sahr2001 - Health Systems Trust

Health Services are provided for in the Bill. According to the Bill provincial
health legislation must provide for the preparation of district health plans by
District Health Authorities.
The Constitution states that ‘Municipal Health Services’ and health services
are functions of local government and provinces respectively, it does however
not define these terms. This has created confusion about the allocation of
functions and funding between the spheres. The Health Act of 1977 reinforces
this ambiguity by allocating the provision of curative primary health care
services to both provinces and local authorities. This has led to functional
overlaps and fragmentation in service provision.
In terms of Municipal Health Services, the draft Bill states that municipalities
must render Municipal Health Services. These services include: environmental
health services, promotive and preventive health services and such curative
health services as are currently offered.
In terms of the Bill a province may request a municipality to perform further
services, these services must be agreed upon by the MECs for Health, local
and provincial government as well as the municipality concerned. Very
importantly this request must be accompanied by the necessary funding for
the performance of the required services.
Various chapters in the Bill deal with operational plans to improve the quality
of service and care in health establishments and academic service complexes.
Also, to improve the relationship between public and private institutions
various measures are put in place.
To ensure that health research remains relevant to the needs of the country
and the prevalent burden of disease the Essential National Health Research
Committee is provided for. To ensure that research on humans and animals
occurs within a human rights and ethical framework a National Health Ethics
Council is provided for which will formulate guidelines and norms and
standards for research.
Many health experts are however concerned about the ‘watered down’ nature
of the draft Bill. The Bill has been altered significantly and the Department
of Health should anticipate an overwhelming response to the gazetted draft.
Also, given the Public Finance Management Act, and its injunction that
policies be thoroughly costed, this legislation could become controversial,
but necessary nevertheless.
If municipalities are expected to budget over three years, managers must be
enabled to plan and budget efficiently and realistically – they will need to be
sensitive to the political landscape and the overall needs of the people.
Monitoring and evaluation of service delivery at all spheres of government
must be stepped up to ensure greater synergy and implementation. National
consensus is needed on a clear definition of Municipal Health Services and a
national definition of the ‘basket of goods’ that forms primary health services.
The national Department of Health has to develop uniform definitions and
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