Good Practices and Innovations in Public Governance 2003-2011

Good Practices and InnovATIONS in Public Governance
Africa
South Africa
2008 Category 2 Winner
Transnet-Phelophepa Health Care Train
Johannesburg, Transnet Foundation, South Africa
Description
Bringing health services in remote rural areas: The Transnet-Phelophepa Health
Care Train of South Africa.
Summary
The Phelophepa Health Care Train is a 16-coach train that travels to 36 remote rural
areas each year, for a period of one week each, to provide affordable and accessible
primary healthcare services and health education to the rural poor. Founded in 1994,
this initiative, which is based on a public-private partnership, is unique in the world.
It reaches tens of thou sands of patients throughout South Africa and provides basic
dental health, and eye care as well as health education and counselling. Graduates of
this programme become volunteers in the community who disseminate the information
they received from Phelophepa. Following the train’s departure, the Order of St
John gives these 16 people a week of instruction in home-based care, with a focus on
HIV/AIDS. Thanks to this programme, that was established as a reaction to the fragmented
and discriminatory health system legacy of the Apartheid, there has been an
increased access to health care services in deep rural areas reaching over 4,500,000
people since its inception in 1994. Since then more than 8,000 community members
have been trained in basic health care and 1,443 people have received home-based
care training. In addition, Phelophepa has created temporary employment for 50-60
local community members at each stop.
The Problem
Although the South African Constitution now recognizes the universal right of access
to health care services, inadequate access to these services still plagues the lives of
the majority of South Africans. It has been recorded that since 1994, doctors and
nurses have been leaving the country in droves. The increasing spread of HIV/AIDS
throughout the country (917 deaths per day in 2006) and its associated epidemic
Tuberculosis (529,320 cases in 2004, and 66.4% HIV+) along with the chronic under-servicing
and under-resourcing of the rural sector all have devastating consequences
on infant mortality (48 deaths per 1,000 live births), maternal health (3,406
deaths between 2002 and 2004), and life expectancy (50.8 years). The result has been
a decline in South Africa’s ranking on the Human Development Index. Whereas
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