South Africa

The development of the District Health System in South Africa: Lessons Learned from the Experience of ISDS: Technical Report 5

Published by: 
Health Systems Trust

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.

A district communication strategy for health

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

Lessons for district managers in putting in place an effective communications strategy.Communication strategies for health in South Africa today risk being equated with the installation of computers! This brief highlights two points: First, comprehensive communication strategies need to be thought out very carefully. Second, computerisation of health facilities can be a waste of time and money unless there are clear reasons for use and adequate technical and user support. An approach to developing a communications strategy.

Training for rational drug use

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

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.

Strengthening community participation: Lessons from the Bergville district

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

Strategies to strengthen community participation in the Bergville district.Strengthening community participation in health districts remains one of the most difficult aspects of health sector development in South Africa. In this Kwik Skwiz, the Bergville District Management Team describes two strategies which it has found particularly effective.

Short courses for nurses: A half-baked response to complex training needs?

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

Letter of concern expressed by Steven Donohue regarding training methods - valuable for wider audience.Recently, facilitators of the Initiative for Sub-District Support in Bothaville (David McCoy and Martha Chao) organised a two-week clinical training programme for nurses, in response to a strongly felt need amongst nurses that they lacked both skills and knowledge for the clinical responsibilities expected of them. Given the urgency, it was decided to fast track a clinical training component. But other ISDS facilitators, notably Steven Donohue, disagreed with this strategy - arguing that short course training in isolation is too simplistic a response to a complex problem. Stevens objections were spelt out quite articulately in an open letter to all ISDS facilitators.

Child Health in South Africa

Series Name: 
HST Update
Published by: 
Health Systems Trust
The care and protection of children is a practice and ethic rooted deep in the wisdom and culture of all societies, wrote James P Grant, the previous executive director of UNICEF. He was referring to a deep and universalbut often neglectedknowledge that children are vulnerable. Their situation is closely linked to poverty, and more closely related to social inequality than to general economic hardship. Under apartheid, South African children were exposed to gross human rights violations such as detention and shooting. But the less dramatic, more pervasive, violations of apartheidsuch as racial exclusion from most of the land and the economy, and discrimination in health care and educationultimately did more harm. These softer violations have left todays children with an historical disadvantage as a result of social inequity, underdevelopment and poverty. About 61% of South African children live in poverty and, since families with large numbers of children are more likely to be poor, a disproportionate number live in poor households. Children's rights raise important questions for all those concerned with the health of children. These range from the macro-economic issues to interactions with individual patients.

Measuring the move towards equity from the site of service delivery - The North West Province Results

Series Name: 
Facilities Survey
Published by: 
Health Systems Trust
These report is targeted at provincial health practitioners - the district health manager, the regional health manager, the policy maker, and the programme planner. It is a supplement to the national results of the clinic survey published in November 1997 entitled 'Measuring the Move Towards Equity'. The aim of the provincial report is to provide a snapshot of what is happening in specific regions and districts of the province - to highlight both inequities and positive progress towards meeting the goal of equity in health delivery.