The Development of District Health Systems

This policy brief summarizes the Department of National Health's proposed vision for the district health system. The Department of National Health views the development of the District Health Systems as the root of the entire transformation of the health system and gives it the highest priority. The concept of a district health system is new to many South Africans and needs to be unpacked for communities.

What are the principles of the district health system?

According to the Department of National Health, the creation of the district health system will be based on 7 principles.

1) It must overcome fragmentation.

• Currently, different authorities control different pieces of the health system. Some services are delivered by local authorities, other by provincial authorities, and still others by national authorities. In the new health care system, all primary health care services in an area must come under the control of a single district health authority.

2) It must be accountable to communities.

• Staff in a district and in each health facility must be accountable to the communities they serve. Communities must participate in the planning, management, and monitoring of health services in their district including at clinics, health centres, hospitals.

3) It must be efficient.

• Money should be spent for the purpose it was intended. Services should be delivered in a cost-effective manner. Communities have the right to know how money is being spent and responsibility to make sure that it is being spent correctly.

4) Control must move from the national and provincial levels to the district level.

• Within the national and provincial guidelines, people will have control of the money and the health care resources in their districts. This should allow them to support community-based initiatives. It should increase their accountability to communities and increase their efficiency.

5) It must provide comprehensive primary care services.

• A district cannot offer only preventive or rehabilitative services to communities. It must deliver a comprehensive package of primary care services up to the community hospital level with an appropriate referral system. People must be able to move to more specialised care if they are very sick.

6) Its boundaries should be the same as political and administrative boundaries.

• This will allow the health district to work with other government departments and with elected officials to address the root causes of health problems in communities.

7) It must promote equity among communities.

• Communities that have had fewer services in the past should see large improvements in their health services in the short-term. In the long-term, all communities should receive quality primary care services.

How will district health systems be implemented?

First, every province must be divided into a number of districts. Many provinces already have begun this process. As mentioned above, these health districts should be similar to the political boundaries used in the local government elections. This will allow for intersectoral collaboration among health, education, public works, welfare and other government departments. The average district will have 100,000 to 200,000 people, but they will vary in size. Peri-urban, farming and rural areas must fall into the same health district as the towns nearest them.

Each district will receive an amount of money from the province to provide primary care services to all of the people staying in that area. The district health authority will be the only employer for all public sector health workers in the district. In addition, the district health authority will have control of the budget and the delivery of primary care services up to the community hospital level. There will be a single salary scale and employment conditions for all public sector health workers throughout the country, but health professionals who work in underserved areas, with few doctors and nurses, will be given some additional incentives.

Provinces have begun the planning process to implement the district health system, but they are at different stages. The development of districts, however, is a long-term process. It is envisaged that some model health districts will begin in 1996, but district health authorities will not be in place nationally until after 2000. Until then, provincial department will be responsible for all of these activities.

What are the functions of a district health authority?

Once they are in place, there will be four major functions of a district health authority:

1) It will provide primary level health care services to all people.

• The district health authority will offer a comprehensive package of promotive, preventive, curative, rehabilitative, and palliative services for all people living in the district. It must collaborate with communities, NGOs, the private sector, and other government departments to make sure that these services are available. In addition, the district health authority will be responsible for environmental health services, including the provision of clean water and sanitation services. It will provide medico-legal services and health care to persons who have been arrested and charged. Finally, the district health authority will ensure support for community development projects.

2) It will provide support services to patients and staff.

• The district health authority should ensure housing for staff. It must maintain all facilities and equipment, including facilities for child birth and mental health services. Finally it must provide basic medicines, laboratory services, and transport within the district.

3) It will provide administrative support.

• The district health authority will develop a budget within national and provincial guidelines. It will buy services from the private sector, if they are needed and it will distribute information about all health laws to communities.

4) It will coordinate long-term planning and human resource development.

• The district health authority will create a health information system to monitor and evaluate the delivery of health services. It will provide for cooperation with all other health care providers, including traditional and complimentary healers, NGOs, general practitioners, and other private practitioners. Finally, it will oversee the development of Community Health Areas as smaller administrative units within the district.

How can you get more information about the district health system?

This information comes from a recent report published by the Department of National Health, Towards A National Health System for South Africa. This document summarises all of the Department's policies. They have asked for public comment on this document by 30 December 1995. If you would like a copy of the full report or have any comments, please write or fax the Director General, Department of Health, Private Bag X828 Pretoria 0001 or (012) 323-1980. Please feed back to the Networker, what can NPPHCN do to raise awareness about the district health system in your area.

For more information about PHILA or if you have comments about any of these reports, please email PHILA@wn.apc.org

Last updated: 14/12/98
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