Unsung Heroes: The Challenges Faced by Rural Healthcare Workers in South Africa

Healthcare workers are often referred to as the heroes of healthcare due to their steadfast dedication and tenacity in the face of countless adversities. Despite these obstacles, healthcare workers demonstrate extraordinary courage and drive, proving their dedication to the well-being of their patients. Their capacity to overcome challenges, and provide compassionate treatment on a constant basis is nothing short of heroic.

As with every year since the first democratic elections in 1994, Worker’s Day is celebrated on May 1, each year. This day holds significant meaning for South Africans, as it commemorates the rights of workers and the contributions they make to society.

Workers’ Day in South Africa has come to symbolise the tough fight against Apartheid in which trade and labour unions played a crucial role and sacrifices made on the long road toward equal employment.

Although sacrifices were made towards good and fair employment, South Africa still has healthcare workers who work under harsh circumstances in rural areas. Rural healthcare workers are essential medical professionals who provide care and support to underserved communities. They are often considered unsung heroes due to their tireless efforts in rural areas.

Rural healthcare workers encounter significant challenges that make providing adequate healthcare services to those living in rural areas challenging. Furthermore, social and cultural barriers, such as language barriers, limited access to education and training, and a lack of community support, contribute to these difficulties.

Nthabiseng Sibisi, chairperson at Rural Nursing South Africa outlines the challenges that rural healthcare workers encounter and they include: 

• In terms of resources, rural districts suffer from significant disparities between urban and rural areas due to factors such as procurement and budget allocation

• Unavailability of medicines

• Lack of accountability and insufficient management support for staff

• Poor health service support systems – ambulance and laboratories are often hard to reach, leading to delayed  diagnosing, treatment, and referrals to higher level of services

• Capacity building challenges, although regional training centres are available, training often relies on District Supporting Partners. 

• Socio-cultural factors (traditional beliefs) relating to medicine use which may lead to polymedicine, often with drug-drug interactions, and, at times, late healthcare access and treatment initiation

• Patient migration leading to loss to follow up for treatment

On Friday, 12 May, the world comes together to celebrate International Nurses Day, a day dedicated to acknowledging and appreciating the contributions of nurses worldwide.

International Nurses Day highlights the critical role that nurses play in our healthcare systems. Their constant dedication, compassion, and skill are critical in improving patient outcomes, promoting health, and delivering comprehensive care to individuals and communities.

According to Nomana Ntshakaza, a nurse working in rural areas of the Eastern Cape, and a representative of Rural Nursing SA, some of the common difficulties of working in rural areas include lack of resources, both human and infrastructural. Delayed EMRS response leading to complications and fatalities. 

She states that some of the working conditions like staff shortage, unavailability of medical and surgical equipment and medicines. Lack  of consistent water supply, Non-functional generators, not enough security guards and non-availability of their  basic equipment need to change in order for rural healthcare workers to be fulfilled in their jobs.

“Communicating with line supervisors, supporting partners, unions and clinic governance structures,” is how Nomana suggests the challenges could be addressed.

Nthabiseng furthers says that nurses are able to work with what is available within their reach. 

“These include daily clinical management of patients as well as sustaining the operations of the facilities.  They have an intrinsic motivation to serve humanity, selflessly, however the health system issues which directly impact on their work, should be addressed. 

“These include healthcare support systems such as ambulance availability; accessible laboratory services; transportation and logistics of supplies, specimen, and referral of patients; nurse accommodation; and capacity building and training. Management support and empathy need to be strengthened as well by involving nurses in the health service planning and driving their voice for change.”

Nthabiseng explains that in order for rural nurses to be fulfilled in their jobs, they need accommodation that allows for living with their families, stewardship and accountability by managers. They also need improved support services and access to medicines.

As we reflect on Worker’s Day, it is important to recognize the vital contribution of rural healthcare workers. Their tireless work and dedication to their patients and their communities is an inspiration to us all, and we must do more to support and empower them in their work.