Summary Bulletin 6 - DHS-LG Discussion List

Functional Integration

The debate had started earlier in the year – see summary bulletin September 2002.A second draft document, Guidelines for Functional Integration: A Key Strategy towards the Full Implementation of the DHS, was circulated by Yogan for comment.The main concern expressed by one contributor was the emphasis being placed on the support and guidance from the top being required for implementation. Experience has shown this to be lacking in the past – how can we be sure that it will be there in the future? Functional integration is a complex and challenging process at the district level.

The draft has been presented to the National DHS Committee in December 2002 – we look forward to hearing the outcome of that and the proposed way forward.

There were a number of issues of concern during the period, most of all around the latest National Health Bill. This has not been released for public comment and its passage is likely to be delayed until at least April 2003.

Other documents of interest shared on the list dealt with

• Division of powers between B and C municipalities
• Definition of Municipal Health Services – discussion on limiting this to EHS
• Press release on authorisation of water, sanitation, electricity and municipal health to category B municipalities

Summaries of these are not being included in this summary, but will be forwarded to anyone who may have missed the documents.

Cross Boundary District Municipalities

A report that the President’s Co-ordinating Council resolved on 1 November 2002 that no municipality should straddle provincial boundaries. The Dept of Provincial and Local Government (DPLG) have now been given the responsibility to implement this plan. No further details were shared.

A proposed district municipal organogram, prepared by the Health and Social Services Manager in a district municipality, was shared for comment. (A copy can be forwarded on request)

Some of the comments received were: -

• Structure follows function – it would be good to have clarity on functions before drawing up the structures.
• Whether provincial managers should report to local government district managers is dependent on what non-mhs services are to be delegated to local government and what will be retained by the province and managed through regional offices.
• Clarity of roles, functions, authority and powers is vital – but does need some mechanism of communicating between the provincial and local government. Staff remain accountable to their employer, but should inform the other sphere as to what they are doing.
• Need to compare the local government organogram with the provincial health district organogram. This should assist with the functional integration between local and provincial health staff
• Focus must be on service provision.

Policy guidelines

The question was asked as to process through which a policy endorsed by National Dept of Health becomes a provincial policy. Is there any provincial process required?

This was shared with specific reference to the 'POLICY GUIDELINE FOR MANAGEMENT OF TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND SEXUALLY TRANSMITTED INFECTIONS IN SEXUAL ASSAULT' and the need to change the use of some drugs which are not available in all parts of all provinces.

No direct answer has been received to the general query. However, one district in KZN shared their experience with implementing the policy, particularly with getting all the parties together to iron out problems. From this experience it seems that it is the SAP who are the most difficult.

Bulletin complied by Wendy Hall (hstwendy@sai.co.za),
Health Systems Trust,
January 2003

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