Presentation to Select Committee On Social Services District Health System Jeanette R Hunter 30 July2013

CONTENT  DHS in brief  District Hospitals  Integration  Key indicators  Areas that require strengthening

DISTRICT HEALTH SYSTEM (DHS) South Africa has made much progress with regard to the DHS since the South African Government of National Unity, through its adoption of the Reconstruction and Development Programme (RDP) in 1994, committed itself to the development of a District Health System based on the Primary Health Care Approach as enunciated at Alma Ata in 1978.

DISTRICT HEALTH SYSTEM (DHS) A National Health System based on this approach is as concerned with keeping people healthy, as it is with caring for them when they become unwell. These concepts of “caring” and “wellness” are promoted most effectively and efficiently by creating small management units of the health system, adapted to cater for local needs. These units provide the framework for our district-based health system.

RATIONALE FOR THE DHS DHS delivering quality PHC services Overcome fragmentation Equity Access and Quality Comprehensive services Effective and efficient Local accountability Community participation Developmental and intersectoral approach sustainability

Health System Jeanette R Hunter Other sectors Public Health Care System Private, Traditional medicine, NGO, Ancillary (Ayurvedic, Homeopathic, etc) Private, Traditional medicine, NGO, Ancillary (Ayurvedic, Homeopathic, etc) Human Settlement, Water, Sanitation, Agriculture, Education, Social Dev, Public Works, Eskom FUNCTIONSFUNCTIONS OUTPUTSOUTPUTS OUTCOMESOUTCOMES WHO Ministry of Health, NDoH Provincial Health Depts Health District CHWs, mobile clinics, satellite clinics, clinics, CHC, District Hospitals, School Health Teams, DCSTs Communities’ Health and Wellness COMMUNITYH&WCOMMUNITYH&W

DHS IN SOUTH AFRICA Our health system, currently structurally consisting of:  National department of health  9 provincial departments of health  52 health districts Through our primary health care reengineering initiative firmly committed to the District Health System with a focus on primary health care (PHC)

DISTRICT HOSPITALS  The district hospital plays a pivotal role in supporting primary health care on the one hand and being a gateway to more specialist care on the other  Size of District Hospitals  small district hospitals with no less than 50 beds and no more than 150 beds  medium size district hospitals with more than 150 beds and no more than 300 beds  large district hospitals with no less than 300 beds and no more than 600 beds.  In some circumstances primary health care services are rendered where there is no alternative source of this care within a reasonable distance.

INTEGRATION WITH REGARD TO DISTRICT HOSPITALS  Integration on two levels  integration between higher level and PHC facilities from community level  Integration within the District Hospital

INTEGRATION BETWEEN PHC FACILITIES FROM COMMUNITY LEVEL  Ward Based Outreach Teams  Health Posts  Mobile Clinics  Satellite Clinics  Clinics with sessional GP support  School Health Teams  Community Health Centers  District Hospital  Regional hospital  Tertiary hospital  Central hospital  Specialized hospital District Clinical Specialist Teams Optimally functioning referral system

INTEGRATION WITHIN DISTRICT HOSPITALS  This is the smallest type of hospital providing generalist medical services  Package of service includes:  Health Promotion and Preventative care  Trauma and Emergency Care  Obstetrics and Gynaecology  Paediatrics and Child Health  General Surgery  Oral Health  Eye Care  Care of the elderly  Mental Health  Occupational Health  Rehabilitation  Except for labour and maternity wards, district hospitals do not have discipline specific wards. Patients are cared for in female, male and children’s wards.  Family physicians (specialist generalist), supported by nurses and other members of the multidisciplinary team provide comprehensive holistic care.  Patients are referred to discipline specific specialists at a higher level when their condition requires

KEY DISTRICT HOSPITAL INDICATORS  The following slides contain key indicators from the 2011/12 District Health Barometer  Usable bed utilisation  Average Length of stay  Usable beds per 1000 uninsured population  Expenditure per patient day equivalent

DHER  presents a clearer picture of funding, distribution and use of health resources in the District and the province  is a diagnostic tool to assess to what extent allocation (budget) and use of resources (expenditure) advance the district and province objectives of:  Access  Quality  Efficiency  Equity  Sustainability

AREAS REQUIRING FURTHER STRENGTHENING  Services and Service Delivery platform  Health Information Management and Use  Human resources  Pharmaceuticals, equipment and medical supplies  Finances  Governance and leadership  Community ownership  Partnerships for health National DHS Strategy to address the above

Thank you