PATHS Final programme report: "Togetherness in Health" the Enugu ...

Developing the District Health SystemWith the political commitment and active support of theState Governor, in October 2003 the State Council on Healthrecommended that the state introduce a District Health Systemas its framework for health care delivery. In order to achieve thisvision there was a need to move away from a centrally managedand fragmented model of health service delivery to one ofintegration at all levels of service delivery with a special emphasison management at the district level.The introduction of the District Health System requiredrestructuring of the Ministry of Health:• A new Policy Development and Planning Directorate (PDPD)was created, which was responsible for strategic planning andpolicy development;• The State Hospital Management Board evolved into the StateHealth Board (SHB); and• Seven newly created District Health Boards (DHBs) and 56Local Health Authorities (LHAs) were established. The Boardsand Authorities were responsible for all aspects of servicedelivery.The DHS promoted:•••Decentralisation of servicesIntegration of primary and secondary servicesDelegated decision making as close to the patient as possible• Increased accountability for service delivery among providersand their managers• Greater opportunities for public private partnerships• More effective referral systemsDeveloping theDistrict HealthSystemStrengtheningunderpinningsystemsEnablingservice deliveryPromoting improvedservice delivery inthe facilitiesIncreasing demandfrom communitiesIncreased patientpatronageReduced maternal andinfant mortality andincreased consumerdemand in both publicand private managedprimary and secondarycare facilitiesThe DHS approach was formally adopted by the State Government in January 2004, Developing and the resulting Districtlegislation introducing the District Health System was passed by the House of Assembly Health in System August2005. While the legislation was pending, the planned constituent bodies of the DHS were establishedin shadow form.StrengtheningunderpinningOnce the State Executive Council had approved the introduction of the system in 2003 systems it becameincreasingly apparent that the DHS framework needed to be sufficiently in place before efforts weremade to develop either the underpinning systems or to improve service delivery. A considerableamount of effort was thus invested in supporting the realisation of the State vision of Enabling a District HealthSystem.service deliveryIn the early days of DHS implementation, the commitment and drive of some key individuals helped toPromoting improvedensure positive progress. This included the then Health Commissioner, Dr FestusserviceUzor, thedeliverytwo HealthinAdministrators of the State Health Board, the seven Chief Executives of the District the Health facilities Boards and“Togetherness in Health” the Enugu Experience in Health Sector Reform, Increasing 2002-2008 demand 25from communities