The effective delivery of health services requires a well functioning district health system. The component of District Health System Strengthening comes under the strategic objective 5 “Improve management and integration of services at all levels”. A thematic group on district health system strengthening component under PAIMAN was formulated to provide guidance in this regard.

Key Focus Areas for District Health System

Appropriate management structures and systems must be in place to assist decision-making within the district. The following areas have been focused:

District Management Team: The establishment of a management team whose members have clearly assigned responsibilities for co-ordination and management of activities in the district is essential. Roles for the various team members must be clearly defined. In line with this, lines of accountability, mechanisms for decision-making and communication strategies within the team must be clarified. The team must be multi-disciplinary in composition, but at the same time be able to function as a single unit. Fostering team spirit and interdependence is therefore essential.

Human Resource Management: Each district must have clear strategies for the acquisition, deployment, motivation and development of its personnel. Training (including in-service or on-site training) should aim to equip health workers with appropriate skills to deal with problems they experience in their work situations. Lines of supervision and support should be clearly defined. The manner in which health workers conduct themselves (by being compassionate, respectful and caring) when dealing with communities and patients is just as important. Each district must have mechanisms for dealing with conflict and grievances in line with framed rules and regulations.

Financial Management: Each district must be able to manage its financial resources in a responsible manner. Financial management requires the ability to plan activities, budget accordingly and monitor expenditure in accordance with approved budget lines. This will be difficult to achieve without appropriate financial management systems. Such systems, although based on provincial and national specifications, must take into account the realities and needs in respective districts.

Drug Management: Each district requires a reliable drug management system for rational procurement, storage, inventory keeping and distribution of medicines.

Information Systems: Management information system is the backbone of any organization. A well functioning MIS, able to provide information for evidence based decision making, will enhance the capacity of the districts to take timely corrective actions.