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 Lerutla @ Wits University : School of Public Health 16 March 2015
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
1. Service platform DISTRICT Fixed clinics Province Fixed clinics LG CHC Province District Hospitals Ekurhuleni MM 3 84 8 1 Johannesburg MM 26 (21%) 86 (40%) 10 (29%) 2 (18%) Sedibeng DM 11 26 4 2 Tshwane MM 39 25 10 4 West Rand DM 43 0 3 2 Gauteng 122 221 35 11 Source: Presentation by M Lerutla on DHS Quarterly Performance Review Period, 2014/15 : q1 2014/15 to q2, 17 November 2014
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 2010...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 - http://www.doh.gov.za/show.php?id=1947 Source: Paulus E, Re-engineering primary health care: A national perspective, 28 February 2013
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
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
(R'000) 2.Rationale for the reengineering of primary health care 50 000 000 45 000 000 40 000 000 35 000 000 30 000 000 25 000 000 20 000 000 17 421 818 15 000 000 12 126 612 10 000 000 5 000 000 3 919 994 2 474 985 0 Where we are today 31 500 000 30 185 530 8 409 390.54 45 138 604 12 575 169 District Health Services Total payments and estimates Source: Gauteng Department of Health Annual Reports 2014/2015 GDoH budget speech amount
3. Health status realities in South Africa comparatively Indicator Brazil Russian India China South Africa Federation Infant mortality rate (per 1,000 17 11 50 17 43 live births) Maternal Mortality Ratio (per 58 39 230 38 410 100,000 live births) Distribution of years of life lost by causes (%) Communicable Non Communicable Injuries 20 56 24 11 64 25 52 35 13 15 65 19 79 15 6 Prevalence of HIV among 0.6 1.0 0.3 0.1 17.8 adults aged 15-49 (%) Prevalence of TB (per 100,000 population) 50 132 249 138 808 Source: National Health Insurance And The Workplace, 25th Annual Labour Law Conference, Sandton, Johannesburg, 30 June 2014
4. Progress made on streams of PHC Reengineering 4.1 District Clinical Specialists Team
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
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
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)
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
4.2 Ward Based PHC Outreach Teams
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 90 35 55 655 Ekurhuleni 42 30 41 442 Tshwane 86 46 39 217 Sedibeng 44 46 57 163 Westrand 48 51 66 336 TOTAL 310 208 258 2030 1 PHC team per 7660 population
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
4.2.3 Gauteng WBOT Indicator report 3 quarters, 2014/15 600000 500000 515 840 400000 300000 273 353 200000 100000 0 7741 22 798 Grand Total WBPHCOTs Data elements
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
4.3 Integrated School Health Programme Teams
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 10 000 learners
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 88 11 99 28 005 Ekurhuleni 72 28 100 41 313 Johannesburg 172 54 198 81 799 Tshwane 182 30 215 65 459 West Rand 40 8 48 18 728 PROVINCIAL TOTAL 529 131 660 235 304
Number of Quintile 1 & 2 visited, number of DISTRICT 4.3.3 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) 16 4 706 74 16 806 0 Joburg 12 (40) 15 4 278 20 4 525 403 Sedibeng 9 (14) 18 5 076 6 514 0 Tshwane 15 (32) 43 12 815 10 1 463 1 035 W/Rand 9 (9) 6 1964 19 6 835 293 PROV TOTAL 61 (116) 98 (14,9%) 28 839 130 30 143 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 2014-1 st round &Sept/Oct, 2014 2cd round
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)
6. End Thank You
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 2000. Health Systems: Improving Performance. https://apps.who.int/whr/2000/en/report.htm (accessed 1 December 2011). South African Health Review Report, 2011 National Department of Health,2014: Primary Health Care Health Professional (PHC-HP) Support Programme