South Africa has poor outcome indicators relative to the amount of resources that are beingspent in the health sector compared to most middle income countries. Much of this is due tothe overwhelming impact of the HIV impact, which itself requires a PHC approach.5.3.
Unless there is fundamental change in the way in which the health sector functions SouthAfrica is unlikely to achieve the MDG health indicators for infant, under-five and maternalmortality rates. Nor is it likely to achieve the MDG goal related to HIV and TB.5.4.
The Minister has committed himself and the health sector to improving these indicatorsthrough his negotiated service delivery agreement (NSDA).5.5.
Many of the health problems are
linked to the social determinants of health (“upstreamfactors”) such as education and water which require inter
-sectoral collaboration which is one of the pillars of the primary health care approach.5.6.
There is the necessary political will to translate the theory of PHC into implementable action.6.
There have been numerous documents written on PHC for SA over the past decade. This documentdoes not try and rewrite these documents but is focussed on making practical recommendations forimplementation. The three key recommendations are essentially:6.1.
Strengthen the district health system (DHS), through the implementation of chapter 5 of theNational Health act, and do the basics better.6.2.
Place much greater emphasis on population based health and outcomes, which includes a newstrategy for community-based services through a PHC outreach team based on communityhealth workers (CHWs) and mobilising communities.6.3.
Pay greater attention to those factors outside of the health sector that impact on health, thesocial
determinants of health (“upstream factors”)
The bulk of this document is built upon making a range of practical suggestions for the “re
engineering of PHC in SA”. These are largely structured around the WHO framework for health
contained in Figure 1. In addition there are a number of community basedinitiatives in provinces which can provide additional lessons for PHC. These include, but are not
limited to, the Premier’s Flagship Project in KZN and the Letsema Circle Project in the E
World Health Organization.
Everybody’s Business. Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action. Geneva: World
Health Organization, 2007