
Now let’s take a look at the various forms that sentence will take when the subject is in the singular or plural form, whether in the first person, second person, or third person:
“In the recent past, I have had to walk for very long distances to seek medical services.”
“In the recent past, you have had to walk for very long distances to seek medical services.”
“In the recent past, he/she/John/Marcia has had to walk for very long distances to seek medical services.”
“In the recent past, we have had to walk for very long distances to seek medical services.”
“In the recent past, they have had to walk for very long distances to seek medical services.”
The strangeness or awkwardness you feel over such “have to” sentences may have to do with that BBC correspondent’s use of the time marker “in the recent past,” which in a very strict sense could be construed as more indicative of the past tense rather than the present perfect. But see how that strangeness or awkwardness diminishes and ultimately disappears when we tweak that time marker to the more precise and more obvious present-perfect forms “until recently” and “until this morning when this rural hospital opened”:
“Until recently, I have had to walk for very long distances to seek medical services.”
“Until recently, you have had to walk for very long distances to seek medical services.”
“Until recently, he/she/John/Marcia has had to walk for very long distances to seek medical services.”
“Until recently, we have had to walk for very long distances to seek medical services.”
“Until recently, they have had to walk for very long distances to seek medical services.”
“Until this morning this morning when this rural hospital opened, I have had to walk for very long distances to seek medical services.”
“Until this morning this morning when this rural hospital opened, you have had to walk for very long distances to seek medical services.”
“Until this morning this morning when this rural hospital opened, he/she/John/Marcia has had to walk for very long distances to seek medical services.”
“Until this morning this morning when this rural hospital opened, we have had to walk for very long distances to seek medical services.”
“Until this morning this morning when this rural hospital opened, they have had to walk for very long distances to seek medical services.”
I trust that these various conjugations and usage variations of the “have had to + bare infinitive” form will increase your level of comfort in accepting and using it.
