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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