Lacking in all the detail, the Green Paper states that norms and standards will be set for this package of care and health providers will be monitored by a special office set up by Parliament. Patients will be able to report poor treatment to an ombudsman.

Primary health care (PHC) will be delivered at a district level via:

·             District-based clinical specialist support teams supporting the delivery of priority health care programmes;

·             School-based PHC services, which will deal with issues such as immunisation, parasites (worms), child abuse, school readiness, sexual health and nutrition.

·             Municipal ward-based PHC ‘€˜agents’€™ (at least 10 per ward), who will be allocated a certain number of families to monitor their health and encourage community involvement in promoting healthy behaviour. There are over 4000 wards in the country.

PHC services will also be delivered through ‘€œaccredited and contracted private providers practicing within a district’€. Government will specify the range of services to be provided by private providers, including GPs, with the aim of ensuring that patients don’€™t have to travel long distances for care.

These private providers will be compensated via the NHI fund, but details of how this will happen still need to be worked out. All the Green Paper says is that accredited PHC providers will be reimbursed ‘€œusing a risk-adjusted capitation system linked to a performance-based mechanism’€. Annual payment will be linked to the size of the district’€™s population, its disease profile, level of use and costs.

‘€œProperly delivered through the primary health care streams, this (district) package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15-years of age, and 10% to 18% of the burden in adults,’€ according to the Green Paper.

The district health package will be designed to ensure that:

• health services are available at convenient hours with enough professional staff;
• patients enjoy privacy, confidentiality and fair treatment by staff members;
• The facilities comply with core quality standards.

Hospital-Based benefits

Hospitals in South Africa will be re-designated as district, regional, tertiary, central and specialised hospitals.

District hospitals will provide general medical services in four basic areas: maternity and gynaecological services, child health, general surgery and family medicine. They will also deal with trauma and emergency care, in-patient care, out-patient visits, rehabilitation services, geriatric care, laboratory and diagnostic services.

Aside from the four services offered by district hospitals, regional hospitals will provide orthopaedics, psychiatry, radiology and anaesthetics. They will receive referrals from district hospitals and provide specialist services to a number of district hospitals (preferably six or less).

Tertiary hospitals will provide specialist services including cardiology, craniofacial surgery, diagnostic radiology, ear, nose and throat (ENT), endocrinology, geriatrics, haematology, human genetics, infectious diseases, as well as the other eight services offered by regional hospitals. They will also train

Central Hospitals are national referral hospitals attached to a medical school and provide a training platform for the training of health professionals and research.

Specialised hospitals are usually one disciple focused, such as tuberculosis and psychiatry.

Private hospitals will also be contracted to deliver health services to all, and will be paid ‘€œusing global budgets .. with a gradual migration towards diagnosis-related groups with a strong emphasis on performance management’€, according to the Green Paper..

But government is still developing ‘€œmechanisms for achieving cost-efficiency’€ in contracting private providers. ‘€“ Health-e News Service.