07 July 2011

1. EFFECTIVE EMPLOYEE HEALTH AND WELLNESS PROGRAMME- HCT Service Delivery Model SABCOHA CONFERENCE Sun City –N.West Ms Morero E. Leseka 07 July 2011

2. Introduction DPSA context for the HIV&AIDS response and HCT • Coordination of HIV&AIDS and TB response DPSA is responsible for the coordination of HIV&AIDS and TB response activities within the Public Service and to monitor, evaluate and report on such responses to SANAC • Policy pronouncements • HIV&AIDS and TB Management in the Public Service-with HCT as an entry-point to treatment care and support

3. Introduction...3 • The burden of HIV&AIDS and TB in the Public Service • HIV Prevalence was 17,8% among those aged 15-49 years with the prevalence being higher in women 25-29 years and men aged 30-34 years (UNAIDS:2010; HSRC:2008 • These are the age groups which are likely to dominate the Public Service world of work.

4. Key Health Trends • The Key Health trends reported by GEMS • TB and HIV related claims among the top 10 cost drivers • Public Servants accessing treatment at a very advance stage of HIV infection, resulting in poor treatment outcomes • Several research studies • 12,7% prevalence among educators (ELRC:2005) • Lower income and non-professionals had higher prevalence rate than in higher income and professional groups • The latter findings same in Health and in Correctional Services

5. * VISION FOR EH&W A Healthy, Dedicated, Responsive and Productive Public Service Occupational HealthQuality of Work Life Research, Monitoring andEvaluation Occupational Health Education and Promotion Occupational Health and Safety Management Individual Wellness Physical Individual Wellness Psycho-Social Human Rights and Access to Justice Injury on Duty & Incapacity due to ILL Health Environmental Management Organizational Wellness Treatment Care and Support Mental Health /Psychosomatic Illnesses Risk and Quality Assurance Work life Balance Prevention Disease Management and Chronic Illnesses HIV and AIDS & TB MANAGEMENT Pillar 1 HEALTH and PRODUCTIVITY MANAGEMENT Pillar 2 SHERQ MANAGEMENT Pillar 3 WELLNESS MANAGEMENT Pillar 4 4 KEY INITIATIVES FOR HIGH PERFORMANCE IN THE PUBLIC SERVICE THROUGH HEALTH AND PRODUCTIVITY MANAGEMENT CORE PRINCIPLES INFORMING IMPLEMENTATION OF EHW STRATEGY LEGISLATIVE FRAMEWORK AS A FOUNDATION

6. HIV&AIDS AND TB MANAGEMENT Presentation Outline Policy Objectives: • To provide HIV&AIDS and TB Prevention • To provide Treatment, Care and Support for those infected and affected by TB and HIV infections • To manage compliance to Human and Legal Rights; and ensure access to Justice • To ensure Monitoring, Research and Surveillance on HIV&AIDS and TB

7. Challenges for EH&W- an HCT Perspective • Poor HCT Uptake against the set targerts (14%) 86 324 vs 637 000. • Low reporting rate from entities (58% national and 87 % Provincial) • Poor data quality • Non compliance to reporting templates

10. Outcomes Impact Inputs Processes/Activities Outputs Results Based Management Approach Int RBM(2) Population Level Effectiveness Project / Program Level Efficiency Services e.g. Facilities offering Service Trained staff Utilization: New clients Return clients Resources e.g. Finance Staff Drugs, Supplies Equipment Long-term e.g. Infection rate Mortality Disability and attrition Functions, Activities e.g. Training Logistics IEC Intermediate e.g. HIV+ on GEMS Disease Management

11. HCT as an example (Efficiency issues) • Base line (Before HCT)- did not exist • Process: • Policy Implementation Readiness Assessment and EH&W System Monitoring Tool - HCT Operational Planning - HCT M&E Plan – Result Framework • Training and Workshops • Resource Mobilization • Partnerships with GEMS et al.

12. HCT as an example (Efficiency issues) • Base line (Before HCT)- did not exist • Outputs: • HCT Coverage – 58 % estimates from reporting rate ( National 58% and Provinces 87%) • HCT Uptake – 14 % of the set target • TB screening rate – 19% • Outcome Evaluation- Change in attitude and behavior • Impact (Evaluation)- IHRA

13. Improving HCT Service Delivery Model • Is at developmental stage • Goal- Improve Coverage and Uptake of HCT services • Coverage- • service broadly available and accessible beyond workplace (site) and outside working hours (time) • Uptake- • more employees consume HCT services

14. Service Delivery Model…2 Process: • DPSA sign MoU with SAMA to implement HCT intensification project beyond June 30th • Technical Task team formed comprising DPSA, GEMS, DOH and SAMA ( discussions to include other Public Sector Unions vs bilateral engagements) • TOR developed to define individual responsibilities

15. Service Delivery Model…3 New opportunities: • DPSA will mobilize its employees to know their HIV status • Negotiate options of testing in the workplace and/or at the General Practitioner’s Network of SAMA • A referral form will be issued for those choosing option 2 • Those not covered will be encouraged to join GEMS

16. Service Deliver Level…4 SAMA • Mobilize their GP-network to participate in the Project • Provide free HCT services and screening for other non-communicable diseases to employees and their dependents via the GP-network • Document services offered and report to DPSA

17. Service Delivery Model…5 DOH • Provide diagnostic packs and condoms to the GP’s under the project • Provide technical support and HCT guidelines as required • Support monitoring and evaluation at local level where possible • Include the Workplace HCT indicators in the DHIS

18. Anticipated HCT Intensification Outputs • Increased no of facilities where employees and their dependents can go for screening • Increased number of hours available for employees to access the services • Standardized reporting and referral tools between GP’s and Public Service

19. Anticipated outputs…2 • Improved tracking of HCT uptake, from members of other medical aid schemes and accurate HCT data. • Reduced chances of loss to follow-up, and improved linkage to care and support • Ongoing documentation of best practice for possible roll-out of the model

20. THANK YOU!