CONTENTS

• Principles
• Implementation
• Operation

The hospitalisation and further treatment of cases are a provincial function and to fulfill that task a network of referral pathways have been developed that a patient must go through till being hospitalised. This ensures that scarce resources (the availability of medical staff and equipment like X-rays and theatre facilities) are optimally utilised. 

The need for additional health facilities in the iSLP has arisen from two sources: the creation of new residential areas; and the burgeoning population in existing townships, housed in informal settlements and backyard shacks - which has shown no sign of diminishing. It has therefore been necessary to extend all of the existing facilities within the project area and to create new resources in any new residential areas that would not otherwise be served.

The hierarchy of health facilities provided in the iSLP project area is:

Hospitals
A 250-bed regional hospital in Philippi - yet to be built. This will provide specialist services in the five ( 5 ) main disciplines of health with the usual support service of theatres, CSSD, X-rays, casualty etc.

The GF Jooste hospital adjoining Guguletu, which provides a 24 hour service and has a maximum of 180 beds. The hospital has done remarkably well in servicing the tremendous load of all the trauma that originates from the violence in the society. The only way to survive is to have a well-trained operational team supported by good management.

Community Health Centres ( Day Hospitals )
The Community Health Centres in Delft, Gugulethu, Cross Roads and Vanguard are the bigger facilities that render a more comprehensive service and where the Maternity and Obstetric Units (MOU) are attached and also X-ray and theatres are available. These centres are run on a 24h service and have trauma units and also contain observation beds for short stay procedures.

Clinics
The other smaller units are situated conveniently in the townships and the will act as satellite clinics and run by Primary Health Care nurses, their referrals being to the CHCs. Clinics in Nyanga, Browns Farm, Gugulethu (2 ), Cross Roads (2), Langa, Weltevreden Valley and Nolugile ( under construction) will serve this purpose. 

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IMPLEMENTATION
The design and construction of the provincial facilities is managed by the provincial Department of Works on behalf of the Department of Health. The municipal facilities are designed and constructed by the City's Architecture branch on behalf of its Health department. There is close cooperation between the provincial and municipal officials in every facet of the work.

Efforts are increasingly being directed at designing facilities to be optimally appropriate for the circumstances, and some unique and unconventional features have been employed. Examples are the open plan casualty/trauma unit that have been implemented in G F Jooste Hospital, Cross Roads CHC, Vanguard CHC and will probably happen at the Philippi Hospital planning as well.

The construction of health facilities is put out to public tender, the terms of which include requirements for the employment of labour from the local community. Preference is also given to the engagement of emerging contractors, either in their own right, in joint ventures with established contractors or as sub-contractors.

As at 31 May 2001 two new health facilities had been constructed in the iSLP and 9 existing facilities had been upgraded - some more than once. These were financed almost exclusively out of iSLP RDP funds. The regional hospital, which is still to be built in Philippi, will have to be financed by the Province.

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OPERATION
The population has increased over a period due to migration and the expanding of informal settlements not reflected on the census of 1996. The Mother to Child Transmission programme has rolled out to the Nyanga district covering Guguletu, Nyanga and Crossroads as well as Langa, Vanguard CHC which covers Valhalla Park, Netreg, Goodwood, Factreton, Table View, Albow Gardens and Maitland.

Voluntary counselling and testing (UCT) via the HIV project will end in December 2001at Vanguard CHC.

The University of Cape Town programme has also been proposed at Delft CHC. Delft has expanded rapidly re: population ±200,000. It also services a population outside the district which impacts on services. The squatter camps are not included in the population figure of 200,000. Currently there are four squatter camps namely Greenpark, Amsterdam, Brown's Farm and Mandela Park.

The after hours services at Guguletu Trauma Unit apart from the Trauma which ranges from rape, MVA's and violence to medical is often inundated with the complications and terminal care relating to HIV/Aids mainly adults. This is specific to the Nyanga district.

Establishments - personnel are never 100% funded, so in essence all and if not most of our CHC's are understaffed. More so, if profiles are escalated in numbers, disease profiles and types of trauma eg. Those who need resuscitation and who are transported to our CHC's not necessarily via EMS.

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