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Abstract: A district hospital in a rural area of the Limpopo Province in South Africa has recently been launched as a 'Health Promoting Hospital', based on the principles of the Ottawa Charter and according to standards developed by WHO-Europe. The initiative was conceived as a project in partnership with stakeholders from the local community and is considered a pilot by Provincial health authorities, representing an advance in health promotion practice in the region. The project was designed as a research intervention, guided by the principles of critical action research integrated with the Precede-Proceed model for the systematic evaluation of health promotion and education. This commentary reports on the process undertaken in successfully transforming this community-based hospital into a Health Promoting Hospital by integrating the concept, values and standards of health promotion into its structure and culture, thereby creating a healthy setting and promoting the health and wellbeing of the hospital's staff, its patients, and their relatives. (Global Health Promotion, 2010; Supp (2): pp. 33-36)
Key words: developing countries, district hospitals, health promotion, rural health
Background
South Africa has recently moved from a triple burden of disease to a quadruple burden of disease (1), consisting of poverty-related diseases, emerging chronic diseases, injuries and the impact of HIV/AIDS. This burden places a high demand on health services struggling to cope with limited resources and structural developments due to national health reform and calls for priority setting at national health policy level. AlthoughHIV/AIDS accounts for the largest burden of disease, the prevalence of non-communicable diseases (NCDs) is rapidly increasing due to lifestyle changes associatedwith urbanization and diet changes, but also due to socio-economic, cultural and environmental factors which put South Africans at risk forNCDs (2).
Current government responses involve population- based approaches for prevention, such as public health campaigns and policy legislation related to tobacco and alcohol use, and identification of individual risk factors in high-risk persons. Despite efforts at improving management and prevention of NCD, awareness campaigns often do not reach their target audience, particularly in rural areas, while routine screening for risk factors is seldom achieved due to lack of skills and training among health workers. This has led the National Department of Health to claim health promotion as a priority area in its strategic...