Editorial Special Series on the DHS

The District Health System (DHS) is the building block of South Africa (SA)’s national health system. The DHS was formally established through the National Health Act No. 61 of 2003[1] as the most decentralised public governance structure for the achievement of an equitable health system based on primary healthcare.

In the decade after 1994, the DHS was a central focus of national policy and system development, but following the advent of the Millennium Development Goals and the rise of HIV, attention shifted to disease priorities and programmes – notably HIV, tuberculosis and maternal and child health. This selective focus has resulted in some successes. Yet it has also, probably unavoidably, left a legacy of fragmented interventions in multiple, poorly co-ordinated programmes, little decentralised authority and insufficient capacity in the DHS. Subdistrict governance and leadership remain underdeveloped, with significant consequences for service delivery.