Justice and equity in the allocation of health resources for mental health in the eThekwini health district.
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Date
2006
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Abstract
Aim
The aim of the study was to establish if resources for health care were
distributed in a manner which reflected justice and equity for people with mental
illness at primary health care (PHC) level where mental health services were
integrated into general health services.
This was done by establishing if relevant South African health policy and
legislation makes relevant provisions for the transformation of health care service
in line with primary health care principles. Selected health care system delivery
strategies were analysed to establish if these reflect justice and equity in the
distribution of health resources within a particular health district. Finally, an
appropriate workload criteria was used to establish how currently employed
health personnel were allocated in terms of skill mix per population size within a
selected health district.
Methodology
The study was conducted in eThekwini District in the Durban Metropolitan area.
A combination of descriptive and analytic study designs were adopted using the
Health Systems Research(HSR)l as the framework for the study. The descriptive
component was used to set the context for the study. The analytic component
was used to establish the causal link between mental health policy provisions
and the current distribution of health resources. Human resource allocation was
used as the indicator for mental health resource allocation.2 Simple random
sampling method was used to select six sampling units of Primary Health care
(PHC) areas from the sampling frame of three Sub-Districts which constituted
eThekwini District; namely North, South and West Sub-Districts. Mental Health Policy and related Legislation was analysed to establish how these made
provisions for resource allocations in mental health care.
The South African Workload ratios from Rispel et.al. in WHO (2003) 3 were used
to determine personnel allocation per level of care and per population size
served. The distribution of personnel was calculated using the fulltime equivalent
scale (FTE).4 The geographical location of health facilities was established from
the District maps to determine the location of mental health personnel.
Results
At policy level, even though relevant health legislation makes specific provisions
for the development, distribution and management of human resources, the
literature review indicated that there are still gaps in policies for human resource
production, distribution, management and health service delivery.
At implementation level research findings indicated marked understaffing across
all primary health care levels. Results also showed that the total number of
currently employed health personnel in most sample PHC areas fell below the
norm recommended for the population size. In addition, integrated primary
health care service was mainly offered by one health discipline compared to the
recommended personnel skill mix of eight health disciplines. On the other hand,
there was also an underlying historical over-concentration of health facilities in
urban-based areas compared to rural based areas.
Description
Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2006.
Keywords
Public health--Law and legislation--KwaZulu-Natal., Theses--Law.