17 Apr 1997

No 12 - 17 April 1997



The Health Minister, Dr Nkosazana Zuma, this week published a ground-breaking
White Paper setting out the strategy for the transformation of the health
system in South Africa. The White Paper, Towards A National Health System,
aims to achieve comprehensive primary health care, to deliver quality health
care for all citizens, efficiently and within a caring environment.

Background to the White Paper

Most South Africans have inadequate access to basic services, such as
health, clean water and basic sanitation. Up to 55 per cent of the population
live in poverty, and three-quarters of these live in rural areas. Mortality
rates for infants, under-fives and mothers in childbirth are much higher
than expected in a country with South Africa`s income level, and there
are gross inequalities in health across racial divides. Reform is urgently
needed to give all South Africans access to good quality health care.

Key Points

The White Paper highlights a series of key policy initiatives, including:

  • decentralising the management of health services, placing the emphasis
    on the district health system
  • increasing access to services by making primary health care available
    to all citizens
  • ensuring the availability of safe, good-quality essential drugs in
    health facilities
  • rationalising health financing through budget reprioritisation
  • focusing on sustainable food security for the needy, through the Integrated
    Nutrition Programme
  • strengthening disease prevention and health promotion in areas such
    as HIV/AIDS, Sexually Transmitted Diseases and maternal, child and women`s
  • developing a National Health Information System, to facilitate health
    planning and management.

Goals and Objectives

Goal: to unify fragmented health services at all levels into a comprehensive
and integrated NHS


  • reorganise the Department of Health, so that it can fulfil its designated
  • integrate the activities of public and private health sectors, including
    NGOs and traditional leaders, to maximise the effectiveness and efficiency
    of all available health care resources
  • reorganise the health care system based on primary health care services,
    with effective referral systems at primary, secondary and tertiary care

Goal: to promote equity, accessibility and utilisation of health


  • increase access to integrated health care services for all citizens,
    focusing on rural, peri-urban and urban poor and the aged, with an emphasis
    on vulnerable groups
  • establish health care financing policies to promote greater equity
    between people living in rural and urban areas, and between people served
    by the public and private health sectors
  • distribute health personnel throughout the country in an equitable

Goal: to extend the availability and ensure the appropriateness of
health services


  • establish a district health system in which all communities are covered
    by a basic health unit, which offers an essential package of care
  • ensure a functioning referral system at the primary, secondary and
    tertiary levels
  • improve access to comprehensive health services
  • ensure the availability of high-quality, low-cost essential drugs
  • ensure that every South African develops his or her potential fully,
    with the support of community-based nutrition promotion activities.

    Goal: to develop health promotion activities


  • promote a healthy environment
  • improve the psychological well-being of people and communities
  • ensure access to health-related information community support and health
    services for adolescents
  • reduce alcohol and other drug abuse, with particular emphasis on tobacco,
    glue, cocaine, Mandrax, heroin and marijuana
  • promote healthy behaviour to prevent sexually-transmitted diseases
    and HIV
  • prevent the transmission of communicable diseases such as tuberculosis,
    and the development of hypertension and diabetes
  • help the disabled to become independent and reach their potential for
    achieving a socially and economically productive life
  • reduce the incidence of intentional and unintentional injuries.

    Goal: to develop human resources available to the health sector


  • promote the optimal use of the skills, experience and expertise of
    all health personnel
  • develop education and training programmes aimed at recruiting and developing
    personnel who are competent to respond appropriately to the health needs
    of the people they serve
  • ensure that the composition of human resources in the health sector
    reflects the demographic patten of the general population
  • promote a new culture of demographic management in the health sector
  • ensure a caring and compassionate health sector.

Goal: to foster community participation across the health sector


  • involve communities in various aspects of the planning and provision
    of services
  • establish mechanisms to improve public accountability and promote dialogue
    and feedback between public and private health providers
  • encourage communities to take greater responsibility for their own
    health promotion and care.

Goal: to improve health sector planning and monitoring of health
status and services


  • develop a National Health Information System to facilitate the measurement
    and monitoring of the health status of the population, enable the evaluation
    of health service delivery and support effective management at all levels
    of the health service
  • ensure that those responsible for the health status of the population
    are kept up to date with the information generated
  • monitor the health impact of the implementation of the RDP, including
    the development of a nutritional surveillance mechanism
  • build capacity at the provincial, district, local and community levels
    to develop plans based on priorities, and ensure appropriate ANC cost-effective