An assessment of the feasibility of implementing a district health system in the City of Cape Town

[摘要] ENGLISH ABSTRACT:The South African Government of National Unity, through its adoption of theReconstruction and Development Programme (RDP) in 1994, committed itself to thedevelopment of a District Health System (DHS) based on the Primary Health Care (PHC)approach as enunciated at Alma Ata in 1978. This approach is the philosophy, on thebasis of which many health systems around the world have been reformed, and out ofwhich has developed the concept of the DHS. District-based health systems are nowapplied successfully in many countries, and have been adapted to a wide variety ofsituations, from developing countries on our own continent, to more sophisticatedsystems elsewhere.A National Health System based on this approach is as concerned with keeping peoplehealthy as it is with caring for them when they become unwell. The concepts of caringand wellness are promoted most effectively and efficiently by creating decentralisedcomprehensive management units of the health system, adapted to cater for local needs.These units will provide the framework for our district-based health system, in which adistrict health authority can take responsibility for the health of the total population in itsarea. This population-based model allows for constant assessment and monitoring ofhealth problems in the district, the facilities and system provided, and leads to efficientand rational planning.The researcher conducted interviews with key stakeholders, used structuredquestionnaires and observation and reviewed the relevant National and Provincialdocumentation and performed a literature review, to assess the feasibility ofimplementing DHS in the City of Cape Town.The main findings of this research are that the City of Cape Town does have the capacityto implement and sustain the DHS, that it is necessary to implement the DHS in the CCTin order to improve the quality of life of the population, and that there is enoughpersonnel to take the process forward.The main recommendations include the need for training of staff, the promotion ofcommunication and transparency in relation to finances and an ongoing support systemfrom the provincial and national health departments.The research assignment has revealed that the move towards DHS has the blessings of thetop management and politicians of the eeT. In addition, it has been established that theCï.T possesses good infrastructure, technical skills, and human resource capacity. Thereis also willingness on the part of the unions to take this process forward.There are also challenges that need to be addressed, such as difficulties around staffattitudes, and the training of officials so as to accommodate the requirements of acomprehensive primary health care system, effective and efficient utilisation of availableresources and change management.

[发布机构] Stellenbosch University