For this policy to be achieved there are a number of necessary factors including:
- Adequate resources, especially financial and human
- Support systems that provide the infrastructure on which service delivery can be built. Examples of these systems are drug supplies, transport and communication
- Health professionals who have the necessary competence and confidence to do the job as well as the commitment
- A managerial team that makes coherent plans based on the best information available
In the 1997 White Paper on Health many references are made to the district health system (DHS). This DHS is the lowest of three levels in the health system with the other two being the national and provincial levels. The DHS is the administrative level closest to the patient. It is where the bulk of decisions about local service delivery are taken. The concept of a DHS has long been mooted by the World Health Organisation. The DHS caters for all people in a designated geographical area and it has a single management team responsible and accountable for the district level health services.
In South Africa the situation right now is that basic district health services have been set up in most provinces. Almost all of these fall under the administration of the provincial health departments. At the same time local government health departments around the country are also delivering primary level health services. In many cases these services are well integrated with provincial primary level services. However, in as many cases the services are still fragmented and do not work together.
A strategic decision has been taken that the delivery of all primary level services will fall under local government. A number of consequences will inevitably result from the implementation of this policy.
A large chunk of provincial health services and personnel will be grafted on to the newly formed local authorities. Over 50 000 health workers will be transferred from the provincial public service to local authority staff. Overall, local authority health budgets will increase more than five fold and there will be an injection of around R5 billion for health services into local government revenue. Local government will be responsible for the running of all primary level services including 24-hour emergency services and level 1 hospitals.
On top of this, local government is in the midst of fundamental change and restructuring. Between now and November 2000 there will be a massive structural transformation of local government, probably the biggest ever seen in this country. It is inevitable that much local government staff time will be spent on the internal changes required for the creation of the new local authorities. New relationships have to be established, new organisational identities have to be created, new management structures need to be established with new organograms, new functions and new goals with new lines of communication. New methods of disbursing funds on new priorities have to be agreed upon. These are but some of the issues facing the local government transformation forums.
So in simple terms the scenario we have is a massive change in the structure and function of local government linked to a large number of health workers moving from provincial to local government.
In order for this exercise to be implemented relatively smoothly in a way that ensures that the quality of service delivery is maintained, a number of factors need to be addressed or taken into account.
|
Publications
