Discrimination towards rural communities in health service delivery persists. This is one of the key findings from the Annual CSO Allocation Update ‘ACUTE’, a report released by the Rural Health Advocacy Project (RHAP). The goal of the report is to monitor and critically evaluate developments with regards to the yearly community service allocations in the South African public health system.
Historically, the community service process has been marred with controversy. The original vision for community service was to address healthcare inequities in rural and underserved areas through the placement of healthcare workers in poorly capacitated health facilities. This vision has yet to materialise. RHAP found large numbers of community service officers concentrated in urban areas. This is not only contrary to the Community Service and Internship Placement Guideline 2017-2018 and the National Department of Health Strategy for Human Resources for Health South Africa, Strategic Priority 8 but is indicative of a system that does not prioritize the needs of the most vulnerable individuals in our society.
Key findings are that the Eastern Cape and North West experienced overall increases in most cadres reviewed. Both provinces have also made attempts to direct community service officers to districts with higher levels of deprivation. However, this initial picture is misleading. Upon closer examination, serious issues of mal-distribution exist. Urban facilities still received the lion share of community service officers for medical officers and audiologists in the Eastern Cape and medical officers, occupational therapists and audiologists in the North West.
In the North West, double the number of medical officers has been placed in urban areas compared to rural areas. In the Eastern Cape, there has been evidence of regression of services. Hospitals which relied solely on community service officers for the provision of certain services such as occupational therapy and physiotherapy, did not receive any community service therapists this year. An occupational therapist herself, RHAP’s Karessa Govender reports, ‘This happened this year to one of the hospitals in the OR Tambo district and is a harsh blow to children and adults living with disabilities in a district ranked as having the highest level of deprivation in the Eastern Cape.’
The allocation process must be transparent and data pertaining to the distribution of community service officers across all provinces.
RHAP urges strict compliance to the NDoH’s directive to place community service officers in rural and underserved areas in realising the right of equitable healthcare to all South African communities. Provincial departments must open sufficient posts and allocation of community service officers must be done based on need.
RHAP’s programme manager on health systems and policy, Russell Rensburg urges that ‘resource prioritization must occur in a manner that favours rural and underserved areas.’ Apart from extenuating circumstances, which the Internship and Community Service Placement Guideline 2017-2018 covers quite liberally, community service officers must not have the privilege to decide where they will be placed but must-see community service as a duty to all South Africans.
Rural Health Advocacy Project material