RHD Prelude Chapter - Health Systems Trust

(3) An agreement contemplated in section 156(4) of the Constitution is known as a service
level agreement and must provide for-
(a) the services to be rendered by the municipality;
(b) the resources that the relevant member of the Executive Council must make
available;
(c) performance standards which must be used to monitor services rendered by the
municipality; and
(d) conditions under which the agreement may be terminated.
Health services are expected to be delivered within the provisions of the Constitution and NHA.
This includes the full basket of primary health care services outlined in Chapter 6 section 4.
Reproductive health is part of this basket of services and is described in Chapter 4.
The right to health and, in particular, reproductive health is enshrined in the Bill of Rights,
Chapter 2 of the Constitution. Section 27 states:
(1) Everyone has the right to have access to
(a) health care services, including reproductive health care;
(b) sufficient food and water; and
(c) social security, including, if they are unable to support themselves and their
dependants, appropriate social assistance.
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(2) The state must take reasonable legislative and other measures, within its available
resources, to achieve the progressive realisation of each of these rights.
Provision and improvement of reproductive health services is focused on within the Department
of Health. New policies, based on the principles of the International Conference on Population
Development (ICPD) of 1994, have been developed and are being implemented. The focus is
on gender rights and empowerment of women through education, accessibility to services and
the right of women to make their own reproductive choices. The new legislation and policies
are outlined in Annexure 1 and include:
• Choice of Termination of Pregnancy, 1996.
• Maternal, Child and Women’s Health Draft policy document, 1995.
• Notification of Maternal Deaths, 1997.
• Policy Guidelines for Youth and Adolescence Health, 2001.
• Guidelines for Maternity Care in South Africa, 2002 (2 nd edition).
• National Contraception Policy and Guidelines, 2002.
• National Guidelines for Cervical Cancer Screening Programmes.
• HIV/AIDS and STD Strategic Plan for South Africa, 2000 to 2005.
• Operational Plan for Comprehensive HIV and Aids Care, Management and Treatment
for South Africa, November 2003.
Implementing these policies requires support from wider health sector change as well as political
and economic reforms, to ensure improvement in reproductive health services and improved
health status.
In South Africa there is wide diversity of race, culture, economic and social standing as well
as historical experiences. The political and health sector reforms contemplated in policy and