NATIONAL HEALTH INSURANCE PILOTS. Forum for Professional Nurse Leaders Conference Sliverstar Casino, Krugersdorp 8 th MAY 2012

Transcription

1 NATIONAL HEALTH INSURANCE PILOTS Forum for Professional Nurse Leaders Conference Sliverstar Casino, Krugersdorp 8 th MAY 2012

2 Outline WHO Dimensions for UHC Constitutional Obligation Principles of NHI NHI Pilots Other Preparatory Work Conclusion 2

3 DIMENSIONS FOR ACHIEVING UNIVERSAL COVERAGE Source: WHO (World Health Report: 2010) 3

4 Constitutional Obligation: The Bill Of Rights Section 27. Health care, food, water and social security 1. Everyone has the right to have access to a. health care services, including reproductive health care; b. sufficient food and water; and c. social security, including, if they are unable to support themselves and their dependants, appropriate social assistance. 2. The State must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights. 3. No one may be refused emergency medical treatment. 4

5 Principles The Right to Access Health Social Solidarity Equity Effectiveness Efficiency Appropriateness Affordability 5

6 Piloting of NHI Starts in 2012 Policy position: Phased-in over a period of 14 years First steps towards implementation start in 2012 through piloting 10 health districts have been selected for piloting Selection of the 10 districts was based on the following factors: Health profiles, demographics Health delivery performance Management of health institutions Income levels and social determinants of health Compliance with quality standards 6

7 Pilot Selection Criteria Demographic Socio-Economic Burden of Disease Health Service Performance District Management Capacity 7

8 Selected Pilot Districts and Respective Population Size Province District Total Population (STATSA 2010 Population Estimates) Eastern Cape OR Tambo 1,353,349 Mpumalanga Gert Sibande 944,694 Limpopo Vhembe 1,302,107 Northern Cape Pixley ka Seme 192,157 Kwa-Zulu Natal umzinyathi 514,840 Kwa-Zulu Natal umgungundlovu 1,066,150 Western Cape Eden 558,946 North West Dr K Kaunda 807,752 Free State Thabo Mofutsanyane 832,172 Gauteng Tshwane 2,697,423 TOTAL POPULATION 10,269,590 Notes: *KZN will pilot two (2) districts due to high population numbers and high disease burden 8

9 Objectives for NHI Pilots (1) To assess utilization patterns (incl. referral systems), costs and affordability of implementing the re-engineered PHC package Improving access to quality health services particularly in the rural and previously disadvantaged areas of the country To assess the practical, affordable and innovative ways of engaging private sector resources for public health purposes To examine the mechanisms needed for introducing a district health system mechanism of funding for health services 9

10 Objectives for NHI Pilots (2) To assess the costs of introducing a fully-fledged District Health Authority as Contracting Agency and implications for scaling-up such institutional and administrative arrangements throughout the country To test ability of the districts to assume greater responsibilities associated with the purchaser-provider split required under a NHI 10

11 The First 5 Years of the Pilots Focus on strengthening the health system in the following areas: Management of health facilities and health districts Quality improvement PHC re-engineering incl. roll-out of three PHC streams Infrastructure development Medical devices including equipment Human Resources planning, development and management Information management and systems support 11

12 SERVICE DELIVERY INDICATORS Ward-Based Teams NHI Pilot Matrix PILOT INTERVENTIONS PHC District Specialist Support Teams School-based PHC Services Private providers (GP & Teams) Model CENTRAL HOSPITALS 7 Hospital Pilot HEALTH SYSTEMS STRENGTHENING (HR; FINANCING; INFORMATION SYSTEMS, MANAGEMENT, ADMINISTRATIVE CAPACITY etc.) Package of Services + EMS District Health Authority Contracting Agency Innovative Financing health services for Delivery Models Human Resources (Norms and standards) HEALTH INDICATORS Referral Networks Contracting, procurement, purchasing, IT, & risk (Fraud prevention) engine Private Providers (GP & Teams) Model Population Registration HEALTH INDICATORS HEALTH INDICATORS Revenue Collection Revenue Retention Systems strengthening Case Management Tools development 12

13 Other Preparatory Work 13

14 Health Facility Audits NDOH commissioned an independent audit on quality of health services and conditions under which they are delivered at public health facilities for the period May 2011 March districts have completed (100% facilities audited with data validated) as at end January

15 Purpose of the Audits To strengthen comprehensive health care delivery at all levels - a process to strengthen the healthcare system To support the development and effective implementation of Facility Improvement Plans that respond to audit findings To strengthen the capacity for continuous healthcare quality improvements To develop a culture for sustained quality healthcare delivery that can be measured To initiate foundational work for the NHI 15

16 Facility Audits Scope Audit information covers: Information about bulk service supply, waste management, opening hours, physical access, etc. HR Infrastructure Services packages Performance against national core health standards namely Availability of medicines and supplies Cleanliness Patient and staff safety Infection prevention and control Positive and caring attitudes Waiting Times 16

17 Districts Completed (Not All Validated) Province Districts completed January 2012 Districts completed Feb 2012 Eastern Cape Free State Chris Hani, Alfred Nzo, O R Tambo, Amathole, Cacadu Motheo, Xhariep, Lejweleptuswa, Thabo Mofutsanyane, Fezile Dabi Gauteng Sedibeng, Ekhurhuleni, Tshwane, City of JHB West Rand KwaZulu Natal Limpopo Mpumalanga Northern Cape North West Umkhanyakude, Uthukela, Ugu, Zululand, Amajuba, Sisonke, Umzinyathi, Umgungundlovu Greater Sekhukhune, Capricorn, Vhembe, Mopani Gert Sibande, Ehlanzeni, Nkangala Frances Baard, Pixley Ka Seme, Siyanda, Namakwa, J T Gaetsewe Ngaka Modiri Molema, Dr Ruth Sekgomotsi Mompati, Bojanala Uthungulu, ilembe Kenneth Kaunda Western Cape Eden, Central Karoo Cape Winelands Total

18 Summary of Completion Rate (February 2012) Prov. Hosp CHC Clinic Prov.Total Tot Fac % Completed at the end of February EC % FS % GP % KZN % LP % MP % NW % NC % WC % Total % 18

19 Establishment of HFITs Components to focus on Health Systems Strengthening & Clinical Health outcomes Financing Health Information Human Resources Medicines (other consumables) Quality Teams of officials from National and Provincial DOHs plus additional expertise where deemed necessary 19

20 HFITs: Scope of Work FITs will be district and or facility based and will focus on Standards benchmarking Human Resources staffing norms, recruitment and retention Staff and community attitudes- caring staff, confident and proud community Clinical care Operational and logistical efficiency Financial Management Health systems strengthening patient centred care and management capacity Quality Infrastructure M&E and Information Management 20

21 Domains for Quality Improvement Initiatives Patient Rights Patient and Staff Safety incl. Clinical Governance and Clinical Care Clinical Support Services Public Health Programmes Operational Management Infrastructure Management and Appropriateness 21

22 National Core Standards Availability of Medicines & Supplies Cleanliness Improve Patient and Staff Safety Infection Prevention & Control Positive & Caring Attitudes Waiting Times 22

23 Establishment of the Office of Health Standards and Compliance (OHSC) All facilities/establishments to be accredited according to the same set of standards and norms Draft Bill on OHSC tabled in Parliament An independent OHSC to be established with 3 main units: Inspection Ombudsperson Certification of Health Facilities Developmental and multidisciplinary approach using evidence-based principles for standard development to evaluate compliance and to monitor progress 23

24 Human Resources For Health Strategy HRH Strategy finalised and published in 2011 Numerous consultations with key players to finalise contents and gap analyses Consultations involved Provincial DOHs, Deans and Heads of Health Science faculties and Colleges of Medicine, NGO groupings, Department of Higher Education, Professional Representative bodies and labour organizations Focuses on 27 professional categories Training, recruitment and retention matters Revitalisation of training platforms Access and availability in disadvantaged areas HR Intelligence & Planning 24

25 Improving Nursing & Increasing Numbers Nursing summit report finalised and social compact developed with a road map for nursing reform (August 2011) Ministerial Nursing Task Team established to Elaborate implementation plan for nursing reforms Work on policy and plans for nurse education and training by the end of 2011/12 financial year Priority infrastructure projects in 2012/13 include renovation, refurbishment and/or the complete rebuilding of about 122 nursing colleges Enhance student intake and training capacity ± R450 m over the MTEF period 25

26 Primary Health Care (PHC) Re-engineering PHC services shall be delivered according to the following three streams: District Clinical Specialist Support Teams supporting delivery of priority health care programmes at the district level Focus: IMR, MMR and CMR (MWCH) School Primary Services Focus: PHC services with the schools environment Municipal Ward-based Primary Health Care Agents Focus: Community outreach programme (promotion + prevention) 26

27 Improving the Functionality & Management of the Health System As part of the overhaul of the health system and improvement of its management, hospitals in South Africa will be re-designated as follows: District hospital Regional hospital Tertiary hospital Central hospital Specialized hospital Each level of hospital designation will be managed at a newly defined level with appropriate qualifications and skills as defined by the National Health Council 27

28 Strengthening Planning & Decision Making 6.1 INFORMATION SYSTEMS./2 National Health Information Repository Data Warehouse Quality Improvement Initiatives Facility Profile on quality issues Monitoring of quality issues Targeted quality improvement strategies in identified districts (HFIT Programme) Integrated Health Facility Planning (PMU) Facility catchment population Travel Distance mapping Emergency Medical Services Health Facility Audits >>> baseline data to inform proactive planning and decision making 28

29 Non-Negotiables for Success of the Health System 1. Infection Control Services 2. Medicines and Medical Supplies including Dry Dispensary 3. Cleaning Materials and Services 4. Essential Equipment and Maintenance of Equipment 5. Laboratory Services: National Health Laboratory Services (NHLS) 6. Blood Supply and Services: South African National Blood Services (SANBS) or Western Province Blood Transfusion Services (WPBTS) 7. Vaccines 8. Food Services and Relevant Supplies 9. Child Health Services (Including Neonatal and Perinatal) 10. Maternal and Reproductive Health Services 11. Registrars 12. Pilot Districts Full Complement of Primary Health Care Teams / Family Care Teams 13. School Health (Quintile 1 and Quintile 2 Schools) 14. District Specialist Teams 15. Infrastructure Maintenance 16. HIV & AIDS 17. TB 18. Security Services 29

30 Conclusion NHI not the only focal area Multiple programmes and activities Systematic approach >>> get the basics right Builds on the strengths of the past, addresses current shortfalls Strong focus on health system overhaul and laying foundation for future Focus: improve performance, address health needs and achieve universal health coverage A Long & Health Life for All South Africans 30

31 Thank You 31