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BRIEFING BY THE NATIONAL DEPARTMENT OF HEALTH TO THE PORTFOLIO COMMITTEE ON HEALTH

BRIEFING BY THE NATIONAL DEPARTMENT OF HEALTH TO THE PORTFOLIO COMMITTEE ON HEALTH. 03 MARCH 2010. 1. STRUCTURE OF THE PRESENTATION. 1. OUTLINE OF THE KEY POLICY MANDATES OF THE HEALTH SECTOR: MEDIUM TERM STRATEGIC FRAMEWORK (MTSF) 2009-2014

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BRIEFING BY THE NATIONAL DEPARTMENT OF HEALTH TO THE PORTFOLIO COMMITTEE ON HEALTH

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  1. BRIEFING BY THE NATIONAL DEPARTMENT OF HEALTH TO THE PORTFOLIO COMMITTEEON HEALTH 03 MARCH 2010 1

  2. STRUCTURE OF THE PRESENTATION 1. OUTLINE OF THE KEY POLICY MANDATES OF THE HEALTH SECTOR: MEDIUM TERM STRATEGIC FRAMEWORK (MTSF) 2009-2014 2. THE 10 POINT PLAN OF THE HEALTH SECTOR 2009-2014 3. OUTLINE OF PROGRESS WITH THE IMPLEMENTATION OF THE 10 POINT PLAN WITH A SPECIAL FOCUS ON: 3.1. IMPROVING THE QUALITY OF HEALTH SERVICES 3.2. OFFICE OF STANDARDS COMPLIANCE 3.3. PRIMARY HEALTH CARE 3.4. HUMAN RESOURCES FOR HEALTH PLANS 3.5. HIV AND AIDS STRATEGIC PLAN 3.6. NEW MEDICINE CONTROL COUNCIL 4. REVISED OUTCOME-BASED MTSF 2010-2014 5. CONCLUSION 2

  3. 1. KEY POLICY MANDATES OF THE HEALTH SECTOR: MEDIUM TERM STRATEGIC FRAMEWORK 2009-2014 • Strategic Priority No 5 in the Medium Strategic Framework (MTSF) of Government for 2009-2014 is entitled: “Improving the Health Profile of all South Africans”. SPECIFIC OBJECTIVES IN THE MTSF INCLUDE: 1. Phasing in National Health Insurance (NHI) over the next 5 years; 2. Increasing institutional capacities to deliver health services and implementing structural reforms to improve the management of health services at all levels; 3. Strengthen TB treatment management and combating Multi-Drug Resistance (MDR) and Extreme-Drug Resistance (XDR) TB; 4. Implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and AIDS; 5. Enhancing the ability of public health services to deal with non-communicable diseases, injuries and trauma 6. Introducing new child vaccines to reduce diarrhoea and pneumonia 3

  4. 2. THE 10 POINT PLAN OF THE HEALTH SECTOR 2009-2014 • Health Sector has adopted a 10 Point Plan to strengthen the health system and improve health outcomes in South Africa, which consists of the following: (i) Provision of Strategic leadership and creation of a social compact for better health outcomes; (ii) Implementation of National Health Insurance (NHI); (iii) Improving the Quality of Health Services; (iv) Overhauling the health care system and improving its management; (v) Improving Human Resources, Planning, Development and Management; (vi) Revitalisation of infrastructure; (vii) Accelerated implementation of HIV and AIDS and Sexually Transmitted Infections National Strategic Plan 2007-2011 and reduction of mortality due to TB and associated diseases; (viii) Mass mobilisation for better health for the population; (ix) Review of the Drug Policy; and (x) Strengthening Research and Development 4

  5. 3. OUTLINE OF PROGRESS WITH THE IMPLEMENTATION OF THE 10 POINT PLAN 2009-2014 3.1. PROVISION OF STRATEGIC LEADERSHIP AND THE CREATION OF A SOCIAL COMPACT FOR BETTER HEALTH OUTCOMES PROGRESS TO DATE • Governance of the National Health System has been strengthened through the National Health Council, led by the Minister. • Focus has been on three key areas: • Unifying the entire health to focus on a common set of goals, being the new 10 Point Plan; • Asserting greater stewardship of the Ministry of Health over the entire public health system and ensuring that it acts in unison at all levels and not independently; • Ensuring that key policies and decisions agreed to in the public sector are implemented. • New policies were developed in several areas including HIV and AIDS – aimed at massively scaling up access to Antiretroviral Treatment (ART); integration of related health programmes (Antenatal Care & Prevention of Mother to Child Transmission; HIV &TB ); and finalisation of the ICT strategy. 5

  6. 3.1. PROVISION OF STRATEGIC LEADERSHIP AND THE CREATION OF A SOCIAL COMPACT FOR BETTER HEALTH OUTCOMES Future Plans • In 2010/11, the Department will convene a National Consultative Health Forum. • Key participants will include: Public Health Sector; Private Health Sector; other Government Departments; Academic institutions; Research Institutions; Community-based Organisations (CBOs); Non-Government Organisations (NGOs); Organised labour; and Faith based Organisations; International Development Partners, amongst others. • A Social Compact (People’s Contract) with the people of South Africa about measures to improve health outcomes, including active community participation, will be adopted. 6

  7. 3. INTRODUCTION OF THE NATIONAL HEALTH INSURANCE (NHI) SYSTEM Progress to Date • Technical work towards the creation of the NHI continued during 2009/10; • NHI policy proposals were also presented to Cabinet. • A dedicated NHI Technical Support Unit was established within the Department to steer the implementation of NHI. • A 27-member Ministerial Advisory Committee on NHI was established in terms of the National Health Act of 2003 in September 2009. Future Plans • During 2010/11, NHI policy will be finalised and public consultations conducted. • Proposed NHI legislation will be presented to Cabinet and subsequently submitted to Parliament. 7

  8. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICES LEGISLATIVE MANDATE AND POLICY CONTEXT • National Health Act of 2003 (Chapter 10) establishes the Office of Standards Compliance. • Designated Health Officers are to inspect all health establishments and agencies every 3 years (public and private). • Inspectorates of Health Establishments at Provincial DoH level are also envisages, which will conduct monitoring, inspections and recommendations. • In addition the Office of Standards Compliance must: • Advise the Minister on prescribed standards, both general service provision and specifically for quality. • Provide leadership and advice on strategies and mechanisms to improve quality across the system. • Monitor and report to the Minister on system performance against standards. • Improving Quality of Health Services is a central component of the 10-Point Plan, and is also highlighted in the Presidency’s Green Paper on Performance Monitoring and Evaluation. 8

  9. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICES BROAD AREAS OF CONCERN: • Lack of standardization of care with poor reliability and poor outcomes • Lack of accountability for delivery of care and use of resources • Skills inadequate and inappropriate • Lack of responsiveness to inadequate patient outcomes and to patient and staff concerns RESPONSE FROM THE HEALTH SECTOR Ethics and values • Leadership conveys and demonstrates the expectation that values underpin the delivery of health care and are the motivating factor for most health professionals Enhanced accountability in the public and private sector • Leaders hold managers accountable for achieving a defined set of standards • performance objectively measured and monitored and with clear consequences. • Will focus initially on the basic or essential aspects of care Developing capacity and skills • Specific skills and knowledge widely diffused and supported throughout the system to assure and improve Quality as core outcome of a single national plan 9

  10. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICESCOMPONENTS OF THE NATIONAL QUALITY PROGRAMME 1. National standards, norms, guidelines (National Core Standards) 2. Accreditation: audit, benchmarking, compliance (Independent body – legislative amendment) 3. Improvement – through multiple mechanisms to support management 1. Standards Mx 3. Improvement 2. Accreditation 10

  11. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICESNATIONAL CORE STANDARDS • Standards are statements of expected (organisational) performance • Purpose of standards is twofold: • A guide for managers at all levels / in all sectors – “what we should be doing” • A basis for measuring own performance or being objectively measured and benchmarked against others • Target audience (or intended users) of standards are • Managers and their management teams; • Supervisors and provincial / national support staff • Public and private sectors • “Core” standards are based on existing legislation, policies, guidelines and protocols, • constitute a reasonable expectation of managers: should already be doing / have been hired to do • not a new initiative or an added burden • A screening tool with universal coverage for use by all sections / programmes 11

  12. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICESNATIONAL CORE STANDARDS • WHO defines a domain as an “area of risk for quality or safety”. • National Core Standards being developed by the Department have 7 domains: (i) Safety, Clinical Governance and Care (ii) Patient Rights (iii) Clinical Support Services (iv) Public Health (v) Leadership and Corporate Services (vi) Operational Management (vii) Facilities and Infrastructure • Assessment tools will be piloted in all 9 Provinces in March 2010. • This will serve as basis for the audit of health facilities in 2010/11. 12

  13. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICESACCREDITATION Office of Standards Compliance The Ministry of Health will establish a “Quality Management and Accreditation Body” to function independently of National, Provincial Departments. The National Health Act of 2003 will be amended to facilitate this process. Required Cabinet and Parliamentary processes will be followed. A Business Case is under development, which includes an international review, SA experience, and interviews with national and provincial stakeholders 13

  14. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICES IMPLICATIONS OF ACCREDITATION Accreditation will be linked to funding through National Health Insurance (NHI) in the future. Accreditation might be required for operating licenses for all establishments (private and public) Core standards and assessment tools will inform regulations to be drafted Public and Private Sectors, Hospitals & PHC facilities Later: non-health establishments, support offices, EMS, GP practices Facilities will be “deemed licensed” for specified period (3-5 years) time to achieve compliance baseline and confirmation audits 14

  15. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICES QUALITY IMPROVEMENTFuture PlansThe Department will fast-track improvements in six priority areas of quality of care namely: (i) Positive and caring values and attitudes: Values and the way caregivers, supervisors and managers, interact with patients, colleagues and the system. (ii) Reduce waiting times: Reducing the total time patients must wait for administration, assessment, diagnostics and pharmacy or other processes of care, as well as reducing the delays in time to referral or transfer for care when needed. (iii) Improve Cleanliness: The degree to which a health facility - its buildings, grounds, amenities, equipment and staff are spotlessly clean and tidy . 15

  16. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICES QUALITY IMPROVEMENTFuture Plans (iv) Improve patient safety: Actions to reduce unintended harm to patients arising from the operations or failures of the health system or its staff. (v) Infection prevention and control: Interventions to specifically focus on health-care-acquired infections as one kind of unintended harm to patients in facilities. (vi) Availability of medicines and supplies: The system and processes that ensure that essential drugs and supplies are reliably available at the point of care. 16

  17. 3.3. IMPROVING THE QUALITY OF HEALTH SERVICES QUALITY IMPROVEMENT Future Plans • In 2010/11, 20% of 4,333 Public Sector Facilities will be supported to comply with quality standards. This figure will increase to 90% by 2012/13. • In 2010/11, 50% of health facilities will produce and implement Quality Improvement Plans. This figure grows to 70% by 2012/13. • Other related areas include: • Improving supervision • Programme outputs and outcomes e.g. PMTCT • Hospital Improvement Plans • Audit of skills and competences of Senior Health Managers, and additional training where this is required • The Department will also monitor patient satisfaction and complaints from users of public health services. • 30% of hospitals will produce patient satisfaction surveys in 2010/11. This will figure grow to 90% in 2012/13. 17

  18. 3.4. OVERHAULING THE HEALTH SYSTEM AND IMPROVING ITS MANAGEMENT Progress to Date • Focus has been on two aspects: (i) Improving the functionality and management of the Health System and (ii) Revitalization of Primary Health Care (PHC). Improving the functionality and management of the Health System • In the last three years, more than 220 Hospital CEOs have enrolled in Hospital Management Training Programmes at the Universities of the Witwatersrand (WITS) and KwaZulu-Natal (KZN). • National Health Council has adopted the Terms of Reference (ToR) developed by the Development Bank of the Southern Africa (DBSA) for the assessment of the skills and competencies of Hospital CEOs; Senior Hospital Managers; and District Managers. • Only 1 out of 9 Provincial DoHs obtained an Unqualified Audit Opinion at the end of 2008/09. In response, the National DoH developed a Financial Management Improvement Plan in collaboration with National Treasury and the Office of the Accountant-General in 2009, to provide dedicated support to all Provinces. 18

  19. 3.4. OVERHAULING THE HEALTH SYSTEM AND IMPROVING ITS MANAGEMENT Revitalization of Primary Health Care (PHC) • Primary Health Care (PHC) approach is endorsed in key policy documents of the health sector (White Paper of 1997; National Health Act of 2003); as the strategic approach for ensuring an accessible, affordable, acceptable, equitable and efficient health system, with full community participation and intersectoral collaboration. • The Department of Health has adopted the District Health System as a vehicle for the delivery health services using PHC approach. • The National Department of Health developed a comprehensive and integrated package for the delivery of Primary Health Care in 2001, as well as Norms and Standards for PHC. • Services are delivered through PHC facilities: i.e: Community Health Centres; Fixed Clinics; Mobile clinics; Health Posts/ Satellite clinics; Clinics that fall under Municipalities (which render limited package). • District hospitals supports PHC facilities through doctors visits and supply of drugs and medical supplies. 19

  20. 3.4. OVERHAULING THE HEALTH SYSTEM AND IMPROVING ITS MANAGEMENT Revitalization of Primary Health Care (PHC) • Health programmes delivered through fixed PHC facilities and mobile clinics include: Maternal, Child, and Women’s Health; Youth Health; Non-communicable disease control ; HIV and AIDS services including Prevention from Mother to Child Transmission (PMTCT), Voluntary Counseling and Confidential Testing; Chronic Care and Care for the Elderly (Geriatrics) including Palliative Care; Health Promotion and Education; amongst others. • PHC services are delivered for: • 8 hours 5 days a week (common in small communities and all municipal clinics) • 12 hours 5 days a week • 12 hours 7 days a week • 24 hours 7 days a week • One day per month (for mobile clinics and health posts) 20

  21. 3.4. OVERHAULING THE HEALTH SYSTEM AND IMPROVING ITS MANAGEMENT Revitalization of Primary Health Care (PHC) Progress to date • A total of 117, 341, 256 visits to primary level facilities in the public health sector facilities were recorded in 2008/09, which marked a 10% increase from the 106,623,648 registered in 2007/08. • To continuously improve and standardize the delivery of PHC services, the Department has implemented the following initiatives: • A Handbook for District Managers was developed • District Health Planning Guidelines have been aligned with Guidelines for the Development of Provincial Annual Performance Plans (AAPs) • Service coverage was increased through the help of community health workers • Governance structures in the health facilities were established – albeit unevenly • PHC facility supervision manual has been finalised and posts of PHC supervisors created in Provinces – albeit unevenly 21

  22. 3.4. OVERHAULING THE HEALTH SYSTEM AND IMPROVING ITS MANAGEMENT (cont) Revitalization of Primary Health Care (PHC) Future Plans • During the 2010/11-2012/13 planning cycle the Department will: • Conduct audit of PHC facilities and package of essential services. The audit will focus on: Infrastructure; delivery of the existing package of PHC services; Human Resources needed to deliver the package of PHC services. • Use outcome of PHC audit to inform the development of the delivery model of PHC. • Expand access to and coverage of PHC services , as well as incorporation of other priority programmes. • Finalise Provincialisation of Personal PHC services. • Strengthen Governance structures in health facilities. 22

  23. 3.5. IMPROVING HUMAN RESOURCE PLANNING, DEVELOPMENT AND MANAGEMENT Review and refinement of the Human Resources for Health Plan • Process of revising and updating the existing National Human Resources Planning Framework for health commenced in 2009. Revision process took into account various studies that were conducted after the Framework was released in April 2006. • In 2007, as a result of a request from the Minister of Education, the then Department of Education convened a high level tri-partite Health Sciences Review Committee in order to develop interventions to strengthen clinical training in the 21 Higher Education Institutions. • The Health Sciences Review Committee has: • Quantified the efficiency of production of graduates in different health science disciplines – and assessing costs associated with even modest growth in production of the order of 3%, using medicine as a tracer discipline • Completed technical work to inform planning and building clinical training infrastructure and capacity at higher education institutions in the country. 23

  24. 3.5. IMPROVING HUMAN RESOURCE PLANNING, DEVELOPMENT AND MANAGEMENT (cont) Review and refinement of the Human Resources for Health Plan • 8/9 Provinces have produced Provincial Human Resources for Health Plan. Work is being done to align these to long-term plans known as Service Transformation Plans and the 10 Point Plan. Assessments of workforce challenges and analysis of workforce indicators are being undertaken with a view to setting realistic targets. • In October 2009, the Health Sciences Review Committee resolved that the mechanism for the allocation of the Health Professions Training and Development Grant (HPTDG) be amended, with detailed policy options and implications; • In December 2009, the Committee agreed that the Department of Health was in a better position to lead the detailed review of the operational aspects of the HPTDG – in consultation with the National Treasury. 24

  25. 3.5. IMPROVING HUMAN RESOURCE PLANNING, DEVELOPMENT AND MANAGEMENT (cont) Future Plans • A Ministerial Committee (Working Group team) will be set up to guide the development of a new Human Resources for Health (HRH) Plan for South Africa, and report directly to the Minister on its progress. • Technical work conducted by the Health Sciences Review Committee to examine all factors associated with increasing the production of health professionals will be taken into account when training targets are developed. • Interventions and plans relating to the implementation of different aspects of the HRH plan including training, research, teaching and production will be developed. • Training of Midlevel Workers (including clinical associates) will also be accelerated to strengthen clinical service delivery. 25

  26. 3.5. IMPROVING HUMAN RESOURCE PLANNING, DEVELOPMENT AND MANAGEMENT (cont) Future Plans • The Agreement on the implementation of the Occupation Specific Dispensation (OSD) for diagnostic, therapeutic and related allied health professionals will be signed in the Social Development and Health Sectoral Bargaining Council and implemented. • Enrolment of Hospital CEOs in formal management courses will be increased from 140/400 CEOs in 2009/10 to 240/400 CEOs in 2012/13. • Policy on Community Health Workers will be finalised. • Nursing Strategy will be implemented in all Provinces. 26

  27. 3.6. REVITALISATION OF INFRASTRUCTURE Progress to date • Development of a comprehensive National Infrastructure Plan, in conjunction with National Treasury, commenced in 2009. Key aspects of this process include: • Reviewing the available Hospital Revitalisation and Infrastructure Grant Plans to show the current financial backlog; • Assessment of the backlog of facilities that need major upgrades and minor repairs. A need also exists to improve the maintenance of health facilities. • A strategy will be developed to meet the set maintenance target of 3-5% of the infrastructure budget. Future Plans • During 2010/11 the Department will focus on three areas of infrastructure revitalisation namely: • Accelerating the delivery of health infrastructure through Public Private Partnerships (PPPs) especially for the construction of the Tertiary Hospitals; • Revitalising primary level facilities; and • Accelerating the delivery of Health Technology and Information Communication Technology (ICT) infrastructure. 27

  28. 3.7. ACCELERATED IMPLEMENTATION OF HIV & AIDS AND SEXUALLY TRANSMITTED INFECTIONS NATIONAL STRATEGIC PLAN (NSP) 2007-11 AND INCREASE FOCUS ON TB AND OTHER COMMUNICABLE DISEASES • The National Strategic Plan (NSP) for HIV&AIDS and STIs 2007-2011 is a multi-sectoral plan, being implemented under the leadership of the South African National AIDS Council (SANAC), and through government and Civil Society participation. • 2 Pillars of the NSP 2007-2011 are to: • Reduce the number of new infections by 50% by 2011 • Reduce the impact of HIV & AIDS by expanding access to treatment, care and support to 80% of people living with HIV and AIDS. • 4 Priorities of the NSP are: • Prevention • Treatment, Care and support • Human Rights and access to Justice • Research, Monitoring and Surveillance 28

  29. 3.7. ACCELERATED IMPLEMENTATION OF HIV & AIDS AND SEXUALLY TRANSMITTED INFECTIONS NATIONAL STRATEGIC PLAN (NSP) 2007-11 AND INCREASE FOCUS ON TB AND OTHER COMMUNICABLE DISEASES Progress to date Access to ART treatment • By the end of March 2009 there were 493 accredited sites to provide Antiretroviral Therapy (ART) services, with 796 down referral sites. • Accreditation is no longer policy and a model of facility readiness is in place to speed up access to ART care at PHC level. ART coverage for adults in 2009/10 • NSP Goal is to provide ART to 80% of those in need • Need for ART is 1.6 million within adult population (according to Statistics South Africa) • A total of 856, 268 patients were on ART by the end of October 2009 29

  30. 3.7. ACCELERATED IMPLEMENTATION OF HIV & AIDS AND SEXUALLY TRANSMITTED INFECTIONS NATIONAL STRATEGIC PLAN (NSP) 2007-11 AND INCREASE FOCUS ON TB AND OTHER COMMUNICABLE DISEASES Progress to date ART coverage for children in 2009/10 • NSP Goal is to provide ART care to 80% of those in need • Need for ART is 106 000 children (Statistics South Africa) • 83, 454 child patients were on ART by the end of October 2009 • NSP PMTCT target is less than 5% vertical transmission rate. • Actual mother to child transmission rate dropped from 30% to 10.6%. 30

  31. 3.7. ACCELERATED IMPLEMENTATION OF HIV & AIDS AND SEXUALLY TRANSMITTED INFECTIONS NATIONAL STRATEGIC PLAN (NSP) 2007-11 AND INCREASE FOCUS ON TB AND OTHER COMMUNICABLE DISEASES Presidential Announcements on World AIDS Day, 01 December 2009 Main aim: • To improve ART access for special groups: pregnant women; TB/HIV co infected people; and children under the age of one • To decrease disease burden • To reduce maternal and child mortality • To improve life expectancy New policies and strategies • Initiate all eligible pregnant women and TB/HIV co infected people at a CD4 of 350 or less • Initiate ART for all children less than 1 year of age regardless of CD4 count • Provide PMTCT prophylaxis to pregnant women not on HAART at 14 weeks of pregnancy until post-delivery. 31

  32. 3.7. ACCELERATED IMPLEMENTATION OF HIV & AIDS AND SEXUALLY TRANSMITTED INFECTIONS NATIONAL STRATEGIC PLAN (NSP) 2007-11 AND INCREASE FOCUS ON TB AND OTHER COMMUNICABLE DISEASES Health Sector’s response to the Presidential Mandates The Health Sector will implement: • Health Care Provider Initiated Testing to mobilise patients for ART • Readiness assessment to ensure access to quality care • Decentralization of ART to PHC facilities • Training and orientation of health workers on the new policy mandates • Task sharing and nurse initiated treatment 32

  33. 3.7. ACCELERATED IMPLEMENTATION OF HIV & AIDS AND SEXUALLY TRANSMITTED INFECTIONS NATIONAL STRATEGIC PLAN (NSP) 2007-11 AND INCREASE FOCUS ON TB AND OTHER COMMUNICABLE DISEASES HIV prevention The Health Sector will enhance: • Behaviour change communication; • Information, Education and Communication (IEC) targeting high risk group; • Aggressive condom distribution, with 1 billion male condoms distributed annually during 2010/11-2012/13, and 22,5 million female condoms distributed by 2012/13. • Youth programmes: Soul city, Lovelife and Youth Friendly Services. 33

  34. 3.7. ACCELERATED IMPLEMENTATION OF HIV & AIDS AND SEXUALLY TRANSMITTED INFECTIONS NATIONAL STRATEGIC PLAN (NSP) 2007-11 AND INCREASE FOCUS ON TB AND OTHER COMMUNICABLE DISEASES CONDITIONAL GRANT BUDGET 34

  35. 3.7. ACCELERATED IMPLEMENTATION OF HIV & AIDS AND SEXUALLY TRANSMITTED INFECTIONS NATIONAL STRATEGIC PLAN (NSP) 2007-11 AND INCREASE FOCUS ON TB AND OTHER COMMUNICABLE DISEASES Challenges • Late presentation by patients with very low CD4 tests; • Human Resources; • Inadequate infrastructure; • Supply Chain and Financial Management 35

  36. 3.8. MASS MOBILISATION FOR BETTER HEALTH FOR THE POPULATION Progress to date • A draft National Integrated Health Promotion Strategy was produced in 2009, which aims to identify priorities for health promotion in the country, and to provide a mechanism for enhancing existing. Key elements of the strategy include creating supportive environments; developing personal skills on health promotion; building health public policies strengthening community participation securing infrastructure for health promotion; and mobilizing appropriate resources. • National Implementation Guidelines for promoting Healthy Lifestyles Programmes were also produced and disseminated. These guidelines identify 5 priority lifestyle programmes namely: tobacco control; physical activity, nutrition; preventing alcohol and substance abuse.

  37. 3.8. MASS MOBILISATION FOR BETTER HEALTH FOR THE POPULATION Accelerating progress towards the Millennium Development Goals Background • In 2009, Ministry of Health received from Ministerial Committees three reports entitled: (i) Saving Mothers 2005-2007: Fourth Report on Confidential Enquiries into Maternal Deaths in South Africa, produced by the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD); (ii) the First Report of the Committee on Morbidity and Mortality in Children under 5 Years (CoMMiC) and (iii) the National Perinatal Morbidity and Mortality Committee Report 2008. • Based on its findings, the recommendations of the NCCEMD focused on four main areas of: knowledge development; quality of care and coverage of reproductive health services, establishing norms and standards and community involvement.

  38. 3.8. MASS MOBILISATION FOR BETTER HEALTH FOR THE POPULATION Accelerating progress towards the Millenium Development Goals Background • Committee on Morbidity and Mortality in Children under 5 Years recommended that clinical care be improved by: • Strengthening the existing child survival programmes adopted by the National DOH including the Community Health Worker (CHW) programme, the Integrated Nutrition Programme, Expanded Programme on Immunisation; Prevention of Mother to Child Transmission (PMTCT); and Integrated Management of Childhood Illnesses (IMCI); Essential Drug List (EDL); and 10 steps for the management of severe malnutrition; • Strengthening Primary Health Care by adopting and implementing the Household and Community component of IMCI (IMCI HHCC); • Introduction and roll out of standardized management and referral guidelines for general practitioners. • Strengthening Emergency referral and treatment capacity in all health facilities and districts through training in triage, assessment and resuscitation of critically ill children, and the development of suitable transport systems for the movement of critically ill children into and within the health system.

  39. 3.8. MASS MOBILISATION FOR BETTER HEALTH FOR THE POPULATION Accelerating progress towards the Millennium Development Goals Background • National Perinatal Morbidity and Mortality Committee also provided a set of 10 recommendations covering: (i) Clinical skills improvement (especially strengthening skills of interns; midwives; nurses); (ii) Improving staffing, equipment and facilities; (iii) Implementation of national maternal and neonatal guidelines; (iv) Training and education; (v) Transport and referral routes; (vi) Normalization of HIV infection as a chronic disease; (vii) Improving postnatal care; (viii) Appointment of regional clinicians to establish, run and monitor evaluate outreach programmes for maternal and neonatal health; (ix) Auditing, monitoring and evaluation and (x) Constant health messages must be conveyed to all understand by all.

  40. 3.8. MASS MOBILISATION FOR BETTER HEALTH FOR THE POPULATION Progress to date • To improve Maternal, Child and Women's’ Health, the Department has implemented the following interventions: • Expanded Programme on Immunisation, including the addition of 2 new vaccines and response to outbreak of measles • Integrated Management of Childhood Illnesses (IMCI) • Training of doctors in emergency obstetric interventions • Assistance of neighbouring countries on reproductive health, especially maternal mortality • Accelerated PMTCT plan with reduced transmission to newborns and children • Introduction of Kangaroo Mother Care for premature babies • Enhanced screening for cervical cancer • Audit of maternal and newborn deaths carried out satisfactorily in many facilities, but follow-up is a challenge • Video-conferencing for genetic consultations

  41. 3.8. MASS MOBILISATION FOR BETTER HEALTH FOR THE POPULATION Progress to date • A National Summit was convened in 2009 to develop an Implementation Plan for the recommendations of the Ministerial Committee. The Summit agreed that: • Implementation of recommendations of the 3 Ministerial Committees – must be included in the Performance Management Agreement of Hospital CEO and Clinical Manager; • HIV Management must be included into women’s and child care (HAART for pregnant women and children); • Contraception and termination of pregnancy services must be q major programme at all levels of care, including teenage pregnancy prevention and management; • Data management and use, as well as monitoring and evaluation of programmes must be strengthened. Perinatal and maternal mortality audit must be convened in all facilities; Facility based information on mortality must be collected, and ways to measure accurately the IMR, <5MR, MMR; • Norms and standards for staff & equipment must be developed and adopted;

  42. 3.8. MASS MOBILISATION FOR BETTER HEALTH FOR THE POPULATION • Integration of HIV Management; PMTCT and ART for children and women with CD4 count <350 must be accelerated; • Access to the 2 new vaccines (pneumococcal and rota virus vaccines) must be expanded; • High immunisation coverage, including polio, measles, must maintained; • Outbreak response times for communicable diseases must be maintained; • Public health education and advocacy for immunisation must be conducted; • Campaign for immunisation must be implemented in April and May 2010 (some provinces have earlier campaigns because of measles); • Newborn care must be enhanced, including breastfeeding, KMC, prevention and management of prematurity • Management and prevention of diarrhoea, ARI, malnutrition at primary and facility levels • Implementation of School Health Policy must be strengthened.

  43. 3.8. MASS MOBILISATION FOR BETTER HEALTH FOR THE POPULATION Future Plans • Implementation of recommendations from the three Ministerial Committees will continue over the planning cycle 2010/11-2012/13 across all Provinces and Districts. • The MCWH&N Strategic Plan 2009-2014 will also be finalised • The Health Promotion Strategy developed in 2009 will be incorporated into all 9 Provincial Health Strategies, and implemented in all 52 Districts going forward.

  44. 3.9. REVIEW OF DRUG POLICY Progress to date • The Review of the Drug Policy was completed in 2009/10. • Sporadic shortages of Antiretroviral Treatment (ART) and TB drugs due to various factors including: • Stocks not being available at provincial depot level, but this information having not been reported to NDoH; • Insufficient budget at provincial depot level resulting in inability to timeously place orders and stock-outs occur; • Drugs being available at depot level but were not supplied to facilities by depots due to logistical reasons (e.g. delivery schedules and orders not timeously submitted; • Drugs being available at depot level but not being supplied to facilities due insufficient budgets at facility and district levels (orders are not authorised). 44

  45. 3.9. REVIEW OF DRUG POLICY Future Plans • Over the next 3 years, the health sector aims to improve monitoring systems for drug supply and management, and ensure a zero stock-out rate for essential medicines, including TB drugs and Anti-retroviral Treatment (ART). • The registration timelines for medicines will also be improved as follows: • Generics from 24 months in 2009/10 to 18 months 2010/11; to 12 months in 2011/12; and finally to 6 months in 2012/13 • NCE from 36 months in 2009/10 to 24 months in 2010/11; 18 months in 2011/12; and finally to 12 months in 2012/13 • Clinical Trials from 8 weeks in 2009/10 to 6 weeks in 2010/11; 4 weeks in 2011/12; and remain at 4 weeks in 2012/13 • The Electronic Document Management System (EDMS) will be piloted and then go live in 2010/11; and reach full implementation 2011/12. • A new Medicines Regulatory Authority will be established to replace the current MCC and to improve efficiencies. 45

  46. 3.10. STRENGTHENING RESEARCH AND DEVELOPMENT Progress to date • The South African Demographic and Health Survey (SADHS) was not completed in 2009/10. • Research instruments were finalised Future Plans • Two key objectives of the health sector for the next three years are to complete the South African Demographic and Health Survey (SADHS) 2010, as well as to initiate planning for the SADHS 2013. • These national surveys which will provide reliable data on the health status of South Africans. Funding for this purpose has not been allocated from the national fiscus, and will be mobilised from other sources. • The Department will also conduct the Annual National HIV and Syphilis Prevalence Surveys.

  47. 4. REVISED OUTCOME-BASED MTSF 2010-2014 Outcome-based MTSF focuses on 4 key areas • Increasing life expectancy; • Combating HIV and AIDS; • Decreasing the burden of diseases from Tuberculosis, and • Improving health systems effectiveness, and proposes 20 deliverables (outcomes and outputs).

  48. 4. REVISED OUTCOME-BASED MTSF 2010-2014 4.1. Increased Life Expectancy at Birth 4.2. Reduced Child Mortality 4.3. Decreased Maternal Mortality Ratio 4.4. Managing HIV Prevalence 4.5. Reduced HIV Incidence 4.6. Expanded PMTCT Programme 4.7. Improved TB Case Finding 4.8. Improved TB outcomes 4.9. Improved access to Antiretroviral Treatment for HIV-TB co-infected patients 4.10. Decreased prevalence of MDR-TB 4.11. Revitalisation of Primary Health Care 4.12. Improved Physical Infra-structure for Healthcare Delivery 4.13. Improved Patient Care and Satisfaction 4.14. Accreditation of health facilities for quality 4.15. Enhanced Operational Management of Health Facilities 4.16. Improved access to Human Resources for Health 4.17. Improved Health Care Financing 4.18. Strengthened Health information systems (HIS) 4.19. Improved health services for the Youth 4.20. Expanded access to Home Based Care and Community Health Workers

  49. 5. CONCLUSION • The health sector has started recording several milestones towards the 10 Point Plan for 2009-2014. • Key challenges remain, which will be responded to in the interventions planned over the MTEF period. • Strategies and interventions to ensure attainment of the 20 deliverables required in the outcome-based MTSF are reflected into the National DoH Strategic Plan for 2010/11-2012/13. • Improving health outcomes and accelerating progress towards MDGs is equally determined by factors that lie outside the health sector, such as access to education, water and sanitation amongst others. • Intersectoral action is required to accelerate progress towards achievement of the health-related MDGs.

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