RHD Prelude Chapter - Health Systems Trust

Developing IDPs in municipal areas is a new process under the Department of Provincial and
Local Government (DPLG). In the first round health plans were not well integrated into the
IDPs.
“They are not well incorporated I must admit that. I would have liked to have seen them
very much more integrated but then on the other hand this was a learning process and our
responsibility now is to go when the IDP’s are being revised and reworked We must now
adopt a very much more aggressive approach to get our district health plans incorporated.
But you must remember that the district health plans are for a much shorter period than
what the IDP’s are. Our district health plans go by here the MTF period but it's based on
a much shorter period than what the IDP’s are.”
(Regional Health Director)
Community members may be involved at a local level in planning specific projects; they are not
involved in planning for general health services.
“Because when we start a project we involve them (the community) with the initial stage
up to the end. And then before involving them, and even after involving them we identify
the gaps in terms of skills development. Then where possible we educate them and then
because we have to rely on them and then we don’t have any problem whether they are left
behind.”
(District HIV/AIDS Coordinator)
The MEC for health said that although planning is done at a local level, the plans are submitted
to the central level for acceptance before being implemented. The IDP is submitted to the National
DPLG and the health plans to the PDoH. 1
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The experience at the lower level shows that the planning process is not clear cut. The strategic
objectives are set by the provincial department; the health programmes may, however, have their
own specific objectives. Some of these may come vertically from the national level. At the
service delivery level in the districts and hospitals the operational planning process starts without
receiving any specific objectives from the programmes. A regional director’s comments suggest
a disjuncture between provincial and local level planning:
“The operational plans…. We have often requested that head office, like the programme
managers, need to give us their priorities for the year, but most of them do not. You find
that at district and regional level we develop our operational plans before the people at
the provincial level. So what happens is that each coordinator and each facility manager
determines priorities. And these operational plans are evaluated on a monthly basis. Then
we have a minimum data set where we have uniform indicators throughout the province
and these are evaluated on a quarterly basis. We actually set targets that we are moving
from this area, and we intend to be there by then.”
(Regional Health Director)
The provincial programme managers tend to focus on and push projects which they themselves
are being pushed to carry out by the national level to see implemented. This may side track the
local level from their identified priorities. An example given in several interviews is termination
of pregnancy as part of reproductive health services (RHS), which is perceived by some health
1 Interview with MEC for Health: North West Province