“There’s really no such thing as the ‘voiceless’. There are only the deliberately silenced, or the preferably unheard.” Arundhati Roy, Author and human rights activist

Summary

The Voice Project aims to improve access to quality rural health care by increasing the number and quality of healthcare provider change agents. As part of this initiative, RHAP provides free of charge CPD accredited Advocacy workshops in institutions of learning and at facility level.

The Voice Project has the following long-term outcomes:

• Universities producing more graduates that choose to work in rural areas due to changed selection and education practices.
• Improved distribution of existing HCWs to rural areas.
• Increased numbers of rural HCW change agents in rural areas.
• Improved access to quality health care in rural areas through strategic and safe advocacy by a sufficient number of HCWs that work in partnership with communities, civil society structures, government bodies and other role-players.

Introduction

The right to access health care services is guaranteed by Section 27 of the South African Constitution. However, despite reforms to the health care system post-1994, marked inequalities in health outcomes continue to exist between urban and rural areas of South Africa. Rural health services remain fraught with health system failures, from medicine and equipment shortages to understaffing, corruption and violations of patient rights.

The country remains far behind in meeting its maternal and infant mortality targets, and chronic diseases such as HIV are placing incredible strain on an overburdened and weak health system. Patient care and health outcomes vary widely nationally and inter-provincially, with rural, under-resourced settings the most disadvantaged.

While the causes of these health system failures are varied, the shortages and maldistribution of Health Care Workers (HCWs) are a common thread. Urbanised provinces such as Gauteng and Western Cape are substantially better staffed than historically disadvantaged rural provinces such as North West and Limpopo. Rural patients bear the brunt of a vicious circle; whereas their local health systems need more resources and more HCWs with inside knowledge to speak out about health care failures, the shortages of such HCWs and their vulnerability due to being isolated in faraway places makes them reluctant to speak out.

HCWs are ideally placed to serve as agents of change within the health care system, however many lack the moral compass, motivation, knowledge, confidence and/or skills to navigate and problem solve specific challenges within the system.

The above scenario illustrates that there is a fundamental problem not only in the way HCWs are distributed but also in the manner that health sciences students are selected, educated and trained. What is needed in South Africa, and specifically rural South Africa, are a sufficient number of HCWs that are informed of their rights and those of their patients and that are confident and well-equipped to defend these rights strategically. Selecting the right students and ensuring they receive appropriate educational experiences are crucial factors in addressing inequities in access to health care.

After need for the Voice Project was established in 2013, concepts and training material were developed and presented at a number of workshops and presentations. The positive response led to the development and launch of the “Voice Manual – a HCW’s guide to reporting health care challenges“. Following a pilot phase in 2014 and 2015, RHAP began rolling out the first year of the three-year project in 2016. Some successes include: Development of a state-of-the-art “Advocacy in the Health Sciences Curriculum” and formal collaboration at Wits through a task team and Voice curriculum meetings and workshops with staff at various other universities, survey findings showing a change in knowledge and attitudes among HCWs that attended Voice workshops; contributions to public dialogue through opinion pieces; collaborative advocacy with health science students through the scorecard project; coalface advocacy with grassroots level stakeholders, such as our work in 2016 and 2016 in  Nyandeni Sub-District, Or Tambo, with health care workers and the hospital board.

Objectives

1. Advocate for the transformation of HCWs education including advocacy for the development of HCW change agents. Here, the intended outcome by the end of the three-year programme is for Universities to change selection and education practices to produce more advocacy competent graduates with intention to go rural.
2. Advocate for implementation of the National Department of Health Human Resources for Rural Health strategy
3. Build advocacy competencies among in-service rural HCWs in collaboration with communities and civil society structures
4. Support HCWs with advice on local advocacy matters and when at risk or experiencing victimization
5. Support rural HCW associations in growing their membership, networks, advocacy (critical mass).

For more information contact Samantha at Samantha@rhap.org.za