DEPARTMENT OF HEALTH

1. DEPARTMENT OF HEALTH

2. ACHIEVEMENTS AND BUDGET PRIORITIES Presentation to Portfolio Committee April 2002 Mid Term Review of Achievements Priorities for 2002/03

3. Our VISION is a caring and humane society in which all South Africans have access to affordable, good quality health care

4. Our MISSION is to consolidate and build on the achievements of the past five years in improving access to health care for all and reducing inequity, and to focus on working in partnership with other stakeholders to improve the quality of care of all levels of the health system, especially preventative and promotive health, and to improve the overall efficiency of the health care delivery system

5. ACHIEVEMENTS Presentation covers achievements for the Mid-Term, as well as achievements for the past financial year

6. Decreasing morbidity and mortality • Maternal, Child and Womens Health • Reduction of incidence and prevalence of childhood infectious diseases • Decrease in measles, NNT and AFP • HiB introduced into EPI • Intradermal BCG • 3 provincial EPI Reviews • Implementation of IMCI in all provinces

7. Decreasing morbidity and mortality cont • Maternal, Child and Womens Health cont • 40 Baby Friendly Facilities: 8% of 480 facilities • Guidelines for Maternity Care • Confidential Enquiry in all Provinces • 309 TOP facilities (255 public, 54 private) • 131 TOP facilities functional (83 public, 48 private) • Contraceptive Policy guidelines

8. Decreasing morbidity and mortality cont • Nutrition • Initiatives: PSNP, INP, food fortification, food consumption survey • PSNP: 4.8 million children, 14,500 schools • Aflatoxin: strategies in place • Food fortification of staple foods • Nutrition guidelines for HIV/AIDs and other chronic diseases • Vitamin A supplementation for Children. • Policy guidelines for youth and adolescent health

9. Decreasing morbidity and mortality cont • HIV/AIDS and STIs • National: Surveillance and research • Diflucan distribution • HIV/AIDS antenatal survey • SANAC and provincial AIDS councils: 28 District AID Councils • Numerous guidelines distributed • Improvement in surveillance

10. Decreasing morbidity and mortality cont • HIV/AIDS and STIs • 250 million male condoms (190 sites) • 700,000 female condoms (127 sites) • 260 sites providing PMTCT services • Partnership with LoveLife • Traditional Leaders HIV/AIDS Forum established • Home based Care • 359 VCT sites operational, with 1800 HIV/AIDS counsellors trained

11. Decreasing morbidity and mortality cont • TB • Steady increase in number of DTDs • More districts meeting target cure rates of 85% • Decision taken to assume responsibility for SANTA hospitals • Challenges: • Need to improve sputum turnaround time • Availability of drugs • Increasing compliance • Strengthening management of TB hospitals

12. Decreasing morbidity and mortality cont • Cholera • 106,000 people. 230 deaths • CFR: 0.2% • Malaria • Dramatic decrease: 62,000 to 36,000 • WHO-AFRO award for best malaria control programme

13. Decreasing morbidity and mortality cont • Chronic Diseases • Number of guidelines • Cataract projects • Range of initiatives • Disability • Rehabilitation policy launched • Assistive devices • Partnerships to reduce backlogs

14. Decreasing morbidity and mortality cont • Mental Health • Mental Health Care Bill • High secure facility • Victim empowerment programmes • Prevention of abuse programmes • Life skills programmes • Policy guidelines for children and adolescents mental health service developed • Policy on psycho-social rehabilitation developed.

15. Decreasing morbidity and mortality cont Issues for Consideration • Improving access to TOP services • Improving coverage of immunisation • Strategies to improve effective immunisation • Strategies to reduce teenage pregnancy • Integration of various initiatives eg mental health and substance abuse • Strategies for cervical cancer

16. Improving Quality of Care • Policy framework on quality of care • Introduction of Patients Charter and Batho Pele • PHC package completed • Minimum data set for PHC • Number of awards to reward good performance

17. Improving Quality of Care Issues for Consideration • Challenges • Staff morale • Caring ethos • Batho Pele • Patients Rights Charter • Strategies to improve medical equipment • Establishment of quality of care units

18. Speeding up delivery of PHC through the DHS • Audit of PHC services being rendered • Identifying the service delivery gap, including the gap analysis • Development of a methodology for resource allocation and district health expenditure reviews

19. Speeding up delivery of PHC through the DHS • Availability of antenatal care improved substantially • DOTS implemented widely • Referral system efficient • Turn-around times of various tests improved. • Study on “referral patterns” • Pro forma service level agreements

20. Speeding up delivery of PHC through the DHS • District Health Information System • Step by step guide to facilitate the transfer of staff from province to local government • Quantification of the size and financial implications as well as the requirements as dictated by the human resource legislative framework has been developed. • Annual DHS Best Practice Awards (DHS Competition)

21. Speeding up delivery of PHC through the DHS Issues for Consideration • Need for uniform indicators and reporting • Improvement of community participation • Structured assessment of users views • Engagement of other departments re infrastructure development • Evaluation of personnel mix • Evaluating impact of different organisational approaches re districts and regions • Gateway clinic concept • Reporting on partnerships with NGOs and different delivery approaches

22. Revitalisation of Hospital Services • ± R423-million spent on hospital rehabilitation • ± R442-million spent on construction of major new hospitals. • Three large Academic Complexes nearing completion. • 242 hospitals will benefit from this programme (3331 individual building projects completed at 86 hospitals)

23. Revitalisation of Hospital Services • Implement cost centres. • 210 managers trained in cost center accounting • Cost Centre Manual developed  • Standard nation-wide data set implemented

24. Revitalisation of Hospital Services Issues for Consideration • Different interpretations of what needs to be done • Too many small projects: not often strategic • Problems with Public Works and alternative approaches to delivery • Levels of CEO posts and people attracted

25. Improving resource mobilisation and the management of resources • Review of the three major conditionals grants and Highly Specialised Services (HSS) was undertaken • An enhanced response to HIV/AIDS and Tuberculosis in the Public Health Sector • Implementation of UPFS • Introduction of PAAB • Number of public private partnerships • National Health Accounts

26. Improving resource mobilisation and the management of resources • Health Technology Policy Framework published • Template for the Essential Health Technology Audits produced • Health technology (HT) audit guidelines produced. • A pilot HT audit has been completed in the Eastern Cape • Strategies to improve equity

27. Improving human resource development and management • Provincial bargaining chambers established • HWSETA established. • Sector Skills Plan. • National Strategy for Human Resources for Health finalized • Mid level workers and scopes of practice • DHS Management Competency profile • Roll out of community service • Number of training courses

28. Improving human resource development and management Issues for Consideration • Distribution of health professionals between provinces and between rural and urban areas • Representativeness in the senior management service • Training of district and other managers • Representativeness in the intake of undergraduate and post-graduate health students

29. Improving human resource development and management • Brain drain of doctors and highly specialised nurses to the private sector and developed countries • Lack of skills, such as epidemiology, health economics, public health and medical scientists; • Programme to deal with the impact of the HIV/AIDS epidemic on health workers • Attitudes of health workers • Transformation within statutory councils • Disciplinary measures by statutory councils • Productivity of personnel

30. Reorganisation of certain support services • South African Telemedicine System implemented on an incremental basis • 28 sites are implemented and operating in the six provinces • National health care management information system (NHC/MIS) implemented • District Health Information System (DHIS) implemented • Common national data dictionary established • New Birth and Death notification forms implemented

31. Reorganisation of certain support services • Systems to strengthen the ability to support the Medicine Control Council: • Development and implementation of a file and document tracking system • System to enforce laws and identify bodies whose licensing fees are outstanding • System to control the issues of licenses for medication.

32. Reorganisation of certain support services • National Health Laboratory Service (NHLS) • South African National Blood Service (SANBS) established

33. Legislative Reform Legislation tabled • The Mental health Care Bill • Medical Schemes Amendment Bill • National Health Laboratory Service Amendment Bill • Other legislation due to be tabled

34. Improving communication • Communication within the Department • Communication and interaction with stakeholders occur at various levels and platforms. • Health Summit • Health month • Various for a to improve consultation

35. Strengthening co-operation with our partners internationally WHO: • Draft work plan for the WHO 2002-2003 Biennium on Legislative Reform submitted • Agreement with WHO to address problem of supervision and decentralization of PHC to local government • Child and adolescent health and development; women’s health; health promotion; surveillance of non communicable diseases and protection of human environment

36. Strengthening co-operation with our partners internationally Japan: • Building of the Zamani clinic in Gauteng • Purchase and maintenance of clinic and hospital equipment in 3 provinces UNFPA: • Support for development of training materials and the development of policies for maternal, child and women’s health

37. Strengthening co-operation with our partners internationally FAO: • Improvement of street foods and the strengthening of the Codex committee USAID: • Assist communities with responses to HIV/AIDS related needs and care and research into potential high transmissions areas for HIV/AIDS in the Eastern Cape CDC: • Assist the Department in the area of HIV/AIDS and infectious diseases

38. AREAS TO BE COVERED • Non Personal Health Services • Environmental Health • Occupational Health • Health Promotion • Disease Prevention and Control • Hospital Services • Human Resource Development • Legal Services • Communication

39. PRIORITIES FOR 2002/2003 KEY PRIORITIES OF THE DEPARTMENT ACCORDING TO TEN POINT PLAN

40. AREAS TO BE COVERED • HIV/AIDS & TB • Pharmaceutical Services • Maternal, Child & Women’s Health and Nutrition • Mental Health • Districts and Development • Health Monitoring and Evaluation • Financial Management • Gender • International Health Liaison

41. TEN POINT PLAN FOR 1999 - 2004 • Decreasing morbidity and mortality rates through strategic interventions • Improving quality of care • Speeding up delivery of an essential package of services through the district health system • Revitalisation of hospital services • Improving resource mobilisation and the management of resources without neglecting the attainment of equity in resource allocation

42. TEN POINT PLAN FOR 1999 – 2004 (cont) • Improving human resource development and management • Reorganisation of certain support services • Legislative reform • Improving communication and consultation within the health system and the communities we serve • Strengthening co-operation with our partners internationally

43. Decreasing morbidity and mortality through strategic interventions Improve the effectiveness of Emergency Medical Services • Provincial business plans for EMS development, including HR and training • Pre-hospital EMS regulations finalised • Part of in-hospital EMS draft regulations finalised • Planning and provision of health, medical and disaster management and fire services for Earth Summit 2003 finalised and implemented.

44. Decreasing morbidity and mortality through strategic interventions • Non Personal Health Services • Develop a National Department of Health Occupational Health Strategy document • Minimum package of Occupational Health Service determined • Strengthening management and control of payments of compensation for mining related Occupational Lung Diseases • Finalisation of proposed regulations for the control of environmental conditions constituting a danger to health or nuisance

45. Decreasing morbidity and mortality through strategic interventions • Rationalization of occupational health and compensation competencies • Monitoring protocols for water quality to be developed and implemented • Business plans for health and hygiene education on sanitation programme

46. Decreasing morbidity and mortality through strategic interventions Health Promotion • Strengthen Health Promoting Schools (HPS) initiatives in all provinces in collaboration with the Departments of Education, Social Developments, the teachers unions and NGOs Education • Facilitate implementation and monitoring of Tobacco Legislation • Finalise HP Policy • Develop guidelines for HP at district level

47. Decreasing morbidity and mortality through strategic interventions Chronic Diseases and Disability • Distribution of health promotion/information material on breast and prostate cancer • Finalise guidelines for the management of asthma in children • Finalise strategy for management of chronic diseases in children • Develop disability and rehabilitation norms and standards • Finalise disability prevention booklets • Distribution and implementation of prevention of blindness programme guidelines • Distribution of guidelines for home-based/ community-based care for older persons

48. Decreasing morbidity and mortality through strategic interventions Communicable disease control • Update and implement 5 year plan and the annual plans for national and provincial malaria control programmes • Collaboration on the SDI project with Mozambique and Swaziland to improve malaria control in South Africa and the Lubombo and Maputo Corridors • Contain and prevent the outbreak of cholera in the provinces

49. Decreasing morbidity and mortality through strategic interventions • Finalise and distribute general guidelines on outbreak response and epidemic preparedness • Develop and distribute guidelines on diarrhoeal diseases, haemorrhagic fevers and central nervous system diseases • Enhance strategies to respond to outbreaks related to bio-terrorism

50. Decreasing morbidity and mortality through strategic interventions Programmes in the Chief Directorate: HIV/AIDS & TB • STIs AND BARRIER METHODS • YOUTH PROGRAMME • PARTNERSHIP SUPPORT • CARE, COUNSELLING AND SUPPORT • GAAP • NGO FUNDING • INTERDEPARTMENTAL SUPPORT • TB