Editorial
If the principal aim of the public health sector is to improve the health of South Africans, then our focus must be the health of rural people. In other words, the reform efforts and upheavals which have left the South African health system creaking and groaning in protest must continue until it is turned on its head - and is explicitly biased towards rural health.
Rural people bear the greatest burden of disease, mainly because rural people bear the greatest burden of poverty. But paradoxically, urban dwellers are better served by both public and private health care resources. Simply put, rural people are generally poorer and less healthy -and have less access to health care. Unravelling this distortion requires twin strategies:
First, health care must be part of an integrated rural development strategy within each province, region and district. Much of the illness stems from conditions of poverty.
And second, rural areas need to be the targets of an accelerated social investment programme - a kind of affirmative action for rural people.
Let me illustrate by example: Increasing socio-economic upliftment is likely for those people living in the Nelspruit-Maputo Development Corridor. While acknowledging the particular health problems that such development may bring, an injection of revenue into the area will inevitably reduce the prevalence of poverty-related diseases - and enhance both the health of its people and their ability to contribute financially to their own health care. On the other hand, there are many deep rural areas which are not explicitly targeted for programmes of economic development. People living in these areas will continue to be at greatest risk for poverty-related illness and death, and will remain vulnerable to the economic and social costs associated with ill-health.
So, a uniform distribution of health care resources across the country is necessary, but may not be adequate to overcome the inequalities in health status and access to health care . We now need to look intently at the specific health care needs of rural people. This issue of HST Update begins to do that. The starting point is to understand the health and health care needs of rural people (which means assessing the needs of the population, not the services!).
- The next step is to describe the characteristics and parameters of rural health care: What should a well-functioning rural health service look like?
- Next, we need to define the additional investment in health care which rural areas consequently require.
- Finally, we need to decide how that additional investment will be obtained. For example, a package of carefully designed incentives may attract more health workers to rural areas.
But even as we try to effect this upheaval and realignment of the priorities of the South African health system, we need to recognise that there is an existing health care infrastructure in rural areas which is not used effectively. In many instances, the main problem is the poor functioning of primary level care, rather than an absolute shortage of buildings or personnel. Improving the efficiency and effectiveness of existing services is the first step to meeting the health needs of rural people. |
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