How a Deep Rural Community got an Ambulance

Community Approaches – Lessons Learnt

In October 2016, an ambulance was placed for the first time in Nqileni Village in the Eastern Cape to serve the Xhora Mouth Administrative Area. The ambulance rests on the rolling hills of the Wild Coast waiting for an emergency.  At night it is secured in a structure built by the community, it is guarded by community members and the Emergency Medical Services (EMS) staff can rest in a 100% community owned lodge, the Bulungula Lodge.   The availability of an ambulance here is a success story.  But how the ambulance got here shows a tale of battered victims of avoidable tragedies and of a community – guided by strong traditional leadership – who have become aware of their human rights and who are empowered to complain, to make demands, and to commit even their own resources to realise the right to health care. It is also a story of collaboration between the community and the Bulungula Incubator (BI) with civil society, SECTION27 in particular, and the South African Human Rights Commission (SAHRC) and one of collaboration, confrontation and eventual partnership with the government.

The right of access to health care remains unrealised for members of the Xhora Mouth Administrative Area.  For one of the poorest areas in the country – where the need is great – the nearest clinic, if you are healthy, is a 2.5 hour walk away (one way) and includes crossing a river and climbing significant hills!  We need so much more human solidarity to address the challenges to realise the right of access to health and we will continue to work with civil society, the SAHRC and government to realise this right.  But we must pause, reflect and celebrate our victories and having an ambulance on our hills is a victory. The paper hopes to share the journey of this victory so that other similar communities can learn from us and learn how to unlock the potential of collaboration across many sectors so that they too can advance the right of access to health care.

In general, communities will have varying resources and potential partners available.  The first step is therefore to map your landscape and identify your allies and supporting factors and what your barriers to progress are.  Other lessons based on our experience include:

  1. Utilise existing community structures: this could include for example your traditional leadership or local ward counselor depending on your assessment as to who will be your best ally, who will provide you with the necessary support and who will unite the community to support your cause. NGOs and activists should also take guidance from communities concerned to see who they think best represents them.
  2. Create a leadership structure to drive the issue: For example, create a committee to be in charge of addressing the issue. Make sure that the committee has the support of the leadership in the community and that its membership includes some of those leaders; this will give it the necessary power to make decisions and drive the process forward.
  3. Collaborate and partner for resources: the community’s partnership with the Bulungula Incubator (BI) is one such example of a symbiotic relationship that was needed to make this a success. The BI employees were on the health committee and they provided guidance, leadership and the necessary infrastructure to make organising possible (such as access to internet, copiers, phone-calls, setting up community members and assisting with the communication between other partners etc.).
  4. Collaborate and partner with allies: this could include partnerships with NGOs, public interest organisations and/or Chapter 9 institutions such as the South African Human Rights Commission (SAHRC). It could also include people within government or certain government departments.
  5. Rights are no substitute for political struggle: know and understand your rights in the Constitution and government’s obligations. But, do not think that because we have a “right to…” anything that we can stop the struggle. These constitutional protections or obligations cannot be a substitute for political struggle and we need to find the necessary partners who will be vigorous advocates for the poor.
  6. Have a broad strategy: that includes a media, political, legal and cultural strategy as well as a strategy in relation to partners.

There is no one right approach.  With sufficient partnerships and engagement, you should be able to create an approach that suits your community.


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  1. Mzukisi Maneli

    This is indeed one major achievement, which the entire community as well as various partners should be proud of. It is a milestone in the democracy of mostly the rural communities, who were feeling neglected & could not access the basic health services, which is a Constitutional requirement. It gives me great pleasure too, that the community has taken it upon themselves to safeguard the resources provided, including looking after the officials who are given responsibility to manage these resources (emergency officials). It is the realisation of the dream of the old man (Rholihlahla), which was to ensure that, even the far located, & most rural people, are empowered & receive the fruits of our democracy. It is a commendable effort & well done.

  2. Amanda

    This is fantastic news guys! And just shows the need for a broad scale approach to rural health issues! Keep up the amazing work!

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