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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

6.2 Improving Leadership and Governance

6.2.1 Improving management and governance at PHC level


159. Strengthening PHC services is critically dependent on improved management at facility (clinics and community health centres) and district levels. In addition to strengthening management capacity (e.g. through improving managers’ skills and upgrading information systems), there will be a need to delegate greater management responsibilities to the district level in the early phases so that the necessary decisions related to service delivery can be made and managers held accountable for their performance.


160. Taking into account the need for separating purchasing functions from provision of services and given capacity constraints in financial management and planning, it will not be feasible to delegate management to individual PHC facilities. The Contracting Unit for PHC (CUP) located at the district level and in a co-operative management arrangement with the district hospital linked to a number of PHC facilities thus creating a contracting unit for the NHI. As the system matures with the full implementation of the Ideal Clinic model, appropriate delegations and management functions may be devolved to the PHC facilities.


161. In addition, given that PHC services will be provided through a range of providers (including WBPHCOTs, school health teams, fixed and mobile public sector facilities and contracted private providers), the PHC re-engineering vision of integrated comprehensive services would best be promoted through coordination and management of these services at the district level.


162. Clinic Committees will be strengthened for all PHC facilities to provide advice and play an advocacy role for the communities they represent. They will also focus on public health campaigns in the catchment areas of their respective clinics. Guidelines have been developed on how these Clinic Committees will be strengthened and how they will function to represent the needs of communities.