The delivery of health care to the farm community in Bothaville

English: The master plan according to which the ANC government envisages to achieve transformation in the South African health care system, is the implementation of a National Health System (NHS), based on a District Health System (OHS) model, with the primary health care (PHC) policy as its foundation. In the process of implementing the OHS, an important challenge has emerged, that is, to translate provincial policy and administrative reorganisation into real improvements in health care delivery at local level. In order to address this challenge at grassroots level, a pilot programme of "bottomup" support to a selected number of health districts in the country was introduced, i.e. the Initiative for Sub-district Support (ISDS). One of the pilot sites selected for this support programme, is the Bothaville sub-district, which is the geographical location of this study. The study was primarily conducted to supply health care managers and governors concerned with the Bothaville sub-district with needed information on the conditions of the farm community and the delivery of health care. This information should enable them to improve the delivery of PHC and facilitate the implementation of the OHS. This is done by providing a broad explanation of development of the South African health care system with particular focus on policy and organisation; general background information on the Bothaville sub-district; a profile of mobile clinic services; an evaluation of the current system of mobile clinic health care; an explanation of the differences between the previous and the new system (implemented approximately five months prior to thë 'survey); baseline information on the rural community and thëir health status; and an assessment of the perceptions of health care providers concerning aspects of health care , delivery. The overall design of the study is exploratory and descriptive. It consists of a literature study and empirical data. The literature study was conducted to contextualise the Bothaville subdistrict within the ISOS and the broader South African health care context. The empirical study consisted of a combination of qualitative and quantitative methods of data gathering, i.e. a survey among a sample of rural dwellers and interviews conducted among farm school teachers, the professional nurses working on the mobile clinics, and general health care personnel in Bothaville. The main findings of the empirical part of the study include: more than half of the rural dwellers interviewed had never made use of the mobile clinics; information is inadequately disseminated to rural clients; transportation difficulties to mobile visiting points in the new system is a serious constraint; there is a lack of community participation in rural health matters; the promotive and preventative functions of PHC are lacking; a lack of communication and cooperation exist among the different public health services; conflict among health care personnel is rife; integration of services would solve numerous problems; and users of the mobile clinic services are generally satisfied with all aspects of mobile clinic services and appreciate the services. The main recommendations comprise: additional modes of transport for rural dwellers need to be provided; a more effective information dissemination strategy to rural clients is needed; the rural community need to be actively involved in health matters; more emphasis needs to be placed on the preventative and promotive dimensions of PHC; communication and cooperation among public health care workers in the area need improvement; and all the public health care services need to be integrated under one authority. In conclusion, the researcher is confident that the results of the study would supply health workers, managers and governors with ample information to optimise health care rendered to rural dwellers in the area, as well as to assist with the implementation of the DHS.