Innovative Approaches to Rural Health Discussed at UKZN

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With many challenges facing the South African health system, a number of reforms have been carried out to help improve access to quality health care.  The Rural Health Advocacy Project (RHAP) and the Centre for Rural Health at the University of KwaZulu-Natal recently co-hosted a roundtable discussion at the Nelson R Mandela School of Medicine to discuss and address innovative approaches to account for rurality in health policy, strategic planning and service delivery.

RHAP, established in 2009 as a partnership between the Rural Doctors’ Association of Southern Africa (RuDASA), SECTION 27 and Wits Centre for Rural Health (WCRH), aims to co-ordinate and lead on advocacy for rural health. It is directed by Ms Marije Versteeg-Mojanaga.

Characterising the rural health context continues to be a challenge and the idea of a rural area and what being rural entails formed a critical part of the roundtable discussion.

In a talk titled “What do we know about Rural Health in KwaZulu-Natal?” Director of the Centre for Rural Health (CRH) at UKZN, Dr Berhard Gaede, spoke about the challenges of measuring deprivation and poverty. ‘Assumptions are often made of rural areas. They are romanticised. But there are higher levels of need in rural areas that are not always apparent. This makes the concept of “rural” quite complex. One way of assessing equity is to examine the distribution of deprivation and how it relates to rural areas,’ he said.

In terms of the South African Multiple Deprivation Index, which has four measurement domains – income and material deprivation, employment deprivation, education deprivation, and living environment deprivation – KwaZulu-Natal is the fourth most deprived province, with eight of its districts among the 20 most deprived in the country.

However, “rural” and “deprivation” are not synonymous, cautioned Gaede. He said while progress has been made despite a stressed health care system, policy planning did not always translate into effective measures on the ground. ‘We need to understand the population better to understand their needs,’ he said.

Mr Daygan Eagar from RHAP drew attention to the fact that while rural areas have lower populations, there exists an infrastructure inequality trap and health financing problems in rural areas. ‘Healthcare workers are also reluctant to work in rural areas due to this,’ he said.

Discussing health priorities in the National Development Plan (NDP) and the role of public-private partnerships, Mr Mfowethu Zungu, Senior General Manager from the KwaZulu-Natal Department of Health, said: ‘We need to respond to the needs of our communities. As a province, we’ve realised that we have to work together to bring about better healthcare outcomes.’

As part of the NDP goals, by 2030, life expectancy is to be raised to 70 years and we are to have a generation of under-20s free of HIV. Other goals are the reduction of the burden of disease, an infant mortality rate of less than 20 deaths per 1 000 live births, and an under-five mortality rate of less than 30 per 1 000.

Mrs Esther Snyman, the Manager of Strategic Planning, said improved health delivery required innovation: ‘The focus shouldn’t just be on clinics, but on mobile services. This is possible once village challenges are identified.’

In a presentation on “Rural proofing for health: accounting for rural policy planning and budgeting”, Richard Cooke from Wit’s Centre for Rural Health emphasised the need to recognise that each rural community has its own values and needs. He described “rural proofing” as policies which were “rural friendly” as opposed to “anti-rural”.

‘One has to ask the question: is it only we who need to have our consciousness raised? What debate needs to be raised amongst civil society members? Are there simple tools to assist us to do rural proofing?’ he said.

Key issues regarding budgeting, rural policy debates and priorities for research were raised in discussion among participants.

-           Zakia Jeewa