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2012/13 SAHR Overview

2012/13 SAHR Overview. René English, Ashnie Padarath SAHR Launch 2 April 2013. Acknowledgements. Co-editor – Ashnie Padarath Authors. Overview of presentation. Introduction Theme of 2012/13 SAHR Overview of chapters. SAHR 2012/13. 1995. 1996. 1997. 1998. 1999.

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2012/13 SAHR Overview

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  1. 2012/13SAHR Overview René English, Ashnie Padarath SAHR Launch 2 April 2013

  2. Acknowledgements • Co-editor – Ashnie Padarath • Authors

  3. Overview of presentation • Introduction • Theme of 2012/13 SAHR • Overview of chapters

  4. SAHR 2012/13 1995 1996 1997 1998 1999 • First launched on 4 October 1995 • SAHR 2012/13 - 16th edition 2000 2001 2002 2003/04 2005 2006 2007 2008 2010 2011

  5. Introduction • Repository of information on prevailing public health issues • Widely used by policy and decision makers, academics, media and inform donor priorities • Flagship HST publication which is eagerly awaited each year, and widely accessed and referenced=>8,244 downloads for SAHR 2011 since launch in 2012

  6. Context • 18 years into democracy; 3 years into new national health leadership: • 10 Point Plan • Negotiated Service Delivery Agreement • PHC re-engineering • Universal coverage • Aim: • Strengthen and transform the public and private health landscapes • Overcoming ever-increasing inequities

  7. Focus of 2012/13 SAHR • Health system • Building blocks of health system • Social determinants of health

  8. WHO Building Blocks Service Delivery Health workforce Information Medical products, vaccines & technologies Financing Leadership / governance WHO 2007. Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action.

  9. THE OUAGADOUGOU DECLARATION ON PRIMARY HEALTH CARE AND HEALTH SYSTEMS IN AFRICA WHO AFRO 2010. The Ouagadougou Declaration on primary health care and health systems in Africa: achieving better health for Africa in the new millennium

  10. Social construction of the health system Social and political context Policy decisions Systems ‘Hardware’ Human resources, medicines & technology, organisational structure, service infrastructure, information systems Systems ‘Software’ Ideas and interests, relationships and power, values and norms Sheikh et al. PLoS 2011. Building the Field of Health Policy and Systems Research: Framing the Questions

  11. 17 chapters • Legislation and Financing • Service Delivery • Social and Environmental Determinants of Health • Leadership and Governance • Medicines, Vaccines and Technology • Emerging Public Health Practitioner Awards • Health information

  12. Overview of each chapter

  13. Health Policy and Legislation (Andy Gray, YousufVawda, Caron Jack) • No new health-related legislation passed • 2 Health-related Bills before Parliament • National Health Amendment Bill (Bill 24 of 2011) • Office of Health Standards Compliance – independent structure outside of the Department of Health • Mental Health Care Amendment Bill (Bill 39 of 2012) • No progress in implementing Medicines and Related Substances Amendment Act (Act 72 of 2008) • Secondary Legislation • Draft Regulations on Tobacco Control Amendment Act (Act 83 of 1993)

  14. Health Policy and Legislation (Andy Gray, YousufVawda, Caron Jack) • Statutory Health Councils • Health Professions Council of South Africa • South African Pharmacy Council • South African Nursing Council • Allied Health Professions Council of South Africa • Interim Traditional Health Practitioners Council of South Africa • Telemedicine • Intellectual property • Suggests that cost of developing health legislation be explored

  15. National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt) • Intended to be phased in over a 14-year period • Will require significant overhaul of existing service delivery, administrative and management systems

  16. National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt)

  17. National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt)

  18. National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt)

  19. National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt)

  20. National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt)

  21. National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt)

  22. National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt)

  23. National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt) • Future • Consultation and communication • Ongoing discussions to enhance relevance and responsiveness • Harnessing cost-effective health technology • Cost-effective HT to be reviewed and implemented; with legislation • Making change happen • Provincial Facility Improvement Project Managers; implementation of business plans • Building up our knowledge on what works • Monitoring and evaluation, and assessment • “Experimentation, evaluation and expansion” – MoH, China • Retaining the focus on equity • Must ensure that underserved benefit from reforms

  24. HIV treatment in South Africa: The challenges of an increasingly successful antiretroviral programme (Francois Venter) • Largest antiretroviral programme in the world and most people on treatment • 3 politically-related era’s • Pre-2004: ART not available in public sector • 2004-2008: implementation • >2008: new political dispensation; reorientation and scale-up of programme

  25. HIV treatment in South Africa: The challenges of an increasingly successful antiretroviral programme (Francois Venter) • Ongoing Challenges • Cost and scale of programme • Evolving treatment guidelines • Integration of HIV with TB and antenatal services • Failure of past and current prevention programmes • Implications of adapting treatment as prevention programme • Poor medicines supply and service delivery systems - can threaten ongoing expansion of the programme

  26. Maternal, Newborn and Child Health (Lesley Bamford) • Overview of mortality rates and trends and causes of mortality • Despite unacceptably high rates of MNC mortality, a decline in under-5 and Maternal Mortality has been observed. • Mortality in children attributed to under-nutrition • Increasing disparity between poorest and most advantaged; interventions should be aimed at this group

  27. Maternal, Newborn and Child Health (Lesley Bamford) • Priority maternal and child health interventions as outlined in the MNCWH&N Strategic Plan • Highlights 56 essential interventions most likely to save lives • An equity-focused approach is also recommended • Key challenges: • Human resources • Poor monitoring and evaluation systems • How to adopt a more explicit equity approach • Management of children with long-term health conditions (health services)

  28. Occupational health challenges facing the Department of Health: protecting employees against tuberculosis and caring for former mineworkers with occupational health disease (Shahieda Adams, Rodney Ehrlich, Nabeel Ismail, Zara Quail, Mohamed F Jeebhay) • Healthcare workers at risk of contracting TB – responsibility of state in terms of doctrine of duty of care, national policy and occupational health and safety legislation • Former mineworkers - medical surveillance and compensation for occupational lung disease due to hazardous dust exposure in mines

  29. Occupational health challenges facing the Department of Health: protecting employees against tuberculosis and caring for former mineworkers with occupational health disease (Shahieda Adams, Rodney Ehrlich, Nabeel Ismail, Zara Quail, Mohamed F Jeebhay) • Healthworkers • Despite global and local policies, statutory provisions and local institutional frameworks for managing TB among healthcare workers – no uniform national strategy that actively supports TB risk management and limited active enforcement of current regulations exist. • Former mineworkers • Failure of statutory examination and compensation systems for occupational lung disease • Institute measures to hold the mining industry accountable for reducing the root causes of the epidemicand for legal, financial and managerial reforms of compensation systems

  30. Citizen reporting on District Health Services (Kerry Cullinan) • OurHealth pilot project – aims at reporting on and ultimately improving health conditions at district level • Started by Health-e News Service • Based in 5 NHI pilot districts • Collective action (“social accountability”) to improve policymaker/service provider accountability • Aims • Expose health issues and challenges • Obtain reports from public sector health facilities users • Hold district service providers and municipalities accountable (conditions and services) • Report on inspirational people and projects that improve the health of ordinary people

  31. Mainstreaming the social determinants of health in South Africa: Rhetoric or reality? (Laetitia Rispel, Sara Nieuwoudt) • Analysis of government health policy documents and budget speeches; interviews of 10 key informants (national and provincial) • Interviews explored: • Knowledge of key global developments in SDH • Has sufficient attention been paid to SDH over the past few years in terms of improving population health and reducing health inequities?

  32. Mainstreaming the social determinants of health in South Africa: Rhetoric or reality? (Laetitia Rispel, Sara Nieuwoudt) • Key issues -analysis of the budget speeches • Institutionalisation of the NSDA (which is seen as a mechanisms for encouraging intersectoral action) • Recognition of the linkages between current disease burden and SDH • Existence of numerous intersectoral structures • SDH not consistently included

  33. Mainstreaming the social determinants of health in South Africa: Rhetoric or reality? (Laetitia Rispel, Sara Nieuwoudt) • Ingredients for mainstreaming • Legislation and/or policy design and structural interventions • High-level political stewardship and leadership • Intersectoral collaboration in government • Dedicated financial and human resources

  34. Violence, alcohol misuse and mental health. Gaps in the health system’s response (Joanne Corrigal, Richard Matzopolous) • Continue the discussion for the need for better intersectoral collaboration and that violence, mental health and alcohol misuse are interlinked. • The interrelationship is underpinned by lack of strategy of the multi-directional links between the ‘triad’ • Key gaps are • Under-resourcing of the health system • Under-detection and inadequate management of these conditions within the healthcare setting • Decreased access that results from a range of logistic, cultural and knowledge related barriers • Surveillance - key component in supporting the identification and management of these

  35. Chronic non-communicable diseases in South Africa: progress and challenges (ThandiPuoane, Lungiswa P Tsolekile, Sam Caldbick, Ehimario U Igumbor, KashmeeraMeghnath, David Sanders) • SA has shown commitment in that it convened a summit in 2011; Strategic plan is under development • Focus on ‘big four’, including risk factors • Heart disease • Cancer • Type II diabetes mellitus • Chronic obstructive pulmonary disease • Framed within risk factor/determinants • Biological • Behavioural • Societal • Structural/environmental

  36. Chronic non-communicable diseases in South Africa: progress and challenges (ThandiPuoane, Lungiswa P Tsolekile, Sam Caldbick, Ehimario U Igumbor, KashmeeraMeghnath, David Sanders) • Presents list of population-wide interventions to promote healthy diet, physical activity, healthy environment, no smoking and harmful alcohol use. • Recommendations • Multi-faceted, multisectoral approach • Focus on policy responses to address structural environment • Surveillance systems • Research (surveys, cohort studies)

  37. Public health impact of and response to climate change in South Africa (Jonathan Elliot Myers, Hanna-Andrea Rother) • Link between climate change and health – increasing concern • Pay attention to South African public sector responses to climate change; presents a vocabulary on subject • Present a set of barriers and enablers to climate change interventions • Underline the need for enhanced knowledge and understanding of the impacts of climate change on health and on the existing burden of disease • Call for modelling of local climatological data; development of climate scenarios; transversal and cross-sectoral collaboration; and successful policy development • Dialogue between academics and public sector • Universally there is agreement that it needs to be part of the post-2015 agenda

  38. The state of the national health research system in South Africa (Flavia Senkubuge, Bongani M Mayosi) • Economic returns can be envisaged when medical research is invested at country level • Global commissions have shown that health research is not given its rightful place in improving health, equity and development in LMICs • At least 2% of health budget be spent on research with donors adding at least 5%

  39. The state of the national health research system in South Africa (Flavia Senkubuge, Bongani M Mayosi) • Challenges and recommendations for revitalising presented • Increasing financial allocation • Increasing funding to increase the number of relevant HR • Investing in health research facilities and infrastructure • Creating a national priority research fund to stimulate new and innovative research and address key health system priorities • Developing a national regulatory framework • Establishing a planning, coordination and translation of research findings body • Ensuring the institution of national mechanisms for M&E of research is conducted in the country

  40. Health Policy and Systems Research: Needs, challenges and opportunities in South Africa – a university perspective (Marsha Orgill, NonhlanhlaMxumalo, WoldekidanAmde, Ermin Erasmus, Uta Lehmann, Jane Goudge, Lucy Gilson) • Seek to frame health policy and systems research within a broader research terrain • HPSR – addresses systemic challenges to improved service delivery; support implementation of priority programmes • Approach • Comparative analysis of 3 HPSR groups in HEI • Findings of pre-conference PHASA workshop

  41. Health Policy and Systems Research: Needs, challenges and opportunities in South Africa – a university perspective (Marsha Orgill, NonhlanhlaMxumalo, WoldekidanAmde, Ermin Erasmus, Uta Lehmann, Jane Goudge, Lucy Gilson) • Asks? • Why implementation fails? • What guides implementation at service delivery levels • Role and influence of power and politics and role of actors other than technical capacity • Recommends • More research with a systems focus required • Large-scale domestic scholarship support – post-graduate training • Positions required in government for those with HPSR skills • Increased longer-term funding

  42. Crises, routines and innovations: the complexities and possibility of sub-district management (SorayaElloker, Patti Olkers, Lucy Gilson, Uta Lehmann) • Case study - sub-district based action learning project - focus on leadership and management • Uses systems thinking and management theory • Focuses on intangible software and role in determining behaviours of health system actors, and location of organisational practices and routines • Reflects on managing: • Behind the frontline of service delivery • Multiple actors • Meeting and planning processes

  43. Crises, routines and innovations: the complexities and possibility of sub-district management (SorayaElloker, Patti Olkers, Lucy Gilson, Uta Lehmann) • Three innovations for galvanising actors in the sub-district and for building capacity to improve routines and relationships are presented: • developing pro-active management • developing local service-improvement priorities • generating local knowledge, priorities and action. • Preliminary signs of these innovation impacts are also presented • Competing demands, actors, existing organisational cultures and legacies undermine progress towards decentralisation – managing in ‘calculated chaos’ • L&M training to be tailored accordingly

  44. Medicines, selection and procurement in South Africa (BadaPharasi, Jacqui Miot) • Discussion on medicines selection in the private sector • Medicine formularies and guidelines • Selection of medicines - prescribed minimum benefits • Public sector • Standard treatment guidelines • Essential medicines list • Role of pharmacy and therapeutics committees • Centralisation of medicines procurement • Establishment of Central Procurement Agency 2011 • NDoH taking over medicine tender management from National Treasury • Early gains perceived

  45. Medicines, selection and procurement in South Africa (BadaPharasi, Jacqui Miot) • Emphasise • Evidence-based medicine selection • Pharmacoeconomics • Budget impact analysis when selecting medicine • Medicines supply chain management at district level to be improved • M&E and national review of National Drug Policy

  46. Emerging Public Health Practitioner Awards • The language barrier: the overlooked challenge to equitable health care (Nadia Hussey) • Barriers to the implementation of tuberculosis infection control among South African healthcare workers (OluwatoyinAdeleke)

  47. Health and Related Indicators (Candy Day, Andy Gray) • Demographic • Socioeconomic • Health services • Health financing

  48. SAHR 2012/13 Social and political context Policy decisions Intangible ‘Software’ Ideas and interests, relationships and power, values and norms Hardware Leadership Health workforce Service delivery Health financing Community ownership Health information Health technology Research for Health Partnerships for Health Hardware Tangible ‘Software’ Management and knowledge skills Organisational systems and procedures

  49. Thank you History forbids us to hope this side of the grave. Once in a lifetime the longed for tide of justice can arise and hope and history rhyme (Seamus Heaney)

  50. THANK YOU • Please add contact details: Dr René English rene.english@hst.org.za Tel: 072 566 8713 http://www.hst.org.za

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