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BUILDING THE DISTRICT HEALTH SYSTEM

BUILDING THE DISTRICT HEALTH SYSTEM. BENNETT ASIA AUGUST 2004. WHAT IS THE DHS?. WHO DEFINITION ( TARIMO, 1991) :

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BUILDING THE DISTRICT HEALTH SYSTEM

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  1. BUILDING THE DISTRICT HEALTH SYSTEM BENNETT ASIA AUGUST 2004

  2. WHAT IS THE DHS? • WHO DEFINITION (TARIMO, 1991) : A DHS BASED ON PHC IS A MORE OR LESS SELF-CONTAINED SEGMENT OF THE NHS. IT COMPRISES A WELL DEFINED POPULATION LIVING WITHIN A CLEARLY DELINEATED ADMINISTRATIVE AND GEOGRAPHIC AREA AND INCLUDES ALL HEALTH ACTIVITIES IN THE AREA, BOTH PUBLIC AND PRIVATE District health system.Dbn_May 2003

  3. WHY THE DHS? • VEHICLE TO RENDER PHC • BEST ABLE TO ELIMINATE FRAGMENTATION AND DUPLICATION • ALLOWS INTERSECTORAL COLLABORATION • CLOSEST LEVEL TO THE PEOPLE – ABLE TO ASSESS & MEET NEEDS & ACCOUNTABILITY District health system.Dbn_May 2003

  4. STRATEGY TO IMPLEMENT THE DHS • BOUNDARIES OF HEALTH DISTRICTS TO BE COTERMINOUS WITH METROS AND DISTRICT MUNICIPALITIES • MAY DEMARCATE SUB-DISTRICTS – ONE OR MORE LOCAL MUNICIPALITY • ESTABLISH AND DEVELOP GOVERNANCE BODIES (DHCs/PHC) TO PROVIDE POLITICAL LEADERSHIP District health system.Dbn_May 2003

  5. STRATEGY CONTD • ENSURE CURRENT SERVICE DELIVERY BY MUNICIPALITIES BUT ELIMINATE FRAGMENTATION AND DUPLICATION, USING DATA FROM THE DHIS & OTHER SOURCES, THROUGH: • (A) FUNCTIONAL INTEGRATION (JUNE 03); AND • (B) SERVICE LEVEL AGREEMENTS (JULY 03) • (C) DISTRICT HEALTH PLANS (SEPT 03); District health system.Dbn_May 2003

  6. STRATEGY CONTD • PHC (MINUS MHS) A PROVINCIAL FUNCTION • DEFINITION OF MHS EQUATES TO A LIST OF EH SERVICES • MHS ALLOCATED TO METROS AND DISTRICT MUNICIPALITIES • DISTRICT MUNCIPALITIES MAY DELEGATE MHS FUNCTION TO LOCAL MUNICIPALITIES • PROVINCES MAY DELEGATE OTHER PHC SERVICES TO METROS AND DISTRICT MUNICIPALITIES District health system.Dbn_May 2003

  7. ROLE OF DISTRICT HOSPITALS? • IN MANY PARTS OF THE COUNTRY PROVIDE BOTH LEVEL 1 AND PHC SERVICES • PROVISION OF PHC SERVICES NOT APPROPRIATE IN GENERAL BUT MAY BE CHEAPER AND IMPROVE ACCESS IN SOME • GATEWAY CLINICS AND SELF STANDING COST CENTRES PREFERRED District health system.Dbn_May 2003

  8. DISTRICT HOSPITALS • PRINCIPLE • PATIENT MUST EXPERIENCE A SEAMLESS HEALTH SYSTEM BUT DISTRICT HOSPITALS SHOULD NOT BE DELEGATED TO LOCAL GOVERNMENT • QUESTION IS: WHAT WE MEAN BY SEAMLESS AND HOW TO OPERATIONALISE THIS GIVEN THE PRINCIPLE? District health system.Dbn_May 2003

  9. DISTRICT HOSPITALS • KEY ISSUES: • ONE MANAGEMENT FOR BOTH PHC AND DISTRICT HOSPITAL • SEPARATE MANAGEMENT • CLEAR STANDARD OPERATING PROCEDURES • BUDGET & RESOURCE HOLDING; • REFERRAL SYSTEMS; • MECHANISMS OF SUPPORT FOR PHC; • ETC District health system.Dbn_May 2003

  10. ROLE OF DISTRICT MANAGERS • Understand functionality of health system • Influence policy formulation based on best practice models • Develop a system which is responsive to patient/family needs • Provides an integrated seamless service • Cinderella service District health system.Dbn_May 2003

  11. SOME STATS • PHC p/c spending =R114 vs R300 • PHC utilisation rate: 1.9 visits p/a • Supervision: 20% • Cross boundary rural nodes not prioritised for extras • Unsure about step down policy District health system.Dbn_May 2003

  12. CONCLUSIONS • HAVE THE BUILDING BLOCKS IN PLACE • NEED CLEAR LINES OF COMMUNICATION AND ROADMAP FOR DISTRICT DEVELOPMENT (MUST BE WRITTEN DOWN AS POLICY FOR IMPLEMENTATION) • STAKEHOLDERS MUST FEEL PART OF PROCESS • POLITICIANS & COMMUNITIES MUST HOLD MANAGERS RESPONSIBLE FOR IMPLEMENTATION District health system.Dbn_May 2003

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