RHD Prelude Chapter - Health Systems Trust

“We give every manager a chance to collate the information from their facilities and districts
and then to prepare a submission and the entire presentation. That facility manager, district
or hospital manager, is responsible for the collation for the preparation of the report, for
the preparation of the presentation and then to present it there on behalf of the region.”
(Regional Health Director)
Although acknowledged as still developing and not perfect, the monitoring and evaluating system
is seen by health officials to be working. Community members from the governance structures
are part of evaluation meetings, but their opinions are not always acknowledged. As mentioned,
there are councilors with a good understanding of indicators and good knowledge of the health
problems and needs in their own community. A comment made by a community member in a
discussion group indicates some dissatisfaction with the current system of monitoring, especially
in the more disadvantaged, deep rural areas:
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“I can make a comment on the government policy which includes all the people since 1994.
I was carefully looking at the way they do things; they do not have a follow up or have a
monitoring process, to see exactly whether their implementation of that policy is working
on a local level. Things are working well at the top, provincial and local levels. But deep
down at the disadvantaged communities, that’s where things do not work smoothly. You
see, just at local levels, that’s where there is no monitoring process and the government
need to do something on that. Long time ago, during the old government, the white people
were making use of these government health facilities day and night, 24 hours, making sure
that their government policy works, but this new democracy of ours; we don’t guard it to
make sure that it works for the people. So that is why you could find that this new democracy
is enjoyed by the people at the top.”
(District Community Discussion Group)
Conclusion
Planning, monitoring and evaluating of health services are an essential, although complex,
process. Although improving, a top-down approach appears to still dominate. The national Ten
Point Strategic Plan for 2004 to 2009 has shifted from the previous ten points and does not
mention that services are to be delivered through a district health system. Primary health care
and strengthening governance structures (and presumably community participation) are specifically
mentioned. The DHS may be implicit within the Ten Point Plan.
The National Health Act of 2003, Chapter 5, establishes a DHS for South Africa. For this to be
realised horizontal and vertical gaps in the systems need to be bridged. Planning processes for
the vertical programmes at national and provincial levels require coordination; the voice of the
communities served by the health services require to be heard and noted in the planning process.