Project Management Team (PMT) 16 March 2007

1. Presentation to the fourth meeting of the Western Cape Province Burden of Disease Reduction Project Reference Group Project Management Team (PMT) 16 March 2007

2. Where were we?

3. The six original proposals

4. PRG Mandate – 12 July 2006 • Reorganise Proposals into two Work Teams • Proposal 1 -4 • Surveillance • Proposal 5 -6 • Preventative interventions • Evidenced based upstream recommendations

5. Where should WT2 focus?

6. BOD BUT What about hidden burden of Mental Health? What about Childhood Diseases hidden by adult burden?

7. Work team 2

8. Work Team 2 • WT 2 • 5 expert groups with specific champion • examining risk for the top 5 BoD components • examining evidence for intervention effectiveness or promise. • Process • Authors • Multi stakeholder expert group –including many members of PRG • Peer review (incl. international review)

9. Reorganisation

10. PMT • Project Leader • DOH Representative • WT 1 Champion • WT2 Champions (5) Function: Project Management to deliver high quality product within budget and timelines

11. Where are we now? • All reports are complete • Work done will be presented to PRG for input • Determination of Year 2 scope of work • Final report will be presented to DOH on 30 March 2007 with proposals for year 2 • Health and Development Summit planned for after May/June 2007 to engage PGWC (Municipalities & National) on: • Identifying appropriate recommendations • Prioritization • Plan to incorporate priority recommendations into Provincial Plan of Action and planning cycle

12. The Report Volume 1 Foreword by Prof C Househam, Head of Health Overview chapter by Jonny Myers and Tracey Naledi Volume 2 Workteam # 1 outputs Executive summary with appendices by David Bourne • Paper 1: Cape Town Mortality by authors • Paper 2: Boland/Overberg Mortality by authors • Paper 3: Western Cape overall Mortality by authors

13. The Report (2) Volumes 3,4,5,6 Workteam # 2 outputs • Order of appearance follows the degree of contribution to the overall burden of disease • Each has an executive summary. • Authored by Champions plus authors’ groups Volume 3: Major Infectious Diseases (HIV/AIDS and TB) Volume 4: Mental Health Volume 5: Injury – intentional/violence and unintentional/RTI Volume 6: Cardivascular Diseases - IHD and stroke

14. The Report (3) Volumes 7 Workteam # 2 outputs continued… Authored by Champions plus authors’ groups Childhood diseases Overall executive summary for childhood Diseases HIV/AIDS in children Diarrhoea Low birth weight Acute Respiratory Infections Malnutrition

15. The 7 Volumes Constitute a rich source of outputs with useful information about interventions against the major risk factors for the top 5 BoD components for which there is either • Evidence • Or which are agreed to be promising

16. Fidelity to mandate • Maintained faithfulness of mandate to look upstream in terms of • conceptual model and • the health department • While retaining focus on “downstream” health sector based interventions with recursive preventive effects at the primary level eg ARVs, Mental Health Services

17. Overall Summary of report • Synthesis of upstream risk factors and associated interventions tabled at high level consonant with confluence of risk and impact of intervention upstream • Avoidance of telephone directory type lists and tabulations of the totality of evidence based or promising interventions

18. Work Team 1 & 2 reports

19. Inputs from PRG members

20. Last words

21. Whatever we do with interventions into the future we need to know where we are at any one time, and what the impact measurable at the population level could be. • So we need improved and institutionalised mortality surveillance systems sensitive to rapid change at the most disaggregated level

22. Institutionalise surveillance • Institutionalise the mortality surveillance system firmly within the routine operations of DOH • Staff and resourcing implications • Better quality Home Affairs data as primary source • Continual identification of emerging health issues and vulnerable groups for targeting interventions • More generally contributing to intelligence function of Government • Monitoring of interventions using same data and integrated M&E systems

23. Information systems • Are therefore everything • Unfortunately currently leave a lot to be desired • Cannot be bought in • Must be established within as part of routine normal operations • If all else fails, it will tell us where we are going wrong as we enter the future

24. Key challenges for intervention profiling • (Cost-) Effectiveness easier to measure with downstream interventions • Upstream more difficult due to confluence but more potent due to multiple parallel effects. Here we are not alone (CSDH)

25. What we have done • Have highlighted the role of behavioural factors (alcohol, road use, sexual and health-seeking) in contributing to the BoD • And how these link to even more upstream infrastructural risks of material and social deprivation • Hence the critical need for upstsream interventions to dent the BoD

26. Value of the output • Study has not broken entirely new ground • Overlap with WCPoA 07/08 – provincial strategic objectives • Our recommended interventions can provide detail and more concrete proposals for the achievement of these strategic policy objectives • Provide a menu of interventions for policy makers – feasibility and practicability

27. Value of the output (2) • Our recommendations can help assessment of current, consideration of new, and dropping of existing interventions that have been shown not to work. • The devil is in the detail • some interventions are nominally present but not implementable any time soon and • others are inadequately targeted to high risk groups who could benefit most

28. Hi-lights from global and local evidence Based on the Global and Local evidence we provide selected intervention recommendations • Media and service integration to reduce TB • Community development projects to alleviate poverty and improve mental health • Home visiting for new parents in high risk areas to improve MH • School-based dietary intervention for CVD • Mass media physical activity promotion campaign for CVD • Reduction of traffic-related behavioural risks by enforcement for Traffic injury • Increased formal and community policing measures in targeted areas for Violence injury

29. What about Year 2?

30. In order of decreasing priority • Institutionalisation of mortality surveillance to continue • Study and engagement with implementation structures and functions following the Summit • Participation in a local targeted integrated development strategy intervention in a multiply deprived setting at the lowest level of spatial resolution Limited number of research projects dealing with issues emerging thusfar • Formal evaluation of old or new interventions in the local setting