1. Presentation to Select Committee On Social Services District Health System 16 September 2014

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

3. DISTRICT HEALTH SYSTEM (DHS) South Africa has made much progress with regard to the DHS since the South African Government 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.

4. 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.

5. 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

6. 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)

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

8. Current DHS structure National Department of Health Provincial Department of Health District Health Management District Hospital Sub District Management Clinics Satellite Clinics Mobile ClinicsHealth PostsWBOTs Community Health Centers District Specialist team School Health Teams Health Program Coordinators Support Function Managers

9. 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

11. 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.

12. 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

13. 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

17. DISTRICT HEALTH EXPENDITURE REVIEWS (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

20. 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

21. 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 Approved by NHC July 2014 to address the above

22. Objectives based on Guiding Principles 22 PRINCIPLEOBJECTIVES 1EquityService delivery platform configured in each district in cooperation with the Habitat III project within Department of Human Settlements, based on the demographics and epidemiology of the communities to be served. 2Access To ServicesService delivery platform configured in each district in cooperation with the Habitat III project within Department of Human Settlements, based on the demographics and epidemiology of the communities to be served. Number of primary health care clinics in the 52 districts that qualify as Ideal Clinics 3Overcoming Fragmentation Establish functional district management offices Improve the integration of services at all levels of the health system and between private sector and other government departments to address the social determinants of health

23. Objectives based on Guiding Principles 23 PRINCIPLEOBJECTIVES 4Comprehensive ServicesOrganise health services in the community and in primary health care facilities optimally to meet the Office of Health Standards Compliance (OHSC) standards and to achieve targets set for population health outcomes Ensure that municipalities meet environmental health norms and standards in executing their environmental health functions 5QualityOrganise health services in the community and in primary health care facilities optimally to meet the Office of Health Standards Compliance (OHSC) standards and to achieve targets set for population health outcomes Number of primary health care clinics in the 52 districts that qualify as Ideal Clinics

24. Objectives based on Guiding Principles 24 PRINCIPLEOBJECTIVES 6EffectivenessOrganise health services in the community and in primary health care facilities optimally to achieve targets set for population health outcomes 7EfficiencyWell managed budgets and expenditure at district level 8Community ParticipationEstablish functional clinic committees/ district hospital boards in all primary health care facilities 9Local Accountability/Decentrali zation Establish functional district management offices Well managed budgets and expenditure at district level 10Developmental and Inter-sectoral Approach Improve the integration of services at all levels of the health system and between private sector and other government departments to address the social determinants of health 11sustainabilityEstablish functional district management offices Well managed budgets and expenditure at district level

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