BACKGROUND: The Rural Health Advocacy Project (RHAP) has worked with the Dr Kenneth Kaunda District Health Management Team over the past three years in providing rural proofing strategies for incorporation into the District Health Expenditure Review (DHER) and the District Health Plan (DHP). RHAP felt that at present, with the economic decline of South Africa, it would be important, to document the realities of health service provision in rural areas of the country. The Maquassi Hills Sub-District in the Dr Kenneth Kaunda District being identified as the most rural Sub-District in the District, was therefore chosen for this Case Study.
Download the Case Study here: Final MQH Case Study August 3 2017 (1) (1)
OBJECTIVES: The objectives of this project were to: 1) To demonstrate the use of the RHAP Rural Proofing Guidelines (2012), 2) Identify and describe concrete issues that are of benefit from rural proofing in the selected District, 3) Make recommendations to health district management teams, which if implemented, will lead to greater equity in resource allocations and access to health care for rural communities, and 4) Support the District management teams in operationalizing the recommendations, using the district’s health planning, and budget and operational management processes. The last objective of monitoring and documenting the implementation of the recommendations through technical advocacy support is outside of the capacity of this project.
METHOD: The methodology used was a mixed-method investigative rural lens paradigm, utilizing both quantitative and qualitative methods. Information was collected using a rural proofing tool, adapted from RHAP’s Rural Proofing Guideline (2012). Information was collected through in-depth interactions (workshops/focus groups /interviews) with key individuals and groupings of stakeholders in the health service delivery platform in the Dr Kenneth Kaunda District and in the Maquassi Hills Sub-District. The stakeholder engagements included the Maquassi Hills Sub-District 3 Management Team, the District Hospital Management Team, Primary Health Care Facility Managers, Outreach Team Leaders (OTL’s), Information Managers, Data Capturers, District and Sub-District Pharmacy Managers, the District Financial Manager, the District Clinical Specialist Team (DCST), Governance Structures and finally the District Chief Director. RESULTS: The rural proofing tool basically provided a 360-degree evaluation and a realistic “snapshot” of the current state of health services in the Maquassi Hills Sub-District. Numerous recurring themes were identified, upon which a Rural Proofing Implementation Plan was developed. The implementation was broken down into the following categories: 1) A Rural Proofing SocioEconomic and Ecological Determinants of Health Plan (2017 – 2022 (up to 5 Years), which is deemed to be a project which has the potential to make the most impact on the community members in relation to access to services and improvement in the social determinants of health. 2) Short Term Plans (2018-2019 (1 Year), 3) Medium Term Plans (2019-2020 (1 Year) and 4) Long Term Plans (2020-2022 (2 years – Provincial competency).
CONCLUSION: The Maquassi Hills Sub-District Case Study describes a rural health service which is in crisis. The men and women providing the services are themselves overwhelmed by the magnitude of the challenges. The generic cost containment implemented in the North West Department of Health has deteriorated those gains which were made in the first twenty years of democracy. Given the lack of budget and the poorly staffed facilities, the Sub-District continues to perform to the best of their ability. However, there are significant unmet health needs in the far-reaching settlements and farms. The Rural Proofing Implementation Plan identifies concrete opportunities for improvement through integrated service delivery and sustainable community engagement