Editorial
Commitment to a district-based health system in South Africa stems from a recognition that local people are most attuned to local needs, and that communities have greater say over health care when decisions are made locally and jointly. But over the past few years, it has become clear that the reality of district-based care will not simply occur at the stroke of a pen. Implementation will be slow, gradual, even piecemeal. This in itself is not cause for alarm, and is consistent with the experiences of many other countries which have gone the district route. But what is important, is that momentum towards district-based health care is sustained. The more pieces of the puzzle in place, the clearer the picture becomes - and the easier it is to fill in the remaining gaps.
There are really three major energies sustaining this momentum. The first is the process of clarifying policies and overcoming significant political obstacles. A number of difficult issues have dogged district debate for years - not least the relationship of districts to local government, the form of representation of communities, and discrepant salaries between employees of the state and local authorities. Resolving these issues will smooth the way considerably.
The second energy is provincial restructuring toward districts. Borders are being delineated managers are being appointed financial allocations are being reprioritised. There is movement toward getting systems in place.
But the third energy is just as important, and is often glossed over in assessing progress toward district systems implementation. This energy is found in the efforts of people to bring about real improvements in health care delivery. Clear policies and established structures are necessary, but not sufficient, conditions for district-based health care. They provide the framework. Better service delivery provides the substance of district health care.
This issue of HST Update documents progress towards district systems development from all three angles. First, we examine the policy environment in which district development is occurring, and assess the degree to which outstanding policy issues are being resolved. Second, we guage provincial efforts to restructure health services toward district-based care. Finally, we examine several initiatives which home in on service delivery, and describe how these initiatives help give practical meaning to district-based health care. |
Publications
