oa South African Health Review - Developments towards a district health system : chapter 10
The Minister of Health and Members of the Executive Council (MEC's) for Health of the nine provinces have reiterated the vision of a district health system (DHS) being the cornerstone of a national health system. They have also reiterated the view that the final home of the DHS is with local government. Therefore, the developments that took place in the local government sector in the year 2000 have had and will continue to have, a profound impact on the establishment of the DHS. One of the major developments in 2000 was the demarcation of new local government boundaries. The total number of municipalities in the country was reduced from 834 to 285. Health district boundaries are being re-aligned to correspond with the boundaries of Metropolitan and District Councils. Although this will ensure that all government departments have the same managerial area of operation, it has caused major disruptions in terms of staff who have been working in the interim health districts. It is also a problem in terms of the concept of the DHS - many of the new ""health districts"" are now too large to be manageable and will have to be divided into smaller sub-districts. These problems are further elaborated on in this chapter. Community participation and inter-sectoral collaboration are cornerstones of the DHS. This chapter looks at how the pursuit of these goals in the functioning of local government will facilitate their expression in the district health system. The issue of municipal financing is also discussed. In addition, a number of key unresolved issues in local government which will affect the establishment and functioning of the district health system are highlighted. These include the necessity for a strategic framework to guide the implementation of the DHS, the role of national and provincial Health Departments, and capacity development within the newly created municipalities.
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