Delivery Agreement

A Long and Healthy Life for all South Africans


Government adopted an outcome-based approach to service delivery and performance management, and also adopted 12 key outcomes to be achieved during this term of office.  The Free State Department of Health leads the efforts of the provincial government to achieve Outcome 2: “A long and healthy life for all South Africans”. Four key outputs must be produced namely;

  • increasing life expectancy;
  • reducing maternal and child mortality rates
  • combating HIV and AIDS and Tuberculosis
  • strengthening the effectiveness of the health system

Linked to these outputs are clearly articulated indicators and targets. Major targets include the following:

  • Life expectancy must increase from the current 53.9 years for males and 57.2 years for females (Statistics SA 2009) to 58 years for males and 60 years for females by 2014.
  • South Africa’s Maternal Mortality Ratio (MMR) must decrease to 100 (or less) per 100,000 live births by 2014. The Millennium Development Goals (MDG) country report estimates MMR at 625 per 100,000.
  • The child mortality rate must decrease to 20 deaths (or less) per 1,000 live births by 2014. The MDG country report estimates child mortality rates at 104 per 100,000.
  • The TB cure rate must improve from 64% in 2007 to 85% by 2014
  • 80% of eligible people living with HIV and AIDS must access antiretroviral treatment.
  • New HIV infections must be reduced by 50% by 2014.

Specific interventions of the health sector to achieve these outputs are elaborated in detail in the Negotiated Service Delivery Agreement (NSDA) 2010-2014.


Government’s four outputs are premised on the fact that South Africa faces a quadruple burden of diseases consisting of;

  • HIV and AIDS and tuberculosis (TB)
  • high maternal and child mortality;
  • non-communicable diseases; and
  • violence and injuries.

The four outputs outlined in the NSDA 2010-2014 have been considered an integrated response to the quadruple burden of diseases. Interventions to tackle this burden of disease dovetail with efforts to accelerate progress towards the health related Millennium Development Goals (MDGs). A need exists to also address social determinants of ill-health, which lie outside the health sector, such as poverty; lack of potable water; lack of proper sanitation and child neglect.

Increasing Life Expectancy

This is the first of the identified outputs to achieve the desired outcome. The Department will increase its focus on strategies aimed at the primary prevention of non-communicable and chronic diseases through educating individuals, households and communities on the benefits of healthy lifestyles. This will be proactively supported by a programme of community mobilization involving the utilization of community health workers through a re-engineered and integrated Primary Health Care system that encourages health promotion and prevention at the household and community levels.

Decreasing Maternal and Child Mortality

The second output focuses attention on decreasing maternal and child mortality. A Primary Health Care approach that is designed as the foundation of the health system for promoting healthy lifestyles, prevention of diseases (including early detection), provision of early and quality ante- and post-natal services as well as essential infant and child health services and nutritional advice will be used in aggressively reducing the unacceptably high maternal and child mortality rates in the country.

Combating HIV and AIDS and Decreasing the Burden of Disease from Tuberculosis

This is the third output towards achieving Outcome 2. HIV, AIDS and Tuberculosis (TB) contribute a significant proportion to the burden of disease that is faced by the South African population, particularly among the poor and vulnerable groups. This is the primary reason why the government has decided to direct its efforts towards addressing the challenges of HIV and AIDS and TB in an integrated manner. The core of the strategies to effectively combat these diseases is encompassed in the HIV and AIDS Counselling and Testing (HCT) Campaign whose primary focus is to scale up the integrated prevention strategy based on behavioural change, use of barrier methods, provision of medical male circumcision, the scale-up of syndromic management of STI and the early prophylaxes to prevent Mother-To-Child Transmission.

Strengthening Health System Effectiveness

The fourth identified output that contributes to the achievement of Outcome 2 is; “Strengthening Health System Effectiveness”. To effectively strengthen the public health system, a number of parallel but equally important initiatives will also be undertaken by the Department of Health, complementary to those proposed for Output 1 to 3 above. The scope of these activities include the need to overhaul the health services delivery platform from one that is based on a largely curative, high cost care model to one that also promotes cost-effective Primary Health Care delivered as close to the community and household as is possible, supported by strong enhancements in management and supervision.