RHD Prelude Chapter - Health Systems Trust

“Yes in a way they (the NDoH) are supportive, the only thing they are slow, very slow and
sometimes they are not capacitated enough to be able to handle the provincial governance
and differences.”
(Provincial Director HIV/AIDS- NW Province DoH)
Reproductive health policy development and implementation in South Africa
In 1995, the NDoH published a draft policy document for Maternal, Child and Women’s Health
(MCWH). This draft policy document is based on the RDP and ANC Health Plan. The focus
of the policy is on equity of services and on the most vulnerable and disadvantaged, such as
women and children in rural areas. The stated goals of the policy are in line with International
Conference on Population Development (ICPD) principles of 1994, although these are not
identified as such. The policy states, for example:
• To achieve optimal reproductive and sexual health (mental, physical and social) for
all women and men across the life-span of individuals.
• To raise the status of women, their safety, health and quality of life.
The policy further states that services are to be delivered through an integrated approach as part
of the DHS, supported by a vertical management system.
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“Health services for mothers, children and women will be delivered as part an integrated
comprehensive health system (horizontal approach) and supported by an organisation and
management structure which is vertical in emphasis, but linked to the rest of the service
administration at each political level.”
As already mentioned, women’s reproductive health and rights are given high priority in other
policy documents, such as the RDP, the ANC Health Plan, the Constitution of South Africa and
the White Paper on the Transformation of the Health Services in South Africa. HIV/AIDS
programmes, however, appear to be prioritised above other reproductive health programmes.
Although planning within the department is done at the cluster level of Maternal Health, Women’s
Health, Child health and Nutrition, reproductive health programmes are not fully integrated.
The HIV/AIDS and STI programmes are separately funded and largely perceived to run
independently of other programmes. Reproductive health is considered to be part of the whole
package of primary health care and is fully integrated into the “supermarket approach”. Integrating
the vertically managed programmes involved in reproductive health is a challenge at all levels,
from policy formulation, implementation and service delivery. The PMTCT programme, for
example, was started as a research project within the HIV/AIDS directorate at NDoH without
involving the maternal and women’s health directorate. This has been corrected and the two
directorates join for all meetings on PMTCT. The difficulties experienced with coordination
were expressed by two national managers from each directorate – HIV/AIDS and Maternal
Health:
“I’m not against it (integration), but the actual practicality of it is quite difficult. We try
as much as possible to integrate even here at national level, but because there are so many
competing priorities it makes it very difficult. An area I may consider to be important for
us to integrate with MCWH, for instance, may not necessarily happen that way because of
competing priorities. … But it is an excellent approach.”
(Deputy Director- National HIV/AIDS Directorate)