Improved Service Delivery in the Absence of Fully-Fledged District Management Structures:Experience of the Greater Tzaneen Sub-District Mopani District -Limpopo Province

The Limpopo Provincial Department of Health and Welfare, launched the Greater Tzaneen Sub-District in March 1998. According to the World Health Organization (WHO) criteria, Greater Tzaneen qualifies to be categorised as a health district, but the local government demarcations in 2000 categorised it as a sub-district. The new sub-district has a population of about 400 000 people, 2 district hospitals, 4 health centres and 26 clinics. It shares the boundaries and the name with the Greater Tzaneen Local Municipality. Similarly, the former Lowveld Region in which Greater Tzaneen Sub-District was located, is now known as the Mopani Health and Welfare District. This means that the Provincial Health and Welfare Department has aligned its service delivery areas with those of the local government.

After the launch, the sub-district health and welfare workers expected that a fully fledged Sub-DMT comprising of a Manager and six Assistant Directors, responsible for Primary Health Care (PHC), Welfare Services, Finance and Administration, Human Resources, and Technical Support and Quality Assurance would be appointed. However, the national process of demarcating new municipality boundaries and restructuring of local government affected the process of appointing and developing the sub-district management teams. In the case of the Greater Tzaneen only the Manager and the Assistant Director for PHC were appointed. However, their appointments were later withdrawn in writing by the Provincial DoHW, but the two officers were given verbal permission to continue with their planned work since Greater Tzaneen was a pilot site for district development. This incomplete Greater Tzaneen Sub-District Management Team was expected to manage a big sub-district with major health challenges and meagre resources. Faced with this challenge, the Sub-District Manager decided to strengthen her team. She negotiated a voluntary secondment of three staff, from the health centre, local areas and one from the Dr. C.N. Phatudi district hospital to the sub-district office. The three officers were assigned the responsibilities of training, finance and administration as well as quality assurance and technical support in the sub-district. The group of five constituted the Interim (Sub-DMT). The interim Sub-DMT developed a mutually supportive relationship with the Chairperson of the Interim District Health and Welfare Authority (DoHWA), Councillor N.A. Masila, that resulted in a good working relationship between the IDHWA and the sub-district.