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SOUTH AFRICAN EXPERIENCE, IMPLEMENTATION OF DISTRICT HEALTH SYSTEM

SOUTH AFRICAN EXPERIENCE, IMPLEMENTATION OF DISTRICT HEALTH SYSTEM. CAMBRIDGE INTERNATIONAL HEALTH LEADERSHIP PROGRAMME, 21 – 28 APRIL 2004. ABOUT SOUTH AFRICA. POPULATION SIZE: 45 Million 9 provinces, and 9 provincial departments of health, each with health minister

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SOUTH AFRICAN EXPERIENCE, IMPLEMENTATION OF DISTRICT HEALTH SYSTEM

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  1. SOUTH AFRICAN EXPERIENCE, IMPLEMENTATION OF DISTRICT HEALTH SYSTEM CAMBRIDGE INTERNATIONAL HEALTH LEADERSHIP PROGRAMME, 21 – 28 APRIL 2004

  2. ABOUT SOUTH AFRICA • POPULATION SIZE: 45 Million • 9 provinces, and 9 provincial departments of health, each with health minister • Public sector dependent population: 82% • Area (square km): 1 219 090 • Population density (people per sq km): 34.4 • GDP on Health: 7,4%

  3. DISTRICT HEALTH SYSTEM (DHS) AND PRIMARY HEALTH CARE (PHC) • DESCRIPTION OF POLICY: Provision of primary health care through health districts which are co – terminous with boundaries of municipalities. 2. OBJECTIVES • Provision of comprehensive primary health care package through the DHS. • Development of district health plan that is part of Integrated development plan of the municipality.

  4. OBJECTIVES CONTINUED • Management of effective non – hospital PHC as close to the community as possible, to ensure local accountability. • Joint funding from municipalities (local govt) and provincial health department. • A single health budget with clear budget lines/components.

  5. IMPLEMENTATION • District management teams put in place consisting at least of District manager, & managers for Community Health Services and for Administration. • Put district hospital under control of district manager, to ensure that it becomes part of DHS, and supports clinics and health centers. • Governance structures put in place - clinic committees and district health forums. • Classification of each district as cost centers for good financial management.

  6. WHAT WENT WELL • Reduction of burden on hospitals – community awareness about role of non – hospital/PHC. • Community participation, through governance structures became more pronounced. • Financial accountability improved resulting from creation of cost centers. • A health information system that supports DHS successfully implemented. • Clinics and health centers benefited from support provided by district hospitals.

  7. WHAT CREATED DIFFICULTIES • The policy on DHS was not supported by passing of supporting national legislation. • Resulting in inconsistencies - each province introducing own legislation. • Disparate approaches btw provincial health departments and municipal government -functional integration has not been fully achieved. • Appropriately costed funding of PHC has not been fully achieved. • District Health Expenditure reviews have been recently introduced.

  8. LESSONS LEARNT? • Where policy is not supported by a legislative framework, this creates implementation difficulties. • Communication of policy is as important as policy development itself – impacts on effectiveness of implementation. • Management capacity to implement policy is integral to success. • Costing of policy initiatives should precede or at least accompany implementation.

  9. END – THANK YOU.

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