“Rural-Proofing” South Africa’s Laws

On the day we’ve announced the winner of the 2012 ONE Africa Award, we also look at our final runner-up, Rural Health Advocacy Project (RHAP). With two-and-a-half staff members RHAP has made a name for itself in South African policy and medical circles in less than two years.

Seeking an avenue for their voices to be heard, RuDASA (Rural Doctors Association of South Africa) and other medical associations devoted to rural healthcare joined together with leading NGOs and academic institutions to create the Rural Health Advocacy Project (RHAP) in 2009. Over the years, it had become increasingly apparent to these healthcare professionals that South Africa outright ignored or would not address healthcare specifically in rural settings. So they took it upon themselves to develop an initiative that would not only create and propose innovative policies for the government to consider implementing, but also begin to address the myriad problems that these practitioners and their patients face on a daily basis.

Since then, RHAP has been at the forefront of taking the data crunched by the Wits Centre for Rural Health on health outcomes and developing policies shaped by the NGO Section27’s vaunted legal tactics to South Africa’s Ministry of Health and other government bodies.

In its relatively short existence, it has become the leading voice for rural health policy that the government seeks out and to which it pays attention. RHAP also has the support and buy-in of the disparate healthcare practitioner’s organizations, including the rural doctors association, nurses, pharmacists, physical therapists and other healthcare workers’ groups.

RHAP has pioneered an approach by which it is able to score the South African government’s proposed policies on their ability to be implemented in a rural context. RHAP has also been adept at proposing solutions to South Africa’s crisis in adequately staffing its rural hospitalities and facilities, even proposing a revision to the government’s medical service officer personnel policy, which has already been implemented in Kwazulu-Natal province after deliberately building media attention on the issue.

RHAP has also become the de facto ombudsman and quasi-inspector general for rural health workers. Working for government-managed health facilities in rural settings often means that these workers feel pressure to not speak out on problems, whether those problems be drug shortages, poor management practices or missing funds. These workers can now raise their concerns with RHAP, who in turn then takes them directly to the provincial health ministry, the media or the national health ministry in order to find solutions that benefit the patients and rural workers.

RHAP’s core innovation is its “rural-proofing” assessment to which it has subjected South African government policy to score and then recommend changes. It developed the rural-proofing assessment by consulting with the rural health workers closely and also by studying health policies and outcomes from other countries. The credibility that this “rural-proofing” gives RHAP has allowed it to also take up thorny issues with the government that are brought to it by government health workers. Due to the political pressures that district and provincial health authorities feel, they tend to ignore or do not want to act on legitimate complaints and issues that could undermine their work. By involving RHAP, health workers are able to circumvent these politics and reduce any negative repercussions they could face by speaking out.

One other innovation that became readily apparent is that RHAP is not creating its own advocacy juggernaut. RHAP has been incredibly smart in zeroing in on rural health needs, developing its credibility on those, and then piggybacking on the health advocacy work of other community organisations and institutions to infuse a rural perspective that would ordinarily be lacking. In these resource-constrained times for South African’s NGO sector, this has proven hugely beneficial and has resulted in a very lean advocacy machine.

RHAP’s efforts directly address MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6 (fight HIV, malaria and other diseases). They envision a society where rural citizens are just as healthy as their fellow citizens in urban and suburban areas. We at ONE can’t wait to see that day.


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