Open letter in support of Positive Practice Environments

The Rural Doctors Association of Southern Africa (RuDASA) and the Rural Health Advocacy Project (RHAP) commend DENOSA and SAMA for initiating the Positive Practice Environment Campaign.

Rural health care workers are often faced with minimal resources to provide a health care service to communities in the poorest districts of the country, which are faced with high burdens of disease. RHAP receives regular reports from RuDASA members and other health care workers regarding the dismal working conditions and the right to quality health care denied to the communities they serve.We know for a fact that areas with the greatest need receive the least resources. This is not only in terms of health care workers, but also in terms of financial support. In a North West hospital in deeply rural Ganyesa, it took more than three years for a generator to be replaced and in the meantime an infant died an entirely avoidable death during childbirth. In that same hospital, as elsewhere in North West, doctors in severely understaffed facilities are expected to be on standby for overtime every second weekend, yet do not get compensated. A recipe for a high turn-over. In the Eastern Cape, Komga Clinic went from 6 to 3 nurses and entirely halted its mobile outreach clinic service. The issue has been addressed repeatedly with the National and Provincial Department of Health yet no response nor has relief been forthcoming. Rehab professionals have gone without correct payment for months, and have not been able to procure any equipment since 2009.



In Mpumalanga, Tintswalo Hospital, an exodus of committed doctors is taking place due to the hostile work environment. These are just some examples. Rural health continues to lose scarce resources to other areas, private sector and overseas opportunities. To realise the right to health for all, we need to make the provision of health care for under-served populations an attractive career, through Positive Practice Environments! While safeguarding ethical conduct by health care workers, we also need to provide an ethically sound work environment.

We urgently need staffing norms for nurses, doctors, rehabilitation professionals and so on, to share the scarce human resources for health equitably. A health care user's place of residence, or wealth, should not determine his or her access to sufficient and caring health care workers! We also call for the implementation of the chapter on rural health in the HRH Strategy: 2013-2030, which amongst others commits to:

  • Provide personal and professional support to health professionals working in rural areas, specifically:
  • Outreach from referral hospitals
  • Improved living conditions including accommodation (where that is not easily available locally), a safe and supportive working environment, opportunities for career development and CPD programmes
  • Establish a system to support continuing professional development programmes in each rural district
  • Develop, use and evaluate financial incentives to attract rural health care professionals

We pledge our support and wish to join hands in making the Positive Practice Environment campaign a success.

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