About ISDS

The Initiative for Sub-District Support (ISDS) was established as a program of the Health Systems Trust (HST) in 1996. At that time it was recognized that the newly democratic elected government had embarked on major health systems reform with emphasis on the implementation of a National District Health System (DHS) and that whilst there were &lsquogood&rsquo health systems policies, the implementation of these policies to improve quality of care needed support.

The ISDS was therefore set up to support the implementation of Primary Health Care (PHC). This is accepted as the foundation of the South African health system and the District Health System is the vehicle through which it is implemented and managed.

The ISDS aims to demonstrate improved standards of PHC by providing sustained, systematic and comprehensive support to selected sub-districts. The ultimate aim is to provide technical support and assistance to the Department of Health&rsquos mission of developing an equitable, efficient and effective health service for all.

In order to achieve this, the ISDS supports the public sector delivery of comprehensive primary health care through

  • Broad health systems development
  • Strengthening of management teams
  • Development of support systems (e.g. drug supply, information systems, planning process)
  • Quality of care interventions in selected priority programmes.

Our Vision

Optimally functioning health districts which contribute to holistic well-being by providing quality care throughout South Africa

Our Mission

We are a dynamic support agent for change, working towards the improvement of the quality of care for all people of South Africa

The ISDS programme aims to:

  • Demonstrate improvements in the quality of health services through sustained, multi-pronged interventions in selected sub-districts in each of the provinces
  • Undertake a review of health and health care, specifically highlighting those factors which most affect the quality of service provision
  • Design and implement a systematic programme of support, aimed at addressing the factors which impact on the quality of care
  • Evaluate the process, document and share lessons learnt with other stakeholders
  • Stimulate a &lsquoknock-on effect&rsquo (system-wide application) to other districts and higher levels of the health system.

Our Principles

The ISDS applies the following principles:

  • All activities take place with and through the public health care system
  • Support is provided to all levels of the health system
  • A bottom-up approach is used with sub-districts being the entry point into the health system
  • All interventions should be sustained and sustainable when the initiative withdraws from a site.
  • All interventions should be replicable
  • The support is a comprehensive approach and aims at strengthening the management teams and is not limited to one or two technical interventions.

The design of ISDS interventions

Starting with a few sub-districts in 1996, the ISDS now works in over 20 sub-districts throughout South Africa and currently focuses mainly in the 13 most disadvantaged rural districts in South Africa, designated as part of the Presidential Lead Project to improve the lives of the most disadvantaged.

The agenda for support and action is defined by the local needs within the site.

Usually one full-time facilitator works in each sub-district. The facilitator builds relationships with the sub-district management team and provides technical support to enable them to prioritise certain health problems and make improvements to these.

It is important to note that the ISDS works independently but through and with the Department of Health

Our style

As part of an independent NGO, the ISDS is able to be:

  • Flexible in response to health system needs,
  • Opportunistic
  • Fast-acting.

Who is ISDS accountable and responsive to?

  • HST Board of Trustees
  • National DoH
  • Provincial DoHs
  • Local municipalities
  • Front-line heath workers
  • Funders
  • The public

Priority Interventions:

ISDS focuses its efforts on the following priority programmes:

  • TB
  • STIs
  • Maternal and Child Health
  • Nutrition


ISDS has been successful in influencing policy in a number of priority areas including:

  • Use of information for management especially in the area of financial management and strategic planning
  • Functional integration of local government and provincial health workers
  • Tools for measuring quality of care (e.g. client satisfaction index STIs)
  • Service Level Agreements for primary health care.