Justice and equity in the allocation of health resources for mental health in the eThekwini health district.

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.