A new report by the Rural Health Advocacy Project (RHAP) has highlighted the need for the scaling up of interventions within South Africa’s health system post-COVID-19. The pandemic had a severe impact on health services, with the report revealing considerably lower testing for HIV and TB,  negative effects on other essential services, as well as major stockouts of vital medication during the lockdown.

Advance the rights of the rural poor

Speaking at the launch of the report last week, RHAP’s director, Dr Russell Rensburg, said to fix the health system ‘we have to spend more of our time with the poorest of the poor.’

“As we begin to rebuild our health system, we have an important opportunity to strengthen primary care with a particular focus on diagnostic availability, more proactive vaccine roll-outs, and improved governance that puts the community most affected at the centre of the response rather than as subjects of a response,” said Rensburg.

Dr Lungile Hobe, from the Rural Doctors Association, said it’s important to incorporate a community oriented primary care model, where communities are consulted about their needs, and local culture and experience is  integrated. 

She said that more than 80% of people in rural areas first consult with a traditional healer  before seeing a medical doctor. “Patients have lost trust in our health systems.  They feel that they can’t even tell us when they’ve consulted with a healer”, she said. 

She said that there is still a huge disconnect between what communities need, what communities understand and what  healthcare workers think communities need or understand. 

Improving government systems improves health

Government structures, operations, policies, and proper distribution of funding are crucial parts of ensuring that the health system operates and provides services. 

Dr Yogan Pillay, the former Deputy Director-General at the National Department of Health said that it is important to engage with this to ensure that priority setting is at a local level . This will ensure that community participation takes place, taking local priorities, realities and contexts into account. 

“Governance is critical to achieving universal health coverage, as well as improving quality, efficiency, effectiveness, and responsiveness of health systems. Governance can help scientists and the public health system within them function effectively,” said Pillay.

It’s crucial to make services more responsive to communities and invitinvite to participate in co-producing their healthy surroundings. Pillay explained that poor governance, on the other hand, can lead to corruption resulting in losses of public funds or challenges to health services, access and quality. 

“A resilient health system will reduce mortality and morbidity and enable equity and public trust. But it depends on how that health system is designed. The NHI focuses dominantly on the financing and significantly less on the transformation of the service delivery,” said Pillay.

A healthy future depends on a healthy planet

Pillay also emphasised the importance of having a healthy health system to deal with future pandemics. 

Pillay said that the National Health Insurance (NHI) plan doesn’t capture a climate-friendly vision and to include climate change and its impact on health, different aspects have to be reviewed. 

“We need to look at how we can reduce the carbon footprint in the health sector.  Secondly, thinking about solar energy in a much more serious way like in our health facilities,” said Pillay.

“Thirdly, we must decrease carbon emissions from the production and transportation of medical currents. We need to be able to, in our procurement system, add a component that incentivises the private sector. For example, those manufacturing devices or vaccines, to move towards solar efficient and energy efficient plants.”

Encouraging manufacturers in the private sector to use more solar-efficient techniques can contribute positively to greening universal health coverage. 


– Health-e News