Rural Health Care: briefing by Health Systems Trust

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Health

28 October 2002
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Meeting report

HEALTH PORTFOLIO COMMITTEE
29 October 2002
RURAL HEALTH CARE: BRIEFING BY HEALTH SYSTEMS TRUST

Chairperson: Mr. L.V Ngculu (ANC)

Documents Handed Out
Health Systems Trust Bulletin (not available electronically)
Health Systems Trust website

SUMMARY
The Health Systems Trust presented the video "Zamimpilo - Searching for Health" which reports on the findings of a study tour organised by their Equity Gauge Project. The video highlights the challenges to providing rural health care.

The Committee was greatly affected by the lack of infrastructure in rural Eastern Cape and the continued suffering of rural people.

MINUTES
The Chair informed the Committee that the Minister had conveyed her apologies as she could not attend the meeting in order to talk on the Global Fund. He explained that the Minister is in Botswana to attend a regional meeting on the food shortages that are afflicting the southern Africa region.

In introducing the Health Systems Trust (HST) delegation, he reminded members that the Committee's Eastern Cape visit is due and that it would be important to be empowered with relevant information on what is on the ground so that they can be in a position to play their oversight role effectively. He added that this was a continuation of the HST's earlier presentation on equity in health care services.

Health Systems Trust briefing
Ms Antoinette Ntuli noted that the Chair had correctly stated that this input was part of the presentation she had earlier presented to the Committee. They would present video footage that was prepared to report on the findings of a study tour which had involved a wide range of organisations drawn mainly from civil society and professional bodies.

Ms Ntuli explained that the purpose of the video was to draw attention to some of the challenges that the HST encounters especially in far-flung rural outposts. She continued that the video footage is only a case study and that what is revealed in the Eastern Cape is a replica of what is happening elsewhere in disadvantaged areas around the country.

Ms Ntuli noted that the video footage would build on the earlier presentation given to the Committee by heightening understanding and awareness of the important challenges of providing rural health care.

The video footage highlighted the lack of basic infrastructure for the delivery of health services by showing dilapidated health facilities, lack of good roads, the acute problem of inadequate or obsolete hospital equipment and above all a grinding presence of high levels of poverty and under-development. A call was made at the end of the footage for an equitable distribution of health resources in the country.

Discussion
The Chair noted that the relevance of the video footage was crystal clear and that the perennial problem of lack of infrastructure must be revisited once more. He added that it is important to think of the best incentives to offer to personnel working under these difficult conditions in order to motivate them.

Ms Gcwina Radebe (from HST) pointed out that the issue of incentives had been variously discussed at the district level and that the provinces had agreed in principle to pay for visits to the districts to find out what can be done for them. She lamented that the trouble with the Eastern Cape was that there is a worrisome high rate of senior personnel turnover. The resultant lack of continuity affected the implementation of some of these initiatives.

Ms. Mnumzana (ANC) noted that the stark reality of depravation depicted in the video was most touching and that she was greatly taken aback. She observed that the reality presented in the footage was a strong reminder to government and parliamentarians that they are faced with a huge challenge in their efforts to ensure delivery of services to the people. She called on all stakeholders to sit down and reassess the available options.

Dr Rabinowitz (IFP) commended the input on the video footage as a superb job. She regretted the fact that there is a clear contrast between a land of beauty and the suffering found there. She asked whether the difficulty in service delivery in this region could be attributed to the scattered population that reside far and wide from each other.

Ms Radebe pointed out that the real challenge was the expansiveness of the Eastern Cape region and that mobile services had be considered as a viable option.

Dr. Rabinowitz (IFP) suggested that some creative solutions for moving services closer to the people should be considered to alleviate the current suffering that is afflicting the people.

Dr. Jassat (ANC) pointed out that it would appear there was no departmental co-ordination in service delivery as the critical centres that offer essential services - such as a clinic - are not accessible and are without water, electricity and communications lines.

Ms. Radebe acknowledged that co-ordination was indeed a major problem at the district level. She added, however, that district council's were working on ways and means in which to co-ordinate service delivery in rural areas

Ms. Malumise (ANC) wanted to know how conditional grants are utilised in meeting some of these challenges.

Mr. Barron (from HST) said that this was one of the burning issues on the HST's agenda to ensure that its distribution is equitable and targeted.

Ms Baloyi (ANC) admitted that the backlog on service delivery was indeed massive and that it would take time for the government to reach the desired targets. She pointed out that the Committee had paid a visit to the institution in the video and that she was shocked that little had been done since that visit. She submitted that the real problem lies high up in the department and is traceable to a lack of managerial skills. She made a call to members to critically re-examine their oversight role.

Ms Hadebe informed the Committee that the video footage was shot in 2001 and that some improvements have since taken place. She added that renovation work on the institution under review has already started.

Dr. Rabinwitz (IFP) noted that luck of co-ordination at the Local Government level was a serious cause for concern and wanted to know the best way in which to ensure that Local Councils were held accountable.

Ms Hadebe pointed out that there were multiple factors that affected co-ordination and that the best way to go is to introduce appropriate legislative framework upon which proper systems of co-ordination can be built.

The Chair underscored the importance of ensuring that facilities are made available to augment services delivery efforts to the people. He concurred with Ms. Baloyi's sentiments that the Committee should be bold in its oversight role and in particular avoid the temptation to take what the department says at face value.

The Chair pointed out that it was a matter of great interest to the Committee to push for a better health system and this entailed a vigilance that would ensure that people do not find convenient ways to hide their incompetence.

He noted that the President had committed the government to integrated governance and that where there was no delivery, people must be called to account. He continued that the Committee had suggested that a bursary scheme be made available to students from these communities who after completion of their sponsored studies would go back to serve their people.

The Chair then adjourned the meeting after a vote of thanks to the presenters.

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