International evidence reveals that the lack of management capacity impacts on the ability of
health systems to deliver effective health care. Information on managers and district management
structures within the South African health system is, however, limited and this has prevented and
inhibited managerial workforce planning, monitoring and development.
A national assessment of existing district management structures, competencies and current
training programmes was undertaken in order to inform a national strategy and plan to strengthen
district management capacity to ensure effective delivery of primary health care in South Africa.
The study took place under the auspices of the national Department of Healths National District
Health System Committee and was funded by Atlantic Philanthropies.
Phase One of the project (i) describes the district management establishment throughout South
Africa, (ii) reviews competencies appropriate to district health management teams and (iii)
reviews information on training and other capacity development initiatives targeted at district
managers in order to develop a national database of training interventions and to make
recommendations on training programmes.
Phase Two of the project is the implementation of a strengthening strategy. It is to be put out on
tender in an independent process.
Recommendations are presented under each of the three sections, followed by a proposed
strategy for implementing the recommendations to strengthen the district health system.
The strategy comprises five parts:
- Recommital to the district health system
- Establish criteria for a well-functioning district health system
- Conduct initial (baseline) national evaluation
- Conduct initial (baseline) evaluation for provinces
- Support to provinces initiating District Health System strengthening initiatives
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