Mpumalanga Province Health Budget Hearing 2004: Achievements & Challenges

1. MPUMALANGA PROVINCE DEPARTMENT OF HEALTH AND SOCIAL SERVICES HEALTH COMPONENT BUDGET HEARING 14 June 2004

2. Mpumalanga Provincial team • MEC SW Lubisi Member of Executive Council • Mr HE Verachia Deputy Director General • Mr R Mnisi Chief Financial Officer • Dr K Michael Chief Director: Hospital Services • Ms G Mathebula Chief Director: Primary Health Care

3. Mpumalanga Provincial team • Ms R Monyamane Director: Human Resources • Mr. J Mlangeni Deputy Director: Communications • Ms P Gwala Deputy Director: Finance (Strategic planning) • Ms P Rousseau Deputy Director: Office of the DDG

4. Key achievements and challenges against the Ten point plan 2003/2004

5. The Health Sector Strategic Framework1999-2004 also known as the 10 point plan identified the following major elements:1. Reorganisation of certain support services2. Legislative reform3. Improving quality of care4. Revitalisation of Public hospital 5. Speeding up delivery of an essential package of services through the district health system

6. 6. Decreasing morbidity and mortality rates through strategic intervention7. Improving resource mobilisation and the management or resources without neglecting the attainment of equity in resource allocation8. Improving human resource development and management9. Improving communication and consultation within the health system and communities we serve10. Strengthening co-operation with our partners internationally

7. Reorganisation of support services • Health information • Working relationship established with Italian Corporation to strengthen Health Information Systems at all levels • Telemedicine • Completed pilot phase of PHC (Naas Clinic) to hospital (Tonga Hospital) support programme • Reduction of Neurosurgical referrals to Gauteng through effective use of Tele-radiology linkages

8. Reorganisation of support services • Medico-legal Mortuaries • Provincial Project manager and task team established • Negotiations commenced with SAPS • National Health Laboratory Service (NHLS) • Provincial staff absorbed into NHLS structure • Equipment transferred to NHLS • Negotiations to conclude Service Level agreement with NHLS • Two sites for CD 4/Viral load investigations established

9. Reorganisation of support services • Blood transfusion services • Successfully aligned the blood transfusion needs of the Province with the restructured National Blood Transfusion Services. • Occupational Health Services • Backlog on ex-miner compensation claims with Medical Bureau of Diseases reduced from 70% to 50%

10. Reorganisation of support services • Improving Pharmaceutical Services • Revival of the Therapeutic Committee. • All institutions provided with new stock cards. • Trained 42 staff members regarding the operations of the Therapeutic Committee. • After benchmarking with other provinces, plans are underway to build the provincial medical depot.

11. Reorganisation of support services • Challenges • To ensure compliance with Pharmacy Act requirements by May 2005 • Need to establish an inter-sectoral plan so as to develop an integrated food safety and control system • Need to capacitate the Health Information Unit

12. Legislative reform • Public hearings on the National Health Bill • Presentations made to the Provincial Portfolio committee • Implementation of Free Health services to the Disabled • Uniform Patient Fee Schedule (UPFS) presented to Provincial Treasury and Portfolio committee

13. Legislative reform • Challenges • Draft Provincial Health Bill awaiting finalisation • Participate in the finalisation of the Health Technology Legislation

14. Improving quality of care • Complaints procedure implemented at all health facilities • Ongoing training on: • Code of Conduct • Batho Pele • Patients Rights Charter • Tender board approval obtained for 3 year contract with COHSASA

15. Improving quality of care • Critical, strategic positions at facilities and Provincial office filled. • Launched Patient Hotline (0800 20 40 98)

16. Improving quality of care • Challenges • Improve attitude and professionalism of health workers • Establish and train governance structures

17. Revitalisation of hospital services • CEO’s appointed for hospital complexes • Cost Centre Accounting introduced at 4 pilot sites • 4 revitalisation projects on track and next 4 priority hospitals identified • Tertiary services rendered at 2 hospitals • Provincial Hospital plan aligned with National Modernisation of Tertiary services (MTS) model

18. Revitalisation of hospital services • Challenges • Appoint project manager and project steering committees (Provincial and local) • Establish a fully functional health technology unit • Recruitment of level 2 and 3 specialists • Assign a dedicated budget (3%) for maintenance of health facilities

19. Speeding up delivery of an essential package of services through the District Health System • 4 new PHC facilities commissioned (increase of 2,1%) • Outreach service by medical and allied personnel from Hospitals to feeder PHC facilities strengthened through increased numbers of community service personnel • Services at PHC level delivered according to National PHC package

20. Speeding up delivery of an essential package of services through the District Health System • Training of PHC nurses through the University of Pretoria and South African Military Health Services (SAMHS) • Training on forensic nurses at the University of the Free State • Training of health promoters at the University of Limpopo

21. Speeding up delivery of an essential package of services through the District Health System • Challenge • Increase the number of newly qualified PHC nurses • Establish governance structures for PHC facilities • Finalise the exchange of PHC services between the Province and municipalities

22. Decreasing morbidity and mortality rates through strategic interventions • Primary school feeding • Successful feeding for 171days • 457 248 learners in 1 378 schools benefited • Provided income to 35 suppliers, 55 sub-suppliers and 2 664 helpers

23. Decreasing morbidity and mortality rates through strategic interventions • Immunisation • 90% coverage of children under one year • Youth Friendly services • 16 new sites established as National Adolescent Friendly Clinic Initiative (NAFCI) sites

24. Decreasing morbidity and mortality rates through strategic interventions • Improving Child Health • 19 Pilot sites for (IMCI) Integrated Management of Childhood Illnesses were identified • 157 Health Workers trained in Integrated Management of Childhood Illnesses (IMCI)

25. Decreasing morbidity and mortality rates through strategic interventions • Improving Women's Health • 20 midwives from Gert Sibande were provided with in-service training on maternity care guidelines • Increase of hospitals implementing Peri- natal Problem identification programme from 50% to 71% • Provincial Launch of National Contraceptive Policy

26. Decreasing morbidity and mortality rates through strategic interventions • Cholera • Limitedthe cholera outbreak in December 2003. By the end of March 2004 the total cases reported was 1680 and the weekly incidence declined rapidly • All municipal Medical Joint Operations Committee (MJOC) meet once every week to deal with the outbreak

27. Decreasing morbidity and mortality rates through strategic interventions • Malaria • Inter-country and Intersectoral Collaboration and Support – visited Mozambique toactively fight malaria across the borders

28. Decreasing morbidity and mortality rates through strategic interventions • Malaria • Disease Management – planned and still currently studying the efficacy of combination therapy. 91 patients currently enrolled in the in vivo study. Conducted a confidential inquiry intothe deaths notified in the risk areas

29. Decreasing morbidity and mortality rates through strategic interventions • Malaria • Information Education Communication – provided public health education to all health professionals in the high risk areas. Health facilities in the high risk areas were visited and given treatment guidelines

30. Decreasing morbidity and mortality rates through strategic interventions • Malaria • Educated and mobilized communities to use protection measures against mosquito bites to reduce the risk of infection by attending 7 community meetings and visiting 1500 households. Conducted a Knowledge, Attitudes and Practices (KAP) survey to determine children’s knowledge concerning malaria

31. Decreasing morbidity and mortality rates through strategic interventions • Malaria • Disease Surveillance and Monitoring – visited 40 health facilities monthly to collect passive notifications. 100% of high-risk areas under GIS surveillance • Outbreak Response – visited 385 households to treat, educate and test patients. Epidemic and response plans developed and implemented

32. Decreasing morbidity and mortality rates through strategic interventions • Malaria • Vector Control – sprayed 126 400 structures inthe highest risk localities to curb malaria transmission. Achieved a 88% coverage rate of structures targeted for spraying

33. Decreasing morbidity and mortality rates through strategic interventions • Tackling HIV and AIDS • 33 surveillance sites established and training provided • Policy on Post Exposure Prophylaxis available and implemented at all institutions • 2 500 Home-based care kits were ordered and distributed to facilities

34. Decreasing morbidity and mortality rates through strategic interventions • Tackling HIV and AIDS • 245 775 units of Pelargon were purchased and distributed to the PMTCT sites • 680 home-based care volunteers were funded

35. Decreasing morbidity and mortality rates through strategic interventions • Tackling HIV and AIDS • Launch of the Home-based care month was held at Elukwatini on the 1st November 2003. Promotional Material was distributed at the Stadium • 2900 boxes of tablets and 1320 bottles of Nevarapine syrup were bought and distributed

36. Decreasing morbidity and mortality rates through strategic interventions • Tackling HIV and AIDS • 1059 rapid screening tests were purchased and distributed • 7000 Rapid Confirmatory Test kits were bought and distributed

37. Decreasing morbidity and mortality rates through strategic interventions • Tackling HIV and AIDS • 60 Health Care Workers and 30 Lay Counsellors were trained on VCT services • 221 community volunteers from 14 areas were trained on condom use as peer educators • Identification of 12 sites for ARV roll out were done