STATUS OF PRIMARY HEALTH CARE RE-ENGINEERING IN GAUTENG

Transcription

1 STATUS OF PRIMARY HEALTH CARE RE-ENGINEERING IN GAUTENG Presented at the Johannesburg Health District s Workshop On PHC Re-engineering Presented by Modise Makhudu obo Meisie Wits University : School of Public Health 16 March 2015

2 Table of contents 1. Service platform in Gauteng 2. Rationale for the reengineering of primary health care 3. Health status realities in South Africa comparatively 4. Progress made onstreams ofphcreengineering 4.1 DSCTs 4.2 WBPHCOTs 4.3 ISHPTs 5. Issues to ponder on 6. End 7. References

3 1. Service platform DISTRICT Fixed clinics Province Fixed clinics LG CHC Province District Hospitals Ekurhuleni MM Johannesburg MM 26 (21%) 86 (40%) 10 (29%) 2 (18%) Sedibeng DM Tshwane MM West Rand DM Gauteng Source: Presentation by M Lerutla on DHS Quarterly Performance Review Period, 2014/15 : q1 2014/15 to q2, 17 November 2014

4 2. Rationale for the reengineering of PHC--- NDoH perspective "As a country we just have to go back to the basics of primary healthcare. We have to prevent diseases even before they occur. We have to act now Minister Motsoaledi, July more emphasis...be placed on Primary Health Care (PHC) as part of reducing the huge burden of disease the country is faced with. South Africa is one of the countries in the world with huge maternal and infant mortality complicated further by HIV and AIDS. 7 July 2010, Issued by the Ministry of Health - Source: Paulus E, Re-engineering primary health care: A national perspective, 28 February 2013

5 2.Rationale for the reengineering of PHC--- GDoH perspective Primary healthcare requires an activist and communityoriented approach to the delivery of healthcare. To accelerate the provision and improvement of Primary Health Care (PHC) services, we are reengineering Primary Healthcare in all our districts based on the Brazilian and Cuban models. Extract from 2014/15 Gauteng Health Budget Vote Speech Tabled by the MEC for Health Ms Qedani Mahlangu at Gauteng Provincial Legislature, 29 July 2014

6 2. Rationale for the reengineering of primary health care Health Promotion Advocacy PHC Illness prevention Community Development Care of the sick Source: Habib HA (2011), Introduction to Primary Health Care

7 (R'000) 2.Rationale for the reengineering of primary health care Where we are today District Health Services Total payments and estimates Source: Gauteng Department of Health Annual Reports 2014/2015 GDoH budget speech amount

8 3. Health status realities in South Africa comparatively Indicator Brazil Russian India China South Africa Federation Infant mortality rate (per 1, live births) Maternal Mortality Ratio (per ,000 live births) Distribution of years of life lost by causes (%) Communicable Non Communicable Injuries Prevalence of HIV among adults aged (%) Prevalence of TB (per 100,000 population) Source: National Health Insurance And The Workplace, 25th Annual Labour Law Conference, Sandton, Johannesburg, 30 June 2014

9 4. Progress made on streams of PHC Reengineering 4.1 District Clinical Specialists Team

10 4.1.1 DCST Update Teams established and active in all 5 districts in their clinical governance roles COJ and Tshwane have a full complement - all positions Ekurhuleni & West Rand short of Anaesthetist Sedibeng short of Paediatrician and Anaesthetist

11 4.1.2 Achievements to date Morbidity and mortality (M&M) meetings in facilities: Through DCST support, monthly M&M meetings are now happening in most district facilities. Now DCST working on building capacity to ensure highquality action-oriented M&M meetings, to improve care by using the knowledge gained from analysing adverse events Facility audits to ensure MOU capacity Every MOU is now audited monthly for emergency drugs, emergency supplies, essential equipment and protocols. These audits have ensured that the MOUs have the physical capacity to deal with obstetric and neonatal emergencies, managing shortages quickly

12 4.1.2 Achievements to date (cont) In-service Training DCSTs have undertaken accredited and structured training in all District Hospitals and CHCs, & clinics. Trainings include emergency obstetric fire-drill scenarios (see next slide for number of staff trained and types of trainings provided)

13 4.1.2 Achievements to date (cont 2) Training: Number of health providers trained: BANC training 709 Partogram training 71 Full ESMOE training 262 Neonatal resuscitation training (DCST) 691 Neonatal resuscitation training (Johnson & 366 Johnson) Contraception and fertility planning training 381 Cardiopulmonary resuscitation training 50 ESMOE-EOST obstetric fire-drills at facilities 1008 Other training 416

14 4.2 Ward Based PHC Outreach Teams

15 4.2.1 WBPHCOT Progress DISTRICT No teams established 14/15 No. of wards covered No. of trained team leaders 14/15 NO. of CHW S Trained 14/15 Jhb Ekurhuleni Tshwane Sedibeng Westrand TOTAL PHC team per 7660 population

16 4.2.2 Achievements Provincial and Districts Task Teams established Provincial WBOT guidelines developed by WBOT Task Team Five Districts developed Standard Operating Procedures on WBOT Tshwane and Johannesburg District have joint WBOT meetings with Local Government and reporting jointly Provincial WBOT manager is part of NHI Task Team in the pilot site for bench marking and information sharing Cuban doctors are part of the WBOT Task Team in 3 Districts i.e. JHB, Ekurhuleni and Sedibeng

17 4.2.3 Gauteng WBOT Indicator report 3 quarters, 2014/ Grand Total WBPHCOTs Data elements

18 4.2.4 Challenges Challenges 1.WBOT indicators excluding other programme data that were previously collected by CHWs Intervention Task Team looking at data integration 2. Data collection tool is perceived as collecting numbers and not improving service delivery Data tools in process of being reviewed by NDOH, with Provinces input 3. Shortage of Team Leaders and poor supervision of CHWs Awaiting approval of post for Team Leaders

19 4.3 Integrated School Health Programme Teams

20 4.3.1 Health Service Teams Teams establishments informed by number of schools to be serviced, & number of enrolled learners Professional Nurse/Enrolled nurse 1/2000 learners Health promoter for every learners

21 4.3.2 Quintile(Q) 1 & 2 including Special Needs Schools Per District DISTRICT Total Quintile 1 & 2 Schools Total Special Schools Total No Quintile1 & 2, and Special Schools Total Enrolment Quintile 1&2, Special School Sedibeng Ekurhuleni Johannesburg Tshwane West Rand PROVINCIAL TOTAL

22 Number of Quintile 1 & 2 visited, number of DISTRICT Schools visited -Learners Screened per District Teams Established & Required Total Quintile 1 & 2 Schools visited Total Learners Screened Quintile1 & 2 Total Other schools visited Learners screened Other schools Td Vaccine Given 6 &12 years old Ekurhuleni 16 (21) Joburg 12 (40) Sedibeng 9 (14) Tshwane 15 (32) W/Rand 9 (9) PROV TOTAL 61 (116) 98 (14,9%) NB: Less Quintile 1 & 2 Schools visited as compared to others Td Tetanus and Diphtheria Human Pappiloma Virus Vaccination programme Grade 4 learners - Feb/March st round &Sept/Oct, cd round

23 5. Issues to ponder on By end of 2014/15 WBOTs need to cover 508 municipal wards compared to reported 208; ISHPTs needs to be 116 compared to current 61 and remaining specialists to possibly linked/sourced from Universities How we practically support the following programmes/initiatives utilizing PHC reengineering approach: Family Planning Ideal Clinic Initiatives Reduction of maternal and child mortality Community health Care availability and capacity reduction the rate of new HIV infections by 50% Healthy lifestyle Resourcing aspects of PHC (i.e. Health promotion, advocacy, care for the sick, illness prevention and community development)

24 6. End Thank You

25 7. References Gauteng Department of Health (2014), Mahlangu Q, Health 2014/15 Budget Vote Speech Tabled at Gauteng Provincial Legislature, 29 Jul 2014 Gauteng Department of Health (2014), Lerutla, M. DHS Quarterly Performance Review Period, 2014/15 : q1 2014/15 to q2, 17 November 2014 The World Health Report Health Systems: Improving Performance. (accessed 1 December 2011). South African Health Review Report, 2011 National Department of Health,2014: Primary Health Care Health Professional (PHC-HP) Support Programme