Re-engineering PHC for the District Health System Committee of Health Sciences Deans Peter Barron 3 July 2012
Why PHC re-engineering? The evidence that PHC improves health outcomes is incontrovertible South Africa currently punches far below its weight in terms of health outcomes The NHI needs a strong district health system driving PHC The health system needs to find its focus Outwards as service-related organisation to take services to the people to improve and maintain health in all aspects, of communities and individuals; Inwards to create a motivated, enthusiastic committed health workforce in sufficient numbers and appropriately skilled to achieve this. Create an environment where all available resources are used (including academia & private sector with all its human resources e.g. doctors, pharmacists) The time is right and the necessary political will is strong
South Africa Brazil
South Africa Brazil
10 POINT PLAN 2009-2014 4 NSDA OUTPUTS 2010-2014 1. Provision of Strategic leadership and creation of a social compact for better health outcomes (A); 2. Implementation of National Health Insurance (NHI); 3. Improving the Quality of Health Services; 4. Overhauling the health care system 5. Improving Human Resources, Planning, Development and Management; 6. Revitalisation of infrastructure 7. Accelerated implementation of HIV and AIDS and Sexually Transmitted Infections National Strategic Plan and reduction of mortality due to TB and associated diseases; National Health Priorities D A B C A. Increasing life expectancy; B. Decreasing child and maternal mortality rates C. Combating HIV and AIDS and STIs and decreasing the burden of disease from Tuberculosis HEALTH RELATED MDGs 2000-2015 MDG Goal 4 MDG Goal 5 MDG Goal 6 8. Mass mobilisation for better health for the population 9. Review of Drug Policy; and 10. Strengthening Research and Development D D. Enhancing health systems effectiveness 5
District Health System (DHS) Overview Currently 52 districts (in line with local government boundaries) metros and district councils Lowest formal health administrative unit with district management team responsible for health of population of district District manager has dual responsibility: to the District Health Council via the province HOD to the MEC for Health. DHS consists of district hospitals, CHCs, clinics, CBS. In terms of Chapter 5 of National Health Act, districts must draw up: Annual District Health plan Annual District Human Resources Plan
DHS MODEL DISTRICT/SUB-DISTRICT MANAGEMENT TEAM SPECIALIST SUPPORT TEAMS (INCL. EMERGENCY SERVICES Contracted Private Providers Local Govern ment District Hospital Community Health Centres PHC Clinic Doctor PHC Outreach Team PN (x 3) EN (1) CHW (X 6) Community Based Health Services Households Office of Standards Compliance PHC Nurse Pharmacy assistant Counsellor PHC Outreach Team PHC Outreach Team School Health Environmental Health Community Mobilisation Health promotion 7
Strengthening the DHS All 6 building blocks need strengthening The 7 th building block are social determinants of health which play fundamental role in health of communities and individuals Academic institutions can play a role in each of these by providing intellectual leadership E.g. The health system (especially with NHI) needs to make evidence-based decisions using objective information. To do this information needs to be synthesised, analysed, interpreted. The NDOH and PDOH need knowledge management units. Academics are well-placed to support.
PHC Re-engineering In its approach to PHC re-engineering the NDOH has focused on three priorities ( streams ) PHC outreach teams with at least one team for each electoral ward; Strengthening school health services; District based clinical specialist teams with an initial focus on improving maternal and child health.
PHC OUTREACH TEAMS: GENERIC FUNCTIONS Know the demography of the catchment population Know the epidemiology Health promotion and prevention (household and community) Screening and referral of people identified with high risk Palliative care Social mobilisation Linking resources to community needs to improve health outcomes 11
WARD BASED PHC OUTREACH TEAMS PHC OUTREACH TEAM Responsible for 1500 Families No. of teams in a Ward (determined by population size) Preventative, promotive, curative and rehabilitative services (work with EHOs) HBC Community Services including schools, crèches, and early learning centres & home based care services. CHW 250 families CHW 250 Families Professional Nurse (Team leader) Health Promoter Environmental Health Officer CHW 250 Families CHW 250 families CHW 250 Families CHW 250 Families 12
SCHOOL HEALTH SERVICES Mandate is to cover all students and schools in an incremental way starting with quintile 1 and 2 NDOH and DBE have finalised core package of services for ECD, primary and secondary schools Screening, health education/promotion; some service delivery Need to employ more school health nurses/teams and deploy them Strengthen M/E to show impact of school health 13
SCHOOL HEALTH: NEXT STEPS Clearly this needs to build on what exists with rapid scale up Proposal is that we start with schools in quintile 1 (poorest) districts. This is over 10,000 schools! Need to prioritise certain grades for screening and health promotion interventions. Sexuality and reproductive health education is highest priority (to prevent HIV and avoid other STIs and pregnancy). 14
District Clinical Specialist Teams NHC directed that specialist teams to improve maternal and child health be deployed to cover every health district Teams to be composed of: principal O&G, paeds, anaesthetist, family physician, advanced midwife, advanced paed nurse and PHCN National adverts placed; teams will go to areas of greatest need initially 15
Specialist teams: roles Work with institutional based specialists. Adopt a population based focus and participate in outreach activities for the development and support of all health facilities in the catchment area of their institution. Their primary function remains the development and support of an acceptable standard of clinical care throughout the region for which they are responsible. Will not be used to cover staff shortages in the regional hospital (however, may provide some clinical services to ensure own competency is maintained and to continue registration). 16
Relevance to Health Science Deans PHC Re-engineering and NHI need all major stakeholders to pull in the same direction Health Sciences Faculties are major producer of health workers Health workers are required in greater quantities and with greater PHC skills, competencies and attitudes Health system needs intellectual input from academics
Health Sciences Graduates Able to work in teams Understand the need for a comprehensive approach Mentor those with less skills Have necessary skills and competencies to deal with common health problems that occur commonly in South Africa Need to have a population focus and deal with patients in the context of social determinants of health
Health Science Faculties Respond to the needs of SA by producing graduates with appropriate competencies (e.g. nurses, doctors who can work at district hospitals, CHCs) Respond to the needs of SA by producing postgrads with appropriate competencies (e.g. specialists with community orientation - such as paeds, O&G,) Respond to the needs of SA by running courses that fill gaps e.g. managers of districts; CEOs of hospitals; managers of supply chains;
Thank You