Rural Health in Focus: Making expenditure control, equity and efficiency work for Rural Health

12 February 2010

This is the first issue of Rural Health in Focus, which aims to draw systematic attention to the successes and challenges of rural health in order to improve national health outcomes. This issue focuses specifically on rural health financing, efficiency and equity. To fully appreciate the support rural health care needs in order to meet national goals, we invite the President, the Minister and Deputy Minister of Finance, the Minister and Deputy Minister of Health, as well as the other Finance MinMec and Members of the National Health Council to shadow a rural doctor for a full day.

In his State of the Nation Address, President Zuma reinforced the message that government is serious about improving the nation’s health. The National Minister of Health, Dr Motsoaledi, has announced various strategies to achieve this. These include the National Health Insurance, and first and foremost, the overall strengthening of the public health service through improved ‘Quality and Efficiency’, specifically at Primary Health Care level. A central role has been allocated to expenditure control and equity. Enhanced accountability among public servants is another key ingredient, as pointed out in the ANC Today edition of 29 January – 4 February 2010 by Deputy Minister of Health Dr Sefularo.

The announced plans, and focus on quality, efficiency and equity, pose an important opportunity for rural health improvements. Rural communities have fewer resources, less information, less access to health facilities, fewer health care practitioners and worsening health outcomes. To meet the national call for equity in health, we need to strive for equal access to quality, affordable health care for those in equal need of health care. With the levels of inequality in our society, this thus requires more resources for specific groups and services.

Caution is required. In the past well-intended policy decisions have had a negative impact on rural health. The closing of nursing colleges in rural hospitals, the OSD, and the separation of hospitals from clinics are some examples. How do we ensure that the newly announced plans at national level have far-reaching, sustainable benefits for rural communities, where 43,7% of our population resides? They key question is:

Will the move to expenditure control and achieving quality and equity lead to more funds for rural health care, better planning and less waste?

As we speak today, decisions continue to be made that harm quality, efficiency and equity in rural health. Improper planning, insufficient and inequitable allocations, waste and budget cuts hamper service delivery on the ground. A brief insight into some of the major problem areas:

We are not sure how national goals can be achieved under these circumstances. In this light, these are our recommendations to achieve equity and quality, while working efficiently with the scarce resources available:

To assess the relevance of these recommendations, and experience first-hand what expenditure control, equity and efficiency means for rural health services we invite the President, the Minister and Deputy Minister of Finance, the Minister and Deputy Minister of Health, as well as the other Finance MinMec and Members of the National Health Council to come and spend a day at a rural hospital:

If we want to prepare the country for a NHI, with the intention of promoting equity, let us plan and budget for rural health appropriately. This can only be done on the basis of a proper understanding of what is happening on the rural ground.

As RuDASA Chairperson Dr Karl Le Roux states: “As Rural Doctors, we are at the coalface of healthcare delivery to the Nation. On a daily basis, we are confronted by poverty, illness, suffering and unnecessary death, but also by the hope and dignity of our patients. We believe that all politicians have something to learn from the people that we are privileged to serve, and hope that many will take up this invitation.


Contact Dr. Karl le Roux, Chairperson of RuDASA, who will link you to a rural doctor in a province of your choice:
Cell: 072 858 9751

For general comments or information: Marije Versteeg, Rural Health Advocacy Project
Cell: 074 -106 3800
Office: 011-356 41 00
Fax: 011-339 4311