Giyani View

Going Home To Limpopo, Is That A Wise Decision? What Does Health Research Tell Us…

Writes, Vera-Genevey Hlayisi, 
Academic and Health Researcher, University of Cape Town.

Official Lockdown:
According to the presidential address on Monday 23rd March 2020, South Africa is on lockdown for the next 21 days. South Africans are being discouraged against domestic travel, especially interprovincial travel from provinces with high numbers of COVID-19 confirmed cases like Gauteng to rural provinces like Limpopo.

Limpopo is one of the most rural and poor provinces in South Africa with over 5 million people living there. The 2016 community poverty survey measured poverty according to health, living standards, education and economic activity as indicators, and findings showed that Limpopo is struck the hardest with 11.5% of the poorest households nationally, based in Limpopo.

Masses Travelling to Limpopo…
April is often a busy month with millions heading to Limpopo for various reasons with the majority travelling for the annual religious pilgrimage with some of the biggest churches in Africa, based in Limpopo.

Local government leaders like the Premier of the province, the MEC of health and others have taken to media to discourage travel to Limpopo with fears that Limpopo will not be able to handle the COVID-19 spread based on the debilitating socioeconomic determinants of health that prevail in the province like high unemployment, low access to water and sanitation as well as high morbidity with diseases like HIV/AIDS, TB and Diabetes.
What does Health Research tell us about preparedness of Health Facilities in rural provinces?

According to the recently published district health barometer of 2018/19 where all national Public Health Care facilities were assessed using the Ideal Clinic framework (which is a set of standards to determine if a facility can provide good-quality health services, and an Ideal Clinic is defined as a clinic with good infrastructure, adequate staff, adequate medicines and supplies, good administrative processes, and sufficient adequate bulk supplies). Unfortunately, of the 3468 public health facility clinics assessed nationally, only 55.4% are classified as ideal clinics with developed provinces like Gauteng leading the pack with 89.2% ideal clinics, followed by KZN with 76.2%, Free State with 75.7% and Western Cape with 68.3%. More rural provinces like Limpopo and the Eastern cape are at the bottom of the pack with only 34% and 32% of their public health facility clinics respectively, classified as ideal. See table below adapted from the District Health Barometer on health service capacity and access from 2015/16 to 2018/2019 (Health Systems Trust).

State of Affairs with Limpopo’s Public Health Facilities
When zooming into Limpopo and its districts, Mopani was reported to be the worst performing district with the lowest number of ideal clinics in the country at 10.5%. This is a worrying statistic with up to 1.2 million people residing in the district and most (93.2%) depending on public health facilities. Even more devastating is the statistics that measure the proportion of health facilities that, in Limpopo, have a core set of relevant essential medicines available and affordable on a sustainable basis, and these revealed that all five districts in Limpopo, including Mopani, scored below the national average of 84.7%.
So, is going home to Giyani, during the COVID-19 lockdown, a wise choice?

In terms of capacity to admit and treat patients with the impending COVID-19 crisis, South Africa as a whole does not have enough hospital beds. Worse yet, rural provinces like Limpopo and districts like Mopani, are not equipped to handle mass in patient management. The District Health Barometer indicates that as of March 2019, the number of inpatient hospital beds for all types of hospitals in the public sector was 17.9 per 10 000 uninsured population. Limpopo is 3rd to last in this ranking with 14.2 beds per 10000 for their population and Mopani district is even lower than the provincial ranking with 13.8 beds.

Health Research numbers are striking and should highlight to the masses planning to travel that, rural provinces like Limpopo and the Eastern Cape simply do not have the capacity in terms of health facilities, medication or in-patient beds, to handle the COVID-19 outbreak. Citizens are therefore advised to avoid inter-provincial travel and stay in the more urban, developed provinces where they may have better facilities.

Moreover, pandemics like these help us all as a nation to highlight the high healthcare needs for our country and respective provinces, and it is hoped that the government moving forward will invest more resources into the system to increase capacity and quality of care for the people of South Africa as health care is a human right in our land.

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