oa South African Health Review - The state of the right to health in rural South Africa
This chapter explores successes and constraints in terms of the right to access health care in rural areas. We present a case study that provides insight into daily challenges patients from poor rural communities face when accessing health care. While assessment of health and health care in rural areas is challenged by lack of a standardised definition of rurality, marked inequities are noted between health outcomes in more urbanised and rural provinces. Reasons include inadequate efforts to address social determinants of disease such as the levels of deprivation in rural areas. Furthermore, rural communities experience significant barriers to accessing health care, including financial barriers, inadequate transport, and distance to the nearest facility as well as limited services available. Understaffing and the poor state of infrastructure in many rural facilities further entrench existing inequities.
The central role of management in providing adequate care within the healthcare system is emphasized. There are several examples of good practices in rural areas. With good leadership and innovation, access to health care is possible in rural areas - even with limited resources. The rural healthcare context needs to be taken into account during design and implementation of health policies and strategies. A number of questions must be taken into consideration to 'rural-proof' key strategies currently being introduced, such as National Health Insurance and the new Human Resources for Health Plan. From policy development to resource allocation and implementation, requirements for rural populations need to be taken into account to ensure equitable outcomes.
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