ANNEXURE 2 - DISTRICT HEALTH SYSTEM - …

1 27 ANNEXURE 2 - DISTRICT HEALTH SYSTEM Situation analysis The delivery of PHC services remains dependant on the DHS. However, the Province has an outstanding task of defining the role of Local Government in delivery o Primary HEALTH Care. The National HEALTH Act, Act No. 61 of 2003 defines Municipal HEALTH services as Environmental HEALTH services excluding port HEALTH , malaria control and control of hazardous substances. The 13 February 2001 MINMEC resolved that provinces must: Establish a Provincial HEALTH Authority and Provincial HEALTH Advisory Committee Establish DISTRICT HEALTH Authorities and Community HEALTH Committees Ensure planning and coordination of delivery of a comprehensive and integrated DISTRICT HEALTH services Delegate the delivery of primary HEALTH care services where appropriate capacity.

2 Support and resources exist Develop services agreements with clear performance indicators between province and municipalities/districts Audit all HEALTH care resources in each DISTRICT or metropolitan area Provide support for development of DISTRICT based service plans. The Province has continued to use the DHS to facilitate the implementation of PHC. The decentralisation of services has taken a form of de-concentration with DISTRICT Management structures reporting to the provincial office.

3 The provincial Department of HEALTH has finally decided to keep the delivery of Primary HEALTH Care as a provincial competence as stipulated in the National HEALTH Act, Act No. 61 of 2003, several municipalities will enter into a service level agreement with the Department for rendering primary HEALTH care. Whilst the DHS by definition is limited to DISTRICT Hospital Services and Primary HEALTH Care, the Provincial Department of HEALTH gave it a broader meaning. For KwaZulu- Natal purposes, the DHS relates to all HEALTH services that operate within a DISTRICT .

4 This is inclusive of all PHC, hospital services, emergency medical and rescue services. The aim of this programme is to improve the HEALTH status of all individuals living within a DISTRICT . The following sub-programmes will be discussed under Programme 2. DISTRICT Management Community HEALTH Clinics Community HEALTH Centres Community Based Services Other Community Services HEALTH promotion strategies including HEALTH information, education and counselling are implemented at DISTRICT level supported by Provincial HEALTH Programmes.

5 The DHS draws its priorities and plans from the Department s Strategic Goals. These are Effective implementation of the comprehensive HIV and AIDS strategy Strengthen Primary HEALTH Care and provide caring, responsive and quality HEALTH services at all levels 28 Promote HEALTH , prevent and manage illnesses with emphasis on poverty, lifestyle, trauma and violence Human resource management for Public HEALTH Infrastructure investment in HEALTH technology, communication, management information systems and buildings Demographic Profile Approximately 88% of the population of KwaZuluNatal is uninsured and thus relies on the Public HEALTH services for HEALTH care.

6 Although fifty-three percent (53%) of the population is urbanised, a high proportion of this live in underdeveloped informal settlements. The rest of the communities reside in deep rural and rural settlements. The sparse settlement pattern found in these areas poses a challenge in improving access to HEALTH care at DISTRICT level. The mountainous topography, with deep valleys, compounds the challenge of making services accessible. Cross border flows occur at Sisonke, Ugu (1,4% of Eastern Cape population) as well as at Zululand and Umkhanyakude Districts ( 30 000 Mozambique population and 15 000 Swaziland population respectively).

7 This poses further challenges for DISTRICT HEALTH Service provision. HEALTH service demand is also increased by the disease burden emanating from relatively high poverty levels and unemployment. Backlogs in the provision of water, sanitation and housing contribute to the morbidity profile at DISTRICT level. Appraisal of Service Performance Since 1994, 125 additional clinics have been built and the access to services has improved 236 clinics to date and the headcount has increased from 16 313 406 in 2001/2002 to 18 411 276 in 2003/2004.

8 The relationships between Provincial and Local Government HEALTH Service Managers are being strengthened through joint planning and service monitoring processes at DISTRICT and Local Municipality level. Although the service packages are not fully implemented with 80% of the package being implemented Provincially training of staff to expand the programme is under way and planned for the financial year. Improving access through additional Community HEALTH Workers, Community-Based Lay Counsellors, Home-Based Carers and Mobile Teams is essential given the terrain in the Province.

9 Although the average population per fixed PHC clinic was reduced to 17 379 across the Province in 2003/2004 this will have to be addressed through additional facilities in order to reach the national norm of 10 000 population per facility. Recruitment and retention of staff especially to facilitate provision of 24-hour services in rural areas will increase the financial demands at DISTRICT level. This will reduce the referrals to higher levels of care, long queues and improve access to the community with accompanied lower costs per visit.

10 Programme development TB, STI, HIV and AIDS, Chronic Diseases, as well as Mental HEALTH will have to be given priority in order to enhance the quality of life of the Districts populations. The expansion in the MCWH and HEALTH Promotion Programmes will be critical in order to address the needs of women and children both at community level and through the HEALTH Promoting Schools Programme given the gaps in performance against National Targets. The resourcing of these Programmes has financial implications.