1 / 12

BUILDING THE DISTRICT HEALTH SYSTEM

BUILDING THE DISTRICT HEALTH SYSTEM. BENNETT ASIA AUGUST 2004. WHAT IS THE DHS?. WHO DEFINITION ( TARIMO, 1991) :

melba
Download Presentation

BUILDING THE DISTRICT HEALTH SYSTEM

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. BUILDING THE DISTRICT HEALTH SYSTEM BENNETT ASIA AUGUST 2004

  2. WHAT IS THE DHS? • WHO DEFINITION (TARIMO, 1991) : A DHS BASED ON PHC IS A MORE OR LESS SELF-CONTAINED SEGMENT OF THE NHS. IT COMPRISES A WELL DEFINED POPULATION LIVING WITHIN A CLEARLY DELINEATED ADMINISTRATIVE AND GEOGRAPHIC AREA AND INCLUDES ALL HEALTH ACTIVITIES IN THE AREA, BOTH PUBLIC AND PRIVATE District health system.Dbn_May 2003

  3. WHY THE DHS? • VEHICLE TO RENDER PHC • BEST ABLE TO ELIMINATE FRAGMENTATION AND DUPLICATION • ALLOWS INTERSECTORAL COLLABORATION • CLOSEST LEVEL TO THE PEOPLE – ABLE TO ASSESS & MEET NEEDS & ACCOUNTABILITY District health system.Dbn_May 2003

  4. STRATEGY TO IMPLEMENT THE DHS • BOUNDARIES OF HEALTH DISTRICTS TO BE COTERMINOUS WITH METROS AND DISTRICT MUNICIPALITIES • MAY DEMARCATE SUB-DISTRICTS – ONE OR MORE LOCAL MUNICIPALITY • ESTABLISH AND DEVELOP GOVERNANCE BODIES (DHCs/PHC) TO PROVIDE POLITICAL LEADERSHIP District health system.Dbn_May 2003

  5. STRATEGY CONTD • ENSURE CURRENT SERVICE DELIVERY BY MUNICIPALITIES BUT ELIMINATE FRAGMENTATION AND DUPLICATION, USING DATA FROM THE DHIS & OTHER SOURCES, THROUGH: • (A) FUNCTIONAL INTEGRATION (JUNE 03); AND • (B) SERVICE LEVEL AGREEMENTS (JULY 03) • (C) DISTRICT HEALTH PLANS (SEPT 03); District health system.Dbn_May 2003

  6. STRATEGY CONTD • PHC (MINUS MHS) A PROVINCIAL FUNCTION • DEFINITION OF MHS EQUATES TO A LIST OF EH SERVICES • MHS ALLOCATED TO METROS AND DISTRICT MUNICIPALITIES • DISTRICT MUNCIPALITIES MAY DELEGATE MHS FUNCTION TO LOCAL MUNICIPALITIES • PROVINCES MAY DELEGATE OTHER PHC SERVICES TO METROS AND DISTRICT MUNICIPALITIES District health system.Dbn_May 2003

  7. ROLE OF DISTRICT HOSPITALS? • IN MANY PARTS OF THE COUNTRY PROVIDE BOTH LEVEL 1 AND PHC SERVICES • PROVISION OF PHC SERVICES NOT APPROPRIATE IN GENERAL BUT MAY BE CHEAPER AND IMPROVE ACCESS IN SOME • GATEWAY CLINICS AND SELF STANDING COST CENTRES PREFERRED District health system.Dbn_May 2003

  8. DISTRICT HOSPITALS • PRINCIPLE • PATIENT MUST EXPERIENCE A SEAMLESS HEALTH SYSTEM BUT DISTRICT HOSPITALS SHOULD NOT BE DELEGATED TO LOCAL GOVERNMENT • QUESTION IS: WHAT WE MEAN BY SEAMLESS AND HOW TO OPERATIONALISE THIS GIVEN THE PRINCIPLE? District health system.Dbn_May 2003

  9. DISTRICT HOSPITALS • KEY ISSUES: • ONE MANAGEMENT FOR BOTH PHC AND DISTRICT HOSPITAL • SEPARATE MANAGEMENT • CLEAR STANDARD OPERATING PROCEDURES • BUDGET & RESOURCE HOLDING; • REFERRAL SYSTEMS; • MECHANISMS OF SUPPORT FOR PHC; • ETC District health system.Dbn_May 2003

  10. ROLE OF DISTRICT MANAGERS • Understand functionality of health system • Influence policy formulation based on best practice models • Develop a system which is responsive to patient/family needs • Provides an integrated seamless service • Cinderella service District health system.Dbn_May 2003

  11. SOME STATS • PHC p/c spending =R114 vs R300 • PHC utilisation rate: 1.9 visits p/a • Supervision: 20% • Cross boundary rural nodes not prioritised for extras • Unsure about step down policy District health system.Dbn_May 2003

  12. CONCLUSIONS • HAVE THE BUILDING BLOCKS IN PLACE • NEED CLEAR LINES OF COMMUNICATION AND ROADMAP FOR DISTRICT DEVELOPMENT (MUST BE WRITTEN DOWN AS POLICY FOR IMPLEMENTATION) • STAKEHOLDERS MUST FEEL PART OF PROCESS • POLITICIANS & COMMUNITIES MUST HOLD MANAGERS RESPONSIBLE FOR IMPLEMENTATION District health system.Dbn_May 2003

More Related