Foreword by the Minister of Health
Acknowledgements
Acronyms
Since 1994 the post apartheid government and the Department of Health have developed and implemented a number of policies and pieces of legislation that impact directly and indirectly on the delivery of health services. We are often told that South Africa has some of the world`s best policies. We acknowledge, however, that sometimes we struggle with their implementation.
In our effort to strengthen the implementation of our policies we have compiled this booklet which contains a synopsis of some of these policies. This booklet will be distributed to both health professionals in the field and those who teach the next generation of health workers, of all categories, so that when they enter their respective professions they will have a clear idea of what we are trying to do to transform the health system in South Africa to ensure a better life for all.
I hope that you find this booklet helpful to begin to understand or to reinforce your understanding of the health policies of the country. We must ensure that we participate together in building a better health system for all South Africans.
Best wishes,
Dr Manto-Tshabalala-Msimang (Minister of Health)
Many people were involved in the production of this booklet. The editors wish to thank all those managers in the National Department of Health who contributed to its publication. A special word of thanks goes to the Director-General, Dr Ayanda Ntsaluba, for his vision and guidance. We also wish to thank Cathleen Fourie of the EQUITY Project for design and layout.
Yogan Pillay and Nomvula Marawa
| AHSC | Academic Health Services Complexes |
| AIDS | Acquired Immune Deficiency Syndrome |
| ANC | African National Congress |
| CDC | Communicable disease control |
| CFO | Chief Financial Officer |
| DHS | District Health Systems |
| DOTS | Directly Observed Treatment Short-Course |
| ENHR | Essential National Health Research |
| HIV | Human Immunodeficiency Virus |
| IMCI | Integrated Management of Childhood Illnesses |
| INP | Integrated Nutrition Program |
| MCC | Medicines Control Council |
| MCWH | Maternal, Child & Women’s Health |
| MEC | Member of the Executive Committee |
| MTCT | Mother-to-child transmission |
| MTEF | Medium-term Expenditure Framework |
| NCCEMD | National Committee on Confidential Enquiries into Maternal Deaths |
| NCESS | National Committee for Education Support Services |
| NCSNET | National Commission on Special Needs in Education and Training |
| NDP | National Drug Policy |
| NGO | Non-Governmental Organisation |
| NHISSA | National Health Information System of South Africa |
| NHLS | National Health Laboratory Services |
| NHS | National Health System |
| OAU | Organisation of African Unity |
| PFM | Public Financial Management |
| PFMA | Public Finance Management Act |
| PHC | Primary health care |
| PLWA | People living with AIDS |
| RDP | Reconstruction and Development Program |
| SADC | Southern African Development Community |
| STD | Sexually transmitted diseases |
| TB | Tuberculosis |
| TOP | Termination of Pregnancy |
| VTC | Voluntary HIV Testing and Counselling |
| WHO | World Health Organisation |
This publication is intended for use by all health workers and is an attempt to summarise the most important national health policies and legislation. This is in response to the perception that many health workers are not aware of national health policies and legislation that affect their practice.
We have also included summaries of other policies and legislation that have a bearing on the delivery of health services, like the White Paper on Transforming Public Service Delivery, the Employment Equity Act, the Public Service Act and the Public Finance Management Act. The rationale for this is that these pieces of legislation impact significantly on health personnel and financial matters.
The publication is not intended to replace the original documents but it is hoped that after reading this summary the interest of readers will be stimulated sufficiently to read the original documents. Contact numbers to obtain additional information is provided after each summary.
2.1 Introduction
In 1994 the African National Congress (ANC) published, after wide consultation with its members, the Reconstruction and Development Programme (RDP). It used this document as its election manifesto to fight the first democratic elections in South Africa which it won by a significant majority. The RDP was adopted by the Government of National Unity as its programme of action since the installation of the ANC led-government in 1994.
2.2 Aims and Objectives
What is the RDP? It is "an integrated, coherent socio-economic policy framework. It seeks to mobilise all our people and our country`s resources toward the final eradication of apartheid and the building of a democratic, non-racial and non-sexist future" (RDP, p. 1).
The aims of the RDP are to "meet the objectives of freedom and an improved standard of living and quality of life for all South Africans within a peaceful and stable society" (RDP, p. 4). The RDP is based on six principles:
- An integrated and sustainable programme
- A people-driven process
- Peace and security for all
- Nation-building
- Linkage between reconstruction and development
- Democratisation of South Africa
2.3 Contents
2.3.1 Overview
The RDP is divided into five programmes:
- Meeting basic needs
- Developing our human resources
- Building the economy
- Democratising the state
- Implementing the RDP
2.3.2 Improving nutrition and health care
Part of the programme to meet basic needs is the need to improve nutrition and health care.
With regard to improving nutrition the RDP proposes the following:
- improving food security through land reform, job programmes and reorganisation of the economy;
- short term interventions like nutrition education with targeted income transfers and food subsidies; and
- the implementation of a national nutrition surveillance system which should weigh children under five to establish their levels of growth and well-being.
The RDP proposed the restructuring of the health system: "one of the first priorities is to draw all different role-players and services into the NHS. This must include both public and private providers of goods and services and must be organised at national, provincial, district and community levels" (RDP, p. 43).
The health system would be based on the district health system which is the vehicle for the delivery of primary health care (based on the primary health care approach): "This emphasises community participation and empowerment, intersectoral collaboration and cost-effective care, as well as integration of preventive, promotive, curative and rehabilitation services" (RDP, p. 45).
Health services to be targeted included:
- Free health care for children under six and for all homeless children at public clinics and health centres;
- A programme to improve maternal and child health through access to quality antenatal, delivery and postnatal services for all women to be implemented free at the point of delivery;
- Preventive and promotive health programme for children must be improved including a more effective, expanded programme of immunisation with 90% coverage in three years;
- Every women must have the right to choose whether or not to have an early termination of pregnancy according to her beliefs;
- Comprehensive measures to reduce substance abuse must be implemented;
- Mental health services must be improved to ensure the accessibility of mental health support and counselling services, particularly for those affected by domestic and other forms of violence, by rape and child abuse;
- Improved communication between the formal health sector and traditional healers;
- Programmes to reduce the spread of sexually transmitted diseases (STDs) and Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) must include active and early treatment and mass education. AIDS education for rural communities and especially women must be a priority;
- Programmes to treat specific priority diseases like tuberculosis (TB), carcinoma of the cervix, hypertension and diabetes must be implemented;
- Emergency health services must be improved;
- Chronic disease care needs emphasis including a focus on the promotion of healthy lifestyles;
- Services for the youth need to be co-ordinated;
- Occupation health services must be expanded to focus on especially the most vulnerable e.g, domestic and farm workers and commercial sex workers;
- Appropriate use of technology must be regulated;
- An effective National Health Information System must be implemented and an Essential National Health Research (ENHR) programme initiated;
- A human resource strategy must include: provision of core teams; training and reorientation of all existing health workers in the primary health care (PHC) approach; redistribution of personnel; programmes to attract health personnel to the public sector; implementation of human resource planning and management system; and review of all training programmes and selection criteria;
- Shift budgets in favour of primary health care;
- Provision of essential drugs in all PHC facilities (with essential drug lists);
- Implement mechanisms to reduce the costs of medication in the private sector.
2.4 Additional Information
For additional information and to read what the RDP proposes for other sectors that impact on health please refer to the original document: ANC (1994) The Reconstruction and Development Programme: A Policy Framework. ANC: Johannesburg.
3.1 Introduction
The White Paper for the Transformation of the Health System in South Africa was published as Notice 667 of 1997 in the Government Gazette no. 17910. It was preceded by a document called Towards A National Health System (NHS) and was widely consulted on before publication. Its basis was the RDP and the ANC`s National Health Plan.
3.2 Aims and Objectives
The objective of the White Paper is to "present to the people of South Africa a set of policy objectives and principles upon which the Unified National Health System of South African will be based" (p. 1). In addition the document contains a series of implementation strategies designed to meet the needs of South Africans within the constraints of available resources.
3.3 Contents
The White Paper contains 21 chapters. These are:
- mission, goals and objectives of the health sector;
- reorganising the health service;
- financial and physical resources;
- developing human resources for health;
- essential national health research;
- health information;
- nutrition;
- maternal, child and women`s health;
- HIV/AIDS and STDs;
- communicable diseases;
- environmental health;
- mental health and substance abuse;
- oral health;
- occupational health;
- academic health service complexes;
- national health laboratory services;
- the role of hospitals;
- health promotion and communication;
- the role of donor agencies and non-government organisations (NGOs);
- international health; and
- Year 2000 health goals, objectives and indicators for South Africa.
Five key strategies are outlined in the White Paper based on the principles of the RDP. These are: "(a) the health sector must play its part in promoting equity by developing a single, unified health system; (b) the health system will focus on districts as the major locus of implementation, and emphasise the PHC approach; (c) the three spheres of government, NGOs and the private sector will unite in the promotion of common goals; (d) the national, provincial and district levels will play distinct and complementary roles; and (e) an integrated package of essential PHC services will be available to the entire population at the first point of contact" (p. 12).
The mission of the health sector is to "provide leadership and guidance to the National Health System in its efforts to promote and monitor the health of all people in South Africa, and to provide caring and effective services through a primary health care approach" (p. 13).
The White Paper spells out seven key goals (and a range of related objectives). The goals are:
- To unify fragmented health services at all levels into a comprehensive integrated NHS;
- To promote equity, accessibility and utilisation of health services;
- To extend the availability and ensure the appropriateness of health services;
- To develop health promotion activities;
- To develop the human resources available to the health sector;
- To foster community participation across the health sector; and
- To improve health sector planning and the monitoring of health status and services.
Chapter two sets out the roles and functions of the national, provincial and district levels of system and spells out how the National Department of Health will be restructured (note: the National Department has undergone additional change since 1997). The chapter also points to ways in which the public and private health sectors can work together and how communities can become involved in the health system.
The next chapter deals with financial and physical resources. It lists the principles by which financial and physical resources will be planned. These are: "health care financing and resource allocation policies should promote equity of access to health services among all South Africans, between urban and rural areas, between rich and poor people, and between the public and private sectors. Policies should also promote the optimal utilisation of resources. Financial resources should be allocated equitably. Physical resources should be distributed equitably" (p. 40).
In terms of increasing access to PHC services the goal set is 2,8 and 3,5 consultations per person per year by 2000/01 and 2005/06 respectively. Another important section of this chapter is that on `revised procedures for budgeting` (pp. 46-48). This section includes strategies for budget controls and criteria for budget reprioritisation.
Chapter four sets out the principles and strategies for the development of human resources for health. Three principles are listed including: (a) a national framework for the training and development of health personnel will be established; (b) the skills, experiences and expertise of all health personnel should be used optimally to ensure maximum coverage and cost-effectiveness; and (c) health personnel should be distributed throughout the country in an equitable manner. The chapter emphasises the need to train health personnel in the PHC approach and also the need to create a caring ethos. Various principles and strategies to change the nature of management from authoritarian to one that is participative and democratic are listed.
With regard to clinical skills development the White Paper lists both principles and strategies to be used. The need for affirmative policies and practices are also mentioned in this chapter.
The next chapter focuses on essential national health research (ENHR) and lists three principles to be used in developing an ENHR programme. These are: (a) "the research agenda should be developed to address the country`s major health problems and initiate a process involving scientist decision-makers and population representatives as equal, inclusive partners; (b) health problems should be addressed by means of a full range of methodologies including epidemiology, social and behavioural, clinical and biomedical, health system and policy analysis. Priorities should be set by the stakeholders involved; (c) research should be relevant to health needs and aimed at informing health planning, effective delivery, management and policy development" (p. 74).
Chapter six lists three principles of the national health information system that should be established. These include: (a) "the National Health Information System (NHISSA) should be nationally co-ordinated in order to support the effective delivery of services at all levels of the health system; (b) the NHISSA should be used to monitor the implementation and success of the health priority programmes, both of the Department of Health and the Reconstruction and Development Programme (RDP); and (c) Reporting of NHISSA data at all levels should be timeous, accurate and complete" (p. 79).
Three principles are listed in the White Paper with regard to nutrition (chapter 7). These are: "(a) Nutrition for all South Africans should be promoted as a basic human right and an integral component and outcome measure of the country`s social and economic development; (b) nutrition programmes should be integrated, sustainable, environmentally sound, people and community driven and should target the most vulnerable groups, especially children and women; (c) nutritional well-being should be promoted and monitored within nationally-defined goals.
A three pronged nutrition strategy is proposed: health facility-based nutrition programme; community-based programme; and nutrition promotion, including communication, advocacy and legislation.
Chapter eight covers maternal, child and women`s health and contains six key principles: (a) "maternal, child and women`s health (MCWH) services should be accessible to mothers, children, adolescents and women of all ages, the focus being on the rural and urban poor and farm workers; (b) MCWH services should be comprehensive and integrated; (c) clear objectives and targets should be set at the national, provincial, district and community levels in accordance with the goals of the RDP, the health sector and the United Nations Convention on the Rights of the Child; (d) individuals, households and communities should have adequate knowledge and skills to promote positive behaviour related to maternal, child and reproductive health; (e) MCWH services should be efficient, cost-effective and of a good quality; and (f) women and men will be provided with services which will enable them to achieve optimal reproductive and sexual health.
HIV/AIDs and sexually transmitted diseases are major problems which are tackled in chapter eight of the White Paper. The National AIDS Control Programme focuses on five key objectives: (a) prevention of the spread of the disease through the promotion of safer sex behaviour, adequate provision of condoms and control of STDs; (b) protection and promotion of the rights of people living with HIV/AIDS by ensuring that discrimination against them is outlawed; (c) reduction of the personal and social impact of HIV/AIDS through the provision of counselling, care and support, including social welfare services for persons with HIV/AIDS, their families and communities; (d) use of the mass media to popularise key prevention concepts and the development of life skills education for youth in and out of school; and (e) mobilisation and unification of local, provincial, national and international resources to prevent and reduce the impact of HIV/AIDS.
Decreasing morbidity and mortality rates through strategic interventions
- Improving quality of care
- Speeding up delivery of an essential package of primary health care services through the district health system
- Revitalisation of hospital services
- Improving resource mobilisation and the management of resources without neglecting the attainment of equity in resource allocation
- Improving human resource development and management
- Reorganisation of certain support services
The key strategies listed to achieve the above include:
- life-skills programmes targeted at the youth;
- use of mass communication media to popularise key prevention concepts in AIDS;
- appropriate treatment and management of patients seeking treatment for STDs;
- improved access to barrier methods; and
- promotion of appropriate care and support.
Besides HIV/AIDS the White Paper also includes a series of principles and implementation strategies with respect to other infectious and communicable diseases. The six principles contained in the White Paper include: (a) communicable disease control services (CDCS) should be assessable and integrated into comprehensive PHC services; (b) CDCS should be efficient, cost-effective and of good quality; (c) health care staff should be adequately trained in clinical management and on strategies of communicable disease control; (d) communities and individuals should be adequately informed about communicable diseases and should be involved in communicable disease control (CDC) activities; (e) the CDC programmes should ensure accountability through the use of recording and reporting systems, by establishing a financial management system and through regular evaluation and review; and (f) CDCS should ensure effective infection control, including control and management of epidemics.
Chapter ten advocates the Directly Observed Treatment Strategy (DOTS) as the major strategy to be used to achieve the target of 85% cure rate of new smear positive cases. It also advocates community involvement in DOTS as treatment supporters and in malaria control. A range of other implementation strategies, including training of health workers, health promotion and involvement of employers in CDCS is also proposed.
Chapters 11 and 14 deal with environmental and occupational health respectively. Some of the strategies advocated to improve environmental health include: (a) development of more appropriate human resources; (b) equitable distribution of environmental health officers; (c) intersectoral collaboration with other government departments; (d) making environmental health a shared responsibility with each individual taking some responsibility; (e) strengthening the enforcement of health legislation; (f) doing health impact assessments as part of environmental impact assessments; and (g) community empowerment and advocacy.
With respect to occupational health five principles are proposed. These are: (a) effective interdepartmental coordination and organisation of the various components of occupational health and safety; (b) the development of occupational health services at national, provincial, regional and district levels; (c) the development of norms and standards for a healthy and safe environmental in collaboration with stakeholders; (d) the extension of benefit examinations for the identification of compensable diseases in former miners; and (e) the development of occupational health and safety across Southern Africa.
Mental health is dealt with in chapter 12. Policies and implementation strategies are to be guided by three principles viz., (a) a comprehensive and community-based mental health and related service should be planned and co-ordinated at the national, provincial, district and community levels and integrated with other health services; (b) essential national health research should include an analysis of mental health and substance abuse; and (c) human resource development for mental health services should ensure that personnel at various levels are adequately trained to provide comprehensive and integrated mental health services based on the PHC approach.
Chapter 13 deals with oral health services. Various implementation strategies are listed. These are: (1) prioritisation of service delivery (focusing on prevention and equitable distribution of services); (2) prevention of oral diseases; (3) integration of oral health care with other health services based on a basic package of oral health services; (4) review of training of oral health personnel; (5) water fluoridation; and (6) reduction of the consumption of refined sugar.
Chapter 15 lists four principles that should underpin implementation strategies with respect to Academic Health Service Complexes (AHSC) . These are listed as: “The activities of different AHSCs will be co-ordinated with those of other stakeholders. Services in provincial and district facilities that are part of an AHSC will be linked with similar facilities, for the benefit of all communities. AHSCs should be accountable to both the national department and provincial health authorities. AHSCs should maximise the benefits from available resources and adopt cost-effective approaches. The curricula of AHSCs will be revised to place greater emphasis on the needs of the communities, in accordance with primary health care principles” (p. 153).
Seven principles related to the provision of hospital services are listed in chapter seventeen. These include: (a) the role of hospitals will be redefined to be consistent with the PHC approach; (b) plans will be developed to rationalise hospital services, facilities, staffing and capital investment; (c) decentralised hospital management will be introduced to promote efficiency and cost-effectiveness; (d) hospital boards will be established to increase local accountability and power; (e) a targeted, efficient and equitable user fee system will be introduced and facilities will retain part of the revenue generated to encourage efficient collection and improved services; (f) policy and regulations pertaining to private hospitals will be implemented to encourage cost containment in the private sector, and ensure that private hospitals contribute optimally to the National Health System; and (g) hospitals providing unique or highly specialised services will be treated as a national resource. A list of implementation strategies are contained in the White Paper linked to each of the principles listed above.
Chapter eighteen lists principles and implementation strategies on health promotion and communication. With respect to health promotion the five areas outlined by the Ottawa Charter are promoting health public policy; creating supportive environments; supporting community action; developing personal skills especially in the education sector; and reorienting health services. Priority groups identified include: children, women, youth, the aged, the disabled and the poor. Priority health problems to be targeted include violence, substance abuse, HIV/AIDS and problems related to lifestyle.
Chapter sixteen proposes the creation of a National Health Laboratory Service (NHLS) which will be nationally controlled or co-ordinated. It would include the following services: (a) pathology; (b) environmental health services like water, food and water; (c) occupational health; forensic services; and (d) other laboratory-based services.
The White Paper (chapter 19) contains a set of policy guidelines for donor funding and assistance. This chapter also emphasises the importance of a healthy relationship between the Department of Health and NGOs and includes guidelines for funding of NGOS by the Department.
Chapter twenty deals with international relations and lists five principles: (a) an effective mechanism for international health liaison will be established and awareness of international issues and opportunities created; (b) international health relations should serve the interests of South Africans, and contribute to the advancement of global health goals; (c) development co-operation and donor assistance should support health reform; (d) international liaison activities should support regional health sector co-operation in Southern Africa; and (e) South African participation in international health science development should be encouraged.
The final chapter includes a list of Year 2000 health goals, objectives and indicators to be used in monitoring the implementation of the principles and strategies contained in the White Paper.
3.4 Additional Information
Additional information on the contents of the White Paper can be obtained by the reading the original document which is available from the Government Printer as Government Gazette No. 17910 (16 April 1997). The document may also be downloaded from the internet at www.doh.gov.za.
4.1 Introduction
The White Paper on Transforming Public Service Delivery is also known as the Batho Pele White Paper. This document is related to the White Paper on the Transformation of the Public Service published in November 1995 which sets out eight transformation priorities of which transformation of public service delivery is one.
4.2 Aims and Objectives
The purpose of this White Paper is to "provide a policy framework and a practical implementation strategy for the transformation of Public Service Delivery".
4.3 Contents
The White Paper lists eight principles of Batho Pele. These are:
- "Consultation: citizens should be consulted about the level and quality of the public services they receive and, wherever possible, should be given a choice about the services that are offered;
- Service standards: citizens should be told what level and quality of public services they will receive so that they are aware of what to expect;
- take care of her/his health;
- care for and protect the environment;
- respect the rights of other patients and health providers;
- utilise the health care system properly and not abuse it;
- know his/her local health services and what services they offer;
- provide health workers with relevant and accurate information for diagnostic, treatment, rehabilitation or counselling purposes;
- advise the health worker of her/his wishes with regard to death;
- comply with the prescribed treatment or rehabilitation procedures;
- enquire about the related costs of treatment and/or rehabilitation and to arrange for payment; and
- take care of health records in her/his possession.
- Access: all citizens should have equal access to the services to which they are entitled;
- Courtesy: citizens should be treated with courtesy and consideration;
- Information: citizens should be given full, accurate information about the public services they are entitled to receive;
- Openness and transparency: citizens should be told how national and provincial departments are run, how much they cost and who is in charge;
- Redress: if the promised standard of services is not delivered, citizens should be offered an apology, a full explanation and a speedy and effective remedy; and when complaints are made, citizens should receive a sympathetic, positive response;
- Value for money: public services should be provided economically and efficiently in order to give citizens the best possible value for money" (p. 15).
In terms of an implementation strategy the White Paper proposes the following steps:
- identify the customer
- establish the customer`s needs and priorities
- establish the current service baseline
- identify the `gap improvement`
- set the service standard
- gear up for delivery
- announce service standards
- monitor delivery against standards and publish results.
In addition, the White Paper mandates that national and provincial departments publish their service standards in a Statement of Public Service Commitment whose aim is to "make a clear commitment to the Service Standards that citizens can expect, and to explain to citizens how the organisation will fulfil each of the Principles of Batho Pele.
4.2 Additional Information
For additional information consult the White Paper on Transforming Public Service Delivery (Batho Pele White Paper) which has been published as Government Gazette No. 18340 vol. 388 (1 October 1997). For readers who have access to the internet the document can be found at www.gov.za. The White Paper for the Transformation of the Public Service is obtainable from the Government Printer. It has been issued as Government Gazette No. 16838 (24 November 1995).
5.1 Introduction
Towards the end of the first term of the government elected in 1994 the then Minister of Health Dr Dlamini-Zuma requested the national Department of Health to conduct a review of its activities during the past 5 years and develop a strategic plan for the next 5 years. The findings of this Review formed the basis of an elaboration of a strategic response which was adopted by the new Minister, Dr Tshabalala-Msimang and the nine MECs in 1999. The strategic framework was not intended to replace the White Paper but rather to supplement it. The Strategic Framework was developed with the participation of the provincial departments of health who were requested to develop province specific strategic plans.
5.2 Aims and Objectives
The aim of the Strategic Framework is to provide clear direction on the priorities for the next five years. As stated above provinces are expected to use this Framework to develop province specific plans.
5.3 Brief Description of Content
The Strategic Framework is also called the Ten Point Plan. Besides the ten points the Framework sets out the vision and mission of the Department of Health. These are:
The vision of the Department of Health is a caring and humane society in which all South Africans have access to affordable, good quality health care.
The mission is to consolidate and build on the achievements of the past five years in improving access to health care for all and reducing inequity, and to focus on working in partnership with other stakeholders to improve the quality of care of all levels of the health system, especially preventive and promotive health, and to improve the overall efficiency of the health care delivery system.
The ten points represent the priorities that the Department of Health has set itself for the next five years. The ten points are reflected in the box on the following page.
5.4 Additional Information
The national Department of Health has developed a popular version of the Strategic Plan and has distributed copies to the various stakeholders. Additional copies may be obtained from the National Department of Health`s Communication Unit on 012-3120713 and from the Department’s website at www.doh.gov.za.
6.1 Introduction
In 1999 the newly appointed Minister of Health, Dr Tshabalala-Msimang, decided to undertake a review of the national HIV/AIDS policy and strategy. Following a series of stakeholder meetings and workshops a national HIV/AIDS strategic plan was drafted and adopted by the National HIV/AIDS Council and the Cabinet.
6.2 Aims and objectives
The aim of the Strategic Plan is to refocus the HIV/AIDs strategy to ensure that the country`s response to the epidemic is appropriate and effective.
The primary goals for the South African HIV/AIDS and STD Strategic Plan are to:
- reduce the number of new HIV infections (especially among youth); and
- reduce the impact of HIV/AIDS on individuals, families and communities.
6.3 Brief Description of contents
The primary priority areas are prevention; treatment, care and support; human rights; and monitoring, research and evaluation.
The following general strategies will be used to address the HIV/AIDS epidemic in South Africa:
- Provide HIV/AIDS/STD education to increase public awareness, using an effective communications strategy that will facilitate behavioural change and openness;
- Increase access to voluntary HIV testing and counselling to promote behavioural change and appropriate referral to services;
- Improve STD management, and promote increased condom use to reduce STD and HIV incidence and prevalence; and
- Improve the treatment of HIV positive persons and persons with AIDS to promote better quality of life and limit the need for hospital care;
- Increase the number and extent of projects that target HIV high transmission areas (HTAs);
- Improve prevention and treatment of TB and other opportunistic infections;
- Strengthen the capacity of health personnel to provide HIV/AIDS, STDs and TB treatment, care and support;
- Establish poverty alleviation projects to address the root causes of HIV/AIDS and TB.
The primary foci with respect to prevention are the following 6 areas:
- STD Management
- Promoting safer sex
- Reducing mother-to-child transmission (MTCT)
- Ensuring safe blood supplies
- Providing appropriate post-exposure services
- Voluntary HIV Testing and Counselling (VTC)
The focus areas for treatment, care and support are:
- Care in facilities
- Care in the community (home-based care)
- Orphans
Research priorities for the next five years are:
- Social, cultural and behavioural factors
- Diagnostics for HIV/AIDS/STDs/TB
- Epidemiological research
- Vaccine development
- Biomedical research
- Drug development
- Programme monitoring and evaluation
- Traditional medicines, and
- Policy implementation
The overall aims of the priority area related to human rights are to:
- Create a culture of openness and acceptance around HIV/AIDS & STDs;
- Develop and sustain a legal environment that protects and promotes the rights of PLWAs; and
- Develop appropriate mechanisms to assist PLWAs enforce their rights and to monitor human rights abuses related to HIV/AIDS
An additional major focus area is the youth. The aim is to increase access to youth friendly reproductive health services including STD management, VTC and rapid HIV testing facilities (special focus on youth, women, and migrant workers). Some of the activities will include:
- Review existing reproductive health care service guidelines about youth friendliness;
- Develop criteria for "youth friendly" services;
- Train health care workers; and
- Involve the youth sector
6.4 Additional Information
For further details on the HIV/AIDS strategic plan please contact the National HIV/AIDS and STD Directorate on 012-3120146.
7.1 Introduction
To ensure effective access to all patients to health care as provided for in the Constitution of the Republic of South Africa, the Department of Health has published a Patient`s Rights Charter as a common standard for achieving this right.
Besides the rights of patients, the Charter also lists some of the obligations of patients.
7.2 Aims and Objectives
The rationale for the publication of the Patients` Rights Charter is to provide a clear description to both patients and health workers of what standards of service patients should receive. The objective of this exercise is to improve the quality of care received by patients in the National Health System.
The Charter balances the rights of patients with their obligations. This ensures that patients too play a significant role in ensuring that they become well and maintain their wellness.
7.3 Brief Description of Contents
The Charter consists of a list of twelve rights and ten responsibilities.
Patients have a right to:
- A healthy and safe environment which includes adequate water supply, sanitation and waste disposal and protection from pollution, ecological degradation and infection;
- Participate in decision-making with respect to both health policy development and in matters affecting one`s health;
- Access to health care, including
- Receiving timely emergency care
- Treatment and rehabilitation
- Provision for special needs
- Counselling
- Palliative care
- complications of hypertensive conditions in pregnancy (23,2%);
- AIDS (14,5%);
- obstetric haemorrhage (13,3%);
- Health workers who are courteous, empathetic and tolerant
- Provision of health information in a language understood by the patient
- Knowledge of one`s health insurance/medical aid scheme
- Choice of health service provider or health facility for treatment
- Be treated by a named health care provider
- Confidentiality and privacy
- Informed consent
- Refusal of treatment
- Referral for a second opinion
- Continuity of care
- Complain about health services
As stated above patients also have a series of responsibilities that they need to fulfil. These are responsibilities to:
7.4 Additional Information
For additional information on the National Patient`s Charter kindly contact the Department of Health on 012-312 0059.
8.1 Introduction
In August 1994 an inter-provincial committee called the national District Health Systems Committee was established to draft a policy and implementation strategy for the District Health System (DHS). The committee prepared draft documents and consulted various stakeholders before finalising the document entitled `A Policy for the Development of a District Health System for South Africa`. This document was released in December 1995 and has since been used to guide the implementation of the DHS in South Africa.
The DHS is a model used in many countries, both developing and developed and is advocated as the best vehicle for the delivery of primary health care by the World Health Organisation (WHO).
8.2 Aims and Objectives
The establishment of the DHS in South Africa is intended to provide a vehicle for the delivery of primary health care services in an integrated and comprehensive manner. As stated in the policy document: "The district level is the level at which co-ordination of all district health services takes place, and is the unit of management of the health system that is best able to drive it. The district must be large enough to be economically efficient, but small enough to ensure effective management which is accountable to local communities…" (p. 2).
8.3 Brief Description of Contents
The development of the system rests on a set of twelve principles. These include: overcome fragmentation; equity; comprehensive service provision; effectiveness; efficiency; quality; access to services; local accountability; community participation; decentralisation; developmental and intersectoral approach; and sustainability.
The document defines a health district, using the WHO definition as:
"A District Health System based on Primary Health Care is a more or less self-contained segment of the National Health System. It comprises first and foremost a well-defined population, living in a clearly delineated administrative and geographical area, whether urban or rural. It includes all institutions and individuals providing health care in the district, whether governmental, social security, non-governmental, private or traditional. A District Health System therefore consists of a large variety of inter-related elements that contribute to health in homes, schools, work places, and communities, through the health and other related sectors. It includes self care and all health care workers and facilities, up to and including the hospital at the first referral level, and the appropriate laboratory, other diagnostic, and logistic support services" (p. 7).
The policy document sets of the goals for the transformation of the system at the district level and provides some guidelines for what needs to be done to achieve these goals. These goals include:
- There will be a unitary national health service based on the District Health System that allows access for everybody, to improve their health;
- The country will be divided into geographically coherent, functional health districts;
- There will be a single health service and health management team for each health district;
- The health team in each health district will be accountable to a single authority within a provincial and national framework;
- Ideally, in the long term, district health systems should be part of Local Government, where the boundaries of a health district coincide or are coterminous with those of a local authority;
- A single authority will be the employer of the district health team;
- Uniform salary and service conditions will be phased in for all public sector health personnel.
- The health team will be responsible for providing comprehensive health services throughout the district up to and including District Hospital level;
- The provincial Health Authority will be responsible for monitoring, evaluating and supporting district health services;
- Services rendered by private (independent) and traditional practitioners, NGOs, and provincially-aided hospital services will be seen as integral to the health district.
8.4 Additional Information
For additional information on the DHS please contact the DHS Unit on 012-312 0753. Other publications that discuss the district health system, available from the national Department of Health include: The District Manager`s Handbook; The District Health System: what is it, and how will it work; Integration of Services: a briefing document for Local Government councillors.
9.1 Introduction
The National Drug Policy (NDP) for South Africa was published by the Department of Health in January 1996. Following the elections in 1994 the Minister of Health appointed a national Drug Policy Committee. This Committee prepared a report which the Department of Health used as a basis for widespread consultation with stakeholders during 1995. Inputs from these consultations were used to produce the NDP document.
The attempts by the Department of Health to improve the availability and reduce the costs of drugs has resulted in many challenges from various stakeholders, notably the pharmaceutical manufacturers. Despite these challenges the Department is committed to ensuring that affordable and safe drugs are available to those who need it - the public of South Africa.
9.2 Aims and Objectives
The document outlines a series of objectives of the NDP. These are:
- Health objectives
- To ensure the availability and accessibility of essential drugs to all citizens
- To ensure the safety, efficacy and quality of drugs
- To ensure good dispensing and prescribing practices
- To promote the rational use of drugs by prescribers, dispensers and patients through the provision of the necessary training, education and information
- To promote the concept of individual responsibility for health, preventive care and informed decision making
- Economic objectives
- To lower the cost of drugs in both the private and public sectors
- Ti promote the cost-effective and rational use of drugs
- To establish a complementary partnership between Government bodies and private providers in the pharmaceutical sector
- To optimise the use of scarce resources through cooperation with international and regional agencies
- National development objectives
- To improve the knowledge, efficiency and management skills of pharmaceutical personnel
- To reorient medical, paramedical and pharmaceutical education towards the principles underlying the NDP
- To support the development of the local pharmaceutical industry and the local production of essential drugs
- To promote the acquisition, documentation and sharing of knowledge and experience through the establishment of advisory groups in rational drug use, pharmacoeconomics and other areas of the pharmaceutical sector.
9.3 Brief Description of Contents
The policy covers ten areas and outlines the aim and implementation strategy for each.
Legislation and regulations:
The aim is to ensure that drugs reaching patients are safe, effective and meet approved standards and specifications. This will be achieved through strengthening the Medicines Control Council (MCC), rationalising drug registration, controlling the registration of practitioners and the licensing of premises, enhancing the inspectorate and laboratory functions, and promoting other quality assurance measures.
Drug pricing:
The aim is to promote the availability of safe and effective drugs at the lowest possible cost. This will be achieved by monitoring and negotiating prices and by rationalising the pricing system in both the private and public sectors and by promoting the use of generics.
Drug selection:
The aim is to promote rational choice of drugs in accordance with the essential drug concept. This will be achieved by the development of Essential Drugs Lists (EDL) and standards treatment guidelines.
Procurement and distribution:
The aim is to ensure an adequate supply of effective and safe drugs of good quality. This will be achieved by promoting cost-effectiveness in the public sector and by utilising private sector facilities where appropriate.
Rational use of drugs:
The aim is to promote rational prescribing, dispensing and use of drugs by health workers and to support the informed and appropriate use of drugs by communities. This will be achieved by training, provision of scientifically validated drug information for professionals and the community, the establishment of hospital therapeutic committees, good dispensing practice and an enhanced role for the pharmacist, and control of commercial marketing practices.
Human resource management:
The aim is to develop expertise and human resources to support the successful implementation of the policy and to promote the concepts of EDL and rational drug use and to ensure their adoption throughout the country. The implementation strategy includes: strengthening drug management systems and improving the quality of service in drug supply; improving inspection services and quality assurance for drugs and their rational use; training pharmaceutical support staff so that deficiencies in the distribution chain will be eliminated and transforming training institutions so that they produce health care professionals who function effectively and efficiently.
Research and development:
The aim is to promote research that will facilitate the implementation, monitoring and evaluation of the NDP and to meet the health care needs of the country. This will be achieved through the Department of Health supporting important areas of operational research that can promote the successful implementation of the NDP.
Technical cooperation with other countries and international organisations:
The aim is to ensure that all relevant forms of technical cooperation are investigated and promoted to maximise the effective use of limited resources. This will be achieved through technical cooperation with international agencies like the WHO.
Traditional medicines:
The aim is to investigate the use of effective and safe traditional medicines at primary care level. This will be achieved through the encouragement of closer co-operation with traditional healers and the development of a Code of Practice for traditional healers.
Monitoring and evaluation:
The aim is to support the successful implementation of the NDP through establishing mechanisms for monitoring and evaluation of performance and impact. Indicators for the monitoring of policy will be part of the National Health Information System. A full evaluation of the NDP will be done every three years.
9.4 Additional Information
More information on the NDP, the Essential Drug Lists and and Standard Treatment Guidelines can be obtained from the Department of Health, 012- 312 0335/0362.
10.1 Introduction
Pregnancy and childbirth are important experiences and should be safe events in a woman`s life. However, WHO estimates that 582 000 women die each year world wide due to pregnancy-related conditions, most of which could have been prevented. For every women who dies at least 30 develop debilitating problems. From the South African Demographic and Health Survey the maternal mortality ratio remains high at 150 per 100 000 live births.
10.2 Aims and Objectives of the Enquiry
In recognition of the need to reduce maternal mortality in South Africa, deaths during pregnancy and childbirth were made notifiable events since October 1997.
10.3 Notification Process
The maternal death notification process requires that all deaths of women that occur in pregnancy or within 42 days of being pregnant be reported. These deaths are then subdivided into direct, indirect and fortuitous deaths. Only direct and indirect deaths are counted for statistical purposes.
10.4 Definitions of Maternal Deaths
Maternal deaths
Deaths of women while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
Direct
Deaths resulting from obstetric complications of the pregnancy state (pregnancy, labour and puerperium), from interventions, omissions, incorrect treatment or from a chain of events resulting from any of the above.
Indirect
Deaths resulting from previously existing disease, or disease that developed during pregnancy and which were not due to direct obstetric causes, but which were aggravated by the physiological effects of pregnancy.
Fortuitious
Deaths from unrelated causes, which may occur in pregnancy or the puerperium.
Unknown
Deaths during pregnancy or the puerperium where an underlying cause was not identified.
10.5 The Committee`s Findings and Recommendations
The National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) of South Africa published its first comprehensive report in October 1999. The report entitled `Annual Report on Confidential Enquiries into Maternal Deaths in South Africa Saving Mothers` found that the five major causes of deaths were:
The Committee made the following recommendations to address the problem of high maternal deaths:
- Guidelines on managing conditions, which commonly result in maternal deaths, must be developed, distributed and implemented throughout the country by 2002.
- Referral routes and criteria for referral must be established and implemented by 2001.
- Establishing staffing and equipment norms per level of care must be performed in every health institution concerned with the care of pregnant women by 2001.
- The distribution of the Termination of Pregnancy (TOP) services (especially with respect to second trimester TOP`s) must be expanded and the sites must be advertised to the public.
- The partogram must be used for monitoring labour in every pregnant woman and problems detected on the partogram must be managed accordingly.
- Blood must be available at every institution where caesarean sections are performed.
- Medical Obstetric Clinics must be established to ensure the optimal management of women with pre-existing medical conditions especially women with heart disease and diabetes mellitus.
- Regional anaesthesia should be promoted in all sites performing caesarean sections.
- Family Planning services must intensively educate women 30 years and older or with 5 or more children about the dangers associated with pregnancy. Contraceptive use should be actively promoted in this group of women.
- A National HIV/AIDS policy geared towards managing these women and dealing with the ethical considerations must be available by 2001.
10.6 Additional Information
For further information on Confidential Enquiries into Maternal Deaths kindly contact the Department of Health on 012 -312 0098.
11.1 Introduction
The incidence of TB in South Africa is very high and urgent steps are required to reduce the incidence rate. In order to address this epidemic the Department of Health has adopted the DOTS approach which is advocated by the WHO.
11.2 Definitions
What is DOTS? It is Directly (detection of infectious sick patients) Observed (patients must be seen swallowing the prescribed medication) Treatment (correct treatment).
11.3 Brief Description
DOTS is a comprehensive strategy that ensures that the majority of TB patients presenting at primary health care services will be cured. It makes it easier for patients to obtain treatment by ensuring that they do not have to spend months in hospitals or wait for hours to be treated at clinics and community health centres.
How does it work? Once patients are diagnosed and treatment is prescribed a treatment supporter is identified. A treatment supporter is any person who can supervise the taking of anti-TB drugs by the patient. TB patients have the right to chose their own treatment supporter. It may a member of the patient`s family or community or the nurse at the local clinic.
11.4 Additional Information
For more information on the DOTS strategy please contact the Department of Health at 012-3120100. The Department has recently also produced a set of TB guidelines entitled ‘The South African Tuberculosis Control Programme Practical Guidelines 2000’ which outlines the DOTS strategy in more detail.
12.1 Introduction
Five diseases diarrhoea, acute respiratory infections, malnutrition, measles and malaria are responsible for over 70% of childhood mortality in the developing world. In addition, these diseases account for more than 75% of paediatric visits to health facilities. This picture is also true for South Africa and it therefore makes sense to target our interventions to these diseases.
The WHO has developed a strategy to reduce morbidity and mortality from these diseases called the Integrated Management of Childhood Diseases (IMCI). This is a primary health care approach to managing children that are ill. The approach does not neglect health promotion and emphasizes such strategies as breastfeeding and immunization.
12.2 Aims and Objectives
The aim of the strategy is to reduce morbidity and mortality in children from the five diseases mentioned above. Given the high incidence of HIV/AIDS in South Africa intervention strategies to reduce the incidence from this disease have also been included.
12.3 Brief Description
The IMCI approach consists of guidelines to assist health workers to treat children up to five years of age. This approach consists of assessing and classifying the nature and extent of the illness, treatment, counselling the caregiver and advising on follow-up treatment.
Any health worker (nurse or doctor) can use this approach at the primary health care level. Beside this advantage there are others: simultaneous treatment of all illnesses; fast action for life threatening illnesses; use of all encounters with the child for health promotion and prevention; clear communication with caregivers; efficiency in management of children who are ill; appropriate use of health resources; and cost effectiveness.
12.4 Additional Information
For additional information please contact the Department of Health or 012-3120199 /0213.
13.1 Introduction
Given the HIV/AIDS epidemic and the link between sexually transmitted disease and HIV/AIDS the Department has decided to focus on the prevention and proper treatment of STDs. It is estimated that HIV transmission can be reduced by 40% by improving the quality of STD services.
The STD problem is a large one in South Africa. It is estimated that there are between 4-11 million new infections each year. The South African Demographic and Health Survey results show that one in eight men had STD symptoms when the survey was conducted.
13.2 Aims and Objectives
The Department has adopted the Syndromic Mangement of STDs as the key strategy to improve the management of STDs. The objective of the programme is to train health workers to provide comprehensive care for the management of STDs using the Syndromic Management Approach.
13.3 Brief Description of the Approach
Syndromic management of STDs is the provision of high quality STD care by treating patients with one or more STDs with the most effective drugs at the first point of contact. The emphasis is on rapid treatment and on increasing access to sexual and reproductive health care.
Health workers are trained to diagnose (by taking a detailed history confirmed by examination). Once diagnosed as an STD, treatment is provided for the majority or organisms known to be responsible for the syndrome. Health workers are provided with a flowchart (algorithm) to aid them to treat a given set of symptoms effectively.
Other STD management strategies are also taught to health workers including: (a) contact tracing to ensure that sexual partners are assessed and treated if necessary; (b) the importance of provision of male and female condoms; and (c) counseling and patient education skills.
13.4 Additional Information
For addition information on the syndromic management of STDs please contact the Department of Health at 012-312 0130/0121.
14.1 Introduction
The Department has advocated the disease management model to deal with non-communicable diseases. This covers all aspects of care including clinical care, therapeutic education, non-drug and drug treatment. To assist health workers a number of guidelines have been developed by the Department of Health.
14.2 Aims and Objectives
To find suitable models and to develop user-friendly guidelines to assist health workers to provide the best possible care for chronic diseases, the disabled and the elderly.
14.3 Brief Description
The disease management model allows for:
- A democratic structured way of dealing with the course of the disease process and involves all role-players;
- Knowledge based and shared decision-making;
- Integration at all levels of care;
- Comparison of outcomes;
- Shared risks ethical, financial and legal;
- Standardised treatment, enhanced equality and decreased inappropriate practice;
- Guidelines are the core for quality of care programmes;
- Lower cost of treatment; and
- Continuous revision and improvement.
In this model disease management guidelines are tools, not rules, to assist health care workers to make decisions with and not for patients. Patients thus play a major role in the disease management process.
The differences between the management of non-communicable and communicable diseases are the following:
- Patients consultation time is on average longer and more intense and focused;
- A long standing relationship needs to be developed between patient and provider;
- The patient is the focal point in the process;
- Repeat visits are necessary mostly lifelong;
- There is a need to see the same provider on each visit; and
- Focus should be on abilities and health and not disabilities and disease.
All health providers should know these differences as it impacts on how the service is structured and provided.
Several guidelines for the management of chronic conditions have been developed, including diabetes, hypertension, foot care etc. These are available from the Department of Health.
14.4 Additional Information
For more information, including copies of the guidelines referred to on the previous page, please contact the Department on 012-0472/3.
15.1 Introduction
Health Promotion focuses on facilitating environments conducive to health by addressing the physical and social determinants of health and providing learning experiences to promote health. The Department of Health has developed guidelines for the `development of health promoting schools/sites`. The guidelines were developed in partnership with the Departments of Education and Welfare.
15.2 Definition, Aims and Objectives
The aim of health promotion is to develop educational, social and environmental interventions that promote health through a settings approach which includes the school setting, health service setting, the workplace and community settings.
The WHO defines health promoting schools as: "The health-promoting school aims at achieving healthy lifestyles for the total school population by developing supportive environments conducive to the promotion of health. It offers opportunities for, and requires commitments to, the provision of a safe and health-enhancing social and physical environment".
The National Commission on Special Needs in Education and Training (NCSNET) and the National Committee for Education Support Services (NCESS) developed the term `health promoting sites of learning` to broaden the application of the concept to all learning sites. The term is defined as ` a place that is constantly strengthening its own capacity as a healthy setting for living, learning and working`.
The following objectives relate to the health promoting schools/sites concept:
- To build education and school policies which support health and well-being;
- To create safe and supportive teaching and learning environments which includes a human rights culture;
- To strengthen community action and participation through enhancing and expanding the relationship between schools/sites and the community;
- To promote personal skills of members of the learning community, with a particular emphasis on influencing health knowledge, attitudes and practices through a culturally appropriate health and lifeskills curriculum, and encouraging healthy physical activity and recreation;
- To re-orientate health and education support services towards an accessible, integrated, systemic, preventative and health promotive approach, with a particular focus on reducing the number of learners affected by learning impairment or experiencing barriers to learning and development, reducing the incidence of disease or injury, and addressing factors that place learners at risk.
15.3 Brief Description
The key components of the health promoting schools/sites programme are:
- Building education and school policies which support well-being
- Creating supportive teaching and learning environments
- Strengthening community action and participation within the education context
- Developing personal skills within the education context
- Re-orientating support services like physical (health) and psychological services, welfare and learning support services
Various structures are proposed to co-ordinate activities, e.g. a national interdepartmental committee and a national health promoting schools forum/network (which would be a sub-group of the South African Foundation for Health Promotion- which is yet to be established), provincial health promoting schools for a/networks, district committees and school/site-based support teams. Please note that at the time of publication these structures have not been established.
15.4 Additional Information
For additional information kindly contact the national Department of Health 012-3120166.
16.1 Introduction
In South Africa, malnutrition is manifested in both under nutrition and over nutrition suggesting the need for complementary strategies to address both these problems. Protein energy malnutrition, as measured by stunting levels (13,2% for primary school children in 1994 & 22,9% for children aged 6-71 months in 1995), is a moderate public health problem. Studies report a wide range of under-nutrition, indicating that there are pockets with more serious problems of under nutrition than others, thus signifying that intervention programmes will have to be area-based. Aneamia and marginal vitamin A status are widespread micronutrient deficiencies. Additional factors are the high prevalence of parasitic infestations in some areas, pockets of iodine deficiency and low mean energy intakes particularly amongst rural black children. It is estimated that 39% of the population is vulnerable to food insecurity. Obesity and associated diseases of lifestyle are also common amongst South Africans.
16.2 Aims and Objectives
The Department of Health`s Integrated Nutrition Programme (INP) has, as its main strategy, to ensure optimal nutrition for all South Africans. The INP follows a coordinated intersectoral approach whereby direct and indirect nutrition interventions are combined to address nutrition problems. The programme targets nutritionally vulnerable communities and groups and provides appropriate nutrition education and promotion to all people.
16.3 Brief Description
The INP forms an integral part of primary health care. It requires an integrated service delivery process at the operational level that is organised around target groups, their needs, specific interventions and different points of service delivery.
The INP targets nutritionally vulnerable communities, groups and individuals for nutrition interventions and provides appropriate nutrition promotion and education to all people. The focus areas of the INP include:
- Therapeutic nutrition
- Growth monitoring and promotion (infant and young child nutrition)
- Nutrition education
- Food supplementation
- Micronutrient Deficiency Control
- Food Service Management
- Contribution to household food security
- Nutrition promotion
Intervention packages can include any combination of interventions depending on the prevailing needs and problems. Points of service delivery include health facilities, communities, nutrition rehabilitation centres, care institutions, schools and the population at large.
16.3 Additional Information
For additional information on the INP please contact the Department on 012-3120047.
17.1 Introduction
The Southern African Development Community (SADC), consisting of :
- the Republic of Angola,
- the Republic of Botswana,
- the Democratic Republic of Congo,
- The Kingdom of Lesotho,
- the Republic of Malawi,
- the Republic of Mauritius,
- the Republic of Mozambique,
- the Republic of Namibia,
- the Republic of Seychelles,
- the Republic of South Africa,
- the Kingdom of Swaziland,
- the United Republic of Tanzania,
- the Republic of Zambia and
- the Republic of Zimbabwe,
decided in August 1997 to include health in its Programme of Action by creating a Health Sector.
17.2 Goals and Aims
The goal of the Health Sector is to attain an acceptable standard of health for all citizens by promoting, coordinating and supporting the individual and collective efforts of Member States. Within this goal are two aims:
- to reach specific targets within the objective of "Health for All" in the 21st century by 2002 in all Member States based on the primary health care strategy; and
- to ensure that health care is accessible to all within each Member State`s economic reality.
17.3 Objectives
The Health Sector has twenty-three objectives. These include the following (please note that this is not a full list):
- identify, promote, co-ordinate and support those activities that have the potential to influence the health of the population within the Region;
- co-ordinate regional efforts on disaster and epidemic preparedness, mapping, prevention and control of diseases such as malaria, measles, dysentery, polio, cholera, tuberculosis, HIV/AIDS and STDs, and to develop common strategies to address non-communicable diseases such as diabetes, hypertension and cancer;
- ensure effective utilisation of human resources for health in the Region, including the harmonisation of curricula for the training of health personnel, and the accreditation of health professionals trained in Member States.
This Report was made possible through support provided by the US Agency for International Development (USAID)/South Africa under the terms of contract 674-0320-C-00-7010-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the USAID or Management Sciences for Health (MSH).