title: Primary health services at district level in South Africa: a critique of the primary health care approach.
abstract: BACKGROUND
  The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite South Africa's progress and attempts at implementing primary health care, various factors still limit its success.
  
  
  CONCLUSIONS
  Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met. It is important for all health practitioners to consider the contextual influences on health and ill-health and to recognise the role of the underlying determinants of ill-health, namely, social, economic and environmental influences. The primary health care approach provides a strong framework for this delivery but it is not widely applied.There is a need for renewed political and policy commitments toward quality primary health care delivery, re-orientation of health care workers, integration of primary health care activities into other community-based development, improved management skills and effective coordination at all levels of the health system. There should also be optimal capacity building, and skills development in problem-solving, communication, networking and community participation.
  
  
  CONCLUSIONS
  A well-functioning district health system is required for the re-engineering of primary health care. This strategy requires a strong leadership, a strengthening of the current district heath system and a greater emphasis on health promotion, prevention, and community participation and empowerment.
authors: School of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa.
authors: Sunitha
authors: S
authors: Dookie
authors: Shenuka
authors: S
authors: Singh
mesh_terms: D018672:Community Health Planning; D003153:Community Health Services / Q000379:methods* / Q000458:organization & administration; D003256:Community Participation; D003191:Comprehensive Health Care; D003299:Cooperative Behavior; D005260:Female; D006293:Health Promotion; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards; D054625:Healthcare Disparities / Q000592:standards; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D009313:National Health Programs; D009936:Organizational Innovation; D011314:Preventive Health Services; D011320:Primary Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D015980:Public Health Practice; D011785:Quality Assurance, Health Care / Q000592:standards; D013019:South Africa