District Health System performance in South Africa: Are current monitoring systems optimal?
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i12.1614Keywords:
INDICATORS; USE OF DATAAbstract
In this article, we review the monitoring and evaluation system that is used to measure the performance of primary healthcare delivered through the district health system and district management teams. We then review some global frameworks, especially linked to the World Health Organization, and look at some of the differences between what is internationally recommended and what we do in South Africa. We end with some recommendations to improve the system.
References
Owen CP. A Policy for the Development of the District Health System for South Africa. Johannesburg: Health Policy Coordinating Unit, on behalf of the National District Health Systems Committee, 1995. 2. National Treasury, South Africa. 2024 Medium Term Expenditure Framework. Technical Guidelines. https://www.treasury.gov.za/publications/guidelines/MTEF%202024%20Guidelines.pdf
(accessed 5 September 2023).
SouthAfrica.NationalHealthInsuranceBill.AsamendedbythePortfolioCommitteeonHealth(National
Assembly). https://www.parliament.gov.za/storage/app/media/Bills/2019/B11_2019_National_Health_
Insurance_Bill/B11B_2019_National_Health_Insurance_Bill.pdf (accessed 5 September 2023).
Bitton A, Fifield J, Ratcliffe H, et al. Primary healthcare system performance in low-income and middle-income countries: A scoping review of the evidence from 2010 to 2017. BMJ Global Health
;4:e001551. https://doi.org/10.1136/ bmjgh-2019-001551
Papanicolas I, Rajan D, Karanikolos M, Soucat A, Figueras J. Health system performance assessment:
A framework for policy analysis. Geneva: World Health Organization, 2022.
Karamagi HC, Tumusiime P, Titi-Ofei R, et al. Towards universal health coverage in the WHO African Region: Assessing health system functionality, incorporating lessons from COVID-19. BMJ Global
Health 2021;6:e004618. https://doi.org/10.1136/ bmjgh-2020-004618
South Africa. National Health Act No. 61 of 2003.
Hunter J, Asmall S, Ravhengani N, Chandran M, Tucker J-M, Mokgalagadi Y. The ideal clinic in South
Africa: Progress and challenges in implementation. In: Padarath A, Barron P, eds. South African Health
Review. Durban: Health Systems Trust, 2017.
Davén J, Madela N, Khoele A, Wishnia J, Blecher M. Finance. In: Massyn N, Barron P, Day C, Ndlovu
N, Padarath A, eds. District Health Barometer 2018/19. Durban: Health Systems Trust, 2020.
Barron P, Day C, Loveday M, Monticelli F. The District Health Barometer Year 1. January - December 2004. Durban: Health Systems Trust, 2005. https://www.hst.org.za/publications/District%20
Health%20Barometers/DHB_Year1.pdf (accessed 3 September 2023).
Murray C, Frenk J. A framework for assessing the performance of health systems. Bull World Health
Org 2000;78(6);717-731. https://apps.who.int/iris/bitstream/handle/10665/268164/PMC2560787.pdf
(accessed 3 September 2023).
Massyn N, Day C, Ndlovu N, Padayachee T, eds. District Health Barometer 2019/20. Durban:
Health Systems Trust, 2020. https://www.hst.org.za/publications/Pages/DHB2019-20.aspx (accessed
September 2023).
World Health Organization. The World Health Report 2000. Health Systems: Improving Performance.
Geneva: WHO, 2000.
World Health Organization. Everybody’s Business – Strengthening Health Systems to Improve Health
Outcomes. WHO’s Framework for Action. Geneva: WHO, 2007.
World Health Organization, United Nations Children’s Fund. Operational framework for primary
health care: Transforming vision into action. Geneva: WHO, 2020. https://www.who.int/publications/i/
item/9789240017832 (accessed 21 July 2023).
World Health Organization, United Nations Children’s Fund. Primary health care measurement
framework and indicators: Monitoring health systems through a primary health care lens. Geneva:
WHO, UNICEF, 2022.
Sheikh K, Abimbola S. Learning health systems: Pathways to Progress. Flagship Report of the Alliance
for Health Policy and Systems Research. Geneva: World Health Organization, 2021.
Boulle A, de Vega I, Moodley M, et al. ‘Data Centre Profile: The Provincial Health Data Centre of the Western Cape Province, South Africa’. Int J Population Data Science 2019;4(2):1143. https://doi.
org/10.23889/ijpds.v4i2.1143
Ritshidze. Community led clinic monitoring in South Africa. https://ritshidze.org.za/ (accessed
July 2023.)
Pillay Y, Museriri H, Barron P, Zondi T. Recovering from COVID lockdowns: Routine public sector
PHC services in South Africa, 2019 - 2021. S Afr Med J 2022;113(1):17–23. https://doi.org/10.7196/
SAMJ.2022.v113i1.16619
National Department of Health, South Africa. Ideal clinic definitions, components and checklists. April 2020, version 19, updated April 2023. https://www.idealhealthfacility.org.za/users/common/ documents.php (accessed 20 July 2023).
Office of Health Standards Compliance, South Africa. Biannual Report October 2022 to March 2023.
https://ohsc.org.za/publications/bi-annual-report-certification-of-health-establishments-october-
-to-march-2023/ (accessed 21 July 2023).
Rispel R, Shisana O, Dhai A, et al. Achieving high-quality and accountable universal health coverage
in South Africa: A synopsis of the Lancet National Commission Report. In: Moeti T, Padarath A, eds. South African Health Review 2019. Durban: Health Systems Trust, 2019. http://www.hst.org.za/ publications/Pages/SAHR2019 (accessed 1 September 2023).
Downloads
Published
Issue
Section
License
Copyright (c) 2023 P Barron, H Mahomed, Thulani, K Vallabhjee, H Schneider

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.