| Summary |
In order for South African health services to be transformed and restructured in line with the district health system, it is necessary to integrate previously fragmented services. This fragmentation has led to confusion for patients and has been wasteful of scarce resources.In some districts, such as Brakpan, functional integration has occurred. Here staff from fragmented services and different authorities started working together harmoniously long before formal integration commenced. The story of how the Brakpan health services accomplished this integration of staff serves as an important example for other districts of how to overcome fragmentation and power struggles. |
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The Brakpan district
The Brakpan district is a well-defined area of the East Rand of Gauteng, with a population of some 250 000. The town, which started as a mine settlement, consists of a core of commercial and industrial areas, with adjacent residential suburbs.
Most people live in Tsakane, situated 15 kilometers across the N17 highway that intersects the district. Tsakane is a high-density urban sprawl made up of small formal houses and rapidly enlarging informal settlements. The environment is thus one of rapid urbanisation, with high rates of unemployment, poverty and crime and the health care challenges these entail.
Currently health services are rendered at seven facilities, one in town, the other six in Tsakane. The local hospital, Pholosong is called a regional hospital as it serves several districts
How health services were organised in Brakpan before the integration initiatives of the health workers
During the period before restructuring, three different health authorities had responsibility for the delivery of different primary level services. These were the provincially run family planning service, the hospital outpatient curative service and the local authority preventive and promotive services based around clinics. Three examples illustrate the results of this fragmentation.
- In the town of Brakpan a provincial clinic and a local authority clinic operated 500m apart.
- Two mobile clinics worked in parallel, one for family planning and the other for child health. These sophisticated vehicles, each with two professional and two enrolled nurses visited the same points daily.
- At the main clinic in Tsakane owned by the Brakpan local authority, provincial nurses worked on one side of the building rendering curative services, and local authority nurses had responsibility on the other side for preventive and promotive services, treatment of tuberculosis and sexually transmitted diseases. The fact that the curative side was always busy was easily noticable as there was a common waiting room.
This situation in Brakpan was no different from that in many other areas around the country. |
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