level health services

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 delivery of good quality primary level services to all people in South Africa is one of the key policy principles of the post-apartheid national health system.