IMPLEMENTATION OF WARD BASED OUTREACH TEAMS IN IN KWAZULU-NATAL October 2015
Purpose OVERVIEW Progress with regard to transversal levers General progress with regard to provincial scale up Specific NHI Pilot district progress Key observafons
PURPOSE To share the experience of parfcipafng in the implementafon of ward based teams in KZN.
LegislaFve mandate No. 27.1 of chapter 2 in the Cons4tu4on states Everyone has the right to have access to - health care services Na4onal Development Plan Chapter 10 The key components of primary care include enhanced access to a use of first- contact care, a pa<ent- focused (rather than disease- focused) approach, a long term perspec<ve, comprehensive and <mely services, and home- based care when necessary.
LegislaFve mandate It further states According to the World Health Organiza<on, the six elements of the district health system include: service delivery, health workforce, health informa<on, medical products, vaccines and technologies, sound health financing, and good leadership and governance. These elements aim to achieve beier health outcomes in terms of equity and quality, responsiveness, social cohesion, financial risk protec<on and improved efficiency
PopulaFon 10, 819, 130 (Stats SA Mid Year 2011), Distributed in 10 districts + 1 metro 54% live in rural areas Background 5.3 Million Living in Poverty (1.2 Million on less than 1 USD a day) (Global Insight Poverty Indicators) HIV disease burden: at least 15.8% prevalence in 2008 (1,7 million esfmated infected in KZN) (HSRC) PLHIV 1 622 870 HIV Prevalence ANC Clients 39.5% which is showing signs of stabilizing, (DOH, 2012) TB NoFficaFon rate 808 per 100,000 vs SA 900 per 100 000 TB / HIV co infecfon rate approximately 70% STI incidence at 2.3%
Birth place of : Background 1. COMMUNITY ORIENTED PRIMARY CARE a unique marriage of public health and clinical care. It is a personal, family and community pracfce. It is a strategy that addresses health problems in a defined community (populafon and geographical area). The pracfce is not only in and for the community but with the community according to idenffied needs. It requires inter- professional, inter- sectoral (e.g. water, sanitafon and social services) and team pracfce. It involves monitoring and evaluafon of the intervenfons introduced as well as research
Background Home of : 1. COMMUNITY HEALTH WORKER Foot- soldiers that had passion & love their communifes
Background Home of : 3. OPERATION SUKUMA SAKHE A strategy that aims to rebuild the fabric of society by promofng human values, fighfng poverty, crime diseases, deprivafon and social ills, ensuring normal regenerafon and by working together through effecfve partnerships. Partnerships that include civil society (religious and tradifonal leaders, vulnerable groups, business), development partners, communifes and Government departments; all of whom work together to provide comprehensive integrated service package to communifes
INTRODUCTION Ward based outreach teams one stream of the re- engineered PHC model that provides preventafve, promofve, curafve and rehabilitafve service to communifes, families and individuals at community- based insftufons and at a household level in a ward. Service must be provided in close associafon with facility based health services, other sectors and government departments, CBOs and NPOs providing community based services and local communifes.). ;
WHAT IS PRIMARY HEALTH CARE RE- ENGINEERING It is a process of refocusing the country s health care system towards the Primary Health Care (PHC) approach that puts emphasis on prevenfve, promofve, curafve and rehabilitafve health care. It aims at relieving district hospitals of the unnecessary burden they currently deal with (NaFonal Health Commioee) The PHC that centres around client and community oriented services and is delivered through District Health System depicted below
DHS MODEL DISTRICT/SUB-DISTRICT MANAGEMENT TEAM SPECIALIST SUPPORT TEAMS (INCL. EMERGENCY SERVICES Contracted Private Providers Local Governm ent District Hospital Community Health Centres PHC Clinic Doctor PHC Nurse Pharmacy assistant Counsellor PHC Outreach Team PN (x 3) EN (1) CHW (X 6) PHC Outreach Team Community Based Health Services Households School Health Environmental Health Community Mobilisation Office of Standards Compliance PHC Outreach Team Health promotion
WHAT IS PRIMARY HEALTH CARE RE- ENGINEERING It is the understanding of this DHS model, Community Oriented Primary Care and OperaFon Sukuma Sakhe Strategies That KwaZulu Natal was able to adapt the model in 2011 for beoer understanding and implementafon of the service delivery plaqorms (sites), teams and linkages as follows:
Service Delivery Sites,Teams & Flow WARD BASED HOUSEHOLD Household Champion CCGs Youth Ambassadors & other cadres Schools SATELITE WAR ROOM Family Health Team- Professional Nurse Enrolled Nurses CCG Facilitator/Trainer ( EHP & Nutri4on Advisors) CCG Supervisor/ CCG/YA Community CLINIC Resident Team Family Health Team School Health Team
MAIN /SATELITE WAR ROOM PARTICIPANTS. DAEA DOJ DOH DSD DPW FBO CBO DoL WARD C0UNCILLOR DAC CIVIL SOCIETY DOT SASSA SAPS DoED DoHA DoE DSR 15
CONTRIBUTION OF WBOTS TO SERVICE DELIVERY Improved access to higher level of services to the community (troubleshoofng into households) Improved support to the Community Health Workers in turn improving quality of care and accountability. Strengthened prevenfon and promofon and educafon in households Improved referral systems from household to the higher level through linkages established Assisted in strengthening of interdisciplinary and inter- sectoral collaborafon
CHALLENGES The financial constraints budgetary shrinkages. Health system reconfigurafon slow management of change process from curafve to preventafve health promofonal approach. The major challenge of staff exodus that is aoributed to pension related issues and unclear career pathing for Outreach teams.
FUTURE PLANS Provision of addifonal funding for at least 20 teams as per procurement plan (2015/16 2017/18) Reviewing funding approach in favour of WBOT Unlocking of available resources IntegraFon of service delivery e.g.. 90-90- 90 implementafon supported by increased WBOT.
FUTURE PLANS Health service reconfigurafon over staffed Workload Indicator of Staffing Needs (WISN) process idenffying over staff facilifes and redeployment. CHANGE MANAGEMENT Facilitate change of mindset towards prevenfve and promofve services and resourcing there of. InsFtuFonalizaFon of WBOT into organizafonal structure.
INPUT BY WBOT ACTIVITIES WE PERFORM Importance of exclusive breasqeeding for 6 months then safe transifon auer 6 months taking into considerafon the AFASS principle. Screen all the women on child bearing age for pregnancy i.e. ask about their family planning method, last normal menstrual period. If they are not on any method ask to perform a pregnancy test if posifve counsel and refer to clinic for early ANC booking before 20 weeks and make a follow up to see if they went, and if negafve counsel on family planning and those comfortable with starfng at home, start them on FP method of their choice, those not comfortable we refer them to clinic and do a follow up to see if they went.
INPUT BY WBOT ACTIVITIES WE PERFORM Screen all the RTHB of the under 5 years children for mother and child HIV status, immunizafon status, usual illness of the child, monitoring the child s growth curve to idenffy malnutrifon early, check if they got vitamin A and Deworming medicine at correct intervals. Catch up immunizafon to those defaulted. Do MUAC s, check for pedal edema, sparse hair, emaciafon, indicafng malnutrifon and manage accordingly.
INPUT BY WBOT ACTIVITIES WE PERFORM Screen all the ANC cards for those already started ANC to check for compliance on appointment dates and check abnormalifes. - Do BP s to those with pregnancy induced hypertension and those at high risk. Work with the clinic and post natal ward to ensure that those due for 6 days post natal visits comes to clinic. Teach all mothers with problems on breasqeeding the correct way of proper aoachment i.e. mouth wide open, mouth touching the breast, lower lip curled outward, lower part of the areolar showing more than the upper.