Social Responsiveness Report - 2015 School of Public Health and Family Medicine Head of Department and Director: Prof Mohamed F Jeebhay The School of Public Health and Family Medicine is committed to the concept of a healthy population having equitable access to resources and highly competent health care professionals to achieve a better quality of life. The School is a strong multidisciplinary department in the Faculty with extensive undergraduate and postgraduate teaching and training of medical students as well as students pursuing postgraduate academic study in the public health sciences. The School is organised into 8 disciplinary teaching and training divisions and 4 URC accredited units. In addition, the School hosts the Industrial Health Resource Group (IHRG), which provides health and safety training and support to trade unions Public Health Medicine Division The Health and Human Rights Project in the Division concluded a three year project funded by the European Union through its Primary Health Care Support Programme. The project built the capacity of Health Committees in the Cape Town and Nelson Mandela Bay Metros and linked this training to a range of advocacy and quality assurance interventions for advancing community voice, strengthening civil society and improving patient experience in the health services. The project trained over 580 Health Committee members from 87 Health Committees in the two Metros, developed a range of training and mentoring materials and developed programmes for engaging with health workers over community participation and quality improvement. As a result of the project, community organisations were able to achieve better accountability and responsiveness of services, grassroots leadership was developed, nurtured and mentored, and key policy interventions at national and provincial levels undertaken. For example, communities in the W Cape are now actively engaged in shaping the Western Cape Draft Bill on health facility boards and committees to strengthen community voice and the role of health committees as vehicles of democratic governance, thanks to the collaboration of the HHRP with other civil society and university partners in this project. Collaboration in ongoing, building links with other civil society networks through the People s Health Movement, to ensure the potential of Health Committees to realise the right to health is fulfilled both in policy and practice. Occupational Medicine Division The Occupational Medicine Clinic at Groote Schuur Hospital reached its quarter century of service to the working population of the Western Cape province and beyond. Established in 1990 as a collaboration between the then Department of Community Health and the Department of Medicine, the clinic has provided a comprehensive service to thousands of workers affected by hazardous exposures in their work over the past quarter century. Working with respiratory physicians, dermatologists, hand surgeons, occupational therapists and other professionals, the occupational medicine specialists and registrars have not only provided diagnostic and therapeutic services, but also supported workers with compensation claims to realise their workplace and compensation rights in an often unsupportive environment. The clinic also works with employers and worker representatives to improve workplace conditions, thereby 1
promoting the health and safety of workplaces in the province. More generally, the experience of clinic staff in dealing with the systems that govern the intersection of work and health with regard to work incapacity has enabled them press for systems reform via both scholarly publication and through legal and political channels. We believe the clinic to be a model of a process of public sector care that combines medical expertise, policy concern and a focus on the rights of patients, in this case as workers. Family Medicine Division This Division has been involved in various Social Responsiveness endeavours over the past year. Family Medicine together with the isixhosa and Afrikaans Languages sections in the Faculty of Humanities teaches these two languages to undergraduate medical students in the 1 st, 2 nd, 3 rd, 4 th and 5 th years of the curriculum. The aim is to prepare doctors for their roles in service of our diverse communities in South Africa and to be able to communicate in a meaningful way with these sections of the population. There is enough evidence to suggest that this strategy will improve patient access to health services as well as having a positive effect on adherence to medication and reducing unnecessary investigations. The EU grant which we shared with Public Health from 2012 2014 enabled us to extend the Language teaching into 5 th year as well as to offer Language courses to staff at the Kraaifontein and Delft Community Health Centres on basic and Intermediate levels. We are continuing this Languages course for the Provincial Health Department staff for the next 5 years. The other EU research packages all dealt with issues which directly benefited the community: Primary Care assessment Tool which measured quality of care at CHC s; PROMS (patient related outcome measures) which measured outcomes on patients with terminal illnesses following an intervention; CCAPE: Chronic Diseases Audit in the Western Cape which added an extra question on the patient s view of services rendered which has now been incorporated into the Chronic Disease Annual Audit for the Western Cape. The staff of the Division of Family Medicine performed a screening examination on 94 children at the Etafeni Centre in Nyanga in 2015. We have committed ourselves to perform this function twice a year in the future. Our students also have a compulsory rural rotation through Vredenburg to increase their knowledge about rural communities as well as to stimulate them to return to rural practice after graduating. Palliative medicine staff have been involved in expanding the reach of palliative care in both the NGO and formal health care sector. Staff have been working with National Department of Health to implement the 2014 World Health Assembly resolution recognising palliative care as an essential component of the health system and to include palliative care within NHI. To this end staff are involved locally, in teaching and mentoring colleagues in other departments such as paediatrics, internal medicine and oncology; in the intermediate care facility at Life Esidimeni, Lentegeur; and in developing an on-line training course for academic staff at other medical schools and nursing schools. Research is being undertaken to investigate continuity of care and end-of-life care in collaboration with radiation oncology and an audit of quality care at Victoria Hospital. Staff are involved in support of NGO sector in advocacy for and implementation of palliative care services in the community the South African Alliance for Access to Palliative Care, consultancy to St Luke s Hospice, PaedsPal paediatric consultancy service, PATCH-SA information service for paediatric palliative care. International influence includes 2
involvement in the Worldwide Hospice Palliative Care Alliance and International Primary Palliative Care Group. Health Policy and Systems Division The Division s work has contributed to social responsiveness in three ways: First, we have deliberately strengthened the curriculum of our teaching activities to improve its relevance to understanding societal challenges and taking action on them. In the MPH we have introduced one new module and re-developed a second module to strengthen to support deeper understanding of how to support health system development to secure health and public value gains. We have also strengthened the curriculum of the PG Dip Health Management, to support more effective, workplacebased learning. Many of our teaching materials were also made available as open educational materials to encourage their use globally. Second, our research activities are commonly founded on collaboration with external constituencies, such as health systems managers and policy makers, drawing them into the process of the research itself in order to enhance the relevance and societal value of the research, and encourage the uptake of research findings in decision-making. We also engage in a range of other activities to support researcher-policy maker engagement. Thirdly, we are collectively and as individuals involved in a range of other activities to promote wider public dialogue about health and development challenges including organizing a global health film festival to engage non-academic external constituencies, and participating in a documentary film collective. Environmental Health Division The Division is collaborating with multiple government departments through the Department of Environmental Affair's Multi-stakeholder Committee on Chemicals Management on a chemical awareness raising and risk communication programme nationally for the sustainable management and reduction of chemical risks. Social and Behavioural Sciences Division The social responsiveness work of the Division is divided into three areas: 1) Relationships with local and international NGOs such as MSF-Khayelitsha, MSF-Swaziland and Sonke Gender Justice to support the public health and human rights work in which they are engaged. We are, for example, supporting the development of HIV child disclosure support interventions with MSF and supporting the development of research capacity within Sonke as well as helping to design and evaluate their community mobilization programs for gender transformation. 2) Health activism through relationships with People s Health Movement (PHM). Two of our staff members serve on PHM s steering committee and we are engaged in research around community health workers and worker s rights in support of PHM s focus on CHWs and their role in the NHI. 3) Supporting policymaker s use of qualitative evidence through the GRADE-CERQual project (key paper recently published in PLoS Medicine: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001895) that develops tools for assessing the confidence in findings from reviews of qualitative evidence. 3
Health Economics Division/Health Economics Unit The Division/Unit is actively involved in current health system restructuring in South Africa. Recently, two of its senior staff members have been appointed by the Honourable Minister of Health to serve on various work streams relating to the finalisation of the recently released National Health Insurance (NHI) White Paper and the establishment of the NHI. Further, some of the Division s/unit s outputs provide empirical evidence to support the need for the ongoing health systems restructuring in the country. Centre for Infectious Epidemiology Research (CIDER) CIDER has been involved since 2001 in collaboration with government in developing, improving and supporting implementation of both paper-based and electronic cohort monitoring systems for health services. In late 2009, CIDER piloted an electronic disease monitoring register for HIV services (TIER.Net) in six health care facilities in the Western Cape. This electronic register fills a crucial gap between the paper-based register systems which CIDER helped pioneer in the Western Cape, and full-featured electronic health record systems which require substantially more infrastructure in order to implement. By ensuring data elements, indicators and reports are aligned and data can be easily transferred between the electronic systems, these three monitoring tools can be considered a continuum of solutions which is flexible to the resource constraints in any individual ART service. In February 2015, the National Department of Health announced that the same software developed by CIDER (TIER.Net) would be extended to the tuberculosis services including drug sensitive and drug resistant treatment episodes. The CIDER Strategic Information Team portfolio includes the design, specification, testing, and piloting of each new TIER.Net release in order to draw up best practice documentation to support regional and national guidelines. This also includes direct support to health facilities and sub-structures in the Western Cape to enhance analysis and use of the data. To date TIER.Net is in over 3500 health care facilities in South Africa and being used in projects across 8 other African countries. CIDER colleagues continue to provide technical assistance to the National Department of Health in South Africa and multiple countries in improving routine monitoring services and are regularly called upon by the WHO to partake in writing groups to update documentation and write chapters of new monitoring guidelines. Centre for Environmental and Occupational Health Research (CEOHR) The COEHR has continued its commitment to social responsiveness in 2015 which is involves the translation of its research and providing services. The following lists highlights for 2015: i) The COEHR is collaborating with the Division of Occupational Therapy in the Department of Health and Rehabilitation Sciences and School Development Unit in the Department of Education on a schools awareness programme in Khayelitsha which includes environmental health issues. ii) The SA/Swiss Bilateral Research Chair in Global Environmental Health started in 2015 and one of the key outcomes of the Chair is around research translation. iii) The first ever empirical study of risk perception related to fracking in South Africa done by an MPH student and accepted for publication in 2016. 4
Women s Health Research Unit The WHRU continues to engage in interdisciplinary and translational research to inform policy and practice within the health sector but also more broadly amongst stakeholders and women in the sexual and reproductive health and rights arena. We have researched and developed a range of mobile health interventions to support and empower women around health issues ranging from cervical and breast cancer to pre and post abortion care. We have developed a web based gestational age calculator (www.icalculate.co.za) to assist women with unplanned pregnancies and automated mobile text messages supporting young women in the continuum of care post abortion including contraceptive information. Through a WHO supported multi- country study we have developed a screening tool for community health workers to play a more important and effective role in reducing the burden of unsafe abortion. 5