In this submission to SANAC, we identify critical gaps in the draft NSP and its treatment of rural contexts and communities. While many of the interventions aimed at targeting key and vulnerable populations will undoubtedly benefit rural communities, it is important to understand rural contexts do differ from urban contexts in key ways. Rural factors such as distance, topography, dispersed populations, difficulties in attracting and retaining human resources render service delivery in rural contexts both more difficult and more expensive. These factors also make it more difficult for rural people to access services when they are available.
The draft NSP does not currently recognize these critical rural factors and so does not adequately account for the needs of rural communities. In this submission, we address each objective and several strategic enablers from a rural-proofing perspective. From this discussion, we can distill several key recommendations for how the NSP can better account for rural contexts. These key recommendations include:
- Including rural populations as key and vulnerable populations due to intersecting factors that makes accessing services in rural contexts both more difficult and expensive
- Including the concept of rural-proofing as a strategic priority within the NSP to ensure that future implementation plans account for rural factors in setting priorities and targets and identifying targeted service delivery approaches
- Including a definition of rural that will facilitate planning and the allocation resources strategically
- Giving greater attention to Community Healthcare Workers and Clinical Associates as game changers in the delivery of services (prevention and treatment) in rural settings. This must be done with due consideration of the support and supervision needed to ensure services are of high quality
- Supporting decentralized and community based models of care. Again, this must be done with due consideration of need infrastructure, supervision and support.
- NSP costing should account for rural cost factors such as distance and diseconomies of scale that increase the cost of delivering services in rural areas. These costs should be factored in to resource allocations
- Budget allocations for critical healthcare workers providing services under the NSP should be ring-fenced to ensure that they are protected during times of austerity. This could be included in the HIV and AIDS Conditional Grants to provinces for instance.
- The decentralization of governance and decision-making should be supported to ensure more appropriate and targeted interventions for rural settings. Decentralization must be supported with capacity development.
- Rural supply chain and procurement systems must be developed and strengthened. Investment must be made to shift these systems from paper based systems to integrated electronic systems.