presentation to the portfolio committee on health

PRESENTATION TO THE PORTFOLIO COMMITTEE ON

HEALTH

THE DISTRICT HEALTH SYSTEM AND LOCAL GOVERNMENTDR YOGAN PILLAY (ACTING CLUSTER

MANAGER: DHS & DEVELOPMENT)

Parliamentary.Portfolio Committee_June2003

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WHAT IS THE DHS?

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


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DHS:RATIONALE

• PART OF THE NATIONAL HEALTH SYSTEM

• VEHICLE TO DELIVER PHC IN INTEGRATED AND NON-FRAGMENTED MANNER


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RATIONALE CONTD

UNGER & CRIEL (1995)

DISTRICT CONCEPT DERIVES FROM TWO RATIONALES…THE IMPLEMENTATION OF THE PHC STRATEGY, REQUIRING DECENTRLAISED MANAGEMENT, (AND) THE ORGANISATION OF INTEGRATED SYSTEMS WHICH IMPLIES THAT ONE SINGLE TEAM MANAGES THE DISTRICT HOSPITAL AND CLINICS


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PRINCIPLES

• EQUITY• OVERCOME FRAGMENTATION• ELIMINATE DUPLICATION• COMPREHENSIVE SERVICES• EFFECTIVENESS & EFFICIENCY• QUALITY• IMPROVED ACCESS• LOCAL ACCOUNTABILITY & COMM PARTICIPATION• DEVELOPMENTAL AND INTERSECTORAL• SUSTAINABILITY


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STRATEGY

• A POLICY FOR THE DISTRICT HEALTH SYSTEM FOR SOUTH AFRICA (DECEMBER 1995)

• NATIONAL DHS COMMITTEE

• PROVINCIAL DHS COMMITTEES

• REGIONS (ALIGNED WITH LG)

• DISTRICTS (ALIGNED WITH LG)


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IMPLEMENTATION (BY 2000)

• ALL PROVINCES ESTABLISHED HEALTH REGIONS WITH REGIONAL MANAGEMENT

• 174 HEALTH DISTRICTS ESTABLISHED

• MANY PROVINCES APPOINTED DISTRICT MANAGERS (OTHERS INTERIM/ACTING MX)


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IMPLEMENTATION CONTD

• OPERATIONAL PLANS DEVELOPED

• SOME FUNCTIONAL INTEGRATION WITH LG FACILITIES

• ANNUAL DHS COMPETITION COMMENCED IN 1998

• ISRDP – R 30 M CONTRACT

• UR – AUDIT OF SERVICES

• CROSS BOUNDARY MUNICIPALITIES


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CURRENT STATUS & NEXT STEPS (2000 - )

• LOCAL GOVERNMENT REORGANISED IN DECEMBER 2000 (BOUNDARIES, NEW COUNCILS)

• HEALTH DISTRICTS REALIGNED WITH METROS AND DISTRICT MUNICIPALITIES

• MUNICIPAL HEALTH SERVICES DEFINED – ENVIRONMENTAL HEALTH SERVICES (FUNCTION OF METROS AND Cs)


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DISTRICT DEVELOPMENT: PROGRESS ON SELECTED ISSUES – APRIL 2003

PROVINCE DISTRICTS SUB-DISTRICTS

DISTRICT MANAGERS

SLA PHC DHCs

EC 8 25 19 Appointed6 Acting

Signed Established 5

FS 5 None 5 Signed Established 5

GP 6 27 3 Signed Established 2 Interim

KZN 11 50 11 No No No

LP 6 26 6 No Established No


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PROVINCE DISTRICTS

SUB-DISTRICTS

DISTRICT MANAGERS

SLA PHC DHCs

MP 3 16 3 No Established

3

NC 5 None 5 No Established

No

NW 4 22 4 No Established

No

WC 6 24 None Signed Established

Inter-governmentalCouncil - metro

TOTAL 54 190 62 2 provinces

8 provinces

15 of 54 districts


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TABLE: PHC FACILITIES BY TYPE PER PROVINCE, DHIS

PROVINCE CHC CLINIC MOBILE DISTRICT HOSPITALS

POPULATION

EASTERN CAPE

28 679 142 63 7 130 427

FREE STATE

16 241 123 25 2 857 519

GAUTENG 22 293 59 7 8 641 635

KZN 13 489 144 39 9 215 201


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PROVINCE CHC CLINIC MOBILE DISTRICT HOSPITALS

POPULATION

LIMPOPO 25 382 111 33 5 424 585

MPUMALANGA

29 228 99 18 3 537 334

NORTH WEST

56 304 95 16 3 085 164

NORTHERN CAPE

17 83 62 24 961 353

WESTERN CAPE

75 264 141 28 4 314 196


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CURRENT ACTIVITIES

• STATUS QUO REMAINS RE: SERVICE PROVISION AND FUNDING

• DISCUSSION WITH NT RE: R1,5 B

• SINGLE PUBLIC SERVICE

• FUNCTIONAL INTEGRATION WITH SLAs AS TRANSITION MEASURE

• DISTRICT HEALTH PLANNING

presentation to the portfolio committee on health

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