Managing primary health care in South Africa at district level--the MRC/IUPHC Workshop.

The Medical Research Council and the Institute of Urban Primary Health Care hosted a workshop on managing primary health care (PHC) in South Africa at the district Level in Johannesburg in May 1992. Its purpose was identification of problems in implementing PHC at the district level and development of sustainable solutions. The 30 participants from a variety of health and nonhealth backgrounds agreed that the leading problems were lack of goals no coherent information system and no consensus on PHCs definition or on what services should be provided. No model proposal for district level PHC existed thus making it difficult to discuss PHC. The lengthy period of transition of PHC of 5-10 years consisting of increased growth of the private sector will adversely affect morale and reduce public sector services. Many health care professionals and their councils are against PHC and many authorities quarrel over reduced public sector funds yet there are many years of inequalities to overcome. Few professionals possess good managerial skills. Nevertheless health workers must agree on a basic package of effective services to be provided equitably and in a comprehensive and integrated manner. Higher level health professionals should delegate responsibility to the lowest level health workers. Managers should incorporate evaluation and information management into PHC services. 1 authority should be responsible for health services restructured along district and regional lines. Health services should foster respect accountability and community participation. Policymakers must develop financing methods and fee policies based on the notion that access to health care is a right. They need to examine proposals for regulation of and collaboration with the private sector and encourage nongovernmental groups.