Factors influencing specialist outreach and support services to rural populations in the Eden and Central Karoo districts of the Western Cape : a Delphi study
Thesis (MFamMed)--Stellenbosch University, 2012.
INTRODUCTION: Access to health care, like childhood survival, often depends on where one lives. The infant mortality rate in rural South Africa (SA) is 52.6 per 1000 births, compared to 32.6 per 1000 births in urban areas. Furthermore, three of the four districts in SA with the highest HIV prevalence are rural. These being two commonly used health indicators, it is clear that rural populations have significantly poorer health outcomes than their urban counterparts. About half the world’s population live outside major urban centres, where health services and specialist medical services are concentrated. Rural SA are home to 43.6% of the population, but are served by only 12% of doctors and 19% of nurses. Of the 1200 medical students graduating in the country annually, only about 35 work in rural areas in the long term. There are 30 generalists and 30 specialists/100 000 people in urban areas, compared to an average of 13 generalists and two specialists/100 000 people in rural areas. The question arises whether the poorer access to particularly specialist services is a contributing factor towards poorer outcomes. Specialist outreach to rural communities is one way of improving access to care. In the Eden and Central-Karoo districts of the Western Cape of SA there are one level 2 (regional) hospital and ten level 1 (district) hospitals. All clinical disciplines reach out, with varying frequencies. On average, the four main district hospitals receive 17 specialist outreach visits per month; while the smaller district hospitals receive three specialist visits per month (Appendix 1). A typical outreach visit includes a problem ward round, outpatient session, theatre list for some surgical disciplines and formal/informal educational sessions. In principle, stakeholders agree that specialist outreach and support (O&S) to rural populations is necessary, as it improves access to specialized health care services. In practise however, there are factors that influence whether or not O&S reaches its goals. This in turn affects the sustainability of O&S projects. Understanding these factors would aid recommendations for a suitable model for O&S.