1. District Health in South Africa Appropriate response to current health issues: How do we measure? Dr Kebogile Mokwena Department of Social and Behavioural Health Sciences National School of Public Health MEDUNSA

2. Aim of Presentation Use the National Health Plan and the District Health System Plan as references to measure the success in implementing health care

3. Weaknesses of previous health system Highly fragmented system Biased towards curative care and the private sector –Inefficient and inequitable Team work was been emphasised, and the doctor has played a dominant role within the hierarchy. There has been little or no emphasis on health and its achievement and maintenance, but there has been great emphasis on medical care.

4. Premise Promotion of health, using the Primary Health Care Approach Integration of the country's health system, and the overall social and economic development of the community

5. Expected outcomes of the Implementation of the NHP Ensuring that the emphasis is on health and not only on medical care. Encouraging and developing comprehensive health care practises Emphasising that all health workers have an equally important role to play in the health system Ensuring that team work is a central component of the health system.

6. Expected outcomes of the implementation of the NHP Ensuring that mechanisms are created for effective community participation, involvement and control –Development of the District Health System Introducing management practices that are aimed at efficient and compassionate health care delivery. Ensuring respect for human rights, and accountability to the users of health facilities and the public at large. Reducing the burden and risk of disease affecting the health of all South Africans.

7. Success Indicators How will it be, what will be happening, what will we be doing if our health care system uses the Primary Health Approach as the underlying approach?

8. Yardsticks for service delivery Access to health care for all, especially the vulnerable Ensure services that put the emphasis is on health and not only on medical care. Reducing the burden and risk of disease affecting the health of all South Africans Responding effectively to the most pressing health issues: –e.g. HIV, Diabetes, heart disease, obesity, drug use

9. Training according to identified needs Continuous assessment of health and development needs –Promoting good health and preventing disease as they emerge –Health promotion combines diverse approaches such as legislation, fiscal measures such as taxation, controls on advertising, community action and development, inter- sectoral Programmes, environmental monitoring and education. Require training that integrates these approaches

10. Features of a Health System that is driven by the Primary Health care Philosophy Health promotion practices that utilise the skills of a multi- disciplinary team of workers from many different sectors e.g. education, health, industry etc –Has this happened? Health promotion is central to the health care service –Reference for all aspects of care, e.g. prevention, adherence to treatment, maintenace of optimal health etc Health promotion is one of the health policy priorities –Policy across the wide spectrum of health care, e.g. funding, training, services

11. What is required to implement the DHS? Health care professionals appropriately trained for the needs of the communities –Re-orientation of existing personnel and fuller use of their present skills Evenly distributed in relation to health and health care needs. In-service training and acquisition of new skills to enable them to play a more effective role in promoting, maintaining and restoring health. There will also need to be changes in basic training –Curriculum modification

12. Integration of demand and supply Access to health care for all, specially the poor and vulnerable –Access Life style diseases require services to all Ensuring that the emphasis is on health and not only on medical care –Medical care is expensive and not accessible to all –Increase training for public health professionals Reducing the burden and risk of disease affecting the health of all South Africans. –Prevention is better than cure

13. Radical Approach Basic health training to include primary health care and health promotion for all health care categories Set standards for Primary health training Training in Health Systems Management –District health system requires special and specific training for effective implementation –Lessons learnt from Mexico, Sweden, Norway and Gambia identified a need for strong management training programs (financial, administration etc) Substantial increase in public health training –Health Systems management –Socio-behavioural –Quantitative disciplines (epidemiology and biostatistics) –Environmental health

14. Radical Approach Change the focus of professional training –Balance between training for promotion of health and curative care –Substantial transformation in human resource training for the health sector (quality and quantity) Substantial increase in the functionality of Community Health Centers –Resource centers to support optimal health and not only curative –Well trained professionals –Multi-disciplinary approach to health issues Increase in funding for Community health centers Change the culture of health care –People responsible for their health –Discourage the culture of providers and recipients