Acts Online
GT Shield

National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 6 : Reorganisation of the Health Care System and Services under NHI

6.1 Service Delivery

6.1.1 Primary Health Care (PHC) Services


140. PHC is the heart-beat of NHI. The PHC services include health promotion, disease prevention, curative (acute and chronic clinical) services, rehabilitation and palliative services (including social services).


141. The PHC level being the first point of contact with the health system is critical to ensure health system sustainability as it is associated with fewer visits to specialists and to emergency rooms. Patients will be able to present at the PHC level with any health care requirement (whether for promotive, preventive, curative; rehabilitative, palliative or community-based mental health) and will either receive the care they need at this level or will be referred to a hospital if more specialised services are necessary.


142. PHC starts in the communities and in addition to the clinics, multidisciplinary networks of practices in the private sector will form part of the first level of contact. Facility based services offered at community clinics and Community Health Centres (CHC’s) and multidisciplinary practices will conform to the Ideal Clinic model. PHC services will be comprehensive and integrated and will be supported by a strong feedback referral system and planned patient transportation between the levels of care where appropriate. The referral system will be upward and downward (bi-directional) and within and across the entire health system.


143. PHC Re-engineering is a key health reform that is implemented through four streams namely:
(a) Municipal Ward-based Primary Health Care Outreach Teams (WBPHCOTs);
(b) Integrated School Health Programme;
(c) District Clinical Specialist Teams; and
(d) Contracting-in of private health practitioners at non-specialist level.


(a) Municipal Ward-based Primary Health Care Outreach Teams (WBPHCOTs)


144. The Municipal Ward-based Primary Health Care Outreach Teams (WBPHCOTs) form a pivotal part of South Africa’s PHC re-engineering strategy. The outreach teams consist of Community Health Workers (CHWs), led by a nurse and are linked to a PHC facility. CHWs assess the health status of individuals in the households. They provide health promotion education, identify those in need of preventive, curative or rehabilitative services, and health related counselling, and refer those in need of services to the relevant PHC facility.


(b) Integrated School Health Programme (ISHP)


145. School health services are being provided to improve the physical, mental and general well-being of children of school-going age. The ISHP provides a range of promotive, preventive and curative services and include a focus on screening for health-related barriers to learning like, vision, hearing, mental health, cognitive and related developmental impairment. It will include oral health, immunisation against missed EPI vaccines, de-worming, nutritional services, risky behaviour including substance abuse, sexual and reproductive health rights including family planning services, and HIV and AIDS-related programmes. The programme also includes routine vaccination of Grade 4 learners (girls who are 9years old) against the Human Papilloma Virus (HPV). Services of private oral, eye and audiology practitioners will be contracted based on need, to provide corrective interventions to address the problems that have been diagnosed through the ISHP.


(c) District Clinical Specialist Teams (DCSTs)


146. Significant progress has been made in establishing DCSTs across the country. The DCSTs will support capacity building and mentorship, strengthening the use of clinical guidelines and protocols and strengthening the use of information to improve health outcomes. Deployment of DCSTs also contributes to reduction in institutional maternal and neonatal mortality rates 65.The composition of the DCST will be reviewed on an ongoing basis to ensure that issues of public health care are continuously monitored. The review may entail the inclusion of a public health medicine specialist.


(d) Contracting private healthcare providers


147. An essential step in strengthening PHC and ensuring integrated services at PHC-level is the contracting-in and contracting out of private health practitioners to address the health needs of the population and will be aimed not only at improving access but also at reducing the burden of disease. Contracting-in will be undertaken to reduce patient-overload in public health facilities whilst not depleting the numbers of salaried employees of the state. Contracting-out of PHC services will require that multi-disciplinary practices should be configured into horizontal networks that are contracted through the Contracting Unit for PHC (CUPs).Contracting for pharmaceutical services will also be undertaken to facilitate improved access for patients that have been stabilised. The contracted private providers will be reimbursed through a capitation model instead of a FFS as is happening currently.


148. Outcomes will be measured and monitored through a performance management framework and will be in accordance with agreed upon performance standards. Eventually performance management will cover public health outcomes in a specified catchment population. For this model to be successful the clinic settings and environment must comply with the Ideal Clinic model specifications.