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.

Introduction

The devolution of primary health care delivery to local government (LG) means that inter-governmental relations are emerging as a critical issue in the transformation of South Africa's health system. The role of contracts or service agreements 1 in helping to define the nature of these inter-governmental relationships is important and complex. On the one hand, most existing contracts for health care services in South Africa are recognised as having had limited success (see Box 1), suggesting a need to approach their use with some caution. On the other hand, when large sums of money are transferred to LG for the delivery of Primary Health Care (PHC), it is desirable to have some type of contract specifying what these funds should be used for.

This document reflects on the nature of inter-governmental relationships, the type of contract most likely to be appropriate in helping to define and control them, as well as some of the potential pitfalls of an overly zealous' approach to contracting for a service such as primary health care. In addition to the type, design and content of contracts, three other issues are highlighted.

First, the importance of the process in developing contracts or agreements. Second, the link between inter-governmental contracts and the integration and co-ordination of the health system as a whole. Third, the link between inter-governmental contracts and the philosophy and principles of the Primary Health Care Approach.