ECD KBS 2016 Lekwetji Komane TSHWANE DISTRICT WBOT PRESENTATION Presenter: Mrs Lekwetji Komane Date: 9 November 2016 Burgerspark Hotel 1
Introduction Ward Based Outreach Team is one of the 4 streams of PHC Reengineering strategy that provides services to communities, families and individuals at community-based institutions and at a household level within a ward WBOT serve as the cornerstone of community based PHC services and spearhead primary health activities, while providing links to referral networks, thereby helping to ensure the provision of services, care and support at local or municipal level. 2
AIMS Strengthen the district health system (DHS) and do the basics better Team approach including community health workers (CHWs) Improvement of health outcomes Strengthening school health services Ensures that outreach services are provided to communities door to door Ward based PHC outreach team for each electoral ward 3
Benefits of WBOT Health promotion and preventive activities Early diagnosis and referral of patients identified Follow up of patients discharged from the Hospitals different levels Outreach into communities and homes of families with family census Early identification of individuals within families at risk Community involvement Greater interaction with communities to get their support
WBOT Structure WBOT Operational Manager per sub district Team Leader can be Professional Nurse or Enrolled Nurse Community Health Workers (CHW s)
WBOT Team WBOT Operational Manager CHW 270 CHW 270 Team Leader CHW 270 CHW 270 CHW 270 CHW 270
WBOT Structure WBOT DD AREA MANAGERS WBOT AD AREA MANAGERS FACILITY MANAGERS WBOT OPS MANAGERS WBOT OPS MANAGERS WBOT OPS MANAGERS WBOT OPS MANAGERS/CLUSTER WBOT OPS MANAGER TEAM LEADER TEAM LEADER TEAM LEADER TEAM LEADER TEAM LEADER CHW CHW CHW CHW CHW
Activities Team Leader allocate 250 to 270 households to CHW CHW s visits households as per allocated number DOTS for TB patients Monitor treatment compliance Data collected from all family members using standardised tool Data collected is analysed and intervention strategies put in place by the team 8
Activities Data is shared with the PHC facility Delivery of medications HBC Follow up of PCR Pos Babies Individuals are referred to different departments such as Social Department, Home Affairs Awareness campaigns are conducted to address poor performance 9
Implementation of WBOT Community mobilization was conducted Involvement of Ward councillors Identification of Gov funded NGO s Appointment of Team Leaders NGO management and CHW s orientation Mapping in the identified sites Conducting institutional analysis Allocation of 270 households to CHW Training of CHW s and Team Leaders data collection 10 days training for CHW s was conducted from April 2012 in partnership with FPD CHW s are in serviced on different topic in each site
Implementation of WBOT Tshwane District and City of Tshwane outreach programme are integrated Mapping was conducted and wards were shared by CoT and Tshwane An integration and Mapping document was compiled awaiting to be signed Institutional Analysis was conducted by Team Leaders Combined WBOT reporting since January 2015
Referral Route District Hospital Community Health Centre / Clinic Organization by qualified personnel of Community Health Activities and supervision of Health Clinics and Health Post Community Based Health Services Health related activities organized by community leaders community health workers and other community based workers 12
WBOT Expansion Year Team Leaders Teams Wards 2011 7 7 9 2012 8 9 14 2013 18 24 33 2014 46 43 47 2015 ( August) 103 118 68 2016 (August) 243 243 72 13
WBOT Expansion from 2011 2016 (August) 250 243 243 200 150 100 103 118 Team Leaders Teams Wards 68 72 50 7 7 9 8 9 14 18 24 33 46 43 47 0 14 2011 2012 2013 2014 2015 ( August) 2016 (August)
Teams per Sub District Sub District Teams 1 86 2 31 3 28 4 14 5 10 6 57 7 17 Totals 243 15
Teams per Sub District 250 243 200 150 Teams 100 86 57 50 31 28 14 10 17 0 1 2 3 4 5 6 7 Totals 16
Ward Coverage Sub District Total Wards Wards Covered 1 28 23 2 12 10 3 23 13 4 11 2 5 3 3 6 23 16 7 5 5 17
Ward Coverage 120 105 100 80 72 60 Total Wards Wards Covered 40 28 23 23 23 20 12 10 13 11 2 3 3 16 5 5 0 1 2 3 4 5 6 7 Total 18
Training progress 2013-2015 4000 3500 3000 2500 2541 2000 1500 1000 977 500 481 571 0 0 0 2013 2014 2015 CHWs phase 1 CHWs phase 2 Target 19
CHW Competency Rate 1200 76% passed ; 20,7% Re-exam ;04% Failed 1000 970 800 752 600 400 200 0 321 214 156 79 62 18 CHWs Assessed Competent Re-Assessment Incompetent 2014 2015 20
WBOT Perfomance 2015-2016 Household Registration 360,651 Follow Up 299,248 Supervised Visit 20,899 Pregnant Mothers referred 21,939 Postnatal seen 21,263 Ref to Clinic 95,464 Ref Social Services 155,176 Vit A given 53,773 HCT 41,620 21
Narratives Total coverage 72/105 = 68.6 % Sub District 3 & 4 are the elite areas and thus not yet covered by teams Coverage of Disadvantaged areas is 89 % Wards covered are not entirely covered 22
Improved performance NUTRITION Target 201516 201617 (1 ST Q) Vitamin A dose 12-59 months coverage (annualised) 50 % 36.5% 50.2 % Antenatal 1st visit before 20 weeks rate 70 % 46.7 % 57.2 % 23
Improved performance through WBOT 70% 70% 60% 57.20% 50% 50% 46.70% 50.20% 40% 30% 36.50% Vitamin A dose 12-59 months coverage (annualised) Antenatal 1st visit before 20 weeks rate 20% 10% 0% Target 201516 201617 (1ST Q) 24
Vit A : Improved Performance Training of CHW s on Vit A, RTH Booklet and Administration of Vit A Collection of Vit A from the PHC Facility Provision of Vit A at household level Submission of data to facility managers Community awareness and campaigns 25
Early ANC Booking: Improvement Performance History taking at household level Identification of Pregnant mothers Referral for ANC booking Follow up of referred pregnant mothers per facilities Comparison of referred vs those referred who booked at PHC facilities 26
WBOT Intervention Identified challenges are addressed differently eg Referral to different department such as Home affairs, Social workers etc Health challenges can be addressed through awareness campaigns 27