1. PRESENTATION TO THE PORTFOLIO COMMITTEE ON HEALTH
THE DISTRICT HEALTH SYSTEM AND LOCAL GOVERNMENT
DR YOGAN PILLAY (ACTING CLUSTER MANAGER: DHS & DEVELOPMENT)

2. Parliamentary.Portfolio Committee_June2003
WHAT IS THE DHS?
TARIMO (1991)
A DHS BASED ON PHC IS A MORE OR LESS SELF-CONTAINED SEGMENT OF THE NHS. IT COMPRISES A WELL DEFINED POPULATION LIVING WITHIN A CLEARLY DELINEATED ADMINISTRATIVE AND GEOGRAPHIC AREA AND INCLUDES ALL HEALTH ACTIVITIES IN THE AREA, BOTH PUBLIC AND PRIVATE
Parliamentary.Portfolio Committee_June2003

3. Parliamentary.Portfolio Committee_June2003
DHS:RATIONALE
PART OF THE NATIONAL HEALTH SYSTEM
VEHICLE TO DELIVER PHC IN INTEGRATED AND NON-FRAGMENTED MANNER
Parliamentary.Portfolio Committee_June2003

4. Parliamentary.Portfolio Committee_June2003
RATIONALE CONTD
UNGER & CRIEL (1995)
DISTRICT CONCEPT DERIVES FROM TWO RATIONALES…THE IMPLEMENTATION OF THE PHC STRATEGY, REQUIRING DECENTRLAISED MANAGEMENT, (AND) THE ORGANISATION OF INTEGRATED SYSTEMS WHICH IMPLIES THAT ONE SINGLE TEAM MANAGES THE DISTRICT HOSPITAL AND CLINICS
Parliamentary.Portfolio Committee_June2003

5. Parliamentary.Portfolio Committee_June2003
PRINCIPLES
EQUITY
OVERCOME FRAGMENTATION
ELIMINATE DUPLICATION
COMPREHENSIVE SERVICES
EFFECTIVENESS & EFFICIENCY
QUALITY
IMPROVED ACCESS
LOCAL ACCOUNTABILITY & COMM PARTICIPATION
DEVELOPMENTAL AND INTERSECTORAL
SUSTAINABILITY
Parliamentary.Portfolio Committee_June2003

6. Parliamentary.Portfolio Committee_June2003
STRATEGY
A POLICY FOR THE DISTRICT HEALTH SYSTEM FOR SOUTH AFRICA (DECEMBER 1995)
NATIONAL DHS COMMITTEE
PROVINCIAL DHS COMMITTEES
REGIONS (ALIGNED WITH LG)
DISTRICTS (ALIGNED WITH LG)
Parliamentary.Portfolio Committee_June2003

7. Parliamentary.Portfolio Committee_June2003
IMPLEMENTATION (BY 2000)
ALL PROVINCES ESTABLISHED HEALTH REGIONS WITH REGIONAL MANAGEMENT
174 HEALTH DISTRICTS ESTABLISHED
MANY PROVINCES APPOINTED DISTRICT MANAGERS (OTHERS INTERIM/ACTING MX)
Parliamentary.Portfolio Committee_June2003

8. Parliamentary.Portfolio Committee_June2003
IMPLEMENTATION CONTD
OPERATIONAL PLANS DEVELOPED
SOME FUNCTIONAL INTEGRATION WITH LG FACILITIES
ANNUAL DHS COMPETITION COMMENCED IN 1998
ISRDP – R 30 M CONTRACT
UR – AUDIT OF SERVICES
CROSS BOUNDARY MUNICIPALITIES
Parliamentary.Portfolio Committee_June2003

9. CURRENT STATUS & NEXT STEPS (2000 - )
LOCAL GOVERNMENT REORGANISED IN DECEMBER 2000 (BOUNDARIES, NEW COUNCILS)
HEALTH DISTRICTS REALIGNED WITH METROS AND DISTRICT MUNICIPALITIES
MUNICIPAL HEALTH SERVICES DEFINED – ENVIRONMENTAL HEALTH SERVICES (FUNCTION OF METROS AND Cs)
Parliamentary.Portfolio Committee_June2003

10. DISTRICT DEVELOPMENT: PROGRESS ON SELECTED ISSUES – APRIL 2003
PROVINCE
DISTRICTS
SUB-DISTRICTS
DISTRICT MANAGERS
SLA
PHC
DHCs EC 8 25
19 Appointed
6 Acting
Signed
Established 5 FS
None GP 6 27 3
2 Interim
KZN 11 50 No LP 26
Parliamentary.Portfolio Committee_June2003

11. Parliamentary.Portfolio Committee_June2003
PROVINCE
DISTRICTS
SUB-DISTRICTS
DISTRICT MANAGERS
SLA
PHC
DHCs MP 3 16 No
Established NC 5
None NW 4 22 WC 6 24
Signed
Inter-governmental
Council - metro
TOTAL 54
190 62
2 provinces
8 provinces
15 of 54 districts
Parliamentary.Portfolio Committee_June2003

12. TABLE: PHC FACILITIES BY TYPE PER PROVINCE, DHIS PROVINCE CHC CLINIC
MOBILE
DISTRICT HOSPITALS
POPULATION
EASTERN CAPE 28
679
142 63
FREE STATE 16
241
123 25
GAUTENG 22
293 59 7
KZN 13
489
144 39
Parliamentary.Portfolio Committee_June2003

13. Parliamentary.Portfolio Committee_June2003
PROVINCE
CHC
CLINIC
MOBILE
DISTRICT HOSPITALS
POPULATION
LIMPOPO 25
382
111 33
MPUMALANGA 29
228 99 18
NORTH WEST 56
304 95 16
NORTHERN CAPE 17 83 62 24
WESTERN CAPE 75
264
141 28
Parliamentary.Portfolio Committee_June2003

14. Parliamentary.Portfolio Committee_June2003
CURRENT ACTIVITIES
STATUS QUO REMAINS RE: SERVICE PROVISION AND FUNDING
DISCUSSION WITH NT RE: R1,5 B
SINGLE PUBLIC SERVICE
FUNCTIONAL INTEGRATION WITH SLAs AS TRANSITION MEASURE
DISTRICT HEALTH PLANNING
Parliamentary.Portfolio Committee_June2003