RHAP Programme Manager: Rural-Proofing Policy and Budgeting (RPB) Programme for Improved Access to Quality Health Care in Rural South Africa
The Rural Health Advocacy Project is a partnership initiative between the Rural Doctors Association of Southern Africa (RuDASA), the Wits Centre for Rural Health (WCRH) and Section27. The work of the RHAP revolves around the constitutional right of rural and remote communities to have equitable access to comprehensive, quality health care.
The RHAP has established a new programme that aims to improve access to quality health care services in rural South Africa through more equitable and effective planning and financing of rural health services.
Main purpose of the job
To lead, coordinate and implement the RPB Programme objectives
The SAHR 2011 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). A range of experts provide commentary on topics ranging from rural health, health technology to human resources. SAHR 2011 also contains a section on core health issues, where developments in health information systems, financing health care, and health legislation and policy are discussed. The Review concludes with the Indicators chapter which presents a selection of the best available data on the functioning and performance of the health system.
Since 1995, the South African Health Review (SAHR) has been an annual publication of the Health Systems Trust. Viewed as an authoritative and comprehensive publication, the SAHR provides a current and longer-term review of health policy developments and their implementation in South Africa, and monitors changes and challenges in the provision of equitable and accessible health care in the country.
In an attempt to measure in part the progress (or lack of progress) towards equity one step would be to measure the quality of service provision at the community (primary care) level. This would give an overview of the disparities between as well as in provinces, and between rural, urban and peri-urban parts of the country.
The South African Health Review 1996 documents the degree to which structural reform and policy formulation within the health sector has translated into real improvements in service delivery and the quality of peoples lives. In sum, the Review reveals a mixed scorecard. Progress has been excellent in some areas, whereas others show little movement. This, the Review argues, is the nature of health reform.
Perhaps the overriding success of the Ministry of Health has been the process of restructuring towards primary health care, reflected both in the organisation of health care and expenditure patterns. Equally impressive has been the introduction of an essential drugs list within the public sector, which is likely to improve the availability of medicines over a relatively short period of time. At local level, the Department of Health can take credit for generating tremendous enthusiasm for change amongst service managers and health workers.
But in the critical areas of financing and health legislation, progress has been slow. Discussions about some form of social health insurance have borne little fruit. A new Health Act is in its seventh draft, but has not been available for public comment. In addition, controversy over Cuban doctors and vocational training for new graduates has often obscured the need for a comprehensive plan for addressing the maldistribution of health personnel in South African - from province to province, between public and private sector, and between hospital and primary care facilities. All of the above need to be addressed as a matter of urgency in the next year.
The South African Health Review 1996 tackles Sarafina 2 head-on, and considers its effect on HIV/AIDS prevention, the ability of the Department to make progress over the past year, and the relationship between the executive and legislative arms of health governance. But it places the biggest controversy faced by the Health Department during 1996 in the context of the full programme of health care reform initiated by the Ministry. Areas of energy and activity which serve as the vanguard of health reform have been identified, as have bottlenecks which impede progress.
The South African Health review is a recognised barometer of the progress of reform in the health service. This years health review is frank in its assessment of successes and failures, but expands its scope of information by including a survey of the realities in clinics in every province in the country.
While previous reviews have focused on the development of new policies as part of the restructuring in the health sector, this Review concentrates on trying to assess the extent to which new policies have been translated into real improvements in the quality of life of South Africans. The Review found that while major steps forward have been made in the arena of policy, much remains to be done in order to implement these policies.
The clinic survey highlights the fact that despite the commitment to providing primary health care for everyone there is continuing disparity between service provision in rural and urban areas, with rural people, and poorer provinces still losing out. For example, the survey showed that only 41% of rural clinics have an ambulance at their door step within an hour of an emergency call compared with 74% in urban clinics. The move towards more equitable provision has become even more uncertain now that funding for health is at the discretion of provincial cabinets, (from the beginning of the 1997/98 financial year each province received a block grant from the national Treasury).
In contrast with 1996 which saw only one new piece of legislation, in 1997 a number of pieces of legislation with the potential to reform the health services were introduced to parliament, nonetheless problems remain with implementation. The possibility for women to exercise their constitutional right to reproductive choices improved dramatically when termination of pregnancy legislation came into effect in February 1997, but service provision has proved to be patchy at best with a number of provinces doing much less than their proportional share of terminations. The clinic survey reveals that only just over 60% of rural clinics and about 85% of urban clinics offer family planning services on a daily basis.
With South Africa facing one of the worst TB epidemics in the world, there has been commitment at national and provincial level to implementing a new control programme. However many barriers still exist, and despite remarkable improvements in some provinces, the clinic survey demonstrates that only 10% of rural and 25% of urban clinics receive results within the time recommended by the Tuberculosis Control Programme.
In the hospital sector detailed baseline studies have resulted in clear plans for what needs to be done to achieve physical improvements and work towards reducing inequalities as well as make changes in a range of other fields. The challenging task of implementing these plans remains.
In the field of human resources there have been efforts to re-shape an urban centred, hospital based and doctor dominated service. However there has been uneven progress and a comprehensive strategy which will attract personnel to work in currently under resourced predominantly rural areas has still to be developed.
The Review found it was difficult to measure what has really changed for a poor person in need of health care. One thread running through the Review is that more reliable up-to-date information is needed in order to assess, evaluate, plan, prioritise and improve. This information is required in every part of the health system.