THE CONTEXT OF THE HEALTH CARE SYSTEM IN SOUTH AFRICA
3.2 LEGISLATIVE FRAMEWORK
Legislation is having an impact on the local government health sector;
the next section highlights this legislation.
3.2.1 CONSTITUTION OF THE REPUBLIC OF SOUTH AFRICA A C T N O . 108 OF
1996
This Constitution is the system of laws and principles by which South Africa is governed, so much so that any law or conduct inconsistent with it is invalid. The obligations imposed by the Constitution have to be fulfilled.
Bearing the above in mind, local government health sector legislation has to be in line with the Constitution. The main theme of the Constitution is 'One Law for One Nation' (The Constitution of the Republic of South Africa, 1996), which is in contrast to previous apartheid legislation (Government of South Africa, 1996).
The Constitution also provides for cooperative governance which means that the ANC-led government is constituted at national, provincial and local levels and these are distinctive, interdependent and interrelated. This has brought about a major shift whereby the national, provincial and local governments have become partners but are, at the same time, autonomous. The Constitution also prescribes the principles governing co-operative and intergovernmental relations. These provisions give local government the right to design system, for instance, a health system to set research priorities, to establish the Essential Local Health Research Committee (ELHRC) and to formulate a research policy model for ensuring the utilisation of research, as long as the exercising of such rights does not encroach on the geographical, functional or institutional integrity of other spheres of government.
The Constitution also provides for several objectives of local government such as the promotion of a safe and healthy environment (Government of South Africa, 1996). In order to fulfil this objective, local government must provide a package of health services that is informed by research. This requires the establishment of the Essential Local Health Research Committee (ELHRC) which sets research priorities and designs a research policy model for ensuring that research results are meaningfully utilised by councillors and senior management.
LOCAL GOVERNMENT TRANSITION A C T N O . 209 OF 1993
This act sets the scene for the transformation and restructuring of local government. The purpose of the Act is to provide for revised interim measures with a view to promoting the restructuring of local government (Government of South Africa, 1993).
The main aim of this legislation was to begin the process of addressing the apartheid legacy through an equal distribution of resources to address the huge backlogs in service delivery and resource limitation. Secondly, there was the question of addressing issues of the cost of segregation - black people were usually housed far from their places of work and the cost of providing services for such areas will have to be subsidised on an on-going basis.
The Act set the transformation of local government into three stages:
• The pre-interim phase, which set u p structures to govern until the local government election in 1995/6.
• The interim phase, beginning with municipal elections and lasting until a new system was designed and legislated.
• The final stage, when the new system would be established.
Both the purposes of the Act and the three stages of transformation provided by this Act do not cover research which is crucial in helping both councillors and senior management
make informed decisions. Proper planning to address the huge backlog in service delivery, including primary health services, could only be informed through research and information sharing.
The exclusion of research, an essential element in any restructuring process, was a major oversight in this legislation as it led to less emphasis on research in subsequent legislation.
W H I T E PAPER FOR THE TRANSFORMATION OF THE HEALTH SYSTEM IN S O U T H AFRICA, 1997
The main task of the health ministry is to develop a unified system capable of delivering health care to all citizens efficiently in a caring environment. The objectives of the White Paper are:
• To unify fragmented health services at all levels into a comprehensive and integrated National Health System.
• To promote equity, accessibility and the utilisation of health services.
• To extend the availability and ensure the appropriateness of health services.
• To develop health promotion activities.
• To develop the human resources available to the health sector.
• To foster community participation across the health sector.
• To improve health sector planning and the monitoring of the health status and services.
Central to the White Paper is the reorganisation of the health service through the adoption of the comprehensive primary health care and district health system approaches (Government of South
the Essential National Health Research (ENHR) which is an integrated strategy for organising and managing health-related research. The ENHR strategy aims to utilise the full range of health research methodologies including epidemiological, social, behavioural, clinical and biomedical health systems and policy analysis. One of the guiding principles of the ENHR is that a research agenda should be developed to address the country's major health problems and that a process involving scientists, decision makers and population representatives, as equal, inclusive partners should be initiated.
LOCAL GOVERNMENT : MUNICIPAL SYSTEMS ACT N O . 32 OF 2000
One the purposes of this Act is to provide for the core principles, mechanisms and processes that are necessary to enable municipalities to move towards the social and economic improvement of local communities and to ensure universal access to essential services affordable to all. The other purpose of the Municipal Systems Act No. 32 of 2000 is to establish a simple and enabling framework for the core processes of planning, performance management, resource mobilisation and organisational change which underpin government (Government of South Africa, 2000). It is the implementation of these core principles, mechanisms and processes that will ensure that the health services delivered at local level are accessible to all, including the poor and disadvantaged. Appropriate health research has an obvious role in the realization of these objectives.
Essential services are the district health system and Primary Health Care (PHC) approach as proposed by The National Health Act, 2003, and the KwaZulu-Natal Health Act No 4 of 2000. Both councillors and the senior management of municipalities must be informed by local research in their decision-making processes.
This requires the establishment of the Essential Local Health Research Committee (ELHRC) for a metropolitan or district municipality.
KWAZULU-NATAL HEALTH A C T N O 4 OF 2000
According to the South African Health Review (2002), provinces have, in the absence of strong national leadership, lack of national legislation and lack of clear strategic direction over the past eight years, filled the vacuum with the introduction of their own legislative framework and policies.
The KwaZulu-Natal Health Act No 4 of 2000 objectives do not touch on health research either at provincial or local spheres of government. Health research seems to be seen by the province as a mandate by the national sphere of government. This is despite the fact that both provincial health policies and services need to be informed by research - and in particular, local research - which obviously would have to be conducted at municipalities.
Municipalities, especially metropolitan and district municipalities, need to adopt a research policy model that will promote utilisation
the health sector. For example, the research priorities for the Western Cape Province and its metropolitan or district municipalities will differ from the KwaZulu-Natal Province, as the care burden changes.
W H I T E PAPER O N SCIENCE A N D TECHNOLOGY : PREPARING F O R T H E 21ST CENTURY, 2000
The White Paper on Science and Technology calls for transformation of the science and technology system and its integration into a much larger system of innovation (Government of South Africa, 2000). This policy articulates a vision that embodies a coordinated effort to achieve excellence in serving the national goals by:
• Promoting competitiveness and employment creation.
• Enhancing the quality of life.
• Developing human resources.
• Working towards environmental sustainability.
• Promoting an information society.
The premise used in this White Paper is that both applied and basic research in the natural and social sciences are crucial for social and economic development. This development provides the underpinning for good health services. According to this White Paper, challenges posed by a system of innovation have an impact on the manner in which a health research system is designed.
More specifically, the size of the scientific community and its links to industry, the ability of the education system to provide
highly qualified researchers and technicians and the ability to
translate research and development can results in new or improved products, processes and services. A research policy framework developed by the eThekwini Health Unit must be guided by this White Paper.
THE NATIONAL HEALTH A C T N O . 61 OF 2003
The main goal of this act is to provide a framework for a uniform health system within the Republic, taking into account the obligations imposed by the constitution and other laws on the national, provincial and local government levels with regard to health services (Government of South Africa, 2003). Other objectives of the Act are setting out the rights and duties of health- care providers, health workers, health establishments and agents.
Objectives also include protecting, respecting, promoting and fulfilling the rights of all stakeholders.
The Act provides for the health research coordinating forum (National Health Research Committee) at national level. There is no provision for such a forum either at provincial or local level.
This is one of the main contributing factors to not having coordinating forums in provincial and local government.