Programme director
Professor Stephen Tollman, Chairperson: Centre for Rural Health Advisory Board
Professor Loyiso Nongxa, Vice Chancellor: University of the Witwatersrand
Professor Helen Laburn, Dean Faculty of Health Sciences
Professor Ian Couper, Director: Centre for Rural Health
Professor Tom Norris, Vice Dean for Academic Affairs, University of Washington School of Medicine
Lecturers, Students
Distinguished guests
Ladies and gentlemen
It is an honour and a privilege for me to address you at this important occasion to launch the Centre for Rural Health, which aims, among other things, to support undergraduate education in rural health care and conduct collaborative research in this area of expertise.
Several policies, guidelines and pieces of legislation have been developed by the government to facilitate transformation of the health care system in South Africa. Transformation efforts in the health sector, spanning more than a decade, by developing physical infrastructure; offering appropriate incentives to health care professionals; and establishing health care financing policies to promote equity.
Having inherited a highly fragmented health system in 1994, we have paid particular focus to expand health services to rural, farming and remote areas, because their needs which are fundamentally different to those in urban areas. It is in these areas that you find more vulnerable people who experience a higher level of unemployment or underemployment, and have to travel longer distances to the nearest health facilities, with higher associated costs than urban areas. Given these relatively higher levels of deprivation, it is expected that the social determinants of health would contribute more significantly to the burden of disease in rural areas.
We have recorded some successes, against the backdrop of the assertion that health services are inequitably provided in rural despite a range of progressive policies adopted and implemented since 1994. Our achievements include the removal of user fees for all clinics and health centres and for pregnant mothers. The idea was to increase access while also improving service coverage for these rural areas. This is something of note particularly as we celebrate the Women’s Month, with renewed emphasis on ensuring that issues of women remain top of the agenda of this fourth democratic period of governance in South Africa.
The department has put in place a system of quarterly reporting where various programmes are expected to report on the progress made regarding the health services. We have a policy on the Primary Health Care (PHC) supervision, to ensure that there is a manager who monitors the delivery of these services and also to support supervisors in their role of improving the quality of care in clinics. PHC has been our area of focus in the delivery of services, because of its closeness to the people, and its affordability.
Outreach clinics and mobile clinics are some of many approaches of improving service delivery in the rural areas. We have build about 1 600 new clinics since 1994. The World Health Organisation (WHO) concedes that rural areas epitomise the context in which PHC is most needed and can be most successfully applied.
We acknowledge that much is wrong in our public health care system. Serious health system challenges and the problems of inequity remain acute. There are huge inequities in the human resource availability between the private and public sectors, as well as between urban and rural areas in South Africa. The key human resource challenges, as I have already indicated, relate to production, recruitment, and retention of health workers, which results to inequitable distribution of health care professionals and poor access to health services, particularly in rural areas.
The crucial role of human resources in health systems cannot be over emphasised. The health professionals remain the only single precious commodity whose contribution cannot be reduced to rands and cents because they have remained loyal and true to the call and their profession. We appreciate the contribution of all the health professionals who remain in the public sector and in the country, working selflessly at the coal face, warding off all enduring hardships and also continue to deliver health services for our people.
Many health programmes have consistently experienced shortages of suitable health personnel, and this has often been one of the major constraints attributed to such programmes not accomplishing their intended objectives. Human Resources for Health are fundamental and strategic capital for the performance of the health system.
The health sector is not only labour intensive but also depends on precise application of the knowledge and skills of its workforce to ensure patient security and health. Therefore, underproduction of the health professionals on one side and increased burden of diseases on the other have a domino effect on the quality of health services.
A proposal had been developed by Rural Doctors Association of South Africa (RuDASA), in cooperation with the Centre, for funding to employ an expert in the area of advocacy to develop this area further, in collaboration with the AIDS Law project. We achieved great things through collaboration with internal structures such as Rural Doctors Association of South Africa (RuDASA) and with various Schools of Public Health to develop our own rural health strategy.
According to (RuDASA), foreign doctors from other countries have filled the gap in many rural hospitals for years, and have provided the needed support and experience that is vital in many institutions. The introduction of community service has also improved the availability of doctors in rural and under-served areas in some provinces. We need more senior doctors to supervise community service doctors. We also need more community service doctors in the neediest hospitals, to avoid a repeat of what happened in the Eastern Cape in 2001, having to survive a year without community service doctors.
Ladies and gentlemen, the health outcomes have not been the best in the rural areas. This is purely due to the fact that the factors that influence the delivery of health services are outside the ambit of the Department of Health.
We know for a fact that sanitation infrastructure is not well developed in the rural areas, water quality remains the challenges, hence the outbreak of water borne diseases’ poverty resulting to higher numbers of unemployment; poor housing infrastructure, and as such exposing pour people conditions that will predispose them to diseases, waste removal resulting in the environmental degradation and pollution.
Chairperson, our relationship with this topic is historical because, if you were to look at the rate of children not gaining weight, high incidence of diarrhoea, children that are too small for age, children with skin problems, all of these you are assured to find in the rural areas. As a result of this, health can never succeed unless attention is paid to the rural areas. Our performance towards the Millennium Development Goals (MDGs) is frustrated by the manner in which we perform in these areas to the extent that health is concerned.
To overcome the challenges in rural areas and to ensure equitable distribution of resources, Government departments, NGOs and the business community should also act collectively to respond to social and economic crisis facing the country. We need to focus on improving integrated service delivery through better coordination of planning and resource deployment by government and other stakeholders, and strengthening the capacities of local government entities to develop Integrated Development Plans (IDPs).
There is a need to bring rural health more sharply into focus and to delineate the issues for all those who have a role to play in rural health care development. Advocacy for rural health, within the university, within the Departments of Health and within the funding community is an important element of this. Your contribution, as the Rural Health Centre, by becoming a leading academic body in the field of human resources for rural health, will make a difference in the lives of many people. We will also benefit through your efforts of facilitating education and training, as well as supporting recruitment and retention of personnel for rural health services.
The 18 priority districts have been identified in the deprived districts to focus on key indicators for the priority programmes. These districts were chosen because they have poor access to health services. We were guided by the principles which included: (a) equity in the distribution of resources based on need; (b) equitable access to health services provided either in communities or by health facilities; and (c) provision of the best possible health services in terms of quality of care.
Chairperson, ladies and gentlemen, I do not need to remind you that we can have all these policies and practices backed by well-researched interventions, but if we do not have adequate and correct human capital, our brilliant plans will amount to nothing.
In conclusion, intersectoral collaboration is required by government departments to ensure that key social goods and services are available in rural areas. All components of the national and provincial Departments of Health must play a role in improving rural health. The provinces are encouraged to build the key elements of the rural health strategy into their Annual Performance plans so that there is clear integration. This should take into consideration strengthening District Health Management Teams (DHMTs), by assessing management capacity as well as at the Sub-district and facility levels.
The Rural Health Centre is also well positioned to address issues such as; (a) what strategies are most effective in improving the health status of rural people? (b) What role can an academic institutions play in these? (c) What is the optimum skills mix required for clinics, hospitals in rural districts? (d) What are the best methods to achieve recruitment and retention of health care professionals in rural areas?
I look forward to a productive engagement on these issues.
I thank you.
Issued by: Department of Health
13 August 2009
