Decentralization

The provision of appropriate reproductive health care remains one of the main health care challenges in developing countries. The development of the delivery of reproductive health services is continually confronted by challenges from a changing environment, an important element of which is health sector reform, in particular decentralisation, which is being undertaken by most governments in Africa.

Government health policy emphasises the importance of both decentralisation and equity in the public health sector (NDoH, 2002). The draft National Health Bill establishes a health system with decentralised management (p7) and, in particular, a district health system based on a PHC approach (p38). Concurrently, it states that provinces and municipalities must implement the system with regard to key principles, the foremost being equity (p38). However, it is unclear whether decentralisation and equity exist in harmony particularly in relation to the financing of PHC. This report explores this issue by evaluating the funding of non-hospital PHC services, within the decentralised South African system, against indicators of need. An output of the Local Government and Health Consortium, funded by Health Systems Trust and comprising Health Systems Trust, Centre for Health Policy and Health Economics Unit

The reform of the Health System in South Africa is now 6 years down the line. The envisaged National Health System will have district health systems (DHS) as basic building blocks. The DHS is the vehicle for providing Primary Health Care, an important pillar to the reform process.

In order for the health workers (managers, clinicians and support staff) in a district to work efficiently and effectively, they should have as much control over what they do as possible. One of the key areas where districts should have their say is in the management of resources in the district. This means, in effect, that districts should have the accountability and responsibility for financial decision making, and therefore control over staffing.