All Senior Managers and other officials of the Department
Dr Bimilla - Head of City of Jo'burg Health Department
All District Managers and officials from all Health Districts
Managers from Health Departments of municipalities
Health workers
Members of District Specialist Teams
Community Health workers and Lay Counsellors
All community leaders and members of the community.
Ladies and gentlemen,
As we gather to launch this programme which seeks to re-engineer Primary Health Care, we are confirming that indeed the ANC Government’s commitment to improve the lives of our people is becoming a reality.
In the 2009 ANC Election manifesto we made a commitment to go beyond increasing access to Primary Health Care services. We also made a commitment to improve the quality of services that are rendered at clinics and hospitals. Therefore as the ANC Government, we have also ensured that decisions that were taken at a number of ANC National Conferences are translated into policies and programmes that benefit our people, especially the poor and vulnerable.
Although hospitals are an important part of our health services, we have committed ourselves to moving away from a hospicentric approach to delivery of health services. Our focus is to reach the people where they reside before they become sick. That is the essence of the work of a progressive Department of Health, which is to ensure that we reduce the incidence and prevalence of preventable illnesses.
When we took over the reigns of Government in 1994, we committed ourselves to provide health services where people live. We said: “The District Health System will be a vehicle through which we will deliver Primary Health Care services”.
We took this decision in order to ensure that a large portion of our budget is allocated towards improving District Health Services. Since the ANC Government took over in 1994, we have built a total of 56 new clinics across the province. Prior to 1994, Health was not considered as an important government department. But the ANC Government has turned that around and said Health is not just expenditure.
WE REGARD HEALTH AS AN INVESTMENT!
Program Director;
It is our conviction that the Primary Health Care approach is the underlying philosophy for the restructuring of the health system. As we re-engineer Primary Health Care Services we will focus more on taking comprehensive services to communities by emphasising disease prevention, health promotion and community participation.
South Africa, like many other developing countries is faced with infant mortality, maternal mortality, high incidence of HIV and AIDS, TB and other diseases of lifestyle. Unless there is a drastic, rigorous and aggressive change in the implementation of Primary Health Care, we will struggle to attain the Millennium Development Goals. Primary Health Care Re engineering is the only solution to address all the health challenges in the country.
This approach to delivery of Primary Health Care services will result in a strong District Health management and vigorous support to clinics. This means there will be improved supervision, proper monitoring and evaluation of health services, thus improving quality of health care. We will prioritise the interaction between the health workers and the people they serve.
We are moving away from an approach which sees and treats communities as clients. Primary Health Care services are a public good. Therefore it is an incorrect notion to refer to people who access these services as clients. Providing Primary Health Services is not based on a transactional relationship between health workers and people who access these services. This might sound like an ideological banter, but we need to bear in mind that our attitudes and practices are also shaped by the language we use.
We will therefore reach out families with the emphasis on keeping them well through health promotion and preventive activities, early identification of individuals within families who are high risk. The back bone of this new approach to delivery of Primary Health Care will be District Clinical Specialist Team, Ward Based Outreach Teams and Strengthening of School Health services. We are also in the process of finalising contracting of general practitioners who will work a few hours per day in public clinics.
Given the unacceptably high infant, child and maternal mortality in our country, the National Minister of Health and Provincial MEC’s agreed that every district should be supported by a Specialist team of Doctors which include an Obstetrician & Gynaecologist, a Paediatrician, a doctor who specializes in Family Medicine, an Anaesthetist, and Specialist nurses which include an Advanced Midwife, a Paediatric Nurse, and also a Primary Health Care Nurse.
These District Specialist Teams will strengthen clinical governance in clinics and in District hospitals. They will ensure that treatment guidelines and protocols are available and are used, essential equipment is available and that these are correctly used.
They will ensure that mortality review meetings are held and monitor recommendations made at such meetings. These District Specialist Teams will provide support, supervision and mentoring to clinicians in order to improve health outcomes in each district. They will also focus on managing complicated patients in order to preserve lives.
In Gauteng we have already appointed these Specialist Teams in all our five districts.
We are confident that they have started to work very closely with Family Physicians who are supposed to be where patients are instead of being holed up in offices. We emphasize collaboration with Family Physicians because District managers must ensure that Family Physicians spend most of their time in clinics and district hospitals instead of offices!
The Ward Based Outreach Teams will be assigned a number of households within a specified geographic area for whose health they will take collective responsibility. These Outreach Teams will be comprised of a Professional nurse, 6 Community Health Care workers, an Environmental Health Officer and Health Promoters. They will focus on promoting health, preventing ill health, providing information and education to communities and households on a range of health and related matters. They will also provide follow-up and support to persons with health problems including adherence to treatment.
Program Director,
Allow me to speak on the role of Community Health Workers as part of Ward Based Outreach Teams. This cadre of health workers will conduct community, household and individual health assessments and identify health needs and risks (actual and potential) and facilitate for families or individuals to seek the appropriate health care.
They will refer persons for further assessment and testing after performing simple basic screening. They will be trained to provide limited, simple health interventions in a household such as basic first aid and oral rehydration.
They will also provide psycho-social support and manage interventions such as treatment defaulter tracing and adherence support. These Wards Based Outreach teams will be deployed to all 508 wards in Gauteng.
I will therefore take this opportunity and report that we had initially targeted to establish 72 teams by the end of the 2013/14 financial year, and to date we have established 85 teams. These teams have already visited 48 235 households and referred 9 116 people to clinics, and seen 3 468 pregnant women. They have seen 5 744 women within six weeks of child birth. They have also seen 46 144 children under the age of five with a special focus on ensuring that they are immunized against a host of preventable diseases. They have also provided support to ensure treatment adherence to 41 559 people who are on either TB or Anti-Retroviral Treatment.
Program Director;
While we would like to have a school health nurse in every school, the reality is that with the number of schools in the Gauteng, it is not possible in the short to medium term, as we already have 61 School Health Teams. Focus is therefore on quintiles 1 and 2 schools (the poorest Schools).
We are prioritising screening of all grades R and grades 1, ensuring that all those that attend crèches and primary schools are fully immunized. In secondary schools we prioritize strengthening the life skills programme with specific focus on sexual and reproductive health and the reduction of alcohol consumption. The objective of Integrated School Health is to guide the provision of a comprehensive Integrated School Health Policy; which is provided as part of the Primary Health Care package.
Therefore focus will be on Health Promotion, individual learner assessment, on-site service provision and referrals and follow ups where appropriate. The number of Quintile 1 and Quintile 2 and Special Schools that have benefited from this program to date is 128, where we have already screened 58 563 learners.
For this programme of Primary Health Care Re-engineering to succeed, we will need functional collaboration between our districts and municipal departments of health. Just as we collaborate at a political level, we expect joint planning, monitoring and reporting to feature in the manner in which services are delivered.
Turf wars will not be tolerated! When our people visit health facilities they are not interested as to whether this or that clinic is owned and managed by a municipality or the provincial department. Therefore functional integration is non-negotiable. In that way we will improve the health status of the people of Gauteng!
