The District Health System: A Personal Perspective from Zululand

INTRODUCTION This paper is written as a tribute to Anthony and Maggie Barker who built, and then ran, the Charles Johnson Memorial Hospital in Zululand for so many years. Their example enthused many doctors, myself included, to devote themselves to medical practice in this beautiful part of the world. So much has changed since their time, yet so much remains the same'. As South Africa goes through the sort of transition that the Barkers longed for, the district health system (DHS) is emerging as the only way to deliver health care to our communities in an efficient and equitable manner. Paradoxically, it is in the apartheid-created 'homelands' that effective DHS are to be found. The Barkers refused to work within this structure when their mission hospital was taken over by the state, and so they returned to England. Many developing countries have experimented with the DHS as a means of delivering health care, with varying success. In South Africa it is still an emerging concept, but it is becoming accepted as the only solution to the fragmentation that characterizes the health service in this country-. This paper aims to describe some of the concepts of the DHS, to illustrate how effective it can be, and to offer suggestions for the future. It is not a comprehensive overview, rather a personal perspective from a rural hospital in Zululand, much influenced by the ideals practised by Anthony and Maggie Barker. These ideals will live on as long as the need remains.