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.
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.
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.
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.
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.