Download Chapter ten of Health and Democracy – the rights and duties of health care workers

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Download the ILO Manual on Right to Strike here.

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Download the Grievance rules for the public service here.

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Tonight Mark Heywood from SECTION27 speaks at a public WISER seminar on the missing link in realising the right to health: The Health Care Worker. RHAP and its rural partners have demonstrated in various policy submissions (on NHI, PHC) and publications that priority interventions will not achieve intended outcomes of equity and improved health without a central focus on HR4RH. As Heywood calls for in his paper, the National HRH Strategy needs to be funded. In its entirety. Including NDoH HRH Plan – Chapter 8 – Rural Health. Read Heywood’s excellent piece and comment on-line on the Wiser website.

The post Wiser Seminar 1 September 2014: The Broken Thread – Primary Health Care, Social Justice and the Dignity of the Health Worker appeared first on RHAP.

Declaration Rural Health Partners Network – Rural Health – Key to a Healthy Nation

On the 19^th and 20^th of June 2014, the following rural health organisations came together at the Sunnyside Hotel in Parktown, Johannesburg, to discuss principles and actions aimed at strengthening the existing network to achieve maximum impact for rural health:

• Rural Doctors Association of Southern Africa
• Rural Rehab South Africa
• Professional Association of Clinical Associates South Africa
• Rural Health Advocacy Project
• Wits Rural Health Club (health science students)
• UKZN Rural Club (health science students)
• Wits Centre for Rural Health
• UKZN Centre for Rural Health
• UCT: Primary Health Care Directorate
• Africa Health Placements
• The Ukwanda Centre for Rural Health (Ukwnda was unable to attend the meeting but expressed its commitment to the network)

At this historical meeting the following emerged:

Acknowledging the shared mandate across the organizations to advance access to rural health care, and the existing informal collaboration over many years, the network partners committed to strengthening their collaboration to progressively realize the right to rural health care. This commitment is informed by the following uniting principles:

–        A passion for rural health care;

–        A commitment to improving access to health care for rural communities;

–        A belief in equitable health care for all;

–        An unwavering belief in Primary Health Care as the underpinning philosophy of our individual and joint work as network partners, with functional referral systems to higher levels of care

–        A patient-centred ethos in all our work;

–        The need for a policy and systemic focus in advocating for lasting improvements in access to health care

These unifying foundational elements of the Rural Health Partners Network, are supported by the following shared goals:

–        Improved health care for rural patients;

–        Sufficient human resources for rural health care;

–        Accessibility to – and equitable distribution of – rural health care services;

–        Making rural health care attractive by motivating for retention of health care professionals – and promoting improvement of their working conditions;

–        Addressing the difficulties faced by those practitioners working in the rural health care system

These goals can only be achieved by multi-disciplinary health care teams that work together as equal members in a team. Different roles were also identified, with the Centres for Rural Health and UCT: PHC Directorate leading on research and transformation of health education, the membership-based HCP association growing local membership and providing an on-going voice from the rural coalface, students to exercise their legitimate voice on the changes they want to see in health training and health care delivery, and RHAP playing an overall coordinating role in the network.

The Rural Health Partners Network is an aligned network, as opposed to an informal network or formal Alliance. Network partners agreed to the following:

–        Partners will adhere to the key principles stated in this declaration;

–        Partners will work strategically together without necessarily forming a formal alliance with a memorandum of incorporation

–        Partners will maintain their individual identity while being part of the network;

–        The networks aims to establish strong relations with rural patient representative organisations and other rural-health aligned organisations, which may join the network or become friends of the network (see below);

–        Partners will identify themselves as members of the network and there will be regular communication across the network;

–        Partners will participate in an annual network meeting where joint goals and activities are planned;

–        Partners will endeavor to strengthen the network by sharing, consulting and supporting network efforts and will show loyalty and support for each other’s campaigns and issues and, where strategic and viable, will have a joint voice on agreed issues

Join the Rural Health Partner Network

This is an open network and we invite other not-for-profit and pro-rural health civil society organisations to join. By doing so, you agree to adhere to the above principles and network focus, and agree to direct your individual and network activities at improving people’s access to rural health care. We note the absence of other health care worker categories, such as rural pharmacists, rural nurses and rural community health workers and call upon these essential health cadres to join the network through any of the membership organisations. The network does not provide funding support to individual network members.

Become a Friend of the Rural Health Partner Network

Become a friend of the Rural Health Partner Network by supporting our call for improved access to health care for all rural people and by working with the network in specific campaigns and around specific areas of joint interest.

To sign up as network partner or network friend, and for any other queries, contact Marije Versteeg-Mojanaga at marije@rhap.org.za

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The next step in RHAP’s The Voice Project is the piloting of workshops on the basis of our draft manual “A HEALTHCARE PROVIDER’S GUIDE TO REPORTING HEALTHCARE CHALLENGES: PRINCIPLES, TOOLS & STRATEGIES”. Download the The Voice Project – HCP Poster here. So far we provided workshops in KZN, EC, at the Rural Health Conference, at the SA HIV Clinicians Conference and several talks to student groups. The manual will be ready this year and we hope to raise sufficient funds to roll out the initiative across provinces next year. Our partners in this initiative include MSF, the SA HIV Clinicians Society, RuDASA and SECTION27. Contact Dr Prinitha Pillay for more information Prinitha@rhap.org.za

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The Voice Project is a project that RHAP has developed in partnership with RuDASA, RuReSA, PACASA, MSF, The HIV Clinicians Society and S27. It aims to educate and capacitate health care workers from all levels of the public health system and all cadres within on how to identify, problem solve and report health system challenges. The overall goal of The Voice Project is to increase the active engagement of HCWs in addressing health system challenges in a strategic and effective manner and to contribute to a strengthened, equitable health system for all South Africans. By doing so The Voice Project aspires to develop and grow a culture of HCW “change agents”, i.e. health care workers who are willing to challenge the status quo and speak out about health system failures; problem solve challenges; advance patient-centred solutions; and serve as leaders and influencers to colleagues.

A Voice Manual  was developed which informs several activities such as workshops, presentations, public debates and curriculum reform. After a small pilot phase in 2014, where the training material presented at a number of workshops and presentations was well received by the participants, this project is now being implemented on a small scale in 2015 to document effectiveness and to inform its full-roll out from 2016 onwards.

Read more: Resuscutating an ethical climate in the health system_SAMJApril2015

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Bloemfontein recently came to a standstill as community health workers (CHW) and the Treatment Action Campaign (TAC) marched to the magistrate’s court in support of 118 health workers arrested in July last year. Read the full story by Palesa Butler, guest author for Health-e News.

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By Dr Prinitha Pillay. Abstract: South Africa boasts a proud tradition of healthcare professionals speaking out against injustice in line with the medical doctrine of beneficence (to do good) and maleficence (do no harm). There are many who play a part in making the health system better, including the state, managers, patients and healthcare workers (HCWs). This article looks at the role of HCWs beyond providing medical care to individual patients. HCWs often face a lack of resources enabling them to adequately provide care and treatment and respond to life threatening emergencies. As a result, they are forced to make difficult decisions when it comes to allocating those scarce resources. These decisions are not purely fiscal in nature, but also ethical. Deciding who to bump off a theatre list because there is no linen is a choice most HCWs did not imagine they would ever have to make. In order to circumvent a sense of hopelessness, HCWs need to empower and motivate themselves (and others) with knowledge of how to make things better.

Full article: Resuscutating an ethical climate in the health system_SAMJApril2015

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The papers below are part of the Special Issue: Transforming Nursing in South Africa.

http://www.globalhealthaction.net

Published online: 11 May 2015

Utilisation and costs of nursing agencies in the South African public health sector 2005-2010

Using diaries to explore the work experiences of primary health care nursing in two South African provinces

Transforming Nursing policy, practice and management in South Africa

The health system consequences of agency nursing and moonlighting in South Africa

The activities of hospital nursing unit managers and quality of patient care in South African hospitals – a paradox

The indirect costs of agency nurses in South Africa – a case study in two sector hospitals

Social accountability and nursing education in South Africa Practice what you preach – nurses perspectives on the Code of Ethics and Service Pledge in five South African hospitals

Nursing education reform in South Africa – lessons from a policy analysis study

Exploring the characteristics of nursing agencies in South Africa

Exploring the characteristics of nursing agencies in South Africa

Does moonlighting influence South African nurses intention to leave their primary jobs

Contenstations and complexities of nurses participation in policy-making in South Africa

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In this article, psychologist Garret Barnwell calls upon South African psychologists to become more engaged in advocating for social justice and to respond to the challenges faced by the majority of people living in South Africa. “We, as psychologists, can either choose to be complicit in the maintenance of structural disparities or contribute to the transformation of the system” . Read the full article here.

Garret Barnwell is a community service clinical psychologist at Chris Hani Baragwanath Academic Hospital. He has worked nationally and internationally in health and humanitarian assistance. He is the secretary of PsySSA’s Division of Psychology in Public Service, a co-opted board member of Doctors without Borders in Southern Africa and a committee member of the Rural Mental Health Campaign. Garret can be found on twitter @gcbarnwell.

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“This was really insightful & interesting. Perfect time and stuff we haven’t learnt before. Very necessary!!!”

“A very eye opening session that made me realise how we as students shouldn’t think we can’t do anything” (Students feedback).

“Very motivating and empowering. Thank you!”

From 15 to 19 August 2016, RHAP provided a week-long advocacy workshops to over 250 4th year medicine students at Stellenbosch University (SU), as part of SU’s “Doctors as Change Agents” Module, as well as a session with lecturers. The training was provided by RHAP’s Samantha and Mafoko, with inspiring guest lectures by former TAC leader Vuyiseka Dubula on civil society/HCW activism, SECTION27’s Sasha Stevenson on the role of HCWs in working with the Office of Health Standards Compliance and ECHCAC, and RuRESA’s Kate Sherry, on her experiences as a occupational therapist advocate, and the health access rights of people with disabilities. Feedback from the post-workshop questionnaires emphasises the need and value of advocacy training as part of the curriculum. Viva health care worker activism Viva! Viva young leadership Viva!

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This report shows both the gravity and the complexity of the HRH crisis for rural communities in South Africa. While many of the challenges described affect health services at all levels and in urban and peri-urban areas as well, it is clear that rural South Africans are uniquely vulnerable to the effects of staffing cuts, and disproportionately affected by them. In this report we argue that poor access to healthcare for impoverished communities plays a critical role in the vicious cycle of illness and poverty. Disability has also been shown to play a rapidly increasing role in the (ill) health of our citizens, and it is imperative that health services are staffed and equipped to address this. Based on these arguments, we have developed recommendations for HRH which take account of both fiscal constraints and human rights imperatives.

1. Prioritise posts in rural PHC services District HRH planning should take account of rural communities’ lack of service choice and the heavy burden of transport costs to reach facilities.

Research should be conducted to quantify the costs transferred to the community by cutting remote services (including outreach), including both direct (transport) costs, and the indirect costs of failing to access services. These calculations should be used to inform distribution of resources between facilities and subdistricts. HRH decision-making should also take account of the specific challenges in recruiting and retaining staff in rural areas, and seek to protect fragile health teams from across-the-board cuts. The increasing returns on investment in longer-term staff should be considered and retention prioritised.

2. Reconsider utilisation-based measures of need The regressive impact of utilisation-based measures of need has been clearly demonstrated, as well as the false assumptions which underpin them.

Such measures should be balanced against known prevalence rates for given conditions (for example the fertility rate to predict need for obstetric services) and against benchmarked utilisation rates in comparable well-functioning facilities. HRH planning should also be informed by the package of services to be provided. The WISN method offers a rational approach to planning for staffing needs, calculating time requirements for tasks against workload and available working hours. Expecting staff to carry a workload disproportionate to the hours available to them can only lead to deteriorating quality of service and ultimately system collapse. Where HRH cuts beyond this point cannot be avoided, the state itself must take public responsibility for the cuts in essential services required, and not simply transfer rationing decisions to remaining staff.

3. Plan for HRH as part of a complex system Healthcare worker posts cannot be planned for in isolation.

Non-clinical support staff, hospital transport, drug supply and decent staff accommodation have all been shown to play critical roles in rural healthcare. Unless HRH is understood as part of a complex system, investments in frontline posts may be wasted. 38 39 For this to happen, HRH decision-making should be devolved as far as possible to facility level, so that detailed insight into local conditions can be brought to bear on post allocation.

4. Include rehabilitation and mental health workers as essential services at PHC level.

The increasing significance of disability as a dimension of South Africa’s burden of disease, with all its health and economic impacts, must be recognised. Multidisciplinary PHC teams should include a full complement of rehabilitation professionals as far as possible. A mid-level rehabilitation worker cadre could offer the most cost-effective and sustainable route to ‘rehabilitation for all’, and could dovetail psychosocial rehabilitation with the needs of people with physical and sensory disabilities – in accordance with both the national Mental Health Strategic Framework, and the Framework and Strategy for Disability and Rehabilitation.

5. Consider the hidden costs

The costs to communities, the economy and ultimately South Africa itself of poorly functioning health services cannot be underestimated. Money is not ‘saved’ when service conditions result in deepening poverty and marginalisation of the sick and disabled. More easily quantifiable, medico-legal costs pose a monumental threat to the health system as a whole, and current cost-cutting measures will certainly drive claims yet higher. Radical approaches are needed to address this situation, and budgeting for healthcare must take account of these direct costs to the service of rendering inadequate care. Instead of the current short-sighted transfer of funds from service provision to medicolegal payouts, health planners need to invest in preventing incidents through ensuring the resources for decent healthcare.

The post Cutting Human Resources for Health – Who Pays? appeared first on RHAP.

After a consultative process that included stakeholder consultations, internal and external evaluations, the RHAP Board has adopted the 5 year strategic framework for the period 2017-2021. 

Vision: Rural Communities Accessing Equitable and Quality Health Care

Mission: Promoting, Protecting and Realising the Right to Rural Health Care by Connecting Practice, Policy and Partners 

The new strategy speaks to the context of growing budget austerity and resulting HRH pressures. We seek to make visible the impact on services, in particular on rural people’s access to health care in the most deprived parts of our country, mostly former homelands. The great majority of people living here are dependent on the public health system but are often disproportionately affected by the cost-containment measures. This is due to a complex interplay of high levels of poverty, low economies of scale, high HRH vacancies and difficulties attracting health care workers, large distances to facilities with high out of pocket expenditures and high levels of unmet need in turn leading to lower utilisation rates.

In this next phase, we strive to continue our collaborative work with Government, notably Health and Treasury, in seeking solutions that protect and promote access to health care for rural communities, despite the challenges of the current times. We also wish to put more of a spotlight on the good practices out there in the rural areas, driven by passionate health managers and rural health care teams wanting to make a difference despite the odds.

Lastly, we focus on building the advocacy competencies of health care workers and community voice in our work as we believe we can only succeed in our advocacy in partnership with advocacy-competent health care workers and the communities most affected.

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http://www.news24.com/SouthAfrica/News/life-esidimeni-md-doctors-failed-to-speak-out-20171018

As the hurt, loss and suffering of #Esidimeni is now open for all to hear and see, we need a serious conversation as a country about healthcare worker rights and duties to speak out. Some did speak out, internally, and were ignored or silenced, others didn’t and inadvertently contributed to the tragedy. Truth is that whenever a HCW speaks out, publicly, he can be sure of a backlash, victimisation, suspension or dismissal. As society we expect the HCW to speak out, in any event, to avoid such tragedies as Life Esidimeni, BUT we also need to provide moral and political support to those that put patients first.

Open letter to Minister Motsoaledi: Please support healthcare workers to speak out

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Programme: 22Nov HCW Advocacy Debate Programme

Date:  22 November 2017, 1530 for 16:00 – 18:30

Place: University of the Witwatersrand, School of Public Health, Resource Centre

RSVP: For catering purposes RSVP by Monday 20 Nov to Karessa@rhap.org.za

In a context of an ailing health system faced with many challenges, patients and their families need healthcare providers to be the eyes and ears on the ground. To be skilled in advocating for quality health care. To be confident in raising alarm before things go amiss. But if we have learnt one thing from the tragedy of Life Esidimeni, in which 141 lives were lost due to leadership failures and negligence, it is that not all healthcare workers have these skills, or the moral compass, to speak out. Others who do get silenced, ignored or give up after one try. As a nation we have said this never again. But we also know that Life Esidimeni is not an exception and other tragedies have and continue to unfold countrywide as we speak. The questions we therefore ask at this debate are:

• What have we learnt about healthcare worker advocacy from the tragedy of LifeEsidimeni?
• What institutional and political change is needed to ensure healthcare workers speak out and are heard and protected?
• Does society have a role to play in supporting healthcare worker advocacy?
• Are universities doing enough to produce advocacy competent healthcare workers?

Panellists:

Representative from Treatment Action Campaign

Shelley Wilsnach                    Community service Occupational Therapist

Dr. Mvuyiso Talatala               Psychiatrist, SASOP Representative

Dr. Lesley Robertson              Psychiatrist, SASOP Representative

Tendai Mafuma                       Legal Researcher, SECTION27

Prof. Laetitia Rispel:                Wits School of Public Health

Mark Heywood                        SECTION27

Marije Versteeg-Mojanaga   Rural Health Advocacy Project

The post 22 November, Public Debate: Raising Alarm and Being Heard appeared first on RHAP.

The post South Africa Today and Beyond: Rural Health and Healthcare Worker Advocacy appeared first on RHAP.

SASOP-RHAP STATEMENT ON MENTAL HEALTH ADVOCACY TRAINING 2018

The Life Esidimeni tragedy continued to dominate the news throughout 2017. The testimonies of several witnesses in the arbitration hearings, chaired by retired deputy chief-justice Dikgang Moseneke, established how the Gauteng Department of Health continued to dismiss all warnings, despite being engaged by SASOP (South African Society of Psychiatrists), Section 27, SADAG (South African Depression and Anxiety Group) and the SAFMH (South African Federation of Mental Health) in legal action to appoint a curator and subsequently, to obtain an interdict to prevent the move. The arbitration process probed the circumstances and the motivation of decision-makers about the untimely discharge of more than 1700 long-term psychiatric patients to ill-equipped NGO’s. This undoubtedly demonstrated the need for health and mental health care practitioners to raise issues and to take up the responsibility to protect the interests and uphold the human rights of mental health care users. SASOP, a professional association of about 600 public and private psychiatrists, is a member-driven non-profit company, with the core business to promote, maintain and protect the interests of its members, the discipline of Psychiatry, as well as to serve the community. In order to achieve the latter, the SASOP included the following objectives in its activities: to promote and uphold the principles of human rights, dignity and ethics in the practice of Psychiatry; to oppose unfair discrimination in the field of Psychiatry; and to promote the de-stigmatisation of Psychiatry and increase the awareness of mental illness. During 2015 the SASOP has also adopted a programme to review its social contract with society, i.e. with the users of their services, as well as with the public at large. The aim of this programme has been to improve the professionalism with which psychiatrists render services to patients, and also led to the agreement with other stakeholders, such as national and regional advocacy groups, to work towards a national alliance for mental health in South Africa. The Rural Health Action Project (RHAP), a leading health advocacy organization and in particular through the Rural Mental Health Campaign has been such a confirmed partner in this initiative.

The RHAP’s mission is to promote, protect and realise the right to rural health care by connecting practice, policy and practice. The RHAP through its’ Voice project has been instrumental to spearhead the training of health science students and practitioners in advocacy for health, and in how to be effective advocates for patients. The Voice Project was established to serve as a catalyst for long-term systemic change in the selection, education and distribution of HCWs in South Africa. It aims to build a new generation of ethical leadership in health care by inspiring activism and leadership in health science students and HCWs. Through the integration of advocacy into the teaching at universities, HCW workshops, student clubs and grassroots HCW associations, the project will create awareness of the obligation of HCWs to put patients above employers when health rights are violated and provide them with the tools and strategies to use their voices strategically and effectively to advocate for a better health care system. In view of this, the SASOP – through its regional Subgroups, has partnered with the RHAP to arrange several CPD meetings during 2018, offering training workshops in different regions in the country, to ensure that psychiatrists and other mental health care practitioners are well equipped to act effectively as health and mental health advocates. Johannesburg January 2018

For more information, contact:

SASOP President: Dr Bernard Janse Van Rensburg, bernard.sasop@mweb.co.za

RHAP Director: Marije Versteeg-Mojanaga, marije@rhap.org.za

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