This is according to a study recently conducted by the Pretoria-based Foundation for Professional Development (FPD), which provides on-going training to health workers and technical assistance to some districts. As part of the research, FPD surveyed about 240 senior managers from almost half of the country’s health districts to find out what has gone wrong with district health care.

What FPD found was that many districts struggle with a dearth of management experience, manpower, budgets and power, according to FPD Managing Director Gustaaf Wolvaardt. Wolvaardt presented the findings at the Southern African HIV Clinicians Society Conference, which closes today in Cape Town.

“Most of the people tasked with implementing services delivery programmes actually don’t have the strategic or business planning skills… to take a new national initiative and roll it out,” said Wolvaardt who said that just because doctors or nurses were good at health care did not mean that they would make great managers.

“We think it’s a good idea to take a doctor or a nurse and, because they are great clinicians, pop them into management positions and expect them by some mystical way to get managerial skills,” he added.

The study also found high vacancy rates among key positions such as district pharmacists. Scarce numbers of pharmacists, as well as district and assistant pharmacists – as well as antiquated, paper-based stock control measures were helping fuel drug stock outs, according to Wolvaardt.

As key service delivery posts remain vacant, management ranks in some areas continue to swell inappropriately.

“There is a progressive erosion of budgets for clinical posts,” he told Health-e News. “We are getting more and more people appointed to and larger parts of our budgets allocated to people in managerial positions.”

In one municipal HIV unit, 94 percent of the budget went towards managerial salaries, which left just six percent for service delivery, Wolvaardt reported.

District health systems crucial to ambitious policies

[quote float=”right”]“Most of the people tasked with implementing services delivery programmes actually don’t have the strategic or business planning skills… to take a new national initiative and roll it out”

Meanwhile, the National Department of Health is counting on districts to roll out ambitious new policies. In January, the country is set to move to earlier HIV treatment at higher CD4 counts, which measure the immune system’s strength.

According to National Department of Health deputy Prevention of Mother-to-Child HIV Transmission director Precious Robinson, the Department of Health knows that weak health systems and poor patient tracking will be among its biggest challenges in implementing earlier HIV treatment.

But for districts, new national initiatives like earlier treatment or moving drug-resistant tuberculosis care and treatment out of major hospitals rarely come with dedicated budgets. In fact, district managers have very little control over their budgets, which managers said was a prescription for failure.

As part of the FPD study, districts reported not only not being able to feedback to the National Department of Health on policies but also that provinces did nothing to help them prioritise competing initiatives. Despite developing and submitting budgets, district managers also reported that what they ultimately received from provinces was more a mater of historical allocations than need.

Wolvaardt concluded by recommending a range of measure from requiring senior managers to have management training to establishing staff ratios to ensure appropriate money was devoted to service delivery staff.

An edited version of this article first appeared in the 27 September edition of the Saturday Star.