Fitting Functionality into Boundaries: Analysing the health service rendering features of the new Local Government District Councils

Introduction
The health care system is in the process of re-organising its services according to new local government (LG) boundaries. The challenges of this include:

• Health workers will have to make adjustments to new administrative areas.
• Outside of the metropolitan areas, LG consists of two levels (District municipalities and local municipalities) that will operate concurrently in the same geographical area.
• The size, population and resources of each municipality varies from area to area.

What is important is that:

• health services are organised and managed efficiently and effectively.
• equity is improved through the process of devolution by ensuring that municipalities share their resources fairly.
• planning is based on an informed assessment of the local situation

It is critical that the LG councillors who will be elected in December 2000 have the information required to make informed decisions about how the two tiers of LG can work together with the provincial DoH to provide the best deal for the community.

For this reason, the Southern Free State health complex under-took a detailed audit and analysis of its new district and local municipality areas with the intention of understanding how health care can be best organised to meet the needs of the community. The basic approach was to look at various geographic, demographic and health system features and characteristics of a District Council, and its constituent local municipalities.

By looking at these features and characteristics, the organisational, managerial and resource requirements for the provision of an effective service can then be suggested.

This was applied to each of the two District municipalities in the Southern Free State health complex, both of which contain within them three separate local area municipalities (see map). The steps of this study are shown below:

Step 1: A district council is selected for analysis

Step 2:The DC is analysed according to certain health care system features and geographic/demographic characteristics. This is structured according to the local municipalities within the DC.

Step 3:Based on these features and characteristics,recommendations and proposals ar made about the optimal organisational and managerial arrangements for the delivery of comprehensive PHC.