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South Africa is home to an estimated 53 million people, 400 000 of whom play rugby union (‘rugby’) (www.worldrugby.com). Although rare, rugby can be associated with permanently disabling injuries, which are tragic for the player and their family and also negative for the sport’s image.1 To reduce these injuries, a nationwide injury prevention programme, called ‘BokSmart’ (www.boksmart.com), was launched in South Africa in 2009.
Due to its vast socioeconomic disparities, South Africa is a difficult context for the implementation of any health intervention, let alone injury prevention programmes. South Africa ranks as the most inequitable country in the world (www.data.worldbank.org). Moreover, this inequity extends to healthcare: a recent report indicated that the poorest quintile of South Africans receive <10% of the country’s health benefits despite requiring close to 40% of these services, according to their self-reported health (figure 1).2 This disparity is partly due to infrastructure deficiencies in under-resourced communities. For example, rugby coaches in low socioeconomic areas mentioned infrastructure-related barriers to implementing BokSmart that were not mentioned by coaches from high socioeconomic areas.3 The fact that the same programme/strategy is implemented into different contexts …
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