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The Free State Provincial District Health System conference held over the weekend was a resounding success. The conference was held from 24 to 26 August 2001 and was addressed by the national Minister of Health, Dr. Manto Tshabalala-Msimang, the Premier of the Free State, Ms. Winkie Direko, the MEC for Health, Mrs Ouma Tsopo and the MEC for Local Government and Housing, Mr. Lechesa Tsenoli. The chairperson of the Free State Local Government Association, Mr. J Ramokhoase, also addressed the conference on behalf of the association.

In total, 304 delegates attended the conference and these were constituted by several stakeholders amongst whom were people from the Equity Project, Health Systems Trust, private sector, and the national Department of Health. Representatives of health committees, hospital boards as well as councillors charged with health in their municipalities, town managers and health managers from both local and provincial government attended. Delegates from provinces like KwaZulu-Natal, North West, Gauteng, Mpumalanga, Northern Province and the Northern Cape graced the occasion.

This conference was the first of its kind in the country in as far as health service is concerned. The Free State province has set the pace in terms of establishing the Provincial Health Authority (PHA), and the Provincial Health Advisory Board (PHAB). These two bodies were inaugurated at this very conference.

Concretely emerging out of this conference were issues around equity, governance and community involvement and intergovernmental relations as summarised below:

1. Equity

* Conference created sensitivity and recognition of various inequities and recognition that something should be done to alleviate these inequities.

* Main inequities based in rural settings - under-resourcing and under-provision to rural people.

* Poor infrastructure, lack of transport and poor roads contribute significantly to inequities in accessibility to health care and hit rural communities hardest.

* We need to develop standard norms to determine the basis of measuring equity and inequities.

* District Health Expenditure Review should be rolled out to all the districts.

* Identify clear factors to measure equity across municipalities.

* Give guidance to Community Based Organisations on how to support service.

* Increase mobile service to include the peri-urban settlements and reduce pressure on fixed clinics.

* Develop a policy on poverty alleviation and improving illiteracy in communities and compensating community volunteers.

* Double check the information involving other stakeholders and include data that is not included.

* Strengthen the Health Information System to enable stakeholders to engage and use information to improve planning and manage effectively.

2. Governance and Community Involvement

* Conference creates keen awareness that the new structures have key contribution to make to the benefit of communities, however these structures/councils/communities should not be overloaded by unrealistic expectations.

* Community structures have in particular a monitoring and advisory role to play as well as to identify the needs, strengths and weaknesses of their community. They should also play a liaising, conciliating, informing and conflict solving role.

* Need to strengthen community structures and communities.

* Empower community structures to do their work effectively to improve service provision from facilities.

* Empower Non Governmental Organisations and Community Based Organisations to conduct health campaigns and other health support activities.

* Implement District Health Authority with participation of all stakeholders.

* Empower community structures to facilitate the process of ownership and initiate project to improve health services.

* Conduct information workshops to address the fear of the unknown (Roll out District Health System issues).

* Voluntarism is a key aspect of community involvement. It should be strengthened and support and rewarded!

* Poverty is one of the biggest threats to the District Health System and to community involvement in successfully implemented District Health System.

* Community structures to identify problem areas and work together with management to resolve them.

* Improve communication opportunities between clinic committees, hospital boards, Non Governmental Organisations and Community Based Organisations to support improved health service delivering.

3. Intergovernmental Relations

* The conference analysed the problem sufficiently. Such analysis is the first step in developing strategies. Understanding the nature and causes of problems that hamper intergovernmental collaboration is an essential precondition for creating sound and workable intergovernmental co-operation.

* Clear awareness of the learning issues confronting intergovernmental collaboration, as well as clear identification of priority areas in need of action in search of solutions to problems.

* This conference sensitised the two governance and government structures about issues, and hopefully urge them to develop solutions in a true "cooperative government spirit".

* Improve communication channels among stakeholders to facilitate implementation of District Health System.

* Improve trust through unifying working conditions.

* Create regular communication between healthy and local governance.

* Clarify roles and responsibilities between local Government and Province to improve functional integration (use experience of Environmental Health)

* Develop guidelines for implementation of the Free State Health Act.

The way forward was adopted to develop a programme of action to implement District Health System on all recommendations of the conference - broken down to district implementation.

The conference will be held annually for the next coming three to four years.

Enquiries: Shadrack Shuping (CEO: Southern Free State Complex) at 083 709 0827

Office of the MEC for Health, Free State, 27 August 2001