sahr2001 - Health Systems Trust

The District Health System
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Peter Barron i and Bennett Asia ii
i
Initiative for Sub-District Support, Health Systems Trust
ii
Chief Directorate: District Health Systems, Department of Health
The District Health System (DHS) is the vehicle through which the delivery of Primary
Health Care will take place. As Primary Health Care is the foundation of the health
system it is critical for the overall functioning of the system that there is a well-functioning
DHS in place.
During 2001 the concept of the District Health System (DHS) became more entrenched
with a number of crucial milestones being reached:
◆ The formal finalised version of the third sphere of government was put in place. This
means that South Africa is covered by contiguous Metropolitan (Type A) municipalities
and District (Type C) municipalities. Each of the District municipalities is sub-divided
into two or more Local (Type B) municipalities.
◆ A health Ministerial Forum (MINMEC) decision endorsed the vision of a municipalitybased
DHS in South Africa where comprehensive Primary Health Care services will
be delivered.
◆ A Health Bill was published for public comment. This Bill lays down the framework
for the setting up of a District Health System as the foundation stone for a national
health system. Although in general terms this Bill has advanced the progress towards
a DHS immensely, there are still specific areas of confusion, which need clarification.
The definition of Municipal Health Services in the Bill and the schedules setting out
the functions and responsibilities of provincial and district levels have not succeeded
in clarifying the roles of the various parties. If these are not clarified and simplified
then the gains of the Bill as a whole will be nullified.
◆ Many of the provinces established their Provincial Health Authorities (PHAs), which
are the overall governance structures for the District Health System in the provinces.
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