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 on streams of PHC Reengineering

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

Fixedclinics LG

CHC Province

DistrictHospitals

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 theyoccur. 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 isfaced with. South Africa is one of the countries in the worldwith huge maternal and infant mortality complicated furtherby 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 community-oriented 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 …

PHC

Health Promotion

Illness prevention

Care of the sick

Community

Development

Advocacy

Source: Habib HA (2011), Introduction to Primary Health Care

2.Rationale for the reengineering of primary health care …

2 474 9853 919 994

8 409 390.5412 575 16912 126 612

17 421 818

30 185 530

45 138 604

0

5 000 000

10 000 000

15 000 000

20 000 000

25 000 000

30 000 000

35 000 000

40 000 000

45 000 000

50 000 000

(R'0

00

)

District Health Services Total payments and estimates

Source: Gauteng Department of Health Annual Reports2014/2015 GDoH budget speech amount

31 500 000

Where we are today

3. Health status realities in South Africa comparatively

Indicator Brazil Russian

Federation

India China South Africa

Infant mortality rate (per 1,000

live births)

17 11 50 17 43

Maternal Mortality Ratio (per

100,000 live births)

58 39 230 38 410

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

adults aged 15-49 (%)

0.6 1.0 0.3 0.1 17.8

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 high-quality 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 &

Johnson)

366

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 established14/15

No. of wards covered

No. of trained team leaders14/15

NO. of CHW’STrained14/15

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

7741

273 353

22 798

515 840

0

100000

200000

300000

400000

500000

600000

WBPHCOTs Data elements

Grand Total

4.2.4 Challenges

Challenges Intervention

1.WBOT indicators excluding other programme data that were previously collected by CHWs

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 beingreviewed 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 Quintile1 & 2

Schools

TotalSpecialSchools

TotalNo Quintile1 & 2,

and Special Schools

TotalEnrolment

Quintile1&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

4.3.3 Schools visited -Learners Screened per District

DISTRICT Teams

Established&

Required

Total Quintile

1 & 2Schools 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 othersTd – Tetanus and Diphtheria Human Pappiloma Virus Vaccination programme – Grade 4 learners - Feb/March 2014- 1st 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 2014/15Budget Vote Speech Tabled at Gauteng Provincial Legislature, 29 Jul 2014

• Gauteng Department of Health (2014), Lerutla, M. DHS QuarterlyPerformance Review Period, 2014/15 : q1 2014/15 to q2, 17 November2014

• The World Health Report 2000. Health Systems: Improving Performance.https://apps.who.int/whr/2000/en/report.htm (accessed 1 December2011).

• South African Health Review Report, 2011

• National Department of Health,2014: Primary Health Care – HealthProfessional (PHC-HP) Support Programme