classical approach

Topics: Health care, Health care system, Healthcare Pages: 14 (2562 words) Published: October 9, 2014

Kovin S Naidoo: Brien Holden Vision Institute, Public Health Division, Durban, South Africa; University of KwaZulu Natal (UKZN), Durban, South Africa
Brien Holden: Brien Holden Vision Institute, University of New South Wales (UNSW), Australia

Ron Fyfe:Past Chairman of the Public Health Committee of WCO; Currently: Asia Pacific representative on WCO Public Health Committee and member of the board of Vision 2020 New Zealand


The district health system

Defining the role of different cadres

The district health system has been identified as the appropriate building block for a national health system by the WHO.
It is a model that is promoted as a solution to creating access to health care at a local level, distributing services to different levels of the health care system and facilitating the appropriate referral pathways. While many countries have adopted the district health system as a model often the provision of eyecare within this system is ill defined. A greater inadequacy is the absence of a role of optometry within such a model. The district health system is crucial to the delivery of primary health care. CHARACTERISTICS OF DISTRICT HEALTH SYSTEM

A number of discrete geographical sub-divisions, usually called health districts, each with a clearly defined catchment population
“A district health system based on primary health care is a more or less self contained segment of the national health system. It comprises first and foremost a well defined population, living within a clearly delineated administrative and geographic area, whether urban or rural. It Includes all institutions and individuals providing health care in the district, whether governmental social security, non-governmental, private or traditional. A district health system therefore consists of a large variety of interrelated elements that contribute to health in homes, schools, work-places and communities, through the health and other related sectors. Furthermore it includes self-care and all health care workers and facilities, up to and including the hospital at the first referral level and the appropriate laboratory, other diagnostic and logistic support services” (World Health Organisation, 1988)

Clear guidelines are used for demarcation of the health districts such as: o Each to include a hospital
o Population not to exceed 500 000 to 1000 000

August 2012, UPATED

Public Health, Chapter 2-1

Health Systems


Geographical size to be such that the furthest clinic can be reached in approximately 3 hours from the district office

Each health district has a decentralised health management team responsible for: o Delivery
o Planning
o Managing
o Implementing and monitoring
o Ensuring equitable and cost effective use of resources and o Establishing an appropriate referral system
There is a need for comprehensive programs to ensure that the various cadres of eyecare are integrated into a seamless unit of service and referral within the district health system. The fact that optometrists are often not employed in the public sector has compounded the matter as the role of optometrists is often not clearly defined within the district health system.

The objective of the district health system is to streamline delivery and avoid unnecessary duplication. The biggest challenges confronting eyecare care services are the apportioning of responsibilities within the district health system. Barriers to effective human resource utilisation

Inter-professional jealousies: competition between optometry and ophthalmology and possibly between the various cadres of eye health professionals, especially considering the ever expanding scope of practice within each cadre

Limited resources: no funds for the...

References: Pretoria, 2006

Rao GN, 2005.An infrastructure model for the implementation of VISION 2020: The Right to Sight.Journal
of Community Eye Health, 18(54): S61-62.Source:
World Health Organisation, 1988.The challenge of implementation: district health systems for primary
health care.Part A pp 7-11.World Health
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