A rural Eastern Cape village, frustrated and tired of its pleas falling on deaf ears, has taken the bull by the horns and built its own clinic. It is now in talks with the provincial Department of Health to have it officially recognised and operated as a satellite clinic, reports TimesLIVE.
For decades, the residents of Nombanjana village in Centane had to walk nearly 30km and cross dangerous rivers just to reach the nearest clinic. Fed up with waiting for government intervention, the villagers 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 has been completed.
Community leader Lulamile Khetshemiya told Sunday Times 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 healthcare facilities because of the distance. Some even defaulted on their medication,” he said.
They drew inspiration, he added, from other communities that had built their own clinics and later received support from the 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) in the province concluded that the broken, underdeveloped roads continue to deprive rural communities of basic rights.
A key findings was that only 9% of the local 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 maintenance and development contributes to widespread violations of fundamental rights, including access to education and healthcare,” the report reads.
For Nombanjana residents, this is daily life. Though public healthcare is free, Khetshemiya said accessing it is a luxury many cannot afford.
“During Covid-19, we realised we needed our own 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 healthcare overlooked
Professor 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 healthcare system.
“For a community to build its own clinic says a lot. Our country spends around 8% of our GDP on healthcare, 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 added that rural facilities remain under-resourced and poorly maintained, despite pockets of progress, and government should recognise what communities can do and invest in their capacity to work with health services. “Not just financially, but by building trust. Community initiatives should be welcomed – especially when they fill gaps left by the state
“Communities often possess the skills, initiative and will to supplement their own health needs. But the government must ensure these efforts do not place undue burdens on the poorest.”
He warned that failure to acknowledge and support grassroots efforts could lead to fragmentation of service delivery and further erode trust.
Eastern Cape Health spokesperson Siyanda Manana said the department had not been aware of the village’s construction project until it received questions from the Sunday Times.
“The department has since engaged with local traditional leadership, who confirmed their awareness of the initiative and a desire for collaboration,” Manana said.
The department is awaiting formal correspondence from the community to begin structured engagement.
He said the department welcomes the community’s initiative but 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 (MOU) if standards are met.
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