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, women’s 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 district’s 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)

11. 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

12. Requests for 2005/06 & MTEF

13. 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 HIV+ve people not on ARTs • Must add costs of: • Municipal (most environmental) H. services • Community Health Workers & other outreach

18. Rural Health Strategy

19. 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

20. 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