The Health District

Learning objectives What is a health district Why do we focus on the health district What are the tasks of a health district What is the role of the HIS in the health district

What is a health district?

Bridgbe between Primary, secondary, tertiary care Primary care: community level, first point of consultation for all patients Secondary care: provided by medical specialists who in general do not have first contact with patients. Referrals; for example cardiologists Tertiary care: specialized health care for inpatients in hospitals

What is a health district? It is the point of implementation for primary health care (Alma Ata, 1978) What does this mean?

The health district It is the point of the national health system where people can get comprehensive health care It is a clearly defined geographical/administrative area It is the optimal operation unit for the identification of the excluded from health care and for the implementation of health improving strategies

What are the characteristics of a health district ? Population between 30,000 and 500,000 (most cases) Clearly delineated geographical area Identifiable form of local government Managed by few officers Balance between population size and availablity of technical specialised staff

Political agenda of decentralization fromNational --> district (computers) fromDistrict --> community (mobiles) many reforms seek to endow greater autonomy to decentralized units (e.g. districts, chiefdoms, communities, village chiefs)

What advantages presents the health district ? 1/2 It is the most appropriate level for coordinating top-down and bottom-up planning It is close enough to the community (“the patient” to understand and act on its problems and constraints It has easier communication with the community to ensure its participation in planning and organization

What advantages presents the health district ? 2/2 It presents large potential for effective collaboration with other sectors towards the health of the community It has the ability to handle decentralisation of resources and of decision-making It is the most suitable place to provide support to health workers in the health posts and health centres

What are the tasks of the health district ? 1/2 Implementation of all community based health programmes Supervision and control of all community health workers in the district Organization and operation of district hospital services Management of all other public health facilities Coordination and supervision of all public, non- government and private health systems

What are the tasks of the health district ? 2/2 Promotion of active links with local government entities Promotion of community participation in the local health service planning Preparation of annual health plan Raising additional local funds In-service training of health workers Collection, compilation and dissemination of routine health information

Why size matters ?

....greater number of health districts, then...  more management structures and systems  cohesion and co-ordination more difficult at a national or provincial level  it will cost more and fail to capture economies of scale If the health districts are too small...1/2

 district hospitals will be managed as separate entities from the rest of primary level health care  could create a further dislocation between primary level services and district hospital services (many health districts without a district hospital) If the health districts are too small...2/2

 district-level management can become unwieldy and bureaucratic  the District loses its “service delivery" functions  The District becomes too remote from the community. If the health districts are too large...

Community involvement Comprehensive services Population size Geographic size The required balance Technical autonomy

- the many responsibilities of the district health team - the need to carefully allocate scarce resources - the necessity of sound health management  obvious need for adequate information BUT Why the focus on Health District ?  the main constraint for implementing the primary health care approach in practically all countries:...inadequate information for the managerial processes !

It’s called DHIS for a reason.. The district health information system needs to make available... the right information to the right persons and institutions in the right form at the right time in the right place

What is the role of the HIS in the health district?

22 Epidemiology : who, where, when ?

Districts have been identified as the most efficient level of managing primary and secondary health services For this management to be possible and efficient, access to comprehensive district health information is necessary Summary points

“Health Districts” Centralized/decentralized Fragmentation Catchment area Coverage & Quality (will be covered later) Key Concepts from Today’s readings