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HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

The reasons for the prevalence of bad systems of communication in our health districts can be attributed to the poor process and paltry content of messages. Many health workers do not adhere to the correct process (or channel) of communication by often bypassing established channels. Sometimes though, these channels are not made clear to them and they therefore do not know who are the persons that they should be communicating with in the line of duty. Moreover, the content of messages is often unclear and ambiguous which further leads to confusion and a poor work ethic. Not having access to the means (or tools) of communication (such as a basic telephone) is another important factor impeding good communication within a district, and between it and its support spheres. All these factors result in a poorly functioning health district and this ultimately translates into an inferior quality of care given to the patient. A good explanation of some of the more salient aspects of communication within the context of the DHS is given in the overview of this edition.

It is because of the importance of the role of communication in the development and functioning of health districts that the Initiative for Sub-District Support (ISDS) had identified this as a key support strategy when the programme was established three years ago. The Initiative has already made good progress in helping to rectify the problem of poor communication in some of its sites. In this issue of Update we draw upon some of the best practices in the implementation of the ISDS communication support initiative. An integral component of the district health system is an information system. Based on the ISDS experience in the Impendle-Pholela-Underberg (IPU) district in KwaZulu-Natal, we report on the importance of having a good communication system in supporting a district information system. In Mt Frere we report on how community involvement in health is being promoted through the community newsletter. Still on the subject of community involvement in health (but this time in the Northern Province) we have a report on how a local community radio initiative is expected to make an impact on health promotion and community interaction in the Sekhukhuneland area. At the site of service delivery, we explore the nurse/patient interface. This relationship is generally acknowledged to be poor and we hope to shed further light on this matter. We also have a contribution from the telecommunication parastatal Telkom whom, many of you will attest, have been the bane of health facilities with no telephone for a long time.

You will find that many of the articles in this issue are contributions from people involved in helping to improve communication systems within their districts. These are achievable communication task that form part of broader district communication strategies that has been developed in some of the ISDS sites. These best practices consequently provide a practical example of what can be done in other health districts. For a more complete understanding, I would also encourage you to read some of the available publications on communication that are available from Health Sytems Trust.