DISTRICT HEALTH PLAN 2015/2016 - Department of Health

1 DISTRICT HEALTH plan 2015 / 2016 ETHEKWINI HEALTH DISTRICT KWAZULU-NATALETHEKWINI DISTRICT HEALTH plan 2015 /16 2 | Page 1. ACKNOWLEDGEMENTS The following individuals are acknowledged for their role in the completion of this DISTRICT HEALTH plan for 2014/15: Martin Gabela (Planning, Monitoring and Evaluation Manger) responsible for the drafting of the DHP 15/16 with input from Nicky Manivasen for the extraction and compilation of the DHIS data tables; the various program managers at the DISTRICT office that provided strategic input regarding progress and plans for the next financial year. The finance information was compiled by Sandra Moodley. The Human Resource data was compiled by Melanie Dazel and Ronald Dukie. Nkosifikile Ndelu drew the revised map of the sub-districts. Acknowledgement is also extended to Shamim Ganie and Catherine Searle from MatCH ( DISTRICT Support Partner), for valuable assistance with the analysis and write up of the DHP.

2 The support and input of the provincial team under Tracey Hattingh and Ester Snyman is also gratefully acknowledged. ETHEKWINI DISTRICT HEALTH plan 2015 /16 3 | Page 2. OFFICIAL SIGN OFF It is hereby certified that this DISTRICT HEALTH plan : Was developed by the DISTRICT management team of eThekwini DISTRICT with the technical support from the provincial DISTRICT development directorate and the strategic planning unit. Was prepared in line with the current strategic plan and Annual Performance plan of the Department of HEALTH of KZN ETHEKWINI DISTRICT HEALTH plan 2015 /16 4 | Page 3. TABLE OF CONTENTS 1. ACKNOWLEDGEMENTS .. 2 2. OFFICIAL SIGN OFF .. 3 3. TABLE OF CONTENTS .. 3 4. LIST OF ACRONYMS .. 5 5. EXECUTIVE SUMMARY BY DISTRICT MANAGER .. 8 PART A - strategic OVERVIEW .. 11 6. SITUATIONal ANALYSIS .. 11 MAJOR DEMOGRAPHIC CHARACTERISTICS .. 13 SOCIAL DETERMINANTS OF HEALTH .. 15 EPIDEMIOLOGICAL (DISEASE) PROFILE OF THE DISTRICT .

3 17 7. DISTRICT SERVICE DELIVERY ENVIRONMENT .. 19 DISTRICT HEALTH FACILITIES .. 19 TRENDS IN KEY DISTRICT HEALTH SERVICE VOLUMES .. 23 8. DISTRICT PROGRESS TOWARDS THE ACHIEVEMENT OF THE MDG S .. 29 9. PROVINCIAL AND DISTRICT CONTRIBUTION TOWARDS THE HEALTH SECTOR NEGOTIATED SERVICE DELIVERY AGREEMENT (NSDA) .. 31 10. SUMMARY OF MAJOR HEALTH SERVICE CHALLENGES AND PROGRESS MADE FOR THE PREVIOUS THREE FINANCIAL YEARS .. 33 INTRA DISTRICT EQUITY IN THE PROVISION OF SERVICES .. 33 11. ORGANISATIONAL ENVIRONMENT .. 38 Organisational Structure of the DISTRICT Management Team .. 38 Human Resources .. 38 12. DISTRICT HEALTH EXPENDITURE .. 42 PART B - COMPONENT PLANS .. 48 13. SERVICE DELIVERY PLANS for DISTRICT HEALTH services .. 48 Sub-Programme : DISTRICT HEALTH Services .. 48 a. Sub-Program: DISTRICT Hospitals .. 58 14. HIV & AIDS & TB CONTROL (HAST) .. 66 Programme Overview.

4 66 HIV & AIDS, STI & TB CONTROL (HAST): Strategies/ Activities to be implemented 2015 /16 .. 75 15. MATERNAL, NEONATAL, CHILD AND WOMEN S HEALTH AND NUTRITION .. 76 Programme Overview .. 76 Strategies/ Activities to be implemented 2015 /16 .. 91 16. DISEASE PREVENTION AND CONTROL (Environmental HEALTH Indicators) .. 93 Programme Overview .. 93 Strategies/ Activities to be implemented 2015 /16 .. 98 17. INFRASTRUCTURE, EQUIPMENT AND OTHER SUPPORT SERVICES .. 99 18. SUPPORT SERVICES .. 101 PHARMACEUTICAL SERVICES .. 101 EQUIPMENT AND MAINTENANCE .. 104 EMERGENCY MEDICAL SERVICES (EMS) .. 106 *INTER-FACILITY TRANSFER IS FOR OPERATIONS ONLY AND DOES NOT INCLUDE PPT.. 106 19. HUMAN RESOURCES .. 107 20. DISTRICT FINANCE plan .. 108 PART C: LINKS TO OTHER PLANS .. 110 21. CONDITIONAL GRANTS .. 110 22. PUBLIC-PRIVATE PARTNERSHIPS (PPPs) and PUBLIC PRIVATE MIX (PPM) .. 112 ETHEKWINI DISTRICT HEALTH plan 2015 /16 5 | Page 4.

5 LIST OF ACRONYMS Abbreviations Description A AIDS Acquired Immune Deficiency Syndrome ANC Ante Natal Care APP Annual Performance plan ART Anti-Retroviral Therapy ARV Anti-Retroviral B BAS Basic Accounting System BLS Basic Life Support BUR Bed Utilisation Rate C CARMMA Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa CCG s Community Care Givers CEO(s) Chief Executive Officer(s) CHC(s) Community HEALTH Centre(s) COE Compensation of Employees D DCST(s) DISTRICT Clinical Specialist Team(s) DHER(s) DISTRICT HEALTH Expenditure Review(s) DHIS DISTRICT HEALTH Information System DHP(s) DISTRICT HEALTH plan (s)

6 DHS DISTRICT HEALTH System DOH Department of HEALTH DQPR DISTRICT Quarterly Progress Report E EMS Emergency Medical Services Electronic Tuberculosis Register Electronic Register for TB F G G&S Goods and Services H HAST HIV, AIDS, STI and TB HCT HIV Counselling and Testing HIV Human Immuno Virus HOD Head of Department HPS HEALTH Promoting Schools HPV Human papillo virus ETHEKWINI DISTRICT HEALTH plan 2015 /16 6 | Page Abbreviations Description HR Human Resources HTA High Transmission Area I IDP(s) Integrated Development plan (s)

7 IPT Ionized Preventive Therapy J K KZN KwaZulu-Natal L LG Local Government M M&E Monitoring and Evaluation MDG Millennium Development Goals MDR-TB Multi Drug Resistant Tuberculosis MEC Member of the Executive Council MNC&WH Maternal, Neonatal, Child & Women s HEALTH MO Medical Officers MOU Maternity Obstetric Unit MTEF Medium Term Expenditure Framework MTSF Medium Term strategic Framework MUAC Mid-Upper Arm Circumference N NDOH National Department of HEALTH NCS National Core Standards NGO(s) Non-Governmental Organisation(s)

8 NHI National HEALTH Insurance NIMART Nurse Initiated and Managed Antiretroviral Therapy O OSD Occupation Specific Dispensation OSS Operation Sukuma Sakhe P P1 Calls Priority 1 calls PCR Polymerase Chain Reaction PCV Pneumococcal Vaccine PDE Patient Day Equivalent Persal Personnel and Salaries System PHC Primary HEALTH Care PN Professional Nurse R RV Rota Virus Vaccine S ETHEKWINI DISTRICT HEALTH plan 2015 /16 7 | Page Abbreviations Description SCM Supply Chain Management SHS School HEALTH Services SLA Service Level Agreement Stats SA Statistics South Africa STI(s) Sexually Transmitted Infection(s)

9 T TB Tuberculosis U V VCT Voluntary Counselling and Testing W X XDR-TB Extreme Drug Resistant Tuberculosis Y and Z ETHEKWINI DISTRICT HEALTH plan 2015 /16 8 | Page 5. EXECUTIVE SUMMARY BY DISTRICT MANAGER eThekwini DISTRICT is a Metropolitan HEALTH DISTRICT comprising of 103 wards that are urban, rural and peri-rural in nature. The metropolitan area covers a 2, 297 square kilometre area stretching from the Umkomaas in the south, including tribal areas in Umbumbulu, to Tongaat in the north, moving inland to tribal areas in Ndwedwe and ends at Cato Ridge in the west. The DISTRICT is surrounded by iLembe DISTRICT to the north, Ugu DISTRICT to the south, Umgungundlovu DISTRICT to the west and the Indian Ocean to the east. Despite being highly urbanised and densely populated, pockets of rural communities exist on the outskirts of the west, south and north impacting on access to services and equity.

10 3 442 361 individuals reside in the DISTRICT . The data in this DHP is broken down into 8 proposed sub-districts. The South sub- DISTRICT has been divided into three functional areas: 1) South Central, 2) South West, 3) Umlazi/Engonyameni and 4) Lower South. The North/West is divided into 4 sub-districts namely: 1) North Central, 2) Greater Inanda/Tongaat Sub- DISTRICT , 3) Inner West; and 4) Outer West Sub-Districts. eThekwini has a developing population and 62% of the population are below 35 years with high birth rates and infant mortality. Life expectancy remains low as a result of the quadruple burden of disease with HIV, TB, chronic illnesses and deaths due to injury and violence. Maternal and infant mortality and the high TB burden are key challenges that need to be addressed. The DISTRICT also has the highest number of migrants in the province and the PHC headcount indicates the highest rate of migrant populations using DISTRICT services.