The development of the District Health System in South Africa: Lessons Learned from the Experience of ISDS: Technical Report 5
Will districts become effective vehicles for improving the quality of care, or expensive paper-shuffling machines? Will district management teams walk an interminable treadmill, or slowly, but surely improve the quality of care? These are the niggling and uncomfortable questions that motivate participants in the Initiative for Sub-District Support (ISDS).
Over the past year, the ISDS has tried to develop systematic processes of support to management teams in selected districts in South Africa, aimed at strengthening their ability to improve the quality of health care. Through this experience, we hope to be able to share lessons with other districts to create a positive spin-off effect, demonstrate the process of district development, and pinpoint persistent obstacles.
What really improves the quality of primary health care? A review of local and international experience: ISDS Technical Report 3
Step-by-step approach to implementing an effective transport management system.Transport is not only an expensive resource, but is also critical to effective health care delivery. A lack of transport and the poor use of existing vehicles can lead to problems such as poor supplies of drugs to clinics, inadequate supervision of clinic staff, difficulties in referring patients between facilities, infrequent visits to schools by the school health team, and a lack of community outreach health services or mobile clinic services. The ISDS experience suggests that it is imperative for district health services to focus on developing good management for transport.
In an attempt to measure in part the progress (or lack of progress) towards equity one step would be to measure the quality of service provision at the community (primary care) level. This would give an overview of the disparities between as well as in provinces, and between rural, urban and peri-urban parts of the country.
Paying for health care: a comprehensive primary health care approach - alternative to national health insurance
The South African Health Review 1996 documents the degree to which structural reform and policy formulation within the health sector has translated into real improvements in service delivery and the quality of peoples lives. In sum, the Review reveals a mixed scorecard. Progress has been excellent in some areas, whereas others show little movement. This, the Review argues, is the nature of health reform.