Eastern Cape villagers build their own clinic after decades without health-care access

For decades, the residents of Nombanjana village in Centane, Eastern Cape, had to walk nearly 30km and cross dangerous rivers just to reach the nearest clinic. Tired of waiting for government intervention, the villagers decided to build their own clinic.

They rallied together, raising about R250,000 through donations and using rental income from a cellphone network provider that paid for a tower installed in the village.

After two years of labour, mixing cement by hand, ferrying bricks on bakkies and working long days in their fields, the clinic structure now stands completed.

The community is now in talks with the Eastern Cape department of health to have it officially recognised and operated as a satellite clinic.

Community leader Lulamile Khetshemiya told Sunday Times that the project was born out of desperation and loss. “We got tired of the government’s empty promises while people were dying. For years, people struggled to reach health-care facilities because of the distance. Some even defaulted on their medication,” he said.

He said villagers drew inspiration from other communities that had built their own clinics and later received support from the provincial health department in the form of staff, equipment and medicine.

But in Nombanjana, the struggle is not only about distance, it is also about the terrain. When it rains, the gravel roads turn into deep mud and crossing the river becomes almost impossible.

Road infrastructure is an old wound that keeps bleeding

An inquiry by the South African Human Rights Commission (SAHRC) into the human rights implications of poor road conditions in the Eastern Cape found that the province’s broken, underdeveloped roads continue to deprive rural communities of basic rights.

One of the key findings is that only 9% of the province’s roads are paved, compared with the national average of 25%. The inquiry describes the backlog as “a legacy of historical neglect”, worsened by insufficient funding and ineffective planning.

“Persistent lack of road maintenance and development contributes to widespread violations of fundamental rights, including access to education and health care,” the report reads.

For Nombanjana residents, this is not theory; it is daily life. Though public health care is free in South Africa, Khetshemiya said accessing it is a luxury many cannot afford.

“During Covid-19, we realised we needed a clinic in our village. The mobile clinic only comes after three months, which doesn’t help. It costs about R80 for a return trip to the nearest clinic, but if someone is gravely ill you can pay between R1,500 and R2,000 to hire private transport.”

Rural health care is under-resourced and overlooked

Prof Leslie London from the University of Cape Town’s School of Public Health said Nombanjana’s self-built clinic reveals the deeper cracks in South Africa’s health-care system.

“For a community to build their own clinic says a lot. We are a country that spends around 8% of our GDP on health care, which is high, yet we have relatively poor health outcomes. That’s because we are not spending money where it matters: rural areas, informal settlements and underserved communities,” he said.

London said rural health-care facilities remain under-resourced and poorly maintained despite pockets of progress.

Government should recognise what communities can do and invest in their capacity to work with health services.

—  Prof Leslie London of UCTs School of Public Health

The Rural Health Advocacy Project’s study, “Equitable Healthcare in South Africa”, notes that the poor condition of rural roads and infrastructure makes it difficult for patients, health-care workers, and ambulances to reach health facilities.

“Rural areas often have mountainous terrain or are remotely located, increasing the cost of accessing health care and making geographic barriers a major obstacle,” the study states. Poverty further compounds the issue.

What the government must do

London emphasised that communities often possess the skills, initiative and will to supplement their own health needs. Still, the government must ensure these efforts do not place undue burdens on the poorest.

“Government should recognise what communities can do and invest in their capacity to work with health services,” he said. “Not just financially, but by building trust. Community initiatives should be welcomed — especially when they fill gaps left by the state.”

He warned that failure to acknowledge and support grassroots efforts could lead to fragmentation of service delivery and further erode trust.

Health department responds

Eastern Cape Health spokesperson Siyanda Manana said the department had not been formally aware of the village’s construction project until receiving questions from the Sunday Times.

“Following the enquiry, the department engaged with local traditional leadership, who confirmed their awareness of the initiative and expressed a desire for collaboration,” Manana said.

The department is awaiting formal correspondence from the community to begin structured engagement.

Manana said the department has several outreach programmes for rural and deep rural areas, including:

• regular mobile clinic services;
• outreach visits by nurses and health-care teams;
• community health worker programmes; and
• strengthened referral and patient transport systems.

He said the department welcomes the community’s initiative but stressed that any facility seeking government support must comply with safety, governance and legal requirements.

Where communities formally approach the department, he said, they can expect:

• a needs assessment;
• recommendations on appropriate services; and
• possible development of a memorandum of understanding if standards are met.