STATUS OF PRIMARY HEALTH CARE RE-ENGINEERING IN …

1 STATUS OF PRIMARY HEALTH care RE-ENGINEERING IN GAUTENGP resented at the Johannesburg HEALTH District s Workshop On PHC Re-engineeringPresented by Modise Makhudu obo Meisie Lerutla @ Wits University : School of Public Health16 March 2015 Table of Service platformDISTRICTF ixedclinics ProvinceFixedclinics LGCHC ProvinceDistrictHospitalsEkurhuleni MM38481 Johannesburg MM26 (21%)86 (40%)10 (29%)2 (18%)Sedibeng DM112642 Tshwane MM3925104 West Rand DM43032 Gauteng1222213511 Source: Presentation by M Lerutla on DHS Quarterly Performance Review Period, 2014/15 : q1 2014/15 to q2, 17 November 20142. Rationale for the reengineering of PHC---NDoH perspective " Minister Motsoaledi, July 2010 .. (PHC) July 2010, Issued by the Ministry of HEALTH - Source: Paulus E, RE-ENGINEERING PRIMARY HEALTH care : A national perspective, 28 February 2013 for the reengineering of PHC---GDoH perspective PRIMARY healthcare requires an activist and community-oriented approach to the delivery of 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.

2 Extract from 2014/15 gauteng HEALTH Budget Vote Speech Tabled by the MEC for HEALTH Ms Qedani Mahlangu at gauteng Provincial Legislature, 29 July 20142. Rationale for the reengineering of PRIMARY HEALTH care ..PHCH ealth PromotionIllness preventionCare of the sickCommunity DevelopmentAdvocacySource: Habib HA (2011), Introduction to PRIMARY HEALTH for the reengineering of PRIMARY HEALTH care ..2 474 9853 919 9948 409 575 16912 126 61217 421 81830 185 53045 138 60405 000 00010 000 00015 000 00020 000 00025 000 00030 000 00035 000 00040 000 00045 000 00050 000 000(R'000) District HEALTH ServicesTotal payments and estimatesSource: gauteng Department of HEALTH Annual Reports2014/2015 GDoH budget speech amount31 500 000 Where we are today3.

3 HEALTH STATUS realities in South Africa comparativelyIndicatorBrazilRussian FederationIndiaChinaSouth AfricaInfant mortality rate (per 1,000 live births)1711501743 Maternal Mortality Ratio (per 100,000 live births)583923038410 Distribution of years of life lost by causes (%) Communicable Non Communicable Injuries20562411642552351315651979156 Prevalence of HIV among adults aged 15-49 (%) of TB (per 100,000 population)50132249138808 Source: National HEALTH Insurance And The Workplace, 25th Annual Labour Law Conference, Sandton, Johannesburg, 30 June 20144. Progress made on streams of PHC District Clinical Specialists 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 Achievements to dateMorbidity and mortality (M&M) meetings in facilities: Through DCST support, monthly M&M meetings are now happening in most district facilities.

4 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 eventsFacility 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 Achievements to date (cont)In-service Training DCSTs have undertaken accredited and structured training in all District Hospitals and CHCs, & clinics. Trainingsinclude emergency obstetric fire-drill scenarios (see next slide for number of staff trained and types of trainings provided) Achievements to date (cont 2)Training:Number of HEALTH providers trained:BANC training709 Partogramtraining71 Full ESMOE training262 Neonatal resuscitation training (DCST)691 Neonatal resuscitation training (Johnson & Johnson)366 Contraception and fertility planning training381 Cardiopulmonary resuscitation training50 ESMOE-EOST obstetric fire-drills at facilities1008 Other Ward Based PHCO utreach WBPHCOT ProgressDISTRICTN oteams established14/15No.

5 Ofwards coveredNo. of trained team leaders14 CHW STrained14/15 Jhb903555655 Ekurhuleni423041442 Tshwane864639217 Sedibeng444657163 Westrand485166336 TOTAL31020825820301 PHC team per 7660 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 JHB, Ekurhuleni and gauteng WBOT Indicator report 3 quarters, 2014/157741273 35322 798515 8400100000200000300000400000500000600000 WBPHCOTs Data elementsGrand indicators excluding other programme data that were previously collected by CHWsTask Team looking at data integration2.

6 Data collection tool is perceived as collecting numbers and not improving service deliveryData tools inprocess of beingreviewed by NDOH, with Provinces of Team Leaders and poor supervision of CHWsAwaiting approval of postfor Team Integrated School HEALTH Programme Teams HEALTH Service Teams Teams establishments informed by number of schools to be serviced, & number of enrolled learners Professional Nurse/Enrolled nurse1/2000 learners HEALTH promoter for every 10 000 Quintile(Q) 1 & 2 including Special Needs Schools Per DistrictDISTRICTT otal Quintile1 & 2 SchoolsTotalSpecialSchoolsTotalNo Quintile1 & 2,and Special SchoolsTotalEnrolmentQuintile1&2, Special SchoolSedibeng88119928 005 Ekurhuleni722810041 313 Johannesburg1725419881 799 Tshwane1823021565 459 West Rand4084818 728 PROVINCIAL TOTAL529131660235 304 Number of Quintile 1 & 2 visited, number of Schools visited -Learners Screened per DistrictDISTRICTT eamsEstablished&RequiredTotal Quintile 1 & 2 Schools visitedTotal Learners ScreenedQuintile1 & 2 Total Other schools visitedLearners screened Other schoolsTd Vaccine Given6 &12 years oldEkurhuleni16 (21)164 7067416 8060 Joburg12 (40)154 278204 525403 Sedibeng9 (14)185 07665140 Tshwane15 (32)

7 4312 815101 4631 035W/Rand9 (9)61964196 835293 PROV TOTAL61(116)98(14,9%)28 83913030 143NB: LessQuintile 1 & 2 Schools visited as compared to othersTd Tetanus and Diphtheria Human Pappiloma Virus Vaccination programme Grade 4 learners -Feb/March 2014-1stround &Sept/Oct , 2014 2cd round5. 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 supportthe 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 ( HEALTH promotion, advocacy, care for the sick, illness prevention and community development)6.

8 End Thank You7. References GautengDepartmentofHealth(2014),Mahlangu Q,Health2014/15 BudgetVoteSpeechTabledatGautengProvincia lLegislature,29 Jul2014 GautengDepartmentofHealth(2014),Lerutla, ,2014/15:q12014/15toq2,17 November2014 (accessed1 December2011). SouthAfricanHealthReviewReport,2011 NationalDepartmentofHealth,2014:PrimaryH ealthCare HealthProfessional(PHC-HP)SupportProgram m