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02-04 FEBRUARY 2010

HEALTH SECTOR 10 POINT PLAN 2009-2014

(i) Provision of Strategic leadership and creation of a social compact for better health outcomes;

(ii) Implementation of a National Health Insurance Plan;

(iii) Improving Quality of Services;

(iv) Overhauling the health care system and improve its management;

(v) Improving Human Resources Management;

(vi) Revitalization of physical infrastructure;

(vii) Accelerated implementation of HIV and AIDS Plan and reduction of mortality due to TB and associated diseases;

(viii) Mass mobilisation for better health for the population;

(ix) Review of the Drug Policy;

(x) Strengthening Research and Development.2

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Introduction

The National Department of Health has adopted the District Health System as a vehicle for the delivery of Primary Health Services

National Policy on DHS was developed in 1995Chapter 5 of the National Health Act is devoted

to the establishment of the DHSThere are 52 Health Districts whose boundaries

are coterminous with District Municipalities Delivery of PHC is through the provinces.

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Introduction NHA calls for the establishment of the District

Health council which shall be led by the District Municipality

This act also calls for the alignment of the District Health Plan and IDP

The National Department of Health developed a comprehensive and integrated package for the delivery of Primary Health Care since 2001.

In order to ensure that there are quality health services at the point of delivery, the NDoH has also developed norms and standards for PHC.

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Norms and StandardsThe provision of PHC in the Republic is

aligned to the prescribed norms and standards.

With the production of an essential package for comprehensive and integrated PHC, norms and standards have continued to guide the implementation of the PHC package of service.

South Africa has provided comprehensive and integrated PHC services for 10 years.

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Model of Service DeliveryThe Department of Health across spheres of

government remains committed to the provision of primary health care services (PHC) through a functional District Health System (DHS).

Services are delivered through PHC facilities Community Health CentresFixed clinics, mobile clinicsHealth Posts

There are services that are delivered through community health workers

All these form the platform for the delivery of PHC within the DHS.

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Range of Services

The following range of service being delivered through fixed PHC facilities and mobile clinics. These services range from promotive, preventive, curative and rehabilitative health services. They cater for children, women, youth and elderly, mental health, etc. These services are as follow among others:Health Education and Patient EducationFamily PlanningImmunisation Ante-Natal CareRehabilitation etc

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Range of Services

Post Natal CareMaternity and LabourCervical Cancer ScreeningServices Sexual Assault including ProphylaxisHIV and AIDS services including Prevention from

Mother to Child Transmission (PMTCT), Voluntary Counseling and Confidential Testing

Chronic Care and Care for the Elderly (Geriatrics) including Palliative Care at community level

Mental Health and Substance AbuseManagement of trauma and common ailments

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Method of delivering these services

The services are delivered through:Provincial PHC facilities (full package delivered for free)

Municipalities (limited package delivered for free)

There is a limited involvement of private sector in the delivery of PHC delivered at a fee)

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Hours of delivery of PHC ServicesThese services are delivered through:8 hours 5 days a week (common in small communities and all municipal clinics)

12 hours 7 days a week12 hours 5 days a week24 hours 7 days a weekOne day per (for mobile clinics and health posts)

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Future PlanSince 2000 there have been changes and

demands on the health system. The NDoH has planned to audit all PHC

facilities and package of essential services during this current financial year and up till 2012.

The audit will focus on both infrastructure, package and the staffing needed to deliver the package of PHC services

The outcome of this exercise will inform the future delivery model of PHC in the country.

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Deliverables for PHC and DHSObjectives Indicator Target Achieved

Develop functional Health Districts

Districts with DHP developed and submitted

47 47

No of DHP ‘s linked to IDP’s

47 37

No of provinces reporting quarterly on DHP’s

8/9 8/9

No of Districts with established Health councils

52 47

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Deliverables for PHC and DHS

Objectives

Indicator Target Achieved

Develop functional Health Districts

% of PHC facilities where committees are established

52% 60%

No of districts reporting on PHC supervision

52 52

No of districts implementing community based health services framework

27 37

No of districts supporting NGO’s in CBHS

27 37

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Deliverables for PHC and DHSObjectives Indicator Target Achieved

Develop functional Health Districts

Districts with DHP developed and submitted

47 47

No of DHP ‘s linked to IDP’s

47 37

No of provinces reporting quarterly on DHP’s

8/9 8/9

No of Districts with established Health councils

52 47

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Highlights of integrated service delivery

ISRDP :The strategic objective of the ISRDS is “to ensure

that by the year 2010 the rural areas would attain the internal capacity for integrated and

sustainable development”.

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List of Rural Nodes: The following have been identified as rural

nodesProvince District

Chris Hani District MunicipalityOliver Tambo District MunicipalityUkhahlamba District Municipality

Free State Thabo Mofutsanyane District MunicipalityUgu District MunicipalityUmzinyathi District MunicipalityuMkhanyakude District MunicipalityZululand District MunicipalityGreater Sekhukune District MunicipalityMopani District Municipality

Northern Cape John Taolo Gaetsewe District MunicipalityWestern Cape Central Karoo District Municipality

Eastern Cape

Alfred Nzo District Municipality

KwaZulu-Natal

Limpopo

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Information Sources

ISRDP used data drawn from: Stats SA General Household Surveys

and Community Survey 2007, Antenatal and Syphilis Surveys, 2001 Census data and Midyear

Population Estimates and BAS and PERSAL systems for financial data.

The DHIS ZA_NDOH5_06_09 data file.Data disaggregated to facility level in one

combined National data file was used for the health status and Health outcomes indicators.

Data for 2009 is only up to July 2009.

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Factors that characterised these nodesProportion of the area’s population that are

children below the age of 5;From a female headed household;Household heads who have no schooling;Adults between 25 and 59 classified as

unemployed;Living in a traditional dwelling, informal shack or

tent;No piped water in their house or on site;Pit or bucket toilet or no form of toilet; andNo access to electricity or solar power for

lighting, heating or cooking.All these will lead poor health outcomes

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Impact of factors on service deliveryInability to recruit and retain health

professionalsPoor access to facilities due to poor road

infrastructureDiseases of poverty such as HIV and AIDS

and TB as well as STI are prevalentPoor health literacyPoor nutritional status thus high

vulnerabilityPoor absorptive capacity for resources

allocated Poor spending of resources

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Achievements (PHC in general) In order to improve and standardize Health

service delivery the department embarked upon the following:Provincialisation of all PHC services from 2005 to

2015 (no municipality will deliver personal primary health care services except for metros)

Department will revitalize PHC services in order to improve access and coverage, as well as incorporation of other priority programmes

Conducting PHC facility and service package audit starting 2009/2010 to 2011/2012

Collaboration with local and district municipality in the management of health care and health care risk waste

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Achievements (PHC in general)In order to improve and standardize Health

service delivery the department embarked upon the following:Development of handbook for the District

ManagersEstablishment of governance structures in the

health facilities (where municipal councilors play a central role)

Development of the District Health plan and its integration with IDP’s of the local and district municipalities)

Development of the health facility manual and subsequent creation of posts for the health facility supervisors

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Achievements (PHC in general)Participation in the ISRDP working together

with erstwhile DPLG and other stakeholders.Collaboration with local and district

municipalities in identifying and mitigating the social determinants of health such as water, sanitation and poverty etc

Collaboration with municipalities in the prevention and mitigation against outbreaks of communicable diseases as it was seen in Delmas and Musina

Identification of the priority districts that need special attention (with the view of improving services delivery on key priority programmes)

Finalisation of rural health strategy with a view of focusing on the rural and farming areas.

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Achievements (PHC in general)Primary Health Care budget has been increasing

over the years and it moved from R 290 in 2008/09 to R 300 IN 2009/10 and is at R350 for 2010/2011

PHC has been provincialised to be managed at the provincial level (municipalities will not render Personal PHC)

There has been devolution of Municipal Health Services.

The department has been budgeting for the municipal health services without that budget being allocated to the department.

Over the years the department has been responsible for water quality monitoring despite Municipalities being water services authorities

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Achievements (PHC in general)Service coverage was increased through

the help of community health workersJob creation through payment of stipends

to the community health workersUse of donor funding to expand service

delivery

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New initiatives that will improve service delivery

18 Districts project:Overhauling PHC to alleviate pressure from

the hospital OPDNew plan for the implementation of the

District Health SystemDelegations for District Management Teams

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18 Priority Districts

How were they selected:Through looking at deprivation index coupled

with under performance on MDG linked programmes

Purpose:To accelerate performance of these districts

focusing on priority programmesTo galvanize support from all stake holders

including development partners to support these districts

To have them identified and prioritized in the planning by the provinces

To improve performance towards meeting MDG’s

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18 Districts

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Overhauling PHC

Purpose:To improve performance of PHC facilities so

that they can relieve the pressure from the hospital OPD

To create conditions that will encourage people to use PHC services

To ensure that PHC facility support referral system by being the first port of call for patients.

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National plan to implement DHS

To consolidate the health service development

To strengthen health systemTo ensure uniformity in the implementation

of DHS policy and chapter 5 of the National Health act

To ensure a solid foundation on which to deliver PHC services

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Delegations to District Managers

Purpose:To give managers more responsibility and

accountability in the acquisition, custody, control, management, and disposal of resources and commodities

Delegations Domains Finance Human Resources including employment

relationsSupply Chain Management

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Referral PolicyPurpose:

To ensure seamless delivery of health services for patients

To recognize the strata or tiers of service delivery and their connectivity

To avoid loss of patients through the systems

To enhance quality of careTo improve management of patients

throughout the system

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Challenges in the current system of Service Delivery

• Impact of poverty and demand on health services• Inadequate human resource for health• Poor integrated planning framework – across sectors• Poor intersectoral collaboration• Inadequate management and operational capacity• Poor basic management support systems• Lack of accountability, which are further complicated

by inadequate delegations• Inadequate promotion of quality of care - quality

standards being developed• Increased verticalisation and moving away from

service integration

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Recommendations Integrated planning and accountability must

be mandatory for all departmentsResponsibility and power must be

decentralized to the lowers level of service delivery

Prioritization of social determinants of health by all other sector departments such as Roads and Transport, Human Settlement

Cluster arrangement of departments must be enforced up to the provincial level

Capacity must be developed at service delivery level as opposed to the central offices