Decentralisation of district health services in the Free State Province
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Date
Jul-12
Authors
Motsoari, Motsamai Clement
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Experiments with decentralisation began in the late 1970s and continued
throughout the 1980s. Decentralisation is regarded as a key element of the
primary health care approach. It is initially seen as having important political
value that can be used as a means to enhance health service policy. However, in
many instances, western donors who believe that because one form of
decentralisation works in developed countries, it will also work in the
developing world often pursue decentralisation.
The challenge facing the South African National Health System and the Free
State Health System in particular, is to design a comprehensive programme to
redress social and economic injustices brought about by apartheid to the
majority of the population to ensure that emphasis is placed on health and not
just medical care so that issues relating to socio-economic conditions such as
poverty, water and sanitation, and proper housing should be addressed
adequately. At present, implementation of the District Health System (DHS)
based on primary health care (PHC) approach is provided by the Free State
Department of Health (FSDOH) and by local municipalities on an agency basis.
The above approach is concerned with keeping people healthy, as it is with
caring for them when they become unwell.
In an endeavour to address aforementioned challenges, the South African
Government of National Unity (GNU) has adopted decentralisation as a model
for both governance and management. Decentralised governance is embodied
in the Constitution of the Republic of South Africa, 1996, in the form of powers
and functions for the three spheres of government. The powers and functions of
the local sphere of government bear testimony to the importance of this sphere
in particular. The GNU, through its adoption of the Reconstruction and
Development Programme (RDP) in 1994, committed itself to the development
of a DRS based on PRC approach as enunciated at the Alma Ata conference in
1978.
The hypothesis for this study indicated that decentralisation of DRS in the Free
State Province will enhance efficiency and equity and thus make local public
representatives accountable for services rendered. The hypothesis and research
objectives for the study were validated by means of literature review and
empirical survey.
The thesis outlines the conceptualisation and forms of decentralisation and also
draws lessons from the experiences of various countries including Canada,
Zambia, Indonesia, and Brazil and highlights the need to approach the
formulation and implementation strategies for health sector reforms
systematically, rather than importing, uncritically, structural models developed
abroad. Political considerations are inherent in any decision made and a
political environment limits the extent of decentralisation. Without doubt, the
most serious mistake any reformer can make is to assume decentralisation to be
a managerial exercise devoid of political cause and consequences.
The thesis concludes by presenting analysis and interpretation of research
findings while also outlining key recommendations that might be of assistance
for identifying an appropriate form for decentralisation of health services.
Description
Thesis (Ph.D. (Public Management))--University of the Free State, 2012
Keywords
Primary health care -- South Africa -- Free State, Medical care -- South Africa -- Free State, Health planning -- South Africa -- Free State, Decentralization in government -- South Africa -- Free State, Public health administration -- South Africa -- Free State