Strategic priorities for the national health system (2004 -- 2009): Contributions towards building a model developmental state in South Africa.

This chapter attempts to answer the following questions: what progress has been made with respect to achieving the ten priorities of the 2004-2009 strategic framework of the Department of Health? What are some of the major constraints on implementation thereof? Within the stated list of priorities which priorities should drive the agenda of the health sector in order to achieve the Millennium Development Goals and the Presidents vision for a developmental state? President Mbekis emphasis on the capacity of the state is in keeping with the characterisation of the developmental state in the literature - that is a developmental state needs a bureaucracy that can deliver. This chapter reviews the strategic priorities of the National Health System using this lens. We conclude the chapter with the following recommendations: firstly health personnel need to take seriously the challenge of building a strong efficient and effective health system and commit themselves to acting in ways that will pushforward the agenda of the leadership. This in turn will require that political leaders as well as managers in the health system are able to clearly articulate and communicate a vision and a mission that resonates with front line health workers and that the vision is translated into clear operational strategies. Secondly the operational strategies need to be developed with and should capture the imagination of those charged with its implementation. The third crucial ingredient required for building a developmental state is an effective governance and management system. The fourth necessary ingredient is a critical mass of skilled and motivated health managers and health workers at all levels of the health system. Thus urgent steps need to be taken to produce and implement a strengthened national human resources plan for the health system - within the framework of a comprehensive primary health care approach - since this is central to building the states capacity and hence a developmental state. Also given the centrality of PHC services to the health system the possibility of ring fencing PHC funding in each province should be urgently considered. (authors)