Management working environment There is evidence that the performance of district managers is affected because they are not clear about their role and responsibilities. Tackling this issue may improve the effectiveness with which district managers perform their duties, as well as enable provincial authorities to assess district manager performance in a better manner.A starting point for addressing this issue could be to develop well-defined job descriptions and procedure manuals for district health managers. Another recognised problem in the health system is the lack of coordination between national and sub-national health plans. This is partly due to decentralisation and poor clarification of roles and responsibilities of pro
vincial and district government. It affects resources available to district managers for activities such as supervisor visits. Without improvement of the decentralisation program and clarifying the authority of each level of government, it will be difficult to enhance the performance of district health managers.