The rural health care problem in the Sisonke District : St Apolinaris Hospital.
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With the advent of democracy in South Africa, there has been a growing awareness of the poor levels of health care that have been provided to rural areas in previous years. While members of the private sector can afford medical treatment equalling that provided in first world countries, the poor, who rely on the public sector, must rely on the services that are provided by their district hospital system. The remote St Apollinaris Hospital provides health care for approximately 150 000 of the 308 000 people who inhabit the Sisonke District. This hospital is unable to attract and maintain adequate human resource capital due to its remote location, it is frequently confronted with logistical problems. While St Apollinaris Hospital does function within the budgetary constraints of the Department of Health, there seems no effective mechanism by which the problems of this institute can be identified and dealt with. As St Apollinaris Hospital services almost half the district population, any improvement in the hospital's functioning and service delivery will have a direct impact on the health status of this rural area. This study aimed at identifying the shortfalls that were present at the St Apollinaris Hospital and focused on the management and administrative components, as well as human resources and equipment resources, which may contribute to the suboptimal health care of patients. This study was a qualitative observational cross sectional study with some quantitative aspects. As all workers and managers that were present were interviewed, there was no need for a sampling methodology. The sample size consisted of 128 general employees and eight top managers. A response rate of 85% was achieved which allowed the researcher to draw conclusions about all workers at the St Apollinaris Hospital. An inventory of the hospital's equipment was conducted using the Department of Health's essential equipment list. The out patients utilizing the hospital's services were analyzed to determine the effectiveness of the current referral pattern and the financial records of the hospital were analyzed to determine the effectiveness of the budgeting process. Understaffing was one of the most serious problems that the hospital had to contend with as 81% of employees identified this problem. 51% of employees stated that understaffing presented itself on a daily basis. The next problem faced was the low levels of equipment with there being a range of 35 to 69% of essential equipment present. There was no equipment pool. 90% of workers stated that the lack of equipment resulted in them becoming frustrated and 85% of workers stated that they believed that the low levels of equipment resulted in compromised patient care. The recommendations that were made include St Apollinaris Hospital instituting a long term and short term recruitment strategy to help with the understaffing that may be present. A full equipment plan needs to be instituted at St Apollinaris Hospital. Attention should be paid to bringing the essential equipment up to the prescribed levels as soon as possible. An equipment pool should be established and maintained. More research is needed with regard to the outpatient and financial components of this study.