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A major challenge facing health care services worldwide is the need to deliver services appropriate to local community needs. In South Africa, the Department of Health has adopted the District Health System1 as the vehicle to deliver comprehensive health care to an estimated 84%2 of South Africans who do not have private health insurance. Within each health care district, community-based and hospital-based services are to be provided. District hospitals are to play a pivotal role in supporting ambulatory primary care services as well as providing a gateway to specialist health care at regional hospitals and highly specialised care (sub-specialist level) at tertiary hospitals. Documents outlining district and regional hospital service packages1,3 emphasise the need for appropriate packages of care, informed by feedback from service providers at the various levels of service delivery. To date, feedback based on systematic evaluation of service provision is limited.
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