Proactive Healthcare Governance: A Key to Achieving Universal Health Coverage in South Africa

Primary Healthcare (PHC) is the driving force behind efforts to improve access to quality healthcare for all South Africans. This critical tool aims to bridge the healthcare gap across the country and ensure that people receive the care they need, regardless of their location. The Alma Ata principles underpin this approach, making PHC an integral part of the ongoing fight against the challenges that come with a growing population.

The recent Primary Healthcare (PHC) Conference, held in November, put the spotlight on the essential role that PHC plays in ensuring universal access to healthcare in South Africa. The conference didn’t just discuss the issue; it emphasized how PHC is crucial to achieving Universal Health Coverage (UHC).

The Rural Health Advocacy Project was present at the conference, with a strong determination to make a meaningful contribution to the discussions. The organisation shares the vision of a health system that provides equitable, quality health care services to rural communities, and recognizes the importance of PHC in achieving this goal.

 ‘Towards Universal Health Coverage, Strengthening Primary Health Care: A whole of Government, whole of Society approach’ was the theme this year, which emphasises the significant role of strong primary health care for South Africa’s pursuit of Universal Health Coverage.

Universal Health Coverage is a concept that advocates for all individuals and communities to receive the health services they need without suffering financial hardship. It is a global health goal that seeks to ensure that everyone has access to essential health services. Linking UHC to rural health is crucial, as rural populations often face unique challenges in accessing healthcare. 

In keeping with this, the Rural Health Advocacy Project (RHAP) hosted a panel session on the first day of the conference with a special focus on Rural Health Equity. The panel included members of the Rural Health Alliance: Dr Lungile Hobe-Nxumalo (medical manager at Mseleni Hospital and RuDASA[1] chair), Ms Maryke Bezuidenhout (Physiotherapist at Manguzi Hopsital  and cofounder of RuReSA[2]) and Dr Jenny Nash (specialist family physician for the Amathole district clinical specialist team or DCST); and the session was facilitated by RHAP’s outreach and training coordinator, Ms Zimbini Madikiza. 

Bezuidenhout highlighted the specific and unique barriers for people living with disabilities in rural areas. Issues of access and high levels of catastrophic health expenditure with centralised care were highlighted in general in the panel session. These are improved with decentralised care, but there is a need for community outreach services to increase patients’ access to healthcare services, especially for those with disability.

Dr Hobe-Nxumalo underscored the crucial role of E-health in enhancing record-keeping, facilitating the tracking of patients migrating between healthcare facilities, and ensuring the continuity of care. The implementation of E-health is anticipated to not only contribute to budgetary savings but also to enhance overall healthcare outcomes. By enabling timely interventions, E-health has the potential to mitigate morbidity and mortality rates, consequently reducing the likelihood of litigation.

Dr Nash explained that there is hope for health services in this economic climate, however, individuals are urged to embrace a paradigm shift, think innovatively in their areas and share best practices. She continued to say that it is also important to become advocates and encourage communities to advocate for their own needs as well.

In closing the panel session, Dr Samantha Maughan (RHAP programme manager), emphasised the importance of a proactive approach to healthcare governance, rather than a reactive one. Many of the points raised in the panel discussion were in-keeping with this proactive approach, which in practice means that governance structures look ahead and anticipate what is needed to provide quality healthcare for all citizens, thus creating resilience in health programmes and ensuring that essential health services are maintained even in a health crisis. 

The Rural Health Advocacy Project had another platform where junior researcher, Miss Celene Coleman presented the latest report from RHAP entitled Road to UHC: Progress in South Africa’s Journey to Universal Health Coverage.  This included a series of fact sheets on diabetes, TB, contraceptives, childhood immunisations, and service capacity and access. The presentation aligned with the theme of the conference, and acknowledged that achieving UHC in our country is not a straight-road. Rural areas in particular have significantly less access to healthcare due barriers in physical access, level of affordability and acceptability of services. The presentation highlighted 3 main points: diabetes needs prioritisation, increased policy implementation measures are needed for TB and social barriers are a major issue to contraceptive usage. To assist in achieving UHC, particularly in rural areas, RHAP recommends standardisation of data reporting for programme outcomes, post-COVID-19 research and a better understanding of the impact of social factors on health in rural areas.

We hope that the South African Primary Healthcare Conference wasn’t just a gathering; but a big step towards improving healthcare delivery and access in South Africa. The ideas and plans shared during these two days will play a big part in making sure everyone gets the healthcare they need. It’s all about building a strong and fair healthcare system in the country.


[1] RuDASA – Rural Doctors Association of South Africa

[2] RuReSA – Rural Rehab South Africa