Health care

Local Government Transformation - A guide for health workers

Volume: 
1
Series Name: 
Kwik Skwiz
Published by: 
Health Systems Trust
This Kwik-Skwiz aims to provide an overview of the current situation and future changes in local government. This will assist anyone working within the health sector to understand the changes and to contribute to the transformation process. The overview describes the new responsibilities allocated to local government, the methods being developed to enable local government to function more efficiently, the demarcation process, the new types of municipalities to be introduced, and the changing relationship between local government and the health sector.

Transport management: A key component of effective health care

Volume: 
1
Series Name: 
Kwik Skwiz
Published by: 
Health Systems Trust

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.

Annual Report 1999

Series Name: 
HST Annual Report
Published by: 
Health Systems Trust
The Health Systems Trust continues to make a unique and important contribution to health development in our country. One of the main goals of the Trust is to support the implementation of health policies and strategies aimed at promoting equity, and in the past year, the staff have supported this goal through the development of innovative approaches to the promotion of health equity, and the competent maintenance of the established programmes of the Trust.

South African Health Review 1998

Series Name: 
South African Health Review
Published by: 
Health Systems Trust

The 1998 Review concentrates on equity and attempts to highlight progress that has been made as well as identify blocks to providing equitable public sector services throughout South Africa. Research commissioned specifically for the Review sheds light on the health status of South Africas population and key areas of the health system including finance and expenditure, human resources, information systems, pharmacy, and service delivery in clinics and district hospitals. This is provides a comprehensive, authoritative and independent review of South Africas health system.

In 1998 the greatest inequity remains the difference between those who predominantly use private sector health care and those who do not. Just under one fifth of South Africas population belong to a medical aid scheme, yet this group has access to 85% of pharmacists and 60% of medical specialists working in South Africa.

In the field of public sector spending comparisons of provincial health budgets indicate that great steps forward were made in the years 1995/6 and 1996/7 with most budgets coming closer to the national average. However since that time progress has stagnated, with the gap between expenditure per person in the North West, Mpumalanga and Northern provinces and the national average remaining a cause for concern. Comparisons of spending within provinces indicate that disparities are greater even than those between provinces. In Potchefstroom and Grahamstown Districts for example, for every R4 spent on health services in the public sector, R1 was spent in the Odi and Mount Frere Districts.

With regard to the distribution of health sector personnel, disparities tend to occur between the more urbanised and historically better funded provinces and those which are predominantly rural. For example there are forty nurses per 10,000 population in the Western Cape whereas in the Northern Cape and Mpumalanga there are only 20 and Gauteng has 2000 people to every pharmacist while the comparable figure in the Northern Province is 16000.

A survey of 294 clinics and 84 regional and district hospitals provides information about service delivery and indicates the variations that exist between provinces and between rural and urban facilities. While 100% of clinics in the Northern Cape have all TB drugs available this is true for only 20% of clinics in the Northern Province and HIV testing is available in less than half of clinics in the Eastern Cape, North West, KwaZulu-Natal, and Northern Provinces. The investigation of maternal deaths was used as one of the indicators to measure the quality of care in hospitals and it was found that less than half of hospitals have meetings where infant and maternal deaths are investigated and discussed.

Results of this survey are compared with a survey of clinics undertaken in 1997 and the findings indicate improvements in some areas. Seventy one percent of all clinics have a functioning telephone in 1998 as compared with 63% in 1997 and 83% of clinics provide family planning services on a daily basis in 1998 as compared with 72% in 1997.

The South African Health Review is accompanied by Technical Reports that provide more detail in the areas of financing, the private sector, pharmacy and service delivery in hospitals and clinics.

Measuring the move towards equity - from the site of service delivery

Series Name: 
Facilities Survey
Published by: 
Health Systems Trust
It is important that policies and strategies towards equity in service provision are measured in terms of their impact on health service delivery. This would begin to demonstrate the practical impact of health reform.

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.