Establishing the district health system

Author: 
McCoy, David
Other Authors: 
Engelbrecht, Beth
Publication Year: 
1999
Issue: 
1999
City: 
Durban
Country: 
South Africa
Published by: 
Health Systems Trust

The District Health System (DHS) is the means to achieve the end of an equitable, efficient and effective health system based on the principles of the primary health care (PHC) approach. This means that the DHS is more than just a structure or form of organisation. It is the manifestation of a set of activities that includes community involvement, integrated and comprehensive health care delivery, intersectoral collaboration and a strong bottom-up approach to planning, policy development, and management.

The PHC approach and the DHS model apply to the whole of the health system and at all levels of health care delivery. They do not just apply to the primary level of the health system, or just to the district level. In a DHS, the organisation and management of the entire health system is district-based, meaning that even policy areas such as health sector financing, utilisation of regional and tertiary hospitals, the relationship with the private sector and governance should be DHS-based.

The underlying essence of the DHS is the organisation of health care according to geographic sub-divisions of a country, which are managed through a decentralised management structure. The district management structure is supposed to be the point and level at which different health service activities are integrated into a comprehensive and holistic approach to health care.

The DHS represents a profound break from the apartheid health system which was characterised by fragmentation, inefficiency, centralised authoritarianism and the separation of curative services from preventive care.

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