District Health and Local Government

South Africa's health system is undergoing one of its most significant periods of transformation. With local government now entering a phase of stability following the boundary changes of the Municipal Demarcation Board, the passage of the Municipal Structures and Systems Acts and the completion of the local government elections, the stage is set for a significant devolution of responsibilities for primary health care to local government.

Experiences from other countries indicate that decentralisation and devolution are complex and fragile processes fraught with problems and challenges. In addition, they may consist of different models and vary according to the range of responsibilities transferred to local government, the financing of health care, the modes of service delivery, and their forms of governance and accountability. In the planning and process of transition attention must be given to the potential pitfalls of devolution such as increasing inequity, increased administrative costs, fragmentation, a weakening of strategic direction and a weakening of national coordination and cohesion. In many countries devolution has actually resulted in the opposite of what was intended.

For this reason, it is important for the process of devolution and change to be based on robust analysis and useful evidence that will allow:

• groups affected by the process of transition to transmit concerns on how the transition is occurring and impacting on health care,
• positive and effective changes to be identified and their potential for replication understood, and
• problems and challenges to be identified at an early stage and effective action taken to overcome them.

An exciting new research and monitoring project has been initiated to track and support the process of devolving health to Local Government in the country. A consortium of founding partners is busy developing the project - the partners comprising Centre for Health Policy at Wits, Centre for Policy Studies, Health Economics Unit at UCT, and Health Systems Trust as the lead partner.

The aim of this strategy is to contribute positively to the transformation and development of the health system in South Africa.

The specific objectives are:

• To identify and describe the key issues in health sector decentralisation and devolution
• To monitor these issues and identify and describe positive and negative changes that are taking place
• To feed these key findings to decision-makers and other stakeholders, and to facilitate discussions of how the process of transition and devolution could be effectively accomplished and
• To facilitate collaboration between research and development organisations in the field of local government, health systems development and decentralisation.
  

Summaries of the DHS-LG Discussion list:

• Summary Bulletin 11 [04-2004]
• Summary Bulletin 10 [08-2003]
• Summary Bulletin 9 [04-2003]
• Summary Bulletin 8 [03-2003]
• Summary Bulletin 7 [03-2003]
• Summary Bulletin 6 [09-2002]
• Summary Bulletin 5 [07-2002]
• Summary Bulletin 4 [04-2002]
• Summary Bulletin 3 [06-2001]
• Summary Bulletin 2 [12-2000]
• Summary Bulletin 1 [09-2000]
  

Relevant Publications

• Decentralising Health Services in South Africa: Constraints and opportunities (2004-05-17)
• Policy Briefs (only available in electronic format)
  • Public-Private Interactions in the South African Health Sector: Experience and Perspectives from National, Provincial and Local Levels
  • Rapid Appraisal of the Health Content of Selected Municipal Integrated Development Plans
  • Governmental Relationships and HIV/AIDs Service Delivery
  • Primary Health Care Financing and Need Across Health Districts in South Africa
  • Transport for Health Care Delivery
  • Download all five reports
• The Long Road to the District Health System - Legislation and Structures for the DHS in South Africa: An Appraisal as at August 2002 (2002-08-30)
  

Keywords	This Item is associated with the Following Keywords: Research, local government and health.
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