The Eastern Cape Province is situated on the eastern part of South Africa. It is known for producing great leaders such as the world icon Nelson Mandela, Walter Sisulu, Thabo Mbeki and many more. The province lies between KwaZulu Natal and the Western Cape Province and the Indian Ocean. With a population of 6 562 053, it covers an area of 168 966 m2. The area covered by the province is estimated to be about 13, 9 per cent of South African land (census, 2011). The province is widely dominated by rural locations with majority of the people being Xhosa speakers. The location of Mantunzeleni lies between Nqamakwe town and Butterworth town. The location consists of four villages and is surrounded by nine other villages (see figure 2). Figure 3 provides an aerial map to show the layout of the villages and the density of the population in that area.
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The province’s primary healthcare system (provided by the government) is in dire state, facing many challenges including HIV/AIDS, TB and circumcision deaths (Thom, 2014). According to SouthAfrica.info (2012), the Eastern Cape Province has 29.3 per cent of people living with HIV/AIDS virus. Obtaining medication for people living with this virus in the province is difficult as at time, patients are referred back due to shortage of medication. The province also faces infrastructure problems. The Treatment Action Campaign (TAC, 2013) stated that a number of hospitals in the province are failing HIV/AIDS patients when it comes to handling of medication. TAC explained further to say that a large number of hospitals and clinics needed to be renovated as they did not have water, sewage, electricity and equipment. This on its own impacts the delivery of healthcare services to the people.
With many complaints and bad publicity, the ECDOH conducted a research on selected hospitals which were perceived to be poorly performing. The findings revealed that lack of equipment, lack of supplied oxygen, poor storage of records and staff attitude had a negative impact on service delivery. The above-mentioned factors have caused the public healthcare in the province to be among the worst in the country and in some places healthcare facilities have collapsed due to negligence by the province’s government (TAC, 2013; Blacksash, 2015). After it was disclosed that the province’s healthcare was in crisis and needed to be rescued, the Eastern Cape Health Crisis Action Coalition threatened to take the provincial’s health department to court. This was after the coalition conducted a survey “Death and dying in Eastern Cape” where patients had to give their views and experiences when being attending/attended by healthcare professionals. The report revealed that family members lost their loved ones due to the province’s failing healthcare system. The report detailed problems faced by patients as: state of healthcare facilities, shortage of medications, patient transport, emergency services and shortage of equipment (Blacksash, 2015).
Many of the people in the province live in rural areas. Rural areas can be defined as the areas located outside a town. With rural population being unemployed, it is eminent that diseases will spread easily as there is not enough income to get to town where people can get help. Rural people have limited access to healthcare due to the shortage of healthcare professionals and scarcity of healthcare facilities. Literature has identified the following factors as the causes of low number of healthcare professionals working in rural areas. The factors include: infrastructure and facilities, limited number of workers, support and development, longer and less productive hours, lower income, distance to travel to work, fewer choices and opportunities for specialization, flurred division between personal and professional life, lack of medicines and equipment and nurses, retarded development,
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working environment and workplace security (Rickards 2011; & Public Health Association of South Africa, 2013). A clinic serving about 19 rural villages issued a statement on a daily dispatch newspaper revealing that the rural villages has had a significant increase of TB and HIV/AIDS infections. This, according to the head nurse of the clinic was due to the fact that most of the villages were 20 kilometres away from the clinic and patients had to walk long distances to reach the healthcare facility (Daily dispatch, 2014). The location of the clinic fell outside of the department of health’s standard of clinics being within 5 kilometres radius of communities. In addition the paper detailed that patients had to cross rivers and walk in places where there is a high rate of crime to get to the clinic.
Due to the report by Blacksash, the premier of the Eastern Cape in his opening of the province’s parliament said that plans to help curb the dire state of healthcare in the province included revamping 2 new hospitals, an extension of Nelson Mandela academic hospital, 17 clinics which were built at R332.2 million and investing in healthcare professionals (Masualle, 2015). These statements were supported by the health MEC in the province. In his budget vote, he outlined that 1.577 billion was to be made available for HIV/AIDS program, a further 1.221 billion was allocated for medication (Somyo, 2015).