​We need to pay more attention to the context of rural communities, if we wish to make a difference to the healthcare of people in these areas.

This was one of the viewpoints of Prof Ian Couper, Director of the Ukwanda Centre for Rural Health in the Faculty of Faculty of Medicine and Health Sciences (FMHS) at Stellenbosch University (SU), on Tuesday (4 September 2018). He delivered his Inaugural lecture on the topic Place in the sun: Reflections on relationships, rules, and rurality.

Couper said rural communities, especially the former homelands, have been left behind in the struggle for a new society and the health status of people living in these communities is often poor compared to those in urban environments.“

Rural communities are among the most disadvantaged in terms of accessing quality healthcare, with consequent poor health outcomes. Poor rural households in a Mpumalanga district spend up to 60% of their monthly income on repeated healthcare consultations, mainly due to travel and 15% of rural families in a national survey faced crippling expenditure on transport in accessing healthcare, despite free services."

“Rural South Africans have higher rates of HIV/AIDS and TB mortality and increasing rates of mortality due to non-communicable diseases. There is a high burden of stroke in rural communities, which account for about half of stroke deaths in South Africa annually."

“Access to healthcare is a particular challenge for poor, rural, marginalized and disabled people. These issues present a challenge in the development of the National Health Insurance scheme."

Couper said there is a tendency, internationally, for policymakers to develop programmes and policies without considering the consequences in rural areas, which may be quite negative, albeit unintended.

“A well-known example of this in South Africa, was the initial roll-out of antiretroviral therapy for patients with HIV/AIDS. This essentially excluded large numbers of rural patients from receiving treatment."

He argued for the implementation of Rural Impact Assessment for all legislation, policy and government projects, similar to the concept of Environmental Impact Assessment.

Couper said more attention should be paid to rural health and the context of rural communities, especially with regard to the education of healthcare workers and exposing students to these contexts.

He added that context is critical in education and makes a significant difference in training health workers for rural and remote areas.

“Rural students see more patients and perform a greater number of procedures than their urban counterparts, experience comprehensive care and forge strong relationships with health services, and grow in teamwork and understanding of different cultures."

Couper said it is important to consider how the various dimensions of rural communities impact on the health of people living there.

“Our response to rural healthcare needs must include dimensions of health policy, the structure of healthcare services and the nature of health professions education."

He pointed to the establishment of the Ukwanda Centre for Rural Health in 2002 and the Worcester Rural Clinical School, both firsts in South Africa as a way in which rural communities can be served and the healthcare for the people can be improved.

Couper urged SU to continue to take a lead in this, allocating appropriate resources, expanding rural training across all health professional programmes, selecting a cohort of rural students and developing a multi-disciplinary institute to focus on rural health as a broad multisectoral concept.

• Main photo: Pixabay
  
• Photo 1: Prof Ian Couper (middle) with Profs Jimmy Volmink, Dean of FHMS, and Hester Klopper, Vice-Rector: Strategy and Internationalisation, at the event.