Strengthening the decentralised healthcare system in rural South Africa through improved service delivery: testing mobility, information and communication technology intervention options

Abstract

A decentralised healthcare system (DHS) is a system developed to address issues of power, management and functions of local spheres of government and to address the healthcare backlogs created by the previous apartheid system. Prior to the system, healthcare delivery was centred on one sphere of government which held most power, and thus invested most healthcare services in the private sector creating inequalities between rural and metropolitan areas. To speed up and equate healthcare delivery for all, healthcare was then decentralised by shifting power from central offices to peripheral offices such as districts and municipalities. One of the strategies used by the government is to encourage healthcare service providers (private and/or public) to employ their own human resources in providing healthcare services that ultimately counteract these inequalities. Presently, what could be considered the last level of decentralised healthcare is mostly represented by home and community-based healthcare organisations. As part of the DHS, these organisations provide healthcare services to communities and patients that are released from or referred by clinics and hospitals to continue with medication and healing at home. Yet poor transport remains a challenge faced by most of these organisations, therefore exacerbating access difficulties. As a result, access to healthcare facilities (such as hospitals and clinics), access to patients when providing services, and access to financial support (due to lack of information) become most difficult. In addition, access to information and communication technologies (ICT) and systems is cross-cutting through all challenges. As part of the overarching framework, this paper seeks to provide a platform on which ICT systems could be understood as viable solutions and used to reduce transport and communication burdens of healthcare workers within the ambit of the DHS system.