RHD Prelude Chapter - Health Systems Trust

x
Executive Summary
The provision of appropriate reproductive health care remains one of the main health care
challenges in developing countries. The development of the delivery of reproductive health
services is continually confronted by challenges from a changing environment, an important
element of which is health sector reform, in particular decentralisation, which is being undertaken
by most governments in Africa. The general objective of this research is to make health sector
decentralisation more effective in the development of appropriate reproductive health services.
The general research question is: How does decentralisation affect reproductive health services?
The overall research project compares different forms of decentralisation in two anglophone
(South Africa and Uganda) and two francophone (Burkina Faso and Mali) countries in Africa
to assess the impact of decentralisation on, and importance for, the development of reproductive
health services.
This report is one of the deliverables of the European Union funded research project, led by The
Nuffield Centre for International Health and Development (Contract: CA4-CT-2002-10028),
“Understanding the Impact of Decentralisation on Reproductive Health Services in Africa”
(RHD) and reports on the findings of the research in South Africa. The findings of this research
have been used for the comparative study of the two anglophone countries (South Africa and
Uganda) and for the comparison of the anglophone and francophone countries. The final product
of the research project are the guidelines for policy makers which have been published by
Nuffield Centre for International Health and Development.
15
Analysis of the research data
In understanding the impact of decentralisation on health sector reforms cognisance is taken of
the context in which the reforms and decentralisation is taking place. This involves a review of:
1. The broad historical changes
The processes leading up to the democratic elections of 1994 and the end of apartheid
policies in South Africa impacted on the rate and manner in which reforms were introduced.
The Constitution of the Republic of South Africa of 1996 entrenched the rights of the
population to health care, in particular reproductive health care.
2. The policy process
The policy process through which decentralisation and sexual and reproductive health
policies were formulated and implemented, and the impact these have on the relationship
between decentralisation and health sector reforms, is reviewed. The policy process for
both decentralisation and sexual and reproductive health are analysed in terms of:
• Policy rationale and content
• Policy understanding
• Policy linking
• Policy implementation
3. The system of decentralisation and sexual and reproductive health
These structures have an impact on the decentralisation / sexual and reproductive health
relation.
The broad pattern of analysis used in this research is shown in figure no. 1:
The research in South Africa was carried out in 2003 and 2004.