District Health System

1
District Health System

• Briefing to Portfolio Committee
• 16 August 2005
• Dr Tim Wilson, Dept. of Health

2
Outline of presentation

• Implementing Chap 5 of National H. Act
• Clarify policy.
• Key role of District Health Councils
• Expand Municipal Health Services
• Environmental Health Services
• District Health Plans
• Planning guidelines
• Community mid-level workers

3
Outline (cont)

• District Health Information System (DHIS)
• Use to plan, monitor report
• Funding
• MHS
• Personal PHC
• Rural Health Strategy
• Plans for Directorate PHC

4
Chap 5 Clarifying Policy(District Health
System 2005 Annexure A)

• Vision for DHS in each health district
• Boundaries
• District Health Councils
• Non executive. Monitor plans, reality, quality,
  etc
• District Health HR Plans
• Providing MHS Personal PHC
• Funding overcoming fragmentation

5
Expand Municipal Health Services (Environmental)

• Great deficit, esp. in rural areas
• Water, sanitation waste
• Cholera typhoid ??
• Health Care Waste
• Air pollution
• Indoor outdoor
• Pesticicdes
• Community Service EHPs are available

6
District Health Plans

• Planning guidelines approved by DG
• Use DHIS data for 2003/04 2004/05
• nutrition, immunization, womens health, STI,
  etc.
• A planning day in each district in Sept
• Plans for 2005/06 2006/7 by 1 Oct 2005
• Health component of IDP
• Link with IDP consultation process
• District HR planning guidelines
• Tool developed. Need training link to HR Plan

7
Community mid-level workers

• SA commitment to expand
• Pharmacy radiography assistants, medical
  assistants, community-based rehab assistants
• CHWs or Community Care Givers
• Role of NPOs (often funded by provinces)
• Massive expansion in UK
• Issues to be resolved
• Stipends / salaries. Career structures. Etc
• Support supervision

8
DHIS

• Project to support DHIS in 2005/06
• Use own data for each districts H Plan
• List of indicators suggested ranges
• Some examples
• To improve quality of data
• Managers must USE it
• Will need on-going support

9
FUNDING
10
PHC Funding for

• Personal PHC
• Clinics CHCs
• Community Health Workers other Outreach
• Laboratories other support services
• Environmental Health Services
• Port Health, malaria, hazardous substances
• Municipal Health Services (MHS)

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BACKGROUND

• Have clarity on responsibilities
• Personal PHC 3 environmental . Provinces
• Municipal (environmental) Services Districts
• Consolidating services
• Eliminating fragmentation duplication
• Budget Council 3 Feb 2005
• Additional funding from 2005/06 for provinces to
  fund all personal PHC in non-metro areas

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Requests for 2005/06 MTEF
2005/06 Adjust-ment B. 06/07 R million 07/08 R million 08/09 R million
District municipalites for MHS 220 330 440 550
Provinces Personal PHC in metros 300 550 700
Provinces Personal PHC in non-metros 300 550 700
TOTAL 220 930 1540 1950
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DMs Funds for MHS

• Consolidate expand preventive services
• Especially in rural areas
• Prevent or limit outbreaks eg. Cholera, typhoid
• Avoid expensive admissions treatment
• New EHPs available for community service
• Stop war about funding LMs vs DMs
• It is communities that suffer

14
Personal PHC in metros

• Consolidate services single management
• By 2008, Eliminate duplication fragmentation
• Seamless planning services
• Community services, PHC facilities, hospitals
• If co-funding is to continue, need
• Political decision
• Consensus at cabinet, PCC, Metro Councils
• If no consensus, provinces must fund

15
Personal PHC in non-metro areas

• Severe chronic under-funding
• Inequity between provinces between districts
• Some districts as low as R30 - R40 p.c. p.a.
• Strengthen services in clinics CHCs
• To realize rights to health care dignity
• To protect hospitals from overcrowding queues,
  unnecessary admissions, more expensive treatment
• Work in progress to quantify full deficit

16
PHC funding RequirementsInitial results from HEU
study

• Data on real expenditure from 37 studies
• All costs converted to 2003/04 prices
• 84 PHC visits to clinics CHCs
• 16 to district hospital OPDs
• Average cost per visit (in 2003/04)
• R63 at clinic or CHC (IGFR R68 in 04/05)
• R232 at a district hospital
• Must strengthen CHCs
• 24 hour services access to doctors
• Enable patients to get good services not go to
  hospitl

17
HEU study (cont)

• PHC utilization rate for uninsured
• Currently 2.5
• Low by international standards
• Estimate needs to rise to 3.85
• To provide PHC package for all
• VCT care for HIVve people not on ARTs
• Must add costs of
• Municipal (most environmental) H. services
• Community Health Workers other outreach

18
Rural Health Strategy
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Rural Health StrategyGoals under discussion

• Clear definition
• Must be agreed across all depts and StatsSA.
• ? Metro, Other urban, Close rural, deep rural
• Access EMS drugs consumables
• Referral system
• Community participation
• Staffing and support supervision
• Accommodation incentives
• District plan, implementation monitored
  reviewed

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Rural Health StrategyActions under discussion

• Develop agreed definition
• Make rural areas more visible
• Mobilize financial other non-human resources
• Train, recruit retain human resources
• Appropriate supervision management support
• Develop support systems
• Focus on priority programmes
• Develop partnerships
• Mobilize academic training institutions
• Monitor evaluate service delivery and progress

21
Rural Health StrategyDraft Responsibilities

• Community responsibilities
• Welcome support protect staff
• Mobilize community serve on clinic committees
• District level responsibilities
• District level staff
• District Health Council
• Provincial Responsibilities (Budget support)
• Academic Training . National

22
Directorate PHC

• Budget allocated in 2005/06
• Restructuring of Dept has delayed advertising
  filling posts
• Advocates for front-line PHC staff
• Good knowledge of reality
• Practical support