HEALTH SYSTEMS TRUST


PRESENTATION TO THE HEALTH PORTFOLIO COMMITTEE: PUBLIC HEARINGS 19TH AUGUST 2003.

Health Systems Trust
Peter Barron

 

CURRENT ORGANISATION OF PRIMARY CARE SERVICES

Personal PHC &Environmental Health Services

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Local government PDOH

A

B

C

Provincial and all categories of Local Municipality, with some fragmentation, duplication and lack of coordination, currently render personal PHC and Environmental Health Services.

 

ENVISAGED ORGANISATION OF PRIMARY CARE SERVICES AFTER HEALTH BILL ENACTED

 

Environmental Health Services (with exception of port health, malaria & hazardous substances) all responsibility of A (metro) and C (district) Municipality. {Delegation to type Bs is possible}

Personal Primary Services all responsibility of Provincial DOH {Delegation to type A & C municipalities is possible}

This is a huge step forward for the organisation of primary health care and for this alone the Bill should be enacted as speedily as possible.

It is critically important for the responsibility and accountability of programmes such as HIV, TB, Sexually Transmitted Diseases and Maternal and Child Health that it is clear who is responsible for setting of clear plans and targets and who is responsible for achieving these.

 

The Bill is written on the long term premise that there is a District Health System under the control of the Local Government Sphere. However, the reality as illustrated above is that the major component of the DHS, viz. personal health services will be under the control of the province.

The mechanism for provinces to decentralise these personal primary health care services to the A and C municipalities, Section 37 (2) is vague.

This has resulted in a number of anomalies and lack of clarity in the Bill that are illustrated below.

 

THE THREE SPHERES OF GOVERNMENT AND THE RESPECTIVE GOVERNANCE AND HEALTH MANAGEMENT STRUCTURES.

GOVERNANCE MANAGEMENT

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At national level the management is under the DG of NDOH (chair of PHRC)

At provincial level the management is under the HOD of the provincial DOH (chair of the PHAC)

At District level the management is not designated. There is no district manager designated by the Bill.

Because of this there is no management structure to advise the DHC on technical issues.

It is not clear who will brief the DHC on planning, budgeting and monitoring issues envisaged in para 36 (3) (b) and 36 (4) (b).

It is not clear what will be the mechanism for the A & C Municipalities to develop district health plans and present these to the MEC for Health in terms of Section 38. This is complicated by the fact that Provinces will be responsible for all personal primary health care services and that no individual is designated as the district health manager.

The date of 31 March as recommended by the Bill for the presentation of plans in terms of Section 38 is too late for the budgetary cycle.

 

RECOMMENDATIONS

  1. A DHAC be set up to give technical input to the DHC
  2. The DHC be responsible for appointing a chair of the DHAC who will have sufficient authority and responsibility for all health services in the district. In other words this person should be the District Health Manager.
  3. These District Health Managers should be members of the PHAC as established in terms of section 30 (2).
  4. Section 37(2) should be written in such a way so as to give greater clarity to the possibility of a province decentralising personal PHC to Local Government.