The District Health System (DHS) encourages managers to take charge and make decisions about health services and the allocated resources. The role of the District Management Team (DMT) is to: – Mix and allocate the available resources in the best possible way to meet the basic health needs of the community they serve.
District Health Services In South Africa
PHC at district level
The district health system has been sanctioned as the vehicle for the implementation of primary health care at the community level [5]. However the process of implementing and integrating the health system at district level has been slow and inconsistent with some areas reflecting well functioning health units while other areas have fragmented and poorly coordinated primary health care delivery systems [6].
Inequalities in the coverage and quality of health services, inherent inequities in resource allocation, coupled with the historical burden of disease indicates that provinces and districts are not at the same level of health care delivery.
This is further complicated with the burden of the HIV/AIDS pandemic, emerging infectious and non communicable diseases that places a severe strain on scarce resources. This imbalance in health care delivery, together with a curative driven health system; lack of commitment to preventive and promotive services; and ineffective leadership, will ensure that health inequalities and unmet health need will persist [7-9].
Although the South African experience in implementing primary health care does show some positive impact, in terms of increased access in comparison to the pre-Apartheid health service delivery (pre 1994), various factors still limit its success [10,11].
Some of the identified gaps in implementation include resource constraints; migration of professionals; the unequal distribution of personnel in public and private sectors; low skills levels; poor staff motivation and the lack of managerial capacity [10,12-14].
The critical shortage of key health personnel is an important barrier in the provision, implementation and sustainability of district health services. The widening gap between the public and private health sectors, specifically with regard to coordination and resource allocation are also areas of concern [7].
Disease prevention and health promotion
These factors outlined have important implications for the delivery of district health services. Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met.
At the micro level of health delivery, it is important for all health practitioners to consider the contextual influences on health and ill-health and to recognize the role of the underlying determinants of ill-health, namely, social, economic and environmental influences.
Comprehensive primary care using strategies of the primary health care approach could focus on integrated health care delivery, where individuals and communities are managed holistically. This includes the recognition that chronic diseases as a result of lifestyle practices, will result in a number of disease presentations eg. unhealthy dietary practices are linked to obesity, dental caries, cardiac complications, diabetes, etc.
Thus strategies to address the risks to unhealthy lifestyle practices must recognize the role of optimal oral health and nutritional status in improving overall health outcomes [21]. These would include the need to create supportive environments to promote the selection of healthier choices. The primary health care approach provides a strong framework for this delivery but it is not widely applied.
The primary health care framework also allows for assessment of the quality, appropriateness and impact of service delivery, the identification of gaps, and research development. Healthy living and family self care initiatives will make significant contributions to foster individual and community empowerment if there is a coordinated effort to focus on disease prevention and health promotion.
Who is responsible for establishing district health authorities in South Africa?
The national Department of Health, with the concurrence of the Departments of Finance and Provincial and Local Government have yet to define municipal health services as provided for in the constitution (see later sections for the decisions adopted by the Health Ministers and nine Members of the Executive Council
What does the Department of health do in South Africa?
The mission of the National Department of Health is to improve health status through the prevention of illness, disease and the promotion of healthy lifestyles, and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability
What roles do primary health services play in the health care system in South Africa ?
A primary health care approach includes three components:
meeting people’s health needs throughout their lives;
addressing the broader determinants of health through multisectoral policy and action; and.
empowering individuals, families and communities to take charge of their own health.
What are the roles and responsibilities within the department for health and social care provision in South Africa ?
The Department of Health & Social Care’s (the Department) main objective is to help people to live more independent, healthier lives for longer. The Department sets the overall strategy, funds and oversees the health and social care system with, and through, its 28 agencies and public bodies.