RHD Prelude Chapter - Health Systems Trust

of government organs and health services in particularly are taking place. It also helps to explain
the differences in the impact of policies on services delivery that is noted in the three case studies
used in this research.
2.2.4 National Health Care System
The National Department of Health (NDoH) is responsible for health policy development and
legislation and is responsible for monitoring the implementation of policies by the Provincial
Departments of Health (PDoH).
The following section describes the structure and systems in the NDoH, in particular in relation
to decentralisation, the DHS and reproductive health services (RHS).
Structure of National Department of Health
Decision making structures for health include:
• The Health MinMEC; chaired by the National Minister for Health and comprising the
Member of the Executive Committee (MEC) for Health from each province.
• The Provincial Health Restructuring Committee (PHRC); chaired by the Director
General of the National Department of Health and comprising the Provincial Heads of
Department of Health in the nine provinces as well as local government representation.
• The National District Health System Committee (NDHSC); chaired by the National
Chief Director for District Development and responsible for district health development,
decentralisation and DHS. The NDHSC has representation from each province and
from local government.
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Sections of the NDoH organogramme is shown in Figures 2.1a, Figure 2.1b and Figure 2.1c on
pages 75 and 76, to illustrate the relationship between the departments with core responsibility
for decentralisation, DHS and reproductive health.
At present there are two Deputy Director Generals (DDGs) in the department. The Chief
Directorate for District and DHS Development are under the same DDG (Strategic Health
Planning) as are elements of reproductive health. There is no single directorate for reproductive
health. This function is split between the chief directorate of Maternal, Child and Women’s
Health (MCWH) and the HIV/AIDS Chief Directorate. These three chief directorates form
separate clusters for budgeting, management and monitoring. The official contact point between
the three is through the Chief Directors who are part of the extended management team of the
department.
There are plans to change this structure to increase the number of DDGs with a smaller span
of control so as to increase their effectiveness. Human resources will be the responsibility of
one of the new DDGs.
Senior management in the NDoH, comprising all chief directors and above, meet biweekly. The
purpose of these meetings is to assess departmental priorities and planning. Each meeting ends
with a discussion on HIV/AIDS issues and priorities. Coordination, however, between the
directorates and sub-directorates can be difficult and each is perceived to be working in isolation
to the others or as vertical programmes. This perception was evident at all levels of the health
care system.
The District and Development Chief Directorate is very small and lacking in capacity. It consists
of the Chief Director, a Director and one Deputy Director.