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Mac Mashiri |
Rural healthcare delivery - particularly for the terminally ill - appears to have somewhat shifted from the formal healthcare system to home-based care practitioners.
Home-based healthcare entails providing health-related assistance in a variety of areas, including medical, educational, psychological and spiritual needs, and assistance for patients and their families.
It is generally acknowledged that gender and access issues have a significant bearing on rural formal and informal healthcare delivery. Physical and financial access to healthcare is in turn impacted negatively by poverty.
The impact of HIV/Aids and other chronic ailments on poverty has to be cushioned considerably by informal 'safety nets' and extended families, with social institutions currently under severe strain.
"Rural men and women have different roles in the provision of health and social care, with women being the majority of caregivers. Women provide more than 80% of paid as well as unpaid home care. Interventions thus need to be gender-sensitive," explains Mac Mashiri, CSIR researcher in rural infrastructure and services.
Most of his research findings are based on a CSIR case study undertaken in four villages in Mpumalanga. Mashiri's research took into account the most cost-effective delivery of the different kinds of basic healthcare services in rural areas - outreach, fixed clinics, referrals and home care. Transport plays a pivotal role in the effective and efficient delivery of healthcare in rural areas. The transport sector affects the availability of both preventative and emergency care. It is, for example, essential for gaining access to patients in sparsely populated rural areas and for distributing drugs and other medical supplies. It also enables the transfer of patients between health facilities and to the different levels of care of health referral systems.
Caregivers face significant challenges on a daily basis, not least of which is transportation. Research looked at aspects of travel including the length of trips, the nature of the route (i.e. infrastructure), the mode of transport, the duration of the trips (minutes), what was encountered along the way, as well as what needs to be done to ensure a better trip.
Time spent waiting for transport due to poor roads and unreliable service, or even walking, adds up to time wasted for rural communities. "We believe non-motorised transport could be part of a potential solution. Transport infrastructure improvements on roads, paths and footbridges, coupled with subsidised services can improve access to healthcare, with robust mobility aids such as bicycles or even bicycle ambulances," says Mashiri. Organisations such as the Bicycle Empowerment Network are already attempting to address emergency transport in Namibia, he notes.
"It is essential to empower rural women to have control over financial resources, such as pensions. Empowerment should also include women's ability to participate in village administration so that they can provide input about the location of clinics or schools."
Another consideration is a communication system to deal effectively with emergencies. While homecare givers currently find cell phone technology too expensive to use, this type of technology holds a lot of promise, particularly with options such as telemedicine.
"To sustain and even improve healthcare service delivery in rural areas, we have to generate gender-sensitive interventions that relieve informal healthcare practitioners' obstacles - which are largely access-oriented - when providing services," concludes Mashiri.
Read the paper: Strengthening informal healthcare delivery: gender perspectives
Enquiries: CSIR Communication
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