The Rural Health Advocacy Project (RHAP) advocates for improved access to high quality, comprehensive health care services in rural areas with the aim of improving the health of the South African population. The RHAP is a partnership between Wits Centre for Rural Health, RuDASA and SECTION27.

RURAL HEALTH – KEY TO A HEALTHY NATION

AUSTERITY MEASURES IMPOSED ON EASTERN CAPE DEPARTMENT OF HEALTH A DISASTER FOR RURAL HEALTHCARE DELIVERY 17 May 2012
There has been much reporting in the media about the human resource crisis in the Eastern Cape, and the fact that many healthcare workers are not being paid due to budget constraints. Although the crisis has been devastating to all types of state health facilities in the province, the impact of delayed or non-payment of critical healthcare workers and the difficulties in replacing such essential staff is even more acutely felt in rural areas, where healthcare teams are small and extremely fragile. Read full statement.

CIVIL SOCIETY ORGANISATIONS CALL FOR AN ENQUIRY INTO THE ONGOING STOCK-OUTS OF MEDICINES. 11 MAY 2012
Statement by the Treatment Action Campaign, the HIV Clinicians Society of Southern Africa, the Rural Health Advocacy Project, the Rural Doctors Association of Southern Africa, SECTION27 and Médecins Sans Frontières

There have been ongoing shortages of antiretroviral medicines, specifically tenofovir(TDF) and abacavir(ABC) since March in facilities across South Africa. These shortages are compromising the health of patients taking these medicines. We call for urgent resolution and for an enquire into their cause. Read the full statement here.

SOUTH AFRICAN HEALTH REVIEW LAUNCHED WITH TWO PUBLICATIONS ON RURAL HEALTH BY RHAP, WITS AND UKZN CENTRES FOR RURAL HEALTH. 14 MARCH 2012
On Thursday the 23rd of February, the Health Systems Trust launched the 15th edition of its prestigious South African Health Review. The 2011 review “provides valuable policy and empirical information on a range of issues that are related to and impact on the Negotiated Service Delivery Agreement and primary health care re-engineering as envisaged by the National Department of Health (NDoH) (SAHR 2011)”. RHAP is pleased to announce that two of the chapters focus on rural health and are authored by RHAP, Wits Centre for Rural Health and UKZN Centre for Rural Health staff. The articles look at the State of the Right to Health in Rural South Africa (Chapter 9) and Human Resources for Rural Health (Chapter 10).

RURAL-PROOFING THE COMMUTED OVERTIME POLICY FOR MEDICAL PRACTITIONERS. 12 MARCH 2012
The success of many of the new health initiatives underway, such as the NHI, PHC Re-Engineering and the new NSP for HIV, TB and STIs stand or fall with the availability of sufficient health care workers in rural areas. This is underlined by the new HRH Strategy for South Africa, launched in October 2012. Burn-out and better working conditions in urban areas are reasons for rural doctors to leave understaffed rural facilities. Yet, these same facilities require doctors to conduct regular and extensive overtime in order to meet the health care needs of rural communities. Rural doctors in various provinces have identified the current overtime system to be impractical for rural health, family-un-friendly and a cause of great distress for many. RHAP and RuDASA formulated a set of recommendations for making the overtime system rural-friendly. An effective overtime policy needs to be part of a broader recruitment and retention strategy, which focuses on five core elements: education and continued development, legislation and policy, professional and personal support, and financial incentives. Read the recommendations here.

FOREIGN DOCTORS HOLD OUT A LIFELINE. 09 FEBRUARY 2012
For Motsoaledi’s vision of quality healthcare for all to be realised, South Africa desperately needs more healthcare workers. The minister has acknowledged the shortage and said he would expand the infrastructure at university medical schools and also build a new medical school in Polokwane, Limpopo. These strategies are necessary, but recruiting foreign doctors is an indispensable piece in solving the doctor shortage puzzle. According to the health department’s human resources strategy document, there are more than 3 000 foreign doctors working in South Africa, constituting about 10% of the medical workforce. However, there is still room to employ more. In the UK, a country with more resources than South Africa, more than one-third of registered doctors qualified abroad…
Read this article by the CEO of Africa Health Placements Saul Kornik, published in the M&G on 3rd February 2012.

RURAL HOSPITALS BUCKLE AS FOREIGN DOCS DELAYED. 26 JANUARY 2012
Rural hospitals in South Africa are facing a serious doctor shortage in 2012 as a result of delays in registering foreign qualified doctors and the failure to place community service doctors in underserved hospitals.

Many of the foreign qualified doctors who provide essential medical care in remote and rural parts of South Africa are from the Developed World (United Kingdom, Europe, Canada, USA, Australia and New Zealand) and their training and experience is considered equivalent to that of South African trained doctors so they can be registered here without passing extra examinations.

But several rural hospitals are facing the prospect of severe doctor shortages in 2012 as the “non-exam track” foreign qualified doctors have to wait many months to be registered by the Health Professions Council of South Africa. There are increasingly time-consuming bureaucratic requirements, resulting from concerns about “bogus doctors”. Read the full article by Health-E news and published in the Star, 25th of January 2012.

ALL IN A HARD DAY’S WORK – A CLINICAL ASSOCIATE’S FIRST DAY AT WORK IN A RURAL HOSPITAL. 25 JANUARY 2012
Hardly two weeks on the job and doctors and nurses at Carletonville Hospital’s maternity ward say that Victor Mokokotlela is a welcome relief.
As one of the inaugural clinical associates to graduate from Wits University in December, Mokokotlela’s duties include taking care of the hospital’s post-natal patients.
“This is a very remote hospital and we need all the help we can get. Being in such a remote area makes it hard for us to attract professionals,” said Matabo Letsoalo, hospital spokesperson. Read the full article published in the New Age on 19 January 2012.

RURAL HEALTH SUBMISSION ON THE NHI GREEN PAPER: RURAL NOW! 11 DECEMBER 2011
RuDASA, RHAP, Wits Centre for Rural Health, UKZN Centre for Rural Health, Ukwanda Centre for Rural Health, UCT: Primary Health Care Directorate, Africa Health Placements and Rural Rehab jointly made a submission on the Green Paper on National Health Insurance. Endorsed by SECTION27,  Black Sash and the People’s Health Movement, our submission sets out the potential effects of the proposed National Health Insurance on rural communities, in terms of access, quality and equity. As a result of previous disadvantage and current inequity in health status and access to health services affecting rural areas, as well as the relative lack of capacity to reverse the situation, a specific strategy is proposed for rural health. We say RURAL NOW! The priority areas are:
Rural Accreditation First
User Fees Abolished and No Increase on VAT
Reverse the Existing Infrastructure/Inequality Trap through Needs-Based Budgeting
Access to Health by Addressing Social Determinants including Transport
Lure Sufficient Human Resources to Rural Areas
No to Delegated Management Responsibility WITHOUT Authority and Accountability
Only through Consultation with Communities, Health Workers and Activists
Wide-ranging PHC benefit package

FIRST CO-HORT OF WITS CLINICIAL ASSOCIATES GRADUATE. 8 DECEMBER 2011
On Thursday 8 December 2011, the first cohort of Wits students completing the Bachelor of Clinical Medical Practice (BCMP) degree graduated to enter the health service as part of a new cadre of health professionals, Clinical Associates. This is a significant development as Clinical Associates are part of the Seven Foundations of South Africa’s Human Resources for Health (HRH) model, captured in the recently launched national Department of Health’s HRH SA 2030 strategic plan. Similar to Physician Assistants in the United States and Clinical Officers in East Africa, Clinical Associates are university-trained medical professionals who will work primarily at district hospitals. They are an integral member of the clinical team, working under the supervision of doctors to provide medical services ranging from conducting routine patient consultations and performing common procedures, to providing emergency care for acute conditions and managing chronic diseases such as hypertension, diabetes, and HIV/AIDS. Clinical Associates are registered with the Medical and Dental Professions Board of the Health Professions Council of South Africa. “Clinical Associates will play a vitally important role in rural health care. From the outset, rural doctors have welcomed this new cadre of workers and have looked forward to working with them. Their support of the team in rural district hospitals will ensure better care for patients and will also enable doctors to engage in greater outreach to clinics,” says Prof. Ian Couper, Director, Wits Centre for Rural Health.

THE NEW NSP on HIV, STIs and TB 2012-2016 SETS GOALS FOR RURAL HEALTH. 6 DECEMBER 2011
In September RHAP and RuDASA made a submission to SANAC on the National Strategic Plan on HIV, STIs and TB, Draft Zero. The needs of rural communities were overlooked. We are therefore glad to announce that the final NSP, launched on World AIDS Day, explicitly identifies rural communities as a vulnerable group with rising HIV prevalence. Amongst other, the country’s new strategy has set the following goals:

• Strategic objective 1) Social and Structural Drivers: “HIV prevalence is increasing rapidly in rural, formal settlements. A big challenge in rural areas is access to appropriate services. A large proportion of the rural population has no sustainable livelihood, which contributes to deprivation and ill health. Government will develop and implement a comprehensive strategy to address the social, economic, infrastructural and governance challenges that have been identified in rural areas. Access to health services, including HIV and TB interventions, has also been prioritised”. “There is a need to implement a unique identifier to ensure a continuum of care for migrant populations, both between rural and urban areas and provinces within South Africa, and between countries in the region.”
• Strategic Objective 2) Prevention: “Current systems for the provision of Post-Exposure Prophylaxis, for adults and children, need to be significantly scaled up and improved, especially in rural areas.”
• Strategic Objective 3) Treatment: “Household contact is a major part of the work of the ward-based primary health care outreach teams in the new primary health care re-engineering programme. Currently, medication is delivered by health care facilities or by couriers (in the private sector). In the case of the former, a huge burden is placed on employed and rural people with chronic illnesses who may not have access to health facilities during working hours. This intervention is critical to decentralised community-based programmes.”
  “Access to services on weekends/out of hours: Most primary health care facilities operate on a five-day, 8h00 to 16h00 basis. This makes these services inaccessible to many people who require primary health care services out of hours, including the employed, those at school or tertiary institutions, and those who travel long distances to seek care, particularly people living in rural areas. Re-examining delivery models and hours for clinical services will allow for improved access to treatment, and better use of scarce health care resources. This also applies to most other social services required by people with chronic illnesses”.

• Ensure that allocation of Community Service health professionals is focussed on underserved and rural areas
• Ensure that provinces do not freeze critical health professional posts in underserved and rural areas as part of hiring moratoria resulting from overspending, through the development of norms for minimum numbers of health professionals for district facilities.
• Agreement on a definition of ‘rurality and remoteness’ to inform resource allocations such as rural allowance, and policies such as OSD, and to measure and compare progress in closing the equity gap between rural and urban areas;
• Increase the proportion of rural students in health professional courses in South Africa;
• Increase the proportion of training of health professionals that occurs in rural areas;
• Increase the uptake of suitably qualified foreign health workers;
• Improve living conditions including accommodation

COMPETITION: A DAY IN THE LIFE OF A RURAL NURSE. 03 OCTOBER 2011
The RHAP and the HIV-Clinicians Society are calling for all rural nurses to enter this competition, which aims to draw attention to the plight of rural nurses. Tell us about your daily experiences, what motivates you, what do you find challenging..have your story published and win a prize! More information here.

PRESS RELEASE: FOREIGN QUALIFIED DOCTOR HONOURED WITH RURAL DOCTOR OF THE YEAR 2011 AWARD. 14 SEPTEMBER 2011
The winner of the prestigious Pierre Jacques Rural Doctor of the Year Award was announced at the Rural Health Conference in the quaint village of Rhodes on 9 September 2011. This year it was awarded to Dr. KR Adigun from Bethal hospital in Mpumalanga Province. In line with the National Department of Health policy, Dr. Adigun developed a blue print of HIV/TB community oriented primary care (COPC) where the community takes responsibility for the HCT/TB campaign. He consulted widely and was able to mobilize the whole community to take ownership of the campaign.Read full statement
Read the Sunday Times coverage article of 25 September 2011.

TOWARDS A NEW HRH PLAN FOR SOUTH AFRICA. 22 AUGUST 2011
On the 15th of August, the Department of Health released its stakeholder consultation document on the HRH Plan for South Africa. The RHAP commends the Department for its inclusion of a Rural Recruitment and Retention Strategic Objective and will make a formal submission after studying the document in detail. The document echoes many of the recommendations developed by RHAP and partners and which are captured, amongst others, in our discussion document submitted to the DoH in June 2011, named “Rural Recruitment and Retention: the SA Context”. The discussion document was reviewed by the South African Committee of Health Sciences Deans (SACOHSD) on the 12th of July 2011, which “strongly commended and unequivocally supported the document”. This high-level committee highlighted some of the key recommendations, such as:

• Outreach support to rural areas: the formulation of a formal policy and implementation framework/guideline with the District Health System as a point of departure
• The use of community service as originally intended, i.e. equitable access to the full range of health services in under-resourced particularly rural areas with a comprehensive ongoing induction and orientation programme for community service healthcare professionals.
• Optimization of recruitment processes without compromising the competency evaluations

The Committee further proposed additional interventions, such as exploring innovative public-private partnerships in increasing the graduate outputs currently constrained by infrastructural and human resources within universities and the public health clinical training platform. For more detail, read the SACOHSD’s full response here. RHAP is calling for all stakeholders to give us feedback on our discussion document to ensure the document is as inclusive and multi-disciplinary as possible. Deadline 30 September 2011.

ABUSE OF RWOPS UNDERMINES RURAL HEALTH. 18 AUGUST 2011
In its latest issue of Equal Treatment, the Treatment Action Campaign published an article on the abuse of Remunerated Work Outside the Public Sector (RWOPS). Dr Karl le Roux, Chairperson of RuDASA, was interviewed and commented the following: “Any abuse of RWOPs or moonlighting by full time […] government doctors is completely unacceptable and immoral. Such actions – apart from the negative impact they have on the health of rural communities – […] undermine the hard work of many deeply committed rural doctors”. Read the full article here.

MINISTER ANNOUNCES NHI PLAN. 12 AUGUST 2011
Government has released its Green Paper on NHI. The NHI aims to bring quality health care within the reach of all, based on need, and regardless of ability to pay. Read this interview by Health-E with the Minister, and download the paper and press statement. Will the NHI benefit rural communities equitably? RHAP and partners will study the Green Paper and comment on the opportunities and risks for Rural Health.

HEROES OF THE NORTH WEST. THE PLIGHT OF HOMEBASED CAREGIVERS. 12 AUGUST 2011
The introduction of a new cadre of Community Health Workers as part of the Re-Engineering Primary Health Care Strategy is one of Government’s strategies to achieve better health outcomes and bring health care closer to people. RHAP applauds this development but is concerned about the continuation of the current model for Home-based Care: leaving caregivers across the country underpaid, irregularly paid and undersupported. RHAP believes that Home-based Caregivers should be equally integrated into the formal health care system. Whereas Community Health Workers will focus on prevention and promotion, Home-based Caregivers’ main role has been to assist vulnerable households through counselling and rehabilitative, post-surgery as well as end-of-life care. Both cadres are essential to make primary health care real. Read this article about the work and challenges of caregivers in a rural district in North West. Download Equal Treatment’s Magazine of August 2011 “Who Does the Caring?” for a full and detailed discussion of the new policy.

PRESS STATEMENT: CIVIL SOCIETY ORGANISATIONS CALL FOR THE STATE AND THE UNIONS TO URGENTLY FINALISE THE MINIMUM SERVICE LEVEL AGREEMENT FOR THE HEALTH SECTOR  24 June 2011
We, a range of organisations, want to draw to your attention to our serious concern about the failure over many years to agree on a Minimum Service Level Agreement (MSLA) that would govern the provision of essential health services during industrial action by health and auxiliary workers. We call on the State, the Minimum Service Level Committee as well as Public Sector Unions to urgently engage in the process to establish a Minimum Service Level Agreement. Given the urgency of the matter, we request a public commitment from all parties to the establishment of the MSLA before the conclusion of wage negotiations, and particularly before any strike action may be considered. Read the full statement.

RURAL RECRUITMENT AND RETENTION: THE SOUTH AFRICAN CONTEXT  22 June 2011
Education, Regulatory Framework, Finances, Personal and Professional Support: these are the core components of a comprehensive rural recruitment and retention strategy. These are also the components that need to be integrated into the new Human Resources for Health plan if we are to meet rural citizens’ right to access quality, comprehensive health care. The Wits Centre for Rural Health, the Rural Health Advocacy Project, Africa Health Placements, the Rural Doctors Association of Southern Africa, the UKZN Centre for Rural Health and the UCT Primary Health Care Directorate have collaboratively developed a discussion document on the basis of the ”WHO global policy recommendations on increasing access to health workers in remote and rural areas through improved recruitment and retention.” The document outlines the priorities and strategies for the South African context. We call for your comment and input by September 2011!

PRESS STATEMENT: RHAP AND RUDASA JOIN SAMA’S DEMANDS FOR URGENT SAFETY MEASURES TO PROTECT OUR HEALTH CARE WORKERS FROM ASSAULT 15 June 2011
The South African Medical Association has called for marches tomorrow morning in Pretoria, Durban and Cape Town to protest against unsafe working conditions for health care workers leading to avoidable risks of assault. The Rural Doctors Association of Southern Africa and the Rural Health Advocacy Project stand firmly behind the demands by SAMA and the Junior Doctors Association of South Africa for the Government to take measures to ensure greater safety of our health care workers.

The murder of Dr Mkhize of Middelburg Hospital in Mpumalanga on the 7^th of June this year does not come in isolation. Dr Mkhize died after being stabbed by a patient in his consulting room. In December 2010 a 35-year old female doctor got raped by a minor during night shift at Pelonomi Hospital in Bloemfontein. In 2007 a medical student got attacked and raped at Baragwanath Hospital in Johannesburg. In all cases improved safety and security was called for. Yet, attacks on health care workers continue to take place. In the meantime, the promised improved safety measures have still not been implemented at Middelburg Hospital.

It is unacceptable that health care workers have to feel unsafe in hospitals and clinics while reasonable measures can be put in place to minimize the risks of assaults. We support SAMA in demanding for:

• Skilled, qualified hospital managers with experience in health management;
• Fencing around hospitals and the installation of metal detectors at controlled entry point;
• Surveillance cameras and good lighting in all corridors, passages, parking and dark corners;
• Appointment of qualified security companies that are accountable to hospital management.

RHAP STRATEGIC FRAMEWORK
RHAP recently completed its 5 year strategic framework resulting in a focus on four key areas:
1: Policy: New and existing policies are rural-friendly
2: Rural Health Financing: Rural health care receives the financial resources to provide a quality, equitable service to rural citizens
3: Human Resources for Rural Health (HR4RH): Every rural citizen has adequate access to caring, qualified health care teams
4: Implementation: Policies are implemented in effective and efficient rural health care systems.

The framework and its strategic priorities have been informed by the experiences of the first year and a half of RHAP’s existence, its strategic partners, and by a multi-stakeholder consultative process culminating in a position paper on rural health care.

15th RuDASA RURAL HEALTH CONFERENCE: REGISTER NOW
The 15th RuDASA Conference will take place in the Eastern Cape from 8 to 1o September 2011. The theme of the conference is PHC: making it work better for rural health, and the closing date for abstract submission is 16 July.  Visit the Conference’s website at www.ruralhealthconference2011.co.za

RHAP, RuDASA, WITS CENTRE for RURAL HEALTH and KZN CENTRE FOR RURAL HEALTH RURAL-PROOF THE PHC REVITALISATION STRATEGY 15 April 2011 
The Rural Health Advocacy Project (RHAP), the Rural Doctors Association of South Africa (RuDASA), the Wits Centre for Rural Health and UKZN Centre for Rural Health strongly support the drive by Government to re-engineer primary health care (PHC). We agree that a strengthened PHC approach within a functional District Health System (DHS) is imperative to improving national health outcomes.  It is against this background that we have welcomed the request by the Department of Health to comment on the PHC Strategy from a rural health care perspective. Whilst fully supporting the overall purpose of the strategy, we argue that certain elements have not adequately taken into account opportunities and challenges related to health care provision in rural areas. In this submission we make a number of recommendations that could enhance the health outcomes of rural citizens and contribute to the realisation of their rights to comprehensive access to health care. Our submission is structured according to the four key steps to improved rural health care identified by the RHAP: rural-friendly policies; equitable and sufficient financing for rural health care; sufficient, well-supported and caring human resources for rural health care; and implementation of policies in effective and efficient rural health care systems.

RHAP POSITION PAPER: DOCTOR NORMS FOR DISTRICT HOSPITALS, OUTREACH AND RURAL-PROOFING.  9 March 2011
These are some of the core recommendations emerging from a year-long consultative process with 53 rural health experts and  a multi-stakeholder workshop, captured into the RHAP position paper on rural health care. The position paper discusses the key challenges and priorities for quality, comprehensive health care delivery to rural communities. One of the key recommendations emerging from this process is the need for rural-proofing to ensure all government health policies, programmes and initiatives both at the design and delivery stages are appropriate and suitable for the rural health context. Read more.

RHAP HOSTS MULTI-STAKEHOLDER RURAL HEALTH CONSULTATION. 9 March 2011
Under the banner of “Rural Health – Key to a Healthy Nation”, the RHAP convened a consultative workshop at Wits Medical School on the 10th of February 2011. The event was well attended by over 55 stakeholders from national and provincial departments of health, rural health care workers of different disciplines, professional associations, academics, research and human rights organisations. The main objectives of this event,was to:

• Present and discuss RHAP’s draft RHAP Strategic Framework
• Present and strengthen the RHAP Position Paper on Rural Health Care by obtaining inputs from key stakeholders
• Exchange knowledge, views, and build relations around rural health advocacy

The keynote address was delivered by Dr Mmabatho Kekana, clinical manager at Hlabisa Hospital in KZN Province and RuDASA Rural Doctor of the Year 2010. Her presentation addressed challenges, successes and strategies in improving health outcomes and HR recruitment and retention. Dr Jane Goudge from the Centre for Health Policy presented on research measuring the costs of seeking health care for two poor rural communities in Mpumalanga Province. Mr Elroy Paulus from Black Sash shared recent findings of a consultative process with communities in five provinces regarding access and quality of health care, with the aim of informing the planned National Health Insurance. The RHAP presented its draft position paper and advocacy framework, which were both well received and supported.

GLOBAL CONSENSUS FOR SOCIAL ACCOUNTABILITY OF MEDICAL SCHOOLS. 19 January 2011.
The 21st Century presents medical schools with a new set of challenges: improving quality, equity, relevance and effectiveness in health care delivery; reducing the mismatch with societal priorities; redefining roles of health professionals; and providing evidence of impact on people’s health status. To address those challenges 130 organizations and individuals from around the world with responsibility for health education, professional regulation and policy-making participated for eight months in a three-round Delphi process leading to a three-day facilitated consensus development conference.The Consensus consists of ten strategic directions for medical schools to become socially accountable, highlighting required improvements to:
• Respond to current and future health needs and challenges in society
• Reorient their education, research and service priorities accordingly
• Strengthen governance and partnerships with other stakeholders

Read more about this critical development for socially accountable health education. Further background information can be found in ”Social accountability and accreditation: a new frontier for educational institutions” by Charles Boelen& Bob Woollard.

PRESS RELEASE: RURAL STUDENTS ACHIEVE A 90% PASS RATE AT UNIVERSITY. 13 January 2011
The Umthombo Youth Development Foundation identifies, trains and supports rural youth with the potential to study a health science degree in order to address the shortages of qualified staff at rural hospitals since graduates are required to serve their communities for the same number of years they were supported for. In 2010, the UYDF supported 108 students studying a wide range of health science degrees including Medicine, Pharmacy, Radiography, Nursing etc at various Universities in South Africa. Of the 108 students, 97 passed their 2010 year end exams, whilst a total of 11 failed and will be repeating the year (2 have been excluded). The high pass rate can be ascribed to the academic and social mentoring support provided to the students by UYDF as well as the students’ determination to succeed. Rural students face many challenges at University, including language and generally being poorly equipped for tertiary study and thus a 90% pass rate is an incredible achievement. Read more.  

End of year Rural Health Quote: “The lack of taking the rural context into consideration causes policies and guidelines to be developed that are not easily implemented in rural settings. The additional resources required for implementation in rural areas is often overlooked and not included in the costing of the interventions.” (Rural Rehabilitation Health Care Worker, August 2010)

RHAP STAKEHOLDER CONSULTATION: 10 February 2011
On the 10^th of February 2011 the RHAP will be holding a Stakeholder Consultation Process. At this event, the RHAP will present its longer term strategy for rural health advocacy. Strengthening current and building new partnerships will be at the core of this strategy. Fore more information contact the RHAP at marije@rhap.org.za.

FREEZING OF POSTS IS AGAINST THE SPIRIT OF THE TEN-POINT-PLAN. November 2010
Staffing moratoriums continue to take place in several rural provinces to cut costs and bring down debts. In November 2010 the RHAP wrote to the MEC of Finance in Kwazula-Natal to oppose the moratorium on the filling of HR posts in KZN. We believe that such measures are having a negative impact on the core mandate of the Department of Health: the delivery of health care services, and the right of communities to access quality health care. The impact of this approach is evident – and will create significant long-term problems in rebuilding already fragile teams and implementing the proposed NHI in years to come. Read our letter to the MEC here.

KZN DEPARTMENT OF HEALTH ADOPTS GROUND-BREAKING RURAL-FRIENDLY COMMUNITY SERVICE OFFICERS POLICY. 20 October 2010.
The RHAP congratulates the KZN Department of Health with their comprehensive and rural-friendly policy for the allocation of community service officers (CSOs). In the past the majority of the CSMOs were placed in urban areas. With the adoption of this policy, this first of its kind in our country, there are now clear guidelines aiming to ensure the equitable allocation of CSOs to public health facilities in KZN, with appropriate supervision and a supportive working environment ‘that would enable and encourage Community Service Officers to remain in the public service, particularly in underserved areas’.  The policy aims to ensure that 90% of CSO posts in each professional category gazetted hospitals and facilities are filled each year. 100% of CSOs will undergo a structured orientation programme within 2 weeks of their arrival. Credit further goes to the UKZN Centre for Rural Health which has assisted the Department in drawing up the policy. Some of the rural-friendly components include:

• Rural and underserved areas will be given preference when allocating CSOs of all professional categories
• CSOs will be required to provide services in Primary Health Care Settings and may be required to travel to deep rural areas. Rehabilitation and Therapeutic Therapists are required to travel at least 40% of their time at PHC level (this includes clinics, community-based services, non-profit organisations and schools).

The policy further contains detailed guidelines for accomodation, training, supervision and mentorship. Research has shown that these are important retention tools, to ensure CSOs are keen to stay in the under-served areas after their placements. For the succesful implementation of the policy the recruitment and retention of senior health practitioners will be paramount, as they are to provide the required support and supervision. The RHAP wishes the Department all the best with the implementation of the policy, which we will send to all provinces in the hope others will soon follow suit.

LACK OF TRANSPORT HAMPERING TREATMENT SUCCESS. 20 October 2010. In this article, Lungi Langa from Health-E news writes that “lack of affordable and accessible transport is emerging as a major hindrance towards poorer South Africans accessing state health care, especially for those living in rural areas.  The Western Cape is perceived as a well resourced province, but for some HIV-positive patients living in Mooreesburg, accessing treatment means relying on the goodwill of strangers for a lift and running the danger of defaulting on their treatment. Several studies have confirmed that lack of transport could be detrimental for access to chronic treatment and adherence, eventually leading to poor treatment outcomes…..Read full article“.

RURAL HEALTH QUOTE OF THE WEEK. “At the clinic we were told to take her to hospital. The problem was that we did not have money for transport“. Quote by a highly vulnerable households in a study in a rural district in Mpumalanga on barriers to accessing chronic care (Goudge et al, BCM Health Services Research, May 2009). Half (6/13) of the highly vulnerable households had no source of income and depended on gifts from family and neighbours, so regular health care consultation was very difficult. As a result 13 of the 16 chronic cases in the highly vulnerable group sought treatment at best intermittently and 4 of these 16 cases either hardly consulted at all or relied on self-treatment.