The role of public healthcare facilities in improving the health security of impoverished people in Fetakgomo Tubatse Local Municipality in Limpopo Province

Abstract

The success of achieving health security is depended on healthcare facilities, thus making comprehensive healthcare service provision fundamental. This study aimed to formulate strategies to ease the serve delivery of quality healthcare in public healthcare facilities in Fetakgomo Tubatse Local Municipality. Quality healthcare is a crucial need for every individual. Good health nurtures happiness and fosters a positive self-esteem. However, numerous public healthcare facilities are facing a number of hurdles that hinder good service delivery for communities nationwide, especially those in rural settings. For instance, overcrowding is one of the main issues highlighting poor service delivery, resulting in people not receiving good quality of care. This affects the patients’ healthcare experience and outcomes. The prevailing challenges emphasise the fundamental issues of healthcare in society. The difficulties faced by both healthcare workers and patients due to poor service delivery spiral out of control. Some of the common issues include inadequate facilities, insufficient resources, poor infrastructure, shortage of medical equipment and supplies, shortage of staff and no consistent water supply among others. The study adopted the Batho Pele Principles and Donabedian Model to understand and analyse the role public healthcare facilities play in improving health services. By examining how these facilities contribute to overall health security. The study aimed to acquire to acquire knowledge into the efficacy of public healthcare facilities in achieving health security. Qualitative methods were adopted for this study. The study population was constituted by auxiliary nurses, assistant nurses, professional nurses, operational managers, home-based care workers, counsellors, patients, and/or community members. Fieldwork was conducted using observations, semi-structured interviews, and focus group discussions with healthcare workers and patients who were the community members. The study area was Fetakgomo Tubatse Local Municipality; however, the research was undertaken only in the Fetakgomo Municipal area, excluding the Tubatse Municipal area, as the two municipalities are now amalgamated. Findings shows that limited facilities, a shortage of resources, a lack of 24-hour services, and poor infrastructure hinder healthcare access. Despite these challenges, patients are generally satisfied with the health services, although issues such as slow services and medication shortages persist. The findings of the study contributes to the advancement, awareness and comprehension of the role management of the facilities play in ensuring effective healthcare provision and that vulnerable populations have access to public healthcare services. Furthermore, the study greatly contributes to the achievement of public health and provides nuances and understanding on the strides, challenges and way forward for attaining health for all and ultimately contributing to broader discussions on public healthcare, sustainable development and poverty alleviation in South Africa. The study concludes that the healthcare facilities in Fetakgomo contributes to health security; however, they face structural and operational challenges. There is a need for policy interventions in healthcare to enable facilities to narrow down the quality care provision gap that already exist. This also study contributes to the current policy dialogue and serve as a foundation for proven methods aimed at enhancing healthcare security for the impoverished people and assisting the country to achieve universal health coverage.

Katlego ya go fihlelela tšhireletšo ya maphelo e ithekgile godimo ga mafelo a tlhokomelo ya maphelo, ka go realo e dira gore kabo ya tirelo ya tlhokomelo ya maphelo ye e feletšego e be ya motheo. Maikemišetšo a nyakišišo ye ke go hlama maano a go nolofatša kabo ya ditirelo tša tlhokomelo ya maphelo ya maemo a godimo ka mafelong a tlhokomelo ya maphelo a setšhaba ka gare ga Mmasepala wa Selegae wa Fetakgomo Tubatse. Tlhokomelo ya maphelo ya boleng ke tlhokego ye bohlokwa go motho yo mongwe le yo mongwe. Bophelo bjo bobotse bo godiša lethabo le go hlohleletša boitlhompho bjo bobotse. Efela, mafelo a mantši a tlhokomelo ya maphelo a setšhaba a lebane le mapheko a mmalwa ao a šitišago ditšhaba nageng ka bophara go hwetša kabo ye botse ya ditirelo, kudu tšeo di lego ditikologong tša dinagamagaeng. Go fa mohlala, go tlala kudu ke e nngwe ya ditaba tše dikgolo tšeo di laetšago kabo ye e fokolago ya ditirelo, yeo e feleletšago ka go dira gore batho ba se hwetše tlhokomelo ya maemo a mabotse. Se se ama maitemogelo a tlhokomelo ya maphelo a balwetši le dipoelo. Ditlhohlo tše di lego gona di gatelela ditaba tša motheo tša tlhokomelo ya maphelo setšhabeng. Mathata ao bobedi bašomi ba tlhokomelo ya maphelo le balwetši ba lebanego le ona ka lebaka la kabo ye mpe ya ditirelo a tšwela pele ka ntle ga taolo. Tše dingwe tša ditaba tše di tlwaelegilego di akaretša mafelo a a sa lekanego, methopo ye e sa lekanego, mananeokgoparara a mabe, tlhaelelo ya didirišwa tša kalafo le disapholaye, tlhaelelo ya bašomi le kabo ya meetse ye e sego ya ka mehla. Nyakišišo e amogetše melawana ya Batho Pele le mmotlolo wa Donabedian go kwešiša le go sekaseka tema yeo mafelo a tlhokomelo ya maphelo ya setšhaba di e kgathago go kaonafatša ditirelo tša maphelo, ka go hlahloba ka moo mafelo a a nago le seabe ka gona go tšhireletšo ya maphelo ka kakaretšo. Maikemišetšo a nyakišišo ye ke go hwetša tsebo ka ga go šoma gabotse ga mafelo a tlhokomelo ya maphelo a setšhaba go fihlelela tšhireletšo ya maphelo. Mekgwa ya khwalithethifi e amogeletšwe nyakišišo ye. Bakgathatema ba nyakišišo ba bopša ke baoki ba okesilari, bathušabaoki, baoki ba profešenale, balaodi ba tshepedišo, batlhokomelabalwetši ba ka magaeng, bathobamatswalo, balwetši le/goba maloko a setšhaba. Mošomo wa kgoboketšo ya tshedimošo o dirilwe ka go šomiša ditemogo, dipoledišano tša peakanyoseripa le dipoledišano tša sehlophanepišo ka bašomi ba tlhokomelo ya maphelo le balwetši bao e bego e le maloko a setšhaba. Lekala la nyakišišo e be e le Mmasepala wa Selegae wa Fetakgomo Tubatse; efela, nyakišišo ye e dirilwe fela Mmasepaleng wa Fetakgomo, go sa akaretšwe Mmasepala wa Tubatse, ka ge bjale mebasepala ye mebedi ye e kopantšwe go ba o tee. Dikutullo di laetša gore mafelo a a sa lekanego, tlhaelelo ya methopo, tlhaelelo ya ditirelo tša diiri tše 24 le mananeokgoparara a mabe di šitiša phihlelelo ya tlhokomelo ya maphelo. Ntle le ditlhohlo tše, balwetši ka kakaretšo ba kgotsofetše ka ditirelo tša maphelo, le ge e le gore ditaba tša go swana le ditirelo tša go nanya le tlhaelelo ya dihlare di sa dutše di le gona. Dikutullo tša nyakišišo di na le seabe go tšwetšopele, temošo le kwešišo ya tema yeo taolo ya mafelo e e kgathago go kgonthiša kabo ya tlhokomelo ya maphelo ye e šomago gabotse le gore badudi bao ba lego kotsing ba na le phihlelelo ya ditirelo tša tlhokomelo ya maphelo ya setšhaba. Go feta moo, nyakišišo ye e na le seabe kudu go phihlelelo ya maphelo a setšhaba gape e fa dintlha le kwešišo ka ga dikgato, ditlhohlo le dikgato tse di latelago go fihlelela maphelo a bohle, mafelelong e ba le seabe go dipoledišano tše di nabilego ka ga tlhokomelo ya maphelo a setšhaba, tlhabollo ya moyagoile le phokotšo ya bodiidi ka Afrika Borwa. Nyakišišo e tšea sephetho sa gore mafelo a tlhokomelo ya maphelo ka Fetakgomo a na le seabe go tšhireletšo ya maphelo; efela, a lebane le ditlhohlo tša popego le tša tshepedišo. Go na le nyakego ya magato a tsenogare a pholisi ka go tlhokomelo ya maphelo go kgontšha mafelo go fokotša sekgoba sa kabo ya tlhokomelo ya boleng seo se šetšego se le gona. Nyakišišo ye gape e na le seabe go poledišano ya bjale ya pholisi gape e šoma bjalo ka motheo wa mekgwa ye e hlatsetšwego yeo e lebantšhitšwego go kgodišo ya tšhireletšo ya tlhokomelo ya maphelo go batho bao ba ihlokelago le go thuša naga go fihlelela kakaretšo ya maphelo ya lefase ka bophara.

Ku humelela ko fikelela vusirhelri bya rihanyu swi lawuriwa fi switirhisi swa nhlayisorihanyu, ku endla nyiketo wo nhlayisorihanyu wo twisiseka na vukorhekeri byo sungula. Dyondzo leyi ley iyi kongomisa ku vumba switirateji ku olovisa vukorhokeri bya nkoka bya nhlayiso rihanyu eka switirhirhisi swa nhlayisorihanyu eMasipala wa Xikaya wa Fetakgomo Tubatse Nhlayisorihanyu wa nkoka i xilaveko xa nkoka ka munhu un’wana. Rihanyu ra kahle ri byara ntsako no kondltela vumunhu kahle. Hambiswiritano, switirhisi swa nhlayisorihanyonyingi swi na swiphiqo swo tala leswi kavanyetaka vukorhokeri bya kahle migangeni ya tiko hinkwaro, ngopfu eka lava nga etindhawini ta le matikoxikaya. Xikombiso, ku tala ka vona ii xin’wana xa swiphiqonkulu swo kombiso vukorhokeri bya le hansi swo va vanhu va nga kumi nhlayiso wa nkoka wa kahle. Leswi swi khumba nhlayiso wa xipiriyoni xa vavabyi na mimbuyelo. Mitlhotlho yi nga kona yi tiyisisa masungulo ya swiphiqo swa nhlayiso wa rihanyu evanhwini. Ku nonohwa loku langutaneke hi vatirhi va hinkwavo va nhlayisorihanyu na vavabyi hikwalaho ka vukorhokeri bya le hansi a bya ha lawuleki. Swin’wana swa swiphiqo swo fanana swi katsa switirhisiwa swi nga ringaniki, swithirisi swi nga ringanelangiki, swimakiwa swa le hansi, vuhlayiseki bya swa vutshunguri na miphakelo, ku kayivela ka vatirhi na nkayivelo wo phakela mati nkarhi un’wana na un’wana. Dyondzo yi tirhisile milawu ya Batho Pele na modele wa Donabedian ku twisisa no hlela ntirho wa switirhisiwa swa vanhu swa nhlayisorihanyu swi wu tlangaka ku antswisa vukorhokeri bya rihanyu, hi ku kambisisa leswi switirhisiwa swi nga na xiae ka vusirheleri hinkwabyo bya rihanyu. Dyondzo yi kongomisa ku kuma vutivi mayelana na vuswikoti byo humesa mbuyelo wa switirhisi swa vanhu swa nhlayiso wa rihanyu. Maendlelo ya nkoka ya tirhisiwile ka yondzo leyi. Eka vanhu hinkavo va dyondzo leyi ku na vaongori va le kaya, vapfuneta vaongori, vaongori va xiphurofexinali, vafambisi va swa matirhelo, vatirhi vo hlayisa va le kaya, vatsundzuxi va swa miehleketo, vavabyi na/ kumbe swirho swa muganga. Ntirho wa le handle ka hofisi wu endliwile ku tirhisiwa vuxoperi, swihlolahlola swa swivutiso fanana na mikanerisano ya ntlawa nkongomo hi vavabyi na vatirhi va nhlayiso rihanyo lava a va va ri swirho swa miganga. Nkongomo wa dyondzo a ku ri wa Masipala wa Xikaya wa Fetakgomo Tubatse, hambiswiritano, ndzavisiso wu endliwile ntsena endhawini ya Masipala wa Fetakgomo, ku nga katsiwi Masipala wa nhawu ya Tubatse, tanihihileswi timasipala letimbirhi tikatsiweke. Swikumiwa swi komba leswaku ku na switirhisiwa swo pimiwa, ku kayivela ka switirhisiwa, pfumaleko wa vukorhokeri bya 24-awara na swimakiwa swa le hansi swi kavanyetaka mfikelelo wa nhlayisorihanyu. Handle ka mitlhontlho leyi, vavabyi va enetekile hi vukorhokeri bya rihanyu, hambileswi swiphiqo swo fana na vukorhokri byo nonoka na nkayivelo wa mirhi ya vutshunguri yi yaka emahlweni. Swikumiwa swa dyondzo swi na xiave ka yiso emahlweni, mipfhumba na matwisiselo ya ntirho wa mafambiselo ya switirhisiwa wu nga na nkoka ku endlela ku va na nyiketo wa nhlayisorihanyu na vanhu hinkwavo va nga riki na ntshembo wo fikello ka vukorhokeri bya vanhu va nhlayisorihanyu. Ku yisa emahlweni, dyondzo yin a xiavenkoka ka ku kuma rihanyu ra vanhu no nyika mavonelo yo hambana na matwisiselo ya magoza, mitlhontlho no yisa emahlweni ku kuma rihanyu ra hinkwavo, emakumu ku va na xiave ka mikanerisano yo anamanyana eka nhlayisorihanyu wa vanhu, nhluvkiso wo yisa emahlweni no susa vusiwani eAfirika Dzonga. Dyondzo yi gimeta leswaku switirhisi swa le Fetakgomo swi na xiave ka vusirheleri bya rihanyu; hambileswi, swi nga na mitlhontlho ya swa xivumbeko na swa matirhelo. Ku na xilaveko xa manghenelelo ya pholisi eka nhlayisorihanyu ku endla leswaku switirhisi swi tsongahata nyiketo wa vangwa ra nkoka wa nhlayiso lowu nga kona. Dyondzo leyi yi na xiave ka n’wangulano wa pholisi ya sweswi no tirha tanihi masungulo ya maendlelo ya vumbhoni yo kongomisiwa ku fikelela mphutselo wu nga pimiwiki wa rihanyu.