Publications
HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

The majority of South Africans depend on the public health service for their health care. For most, the primary care facility is the first point of interaction with the public health service. Historically, the standard of care in these facilities has been poor, causing patients to delay seeking care or bypass primary care facilities and report directly to hospitals.

The main vehicle through which the government plans to improve the primary health care system is the health district. In most provinces, district structures which will facilitate primary health care delivery are beginning to take shape. Boundaries have been delineated. District managers are being appointed. Different administrative authorities are being integrated. But in this process, two major challenges have emerged. The first is the challenge of implementation, that is, to translate provincial commitment and administrative reorganisation into real improvements in health care delivery at local level. The second is to develop effective community participation in health service planning, management and provision.

The Department of Health at national and provincial level is clearly committed to district systems development as a means of improving primary health care. An injection of support from the bottom-up, aimed at strengthening local capacity to effect real changes in health care delivery and to involve communities in that process, will enhance the efforts of the Department. Without a deliberate, systematic programme of support to sub-district health services, districts may remain as administrative entities, rather than agents of better health care. With support, sub-districts can become the engines of health care reform, driven by motivated health workers and communities equipped to respond to local health priorities.