Africa, Civil Society, Development & Aid, Headlines, Health

SOUTH AFRICA: Communities Draft Health Map to Push for Better Services

Miriam Mannak

CAPE TOWN, Apr 21 2009 (IPS) - The quality of South African public health services cannot improve if community-based organisations (CBOs) are not given a greater role in shaping, developing and implementing national and provincial health policies.

This was one of the key demands CBOs made at a health summit at the University of Cape Town (UCT) on Apr. 17 and 18.

“We can only improve the situation in our health care system if we work together,” said Damaris Fritz, chairperson of the Cape Metro Health Forum, a network of CBOs working within Cape Town’s health sector and the gathering’s main organiser.

“People who work at grassroots level know best what communities need, yet government often tends to make decisions without consulting them,” she added. “This needs to change.”

During the gathering – which was attended by 300 representatives of civil society organisations – a map of various public health challenges was drawn up. The document will be handed over to the South African health authorities after the country’s presidential elections on Apr. 22.

CBOs want government to use the health map to improve the public health sector and service delivery.

This was not a request, but a demand, said Fritz: “We, civil society, will hold government accountable to use this document. We will chase them, picket and protest if necessary.”

One of the challenges identified as part of the health map were the long patient queues at clinics and other medical facilities.

“Everywhere in South Africa, people are forced to wait for hours before they receive medical attention,” said Fredalyne Booysen, Western Cape province coordinator of national activist group Treatment Action Campaign. “Often, patients are told to come back the next day.”

Long queues

Public health facilities have long waiting times because they do not have enough health care workers to attend to all their patients immediately. In 2007, the national health department admitted that South Africa had a shortage of 42,000 nurses. The Democratic Nurses Organisation of South Africa says this shortage led to a nurse-to-patient ratio of 1:50 in the public sector, compared to a ratio of 1:3 in private hospitals.

“It is dreadful to see how long people have to wait,” said Lesley London, associate director of UCT’s occupational and environmental health research unit.

“According to the South African constitution, everyone has the right to access to health care. This is not [granted] if a person has to wait for four hours to see a heath care worker,” she explained.

CBOs also request the health department to drastically improve the quality of services in public hospitals. “The situation in our public tertiary hospitals, where patients in need of specialist care are referred to, is horrific. It’s a disaster,” Fritz told IPS.

“I once came across a man who had been lying on a stretcher for two days because there were no beds available. This situation needs to change because the overall majority of our population depends on these facilities,” she said.

According to Oxfam International, a global network of non-governmental organisations working to fight poverty and injustice, about 85 percent of South Africans rely on the public health system. Addressing the shortage of public hospitals should therefore be a priority, explained Booysen.

Taking Khayelitsha, a township near Cape Town, as an example, she said: “There is one hospital in Khayelitsha, an area with approximately 600,000 people. Many patients are therefore referred to GF Jooste hospital in Manenberg, approximately 25 kilometres away.”

“This particular hospital gets a lot of referrals from the township of Mitchell’s Plain,” she added. “[As a result] GF Jooste Hospital is ovecrowded, which automatically has an impact on service delivery.”

Lack of facilities

In October 2008, the provincial Department of Transport and Public Works announced it will build a new hospital in each of the two townships, Khayelitsha and Mitchell’s Plain. CBOs said they will monitor progress on the plan to ensure government keeps its promise.

None of the barriers to accessing public health care are new problems. “We have been raising these issues with the health department year after year. Now it’s time for a plan of action,” said Fritz.

By drawing up a health map, CBOs have outlined a timeframe for government to implement health programmes. “We will give government the current financial year, which runs from 1 April until 31 March next year, to make improvements. In six months from now, we will have a [first] look at the progress made. We will be their watchdogs,” declared Fritz.

Marius Fransman, Western Cape provincial health minister, agrees that the shortfalls in health care as drawn up in the health map need to be addressed. He also acknowledged the importance of communities’ and civil society’s consultation in local health policy making. “The challenges are indeed huge,” he admitted.

“We need more doctors, for instance,” said Fransman, adding that “service delivery and the circumstances health workers operate under need to be improved, too.”

However, he also pointed out progress the health department made since the end of apartheid in 1994: “We have done a lot over the past 15 years. We built more clinics and new hospitals, we improved the salaries of nurses, we replaced old ambulances and improved roll out of antiretrovirals to people living with HIV.”

“It is not that we have not done nothing, yet we do need to do more,” he said.