Presentation to Select Committee On Social

ServicesDistrict Health System

Jeanette R Hunter30 July2013

CONTENT

DHS in briefDistrict Hospitals

IntegrationKey indicatorsAreas that require strengthening

DISTRICT HEALTH SYSTEM (DHS)

South Africa has made much progress with

regard to the DHS since the South African

Government of National Unity, through its

adoption of the Reconstruction and

Development Programme (RDP) in 1994,

committed itself to the development of a District

Health System based on the Primary Health Care

Approach as enunciated at Alma Ata in 1978.

DISTRICT HEALTH SYSTEM (DHS)

A National Health System based on this approach is

as concerned with keeping people healthy, as it is

with caring for them when they become unwell.

These concepts of “caring” and “wellness” are

promoted most effectively and efficiently by

creating small management units of the health

system, adapted to cater for local needs. These

units provide the framework for our district-based

health system.

RATIONALE FOR THE DHS

Health System

Jeanette R Hunter

Other sectors

Public Health Care System

Private, Traditional medicine, NGO, Ancillary (Ayurvedic, Homeopathic, etc)

Human Settlement, Water, Sanitation, Agriculture, Education, Social Dev, Public Works, Eskom

DHS IN SOUTH AFRICA

Our health system, currently structurally consisting

of:

National department of health

9 provincial departments of health

52 health districts

Through our primary health care reengineering

initiative firmly committed to the District Health

System with a focus on primary health care (PHC)

DISTRICT HOSPITALS

The district hospital plays a pivotal role in supporting primary health

care on the one hand and being a gateway to more specialist care on the

other

Size of District Hospitals small district hospitals with no less than 50 beds and no more than 150 beds

medium size district hospitals with more than 150 beds and no more than 300 beds

large district hospitals with no less than 300 beds and no more than 600 beds.

In some circumstances primary health care services are rendered where

there is no alternative source of this care within a reasonable distance.

INTEGRATION WITH REGARD TO DISTRICT HOSPITALS

Integration on two levels integration between higher level and PHC facilities from

community level

Integration within the District Hospital

INTEGRATION BETWEEN PHC FACILITIES FROM COMMUNITY LEVEL Ward Based Outreach Teams Health Posts Mobile Clinics Satellite Clinics Clinics with sessional GP support School Health Teams Community Health Centers District Hospital

Regional hospital Tertiary hospital Central hospital Specialized hospital

District Clinical Specialist Teams

Optimally functioning referral system

INTEGRATION WITHIN DISTRICT HOSPITALS

This is the smallest type of hospital providing generalist medical services Package of service includes:

Health Promotion and Preventative care Trauma and Emergency Care Obstetrics and Gynaecology Paediatrics and Child Health General Surgery Oral Health Eye Care Care of the elderly Mental Health Occupational Health Rehabilitation

Except for labour and maternity wards, district hospitals do not have discipline specific wards. Patients are cared for in female, male and children’s wards.

Family physicians (specialist generalist), supported by nurses and other members of the multidisciplinary team provide comprehensive holistic care.

Patients are referred to discipline specific specialists at a higher level when their condition requires

KEY DISTRICT HOSPITAL INDICATORS The following slides contain key indicators from the

2011/12 District Health Barometer Usable bed utilisation Average Length of stay Usable beds per 1000 uninsured population Expenditure per patient day equivalent

DHER presents a clearer picture of funding, distribution and

use of health resources in the District and the province

is a diagnostic tool to assess to what extent allocation (budget) and use of resources (expenditure) advance the district and province objectives of:

Access QualityEfficiencyEquity Sustainability

AREAS REQUIRING FURTHER STRENGTHENING

Services and Service Delivery platformHealth Information Management and UseHuman resourcesPharmaceuticals, equipment and medical suppliesFinancesGovernance and leadershipCommunity ownershipPartnerships for healthNational DHS Strategy to address the above

Thank youThank you

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