Using a geographical information system to optimize access to primary health care services within the proposed New Hanover Health District.
The health restructuring taking place within the health sector is a direct result of the unfolding socio-political processes presently sweeping across the country's very young democracy. The adoption of a Primary Health Care approach and the transition to a district-based health system is an attempt to bring the health services closer to the people and to correct or redress the way in which money is spent to keep people healthy. Given that 'in South Africa more people die from preventable diseases, a Primary Health Care approach is more appropriate to deal with the country's health needs. However, many also die from degenerative diseases such as heart disease, stroke and cancer and are dependent upon curative hospital-based care. Their health needs have to be catered for as well. Since the declaration of Alma Ata in 1978, the concept of Primary Health Care has been broadened to include other determinants of health such as water, sanitation and health education. As a result, collaboration with other service sectors became essential to support such a holistic view of health. The District Health System is the unit of management of the health system that is best able to compliment an intersectoral collaboration. The technology that is best suited to analyse health resources within a District Health System is a Geographical Information System. The delineation of the boundaries for the proposed New Hanover District Health System was essentially a consultative process. An assessment of the health resources within the proposed district revealed spatial inequalities between the areas of the former Republic of South Africa and the areas of the former Kwa-Zulu. The former Kwa-Zulu areas are disadvantaged in term of health care facilities, health care personnel, health services, water, sanitation, roads and economic opportunities.In collaboration with the Department of Health and the New Hanover Primary Health Care and Development Programme, five potential fixed clinic sites and two mobile clinic points were identified using a Geographical Information System. This study goes beyond considering population as the only and most important variable in the identification of potential sites. Other important variables such as the road network density, the number of primary schools and the number of mobile clinics within a 10 kilometre radius of each site were taken into consideration. The siting of the Khanyile and nKululueko mobile clinic points has demonstrated yet another way by which primary health care services could be made more accessible. Community participation was crucial in identifying and confirming each potential site. A mathematical formula named Pregan's PCs formula was specifically devised to determine the 'potentiality' of each site. For example, if the PCs value was less than one then the site was not considered. In the proposed New Hanover District Health System all sites were considered. The lack of health care facilities and lack of personnel along the densely populated eastern border of the proposed New Hanover District Health System were two major factors that affected access to primary health care services . It is envisaged that the five potential fixed clinic sites and the two mobile clinic points which were identified would help to improve access to primary health care services and at the same time redress the spatial inequalities that exist within the proposed health district. This study concluded that a Geographical Information System is a useful tool for addressing questions of access to primary health care services within a district-based health system.