National Health Service

In this issue we outline activities that should be part of the routine functions of the district health management team, led by the district manager. Given that there are four outcomes in the National Health Service Delivery Agreement (NSDA) that the Minister signed with the President and with all the MECs for Health, these priorities must be implemented at every level of the health system. These priorities are:

• Improve life expectancy

• Decrease the burden of disease from HIV and TB

• Decrease infant, child and maternal mortality rates

• Improve the effectiveness of the health system

Community service has been described by some as a thoroughly worthwhile undertaking, while others describe it as a burden, a blot on their careers and private lives. As with most undertakings in life, there have been positive and negative aspects to this year for me, and the truth of the experience probably lies somewhere between these two extremes.

As the wheels of health care reform move, so should the training curricula for health workers. Various authors have a number of times stated that the nurse is the single most important frontline health worker in a clinic setting. Without the nurses intervention the health care centre/clinic cannot function adequately. It is therefore critical that nurse education and the supply of nurses form an integral part of teh transformation of health services in South Africa. This months issue is dedicated to nurse training with particular focus on the district health system (DHS). In a nutshell the DHS is the best vehicle for delivering primary health care (PHC) since it promotes collaboration between all sectors and reduces fragmentation and duplication of services. Questions such as, are nurses adequately prepared for current health care reforms? are considered in this Update. The current gaps in training, suggestions and recommendations to address these are revisited. Selected key participants in nurse education from the level of the South African Nursing Council (SANC) to nurses themselves, share their views and experiences in this Update.

Lessons for the implementation of the Essential Drugs Programme within districts.Nurses are the frontline health providers for most people in South Africa today. Many nurses feel ill-equipped for their new role as clinical nursing practitioners. At the same time, clinics often experience shortages of medicines. A process of training and support is needed to ensure that medicines are prescribed and dispensed in a rational and cost-efficient manner.

In recent years there have been a number of important developments within the South African health sector. Health Systems Research is a critical tool at this time to evaluate the impact of new policy change, as well as to assist in the implementation of new legislation and guidelines. This report provides an overview of the findings of research funded by the research programme of the HST during 1998. The proceedings of the 1998 HST National Conference have been integrated into this report, which begins with a summary of the new strategic direction of the Health Systems Trust and then provides two summaries of evaluations undertaken of the research programme. The main findings of the research projects are then presented.