Publications
HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

Since the first group of nurses was trained in clinical health assessment, treatment and care in 1982, South Africa has come a long way. Not only has the government policy declared nurses the backbone of the health care system in South Africa, but also there has been a major shift in health care from a mainly hospital based to a mainly primary health care focussed health care service.

This change in direction, like a pebble thrown into a pond, has created ripples in many sectors in South Africa. The building sector was influenced in that new clinics had to be built pharmaceutical and equipment companies have to provide for different orders from clinics and nursing education institutions had to recurriculate to produce nursing and midwifery practitioners that are equipped to provide the South African community with health care that is relevant and of high quality.

These changes have made health care more accessible to the community. Primary health care services were declared free for mothers and children under six in April 1995 and for all citizens in April 1996. A study done by the Health Systems Trust indicated that the health care of women has improved. However, this free primary health care has increased the case load that nurses have to handle at the clinic without the health budgets increasing to make provision for the increased patient load.

These changes have placed a tremendous burden on the clinic nurse. Some nurses were transferred to the clinics without the relevant training and education to deliver the services at clinic level. Support services are non-existent. The voluntary severence packages made available to public servants resulted in a drain of expertise to the private sector and international countries. These posts were never filled and although the staff establishment has decreased, the patient numbers have risen considerably.