The Health District
Learning objectives
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What is a health district
Why do we focus on the health district
What are the tasks of a health district
What is the role of the HIS in the health
district
What is a health district?
Primary, secondary, tertiary care
• Primary care: community level, first point of
consultation for all patients
• Secondary care: provided by medical
specialists who in general do not have first
contact with patients. Referrals; for example
cardiologists
• Tertiary care: specialized health care for
inpatients in hospitals
What is a health district?
• It is the point of implementation for primary
health care (Alma Ata, 1978)
• What does this mean?
The health district
• It is the point of the national health system where
people can get comprehensive health care
• It is a clearly defined geographical/administrative
area
• It is the optimal operation unit for the
identification of the excluded from health care
and for the implementation of health improving
strategies (Harare, 1987)
What are the characteristics of a health district ?
Clearly delineated geographical area
Population between 30,000 and 500,000 (most cases)
Identifiable form of local government
Managed by few officers
Balance between population size and availablity of technical
specialised staff
Why do we focus on the health
district?
What advantages presents the health district ? 1/2
It is close enough to the community to understand and act
on its problems and constraints
It has easier communication with the community to
ensure its participation in planning and organization
It is the most appropriate level for coordinating top-down
and bottom-up planning
What advantages presents the health district ? 2/2
It is the most suitable place to provide support to
health workers in the health posts and health centres
It presents large potential for effective collaboration with
other sectors towards the health of the community
It has the ability to handle decentralisation of
resources and of decision-making
What are the tasks of a health
district?
What are the tasks of the health district ? 1/2
Implementation of all community based health
programmes
Supervision and control of all community health workers
in the district
Organization and operation of district hospital services
Management of all other public health facilities
Coordination and supervision of all public, nongovernment and private health systems
What are the tasks of the health district ? 2/2
Promotion of active links with local government entities
Promotion of community participation in the local health
service planning
Preparation of annual health plan
Raising additional local funds
In-service training of health workers
Collection, compilation and dissemination of routine
health information
Why size matters ?
If the health districts are too small...1/2
....greater number of health districts, then...
 more management structures and systems
 cohesion and co-ordination more difficult at a national
or provincial level
 it will cost more and fail to capture economies of scale
If the health districts are too small...2/2
 district hospitals will be managed as separate
entities from the rest of primary level health care
 could create a further dislocation between
primary level services and district hospital services
(many health districts without a district hospital)
If the health districts are too large...
 district-level management can become unwieldy and
bureaucratic
 the DHS loses its “service delivery" functions
The DHS becomes too remote from the community.
The required balance
Population size
Geographic size
Technical autonomy
Comprehensive
services
Community
involvement
What is a District Health
System (DHS)? 1/2
more or less self-contained segment of the
national health system
it comprises first and foremost a well-defined
population
within a clearly delineated administrative and
geographical area
it includes all the relevant health care activities in
the area, whether governmental or otherwise.
needs to to ensure as comprehensive a range as
possible of promotive, preventive, curative and
rehabilitative health activities
What is a DHS ? 2/2
ideally contains a network of primary health units and a
district hospital for referral of cases
it is the point and level at which different health
service activities are integrated into a comprehensive
and holistic approach to health care
it is able to accept the transfer of responsibility,
resources, authority and seniority from central levels of
management to the periphery
Why the focus on DHS ?
- the many responsibilities of the district health team
- the need to carefully allocate the scarce resources
- the necessity of sound health management
 obvious need for adequate information BUT
 the main constraint for implementing the primary
health care approach in practically all countries:
...inadequate information for the managerial processes !
Why the focus on DHS ? 3/3
The district health information system needs to make
available...
• the right information and the right knowledge
• to the right persons and institutions
• in the right form
• at the right time
• in the right place
What is the role of the HIS in the
health district?
Epidemiology: who, where, when ?
25
HEALTH
CARE LEVEL CATCHMENT AREA POPULATION
PRIMARY
Patient/Client
contact
First level
care unit
SECONDARY
Referred
patients
District
Hospital
TERTIARY
Referred
patients
Regional
Hospital
Referred
patients
National
Hospital
University
Hospital
Routine
Health
Information
System
INDIVIDUAL
HEALTH UNIT
CARE
MANANAGEMENT MANAGEMEET
Community Level
District Health
Management
Team
DISTRICT
LEVEL
Regional Health
Management
Team
REGIONAL
LEVEL
Ministry of Health
Universities
Other Health
Institutions
NATIONAL
LEVEL
SYSTEM
MANAGEMENT
HEALTH CARE SERVICES
HEALTH SERVICES SYSTEM
HEALTH SYSTEM
OTHER SECTORS:
-Environment
-Civil Administration
-Transport
-Education
Summary points
• Districts have been identified as the most efficient level
of managing primary and secondary health services
• For this management to be possible and efficient,
access to comprehensive district health information is
necessary