Primary health care and District health

1. Primary health careand District health

2. Primary healthcare • Definition • Levels of referral • Free health care – who qualifies? • Physiotherapists are first line practitioners!

3. The district health system in South Africa • Decentralisation and health sector reform: Decentralisation/deconcentration is defined by Bossert as “shifting power from the central offices to peripheral offices of the same administrative structure”. South African case the establishment of provincial regional and district offices for health is an example of decentralisation

4. District health system continued • 'A DHS based on PHC is a more or less self-contained segment of the national health system. It comprises first and foremost a well-defined population living within a clearly delineated administrative and geographic area. It includes all the relevant health care activities in the area, whether governmental or otherwise'

5. 'This level of the health care system should be responsible for the overall management and control of its health budget, and the provision and/or purchase of a full range of comprehensive primary health care services within its area of jurisdiction. Effective referral networks and systems will be ensured through co-operation with the other health districts. All services will be rendered in collaboration with other governmental, non-governmental and private structures'

6. District health information system DHIS are defined as the effective and efficient collection, analysis and evaluation of information relating to characteristics of people and communities, their external milieu (i.e. environmental, soci-cultural economic and available health system) and health affecting intervention at individual and collective levels, so as to enable informed decision making. (Ndimande 2001)

7. Community service to improve access to quality health care to all South Africans • Introduced in 1998 with 26 doctors followed by dentists in 2000 and pharmacists in 2001. In 2003 seven more professions started doing community service, namely, clinical psychology, dietetics, environmental health, occupational health, physiotherapy, radiography and speech, language and hearing therapy.

8. If health professionals decide to go abroad without finishing the community service, they are required to complete the programme within a period of 2 years before being registered by the Medical and Dental Board of South Africa or SA Nursing Council. If they do 6 months before leaving the country, they are only required to do the remaining 6 months. If they leave before 6 months, they are expected to start afresh (do 12 months) when they return.

9. Aim of community service • To improve access to quality health care to all South Africans, more especially in previously under-served areas. • To provide young professionals with an opportunity to develop skills, acquire knowledge, behavior patterns and critical thinking that will help them in their professional development.

11. Key responsibilities 1. Treatment of patients using specialized skills and knowledge to improve their over-all well being and recovery thus ensuring successful rehabilitation of the patients. 2. Co-operating with the multi-disciplinary team of doctors, nursing personnel and other staff members to ensure quality patient care. 3. Supervision and management of physiotherapy assistants and to promote physiotherapy and rehabilitation services in the hospital and community. 4. Educational sessions with the patients, medical staff, the community, caregivers, family , personal development and in service training

12. 5. Availability for after hours services where applicable. 6. Responsible for maintenance of equipment, to report low stock levels, shortages of consumables, malfunction of equipment and to give inputs on budget matters. 7. Effective documentation of all treatments, administrative tasks and statistical data to adhere to the ethical and administrative requirements of the Hospital, Physiotherapy Department and other relevant organizations.