Rural Health Initiative

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Discovery Health

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NATIONAL STRATEGIES

National Network

The AHP is part of an active National Network of family medicine and primary care which currently includes:

  • SAAFP (SA Academy of Family Practice/Primary Care)
  • FaMEC (Family Medicine Education Consortium, representing the Departments of Family Medicine and Rural Health Units at Medical Schools)
  • RuDASA (Rural Doctors Association of SA)
  • HPCA (Hospice and Palliative Care Association)
  • CMSA (Colleges of Medicine of SA)

These organisations represent family practitioners in the public, private, urban and rural sectors. This network is focused towards training family doctors and other primary care workers for the best comprehensive care for people and families in South Africa.

Local Networks

The AHP projects are operational in �sites� based usually in a rural district including the district hospital and up to 30 surrounding clinics. Typically this district will serve between 200 000 and 500 000 people. A medical officer or other health care worker usually facilitates the project locally. In order to maximise impact and utilisation of resources, networks are formed with local area NGO�s, government department officials (Health, Social welfare, Education), private health care practitioners, community leaders and forums, community healthcare workers, volunteer groups, and disease support groups.

Rural Practitioner Support Network

Rural healthcare workers face unique challenges which, if addressed, can make a major difference to themselves and the care they can give. These challenges include:

  • Isolation
  • Massive workloads
  • Sense of being professionally left behind
  • Lack of recognition
  • Inadequate facilities and resources
  • Tiredness and hopelessness

'Burnout' is often the final outcome for rural practitioners

AHP responds to these challenges through support and the creation of a practitioner network. RuDASA (Rural Doctors Association of SA) is an important partner in this and the annual RuDASA Congress, convened at a rural site each year is supported by AHP. At this event the AHP convenes its annual meeting with facilitators and associates. AHP local facilitators� network with each other, discuss rural health issues and learn new skills. Private practitioners in rural areas are part of this network.

Communication Network

A National communications infrastructure underpins and facilitates the AHP support activities, reduces isolation and gives easy access to up-to-date and relevant information. The infrastructure includes e-mail, internet, fax and cell phone linkage between sites and regional specialists, universities, electronic libraries and government agencies.

Education and Training

Part of the isolation felt by rural practitioners is due to a sense that professionally and educationally they are out of touch with latest techniques and developments in their field. Moreover, the health of communities is not only related to diagnosis and management of disease, but to environmental and social factors such as sanitation, clean water, shelter and nutrition � especially in rural areas. Medical school training does not always equip the health care worker to deal with the complex problems facing rural communities. If he or she is to play a meaningful role as a member of a multidisciplinary team in rural areas, then additional, ongoing training and orientation is critical.

The basis of training is decentralised educational programmes including equipment and materials, formal on-site CPD programmes, distance learning, short course attendance, libraries, visiting specialists and other resource persons. Training also includes the development of appropriate care and community outreach programmes as part of a multi disciplinary team.

Extensive education and training is also conducted for community health workers, volunteers, support group facilitators. They are trained in basic first aid, counselling, and palliative care. Debriefing workshops and meetings are held regularly.

The community is educated via outreach workshops on subjects ranging from HIV/AIDS, men�s health, arthritis, family violence, mental health and nutrition. Attendance at these workshops is generally excellent.

Recruitment

The out-numbered team

In a soccer game, having the best players is of no advantage if the team is incomplete. Rural health teams are constantly playing soccer with a six-member team. They face even more difficult challenges than urban practitioners who work in an 11-member team.
 Recruitment and retention of healthcare workers, particularly doctors is a major problem in the rural areas all over the world. Many of our rural district hospitals are operating with two or three doctors when the service requires 10-15 doctors. Compulsory community service is meant to address the shortage but the programme suffers due to the lack of supervision for these inexperienced professionals. The urgent need is for creative and sustainable ways to recruit and retain experienced doctors and other staff.

The AHP is establishing a recruitment agency project in collaboration with recruitment professionals and existing local and international networks.

Community Service Support

Community Service doctors arrive at their rural posts inexperienced and often unprepared for the situation in which they find themselves. Often they require levels of mentorship and supervision which it is not possible to provide with the existing staff shortages. It is, however, very important to make their rural experience as positive and fulfilling as possible if we hope to encourage them to choose to stay in rural areas or choose rural health as a career.

The AHP supports orientation programmes focussed around audit and identification of skills gaps, and how these can be addressed. This programme helps young doctors to use their year as a learning opportunity towards meeting their personal goals whilst contributing to the collective goals of the rural health team.

Advocacy and a Voice for Rural Issues

For too long our rural doctors and health workers have been the �unsung heroes� of the health system. AHP provides a voice for our rural heroes and brings to light the issues and difficulties they deal with. This is done through sponsoring a rural section in SA Family Practice, the official family practice journal in South Africa and networking with RuDASA in advocacy for rural health issues. Advocacy for rural communities is planned with other NGO�s

Site Project Management / Fundraising

The AHP provides a much needed resource for the sites in assisting the facilitators with project management, administration, reporting and fundraising. This function makes it possible for already overworked facilitators to implement their own solutions in local sites and local networks.

Small projects nurturing

It is important for the AHP to nurture emerging small projects, which initially do not have the capacity to fundraise, plan and administer properly. The challenges of fundraising and project management are difficult and complex in SA today and many of these projects in rural areas will not survive without this type of support. With support many of them grow and become self reliant in terms of administration and fundraising.


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