Environment

Since Primary Health Care (PHC) is now accepted as the foundation of health care delivery in South Africa, health districts have become the vehicle through which this health care system will be implemented. One of the main reasons for the establishment of the district health system is to engender a move towards decentralised health management. The basic modus operandi for the management and delivery of health care is through a hierarchical four-tiered structure: i.e. national, provincial, regional and district level. The national Department of Health is responsible for overall co-ordination and determination of national health policy the provincial Departments are responsible for the co-ordination of the health system within each province, for the provision of specialist health services, and for the monitoring and support of districts and the district/regional authorities are responsible for the actual delivery of health care and for the provision of non-specialist health services within each district.

Practical approaches to health promotion within a district.

The purpose of this newsletter is to inform health workers in the Northern Province about developments in the district. It has been produced by the Provincial Health and Welfare department in partnership with the ISDS (Initiative for Sub-district Support), which is a program of the Health Systems Trust.

Lessons for district managers in putting in place an effective communications strategy.Communication strategies for health in South Africa today risk being equated with the installation of computers! This brief highlights two points: First, comprehensive communication strategies need to be thought out very carefully. Second, computerisation of health facilities can be a waste of time and money unless there are clear reasons for use and adequate technical and user support. An approach to developing a communications strategy.

Strategies to strengthen community participation in the Bergville district.Strengthening community participation in health districts remains one of the most difficult aspects of health sector development in South Africa. In this Kwik Skwiz, the Bergville District Management Team describes two strategies which it has found particularly effective.

Steps to address Tuberculosis (TB) systematically in Benede Oranje region.TB has been identified as the most important health problem facing the Benede Oranje region/district in the Northern Cape province. In 1996 the district reported a staggeringly high incidence of 1 160 cases per 100 000 people compared to an estimated 340 cases per 100 000 people for the rest of the province (Tuberculosis Research Programme, MRC). ISDS has been working with the district in an effort to reduce the incidence of TB. Although long-term solutions to the problem will depend on poverty reduction and improvements in living conditions, the district team believes that their first task is to ensure an efficient district level TB control programme.

Report on visit to Isinamva in Mount Frere