South Africa Hi currently confronted by multiple challenges of poverty,
unemployment, inequality, and environmental crises. While these challenges
affect people in both rural and urban territories, isolation from the mainstream
economy experienced in rural contexts exacerbates these problems. As a result,
rural settings remain prone to marginalisation and exclusion. In isolated rural
areas in South Africa there is limited access to formal clinics and hospitals,
therefore the rural inhabitants often go without basic health services, and suffer
from inefficiencies in health systems and inconsistent quality of care. Studies in
other developing regions have indicated that healthcare offers great opportunities
for social innovation (e.g. CHATAWAY et al., 201oa and 2010b), but in South Africa
this type of evidence remains scant.
Health status is a basic condition that allows individuals to participate in
social and productive activities. Therefore, addressing healthcare inequalities
often facilitates the processes of social inclusion, especially in vulnerable groups.
Analysing healthcare systems in rural areas and the context in which agents are
able to innovate and generate solutions to overcome the existing gaps in the
provision of basic healthcare becomes intrinsically important in the discussion
around innovation and inclusive development.
Issues of healthcare in South Africa have been typically framed and analysed
from the perspective of a limited spectrum of stakeholders - usually focused on
'formal' actors such as hospitals, clinics, etc. - as well on a limited spectrum of
'formal' knowledge. The proposed interactive process in this study seeks to widen
the stakeholders and modes of learning as well as the sources of knowledge that
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may be relevant for innovation in healthcare systems. One of the critical aspects
of the project relates to our acknowledgement of the diversity of actors and
institutions involved in the provision of healthcare services in the two localities;
including both formal and informal actors.
This study has been conceptually framed within the systems of innovation
framework and more specifically within the notion of Local Innovation and
Productive Systems (LIPS) (CASSIOLATO et al., 2003; LASTRES and CASSIOLATO,
2005). It is worth noting that the study was not restricted to technological
innovations, but instead paid particular attention to social innovations. Social
innovation is defined as "the process through which organizations incorporate
knowledge in the production of goods or services that are new to them and which
are geared to meet social needs. Social innovation derives from an interactive
and transforming dynamic, developed with the participation of local actors
and appropriated by them, representing solutions to social inclusion and to the
improvement of living conditions" (REDESIST, 2012). The LIPs approach provides
an analytical framework that allows exploring the systemic and interactive
processes leading to social innovation.
The focus of this study is, within this conceptual context, to understand the
local system from which innovations in the provision of healthcare services may
emerge. To this end, the paper is structured as follows. Section 2 summarises
the conceptual background that has guided this research, drawing from the
LIPS framework, as well as from the concept of inclusive development and its
relationship to healthcare. Section 3 provides a description of rural health systems
and the key players in the two localities which are the subject of this study. Section
4 describes the empirical findings in terms of emerging interactions across actors
in the systems, as well as identified innovations. Section 5 draws a number of
conclusions and recommendations based on the findings of this study.