Government

The District Health Barometer (DHB) is a collection of health indicators which presents a snapshot of how well the health districts in South Africa provide primary health care to the population. These indicators do not provide any form of complex analysis or in-depth research, yet they point to districts that need improvement and support and likewise to those districts that are doing well. They show how districts are performing relative to one another and relative to their province and the national average.Using the District Health Barometer (DHB), comparisons can now be made between the six metropolitan districts, between the 13 rural node districts or between any districts that are of a similar socio-economic status and size. The purpose of this first District Health Barometer is to function as a tool to monitor progress and support improvement of equitable provision of primary health care, as well as to highlight data irregularities and errors that may occur in the collection and collation of data available in the national District Health Information System. The District Health Barometer Year 1, uses the population figures from the DHIS which are closely based on the Census 1996 and Census 2001 data. In both sets of census data there has been an under-estimation of the number of children under 5 years old. The Department of Health are working together with StatsSA to provide accurate and official population estimates of children under 5 years in each district, and hope to have this work completed by March 2006. These estimates affect especially the immunisation indicators. The next District Health Barometer, which should be available by the end of 2006, will show the corrected immunisation and population figures for 2004 and 2005.

The 2003/04 year has been yet another challenging and rewarding one for HST. On reflection, it has been a year in which HST has shown its ability to successfully adapt to external changes and demands, while remaining true to its mission, and continuing to expand the role and influence of the organisation in South Africa and the region.

This report is an introductory analysis and overview of Public-Private Interactions (PPIs) in the South African health system. It forms part of a broader programme of work looking at decentralisation and health. An output of the Local Government and Health Consortium, funded by Health Systems Trust and comprising Health Systems Trust, Centre for Health Policy and Health Economics Unit

The lack of transport to ensure timeous transfer of patients between levels of health care facilities and for delivery of medicines, vaccines, and other essential equipment is a commonly heard cry from health workers, particularly from those working in rural areas, but is often overlooked and rarely researched. It is essential to have the correct vehicle mix and a sound transport management system to ensure efficient and effective health service delivery. Public sector transport policies and management systems in South Africa are complex. Policy decisions for the management of the national fleet are set by the national Department of Transport, remote from the level of service delivery. The provincial departments of Transport lease vehicles for service delivery to user departments, such as the Department of Health. A Fleet Management Service Provider is contracted to the national Department of Transport to coordinate fuel and oil purchases and maintenance of the national fleet. Management of the national fleet has been identified by the national Department of Transport (NDoT) as not being part of the core business of the department. The policy direction of the NDoT is to outsource the management of the national fleet, (as has been done in the Northern Cape Province), and improve the subsidised car scheme for public servants. How these policy decisions will affect health service delivery is not known, particularly within a decentralised health system. This chapter explores some of the complexities of the present transport management systems for health service delivery within the public sector through three provincial case studies, namely Limpopo, Mpumalanga and Gauteng. Some recommendations for improved management and for further research are made.

There are gaps between policy and practice in primary health care and improving primary level health services is notoriously slow. The Initiative for Sub-district Support (ISDS) has grappled with the dilemma of improving the technical aspects of primary health care delivery, whilst at the same time balancing this with a developmental approach that capacitates local staff. This document is evidence of the success achieved by ISDS in this balancing act. District staff can produce the required outcomes if given time, support, technical guidance and follow-up. This is made possible by the ongoing presence of ISDS facilitators, good working relationships, technical expertise and understanding of districts. The ISDS has been working on two major goals for the past six years. The first is developing and strengthening the district health system and the second is in improving the quality of primary care services. The ISDS has worked in all provinces and in all types of districts ranging from the most well resourced metropolitan districts to the poorest of rural districts. Currently the ISDS is working mainly in the 13 most disadvantaged rural districts in South Africa. This work is part of the Integrated Sustainable Rural Development Programme (ISRDP), a presidential lead project, aimed at improving the lives of the most needy. This document highlights some of the lessons that have been gathered by working with mainly the management structures of the districts and sub-districts, but also from our interactions with senior management at provincial and national level.

The general aim of this study is to provide a cross-sectional, snapshot description of the status of Primary Health Care (PHC) facilities, and to identify changes and developments that could signify relative progress (or lack thereof) towards equity in PHC in South Africa generally and in Mpumalanga particularly, and specifically in the public health sector.

The general aim of this study is to provide a cross-sectional snapshot description of the status of equity in the provision of first level PHC, and to identify changes and developments that could signify relative progress (or lack thereof) towards equity in PHC in the public sector in South Africa generally and Northern Cape in particular.

The general aim of this study is to provide a cross-sectional snapshot description of the status of of first level PHC, and to identify changes and developments that could signify relative progress (or lack thereof) towards equity in PHC provision in the public sector in South Africa generally and in particular, the Northern Province.

The general aim of this study is to provide a cross-sectional, snapshot description of the status of equity in the provision of first level Primary Health Care (PHC), and to identify changes and developments that could signify relative progress (or lack thereof) towards equity in PHC in South Africa generally and in North West particularly, and specifically in the public health sector.

The general aim of this study is to provide a cross-sectional snapshot description of first level PHC, and to identify changes and developments that could signify relative progress (or lack thereof) towards equity in the public sector PHC in South Africa generally and in Western Cape particularly.