Programme director, Me Precious Matsoso,
The Deputy Minister of Health Dr Gwen Ramokgopa,
The MECs of Health present,
HODS of Health,
Our development partners,
Our special guests, the members of the District Clinical Specialist Teams from provinces,
Distinguished Guests,
Ladies and gentlemen.
Good afternoon,
This is indeed a very important occasion for the country! When I conceptualised the idea of teams of specialists, working in our districts to improve the quality of care so that we can reduce maternal and child mortality and improve maternal and child health, I remember many people, including officials asking where we will get the specialists from! I told them that we cannot fail before we try and today’s event signifies the importance of dreaming of the impossible!
Our beloved former President, Tata Nelson Mandela is often quoted as saying: “It always seems impossible until it is done”.
As you may know, before I proceeded I consulted with the Deans of the Medical Schools. They told me that this was a very good idea but they also cautioned that we may not find the people and that most of the clinicians are trained to think about individual patients. This meant that once employed the district clinical specialist team members will have to be oriented to also think about population or public health issues.
After this consultation I appointed a Ministerial Task Team that Prof Jack Moodley chaired. It included a number of senior and very experienced medical specialists and nurses, as well as the Chair of the Medical Deans committee. This committee advised me and the National Health Council on the team’s composition, what experience was needed etc. As you can see from the programme they will also be presenting later this afternoon so I will not provide further details of their work.
At present, through the initial advertisements, I am happy to announce that we have appointed the following medical specialists and senior nurses nation- wide:
- 17 obstetricians and three senior medical officers with diplomas and significant experience in obstetrics
- 17 paediatricians
- 34 family physicians
- nine anaesthetists
- 34 advanced midwives
- 23 paediatric nurses
- 35 Primary health care nurses.
While only 1 district currently has the full complement of seven members of the team, i.e., Umgungundlovu. Two districts, that is, Tshwane and Umzinayti have almost a full complement, they are both only missing a paediatric nurse; Ekurhuleni too has almost a full complement but they are missing an anaesthetist; and Bojanala is missing an anaesthetist and a paediatric nurse.
On the other side of the scale, in some districts, we have serious problems in recruiting. Cacadu, Francis Baard and John Taole Gaetswe have made no appointments and Chris Hani, Alfred Nzo, Namaqwa and Siyanda have only appointed advanced midwives to date.
As is obvious from this list, the rural districts which are usually the more challenged with a greater burden of disease and also a lack of access to health services, are the districts that have the fewest specialists! This level of inequity must be corrected and we are committed to doing so.
This gives us a total of 172 appointments made of a possible 364 or 47% of posts filled. As you can see you are the first cohort, pioneers in this field!
I am providing these statistics only for illustrative purposes to show the districts where we have done well and those where we have thus far struggled to fill positions. For those districts that as yet have no members of the team or very few we will have to find innovative ways of recruiting these specialists. We are exploring a number of options in this regard, including appointing specialists in acting capacities and having contracts with medical schools.
When I conceptualised the District Clinical Specialist Team idea, it was to strengthen primary health care and the district health system. As you know these teams form part of the three streams of Primary Health Care(PHC) re-engineering. The other two streams are the municipal ward based PHC outreach teams which will be composed of a professional nurse and community health workers as well as the new school health programme.
As part of the ward based PHC outreach teams we have re-oriented more than 5 000 community health workers and another 5 000 are in the process of being re-oriented. The teams will be responsible for a catchment area and visit every household. Their primary roles are prevention and health promotion in both families and communities. These teams will assist us in early identification and referral and also focus on improving adherence to treatment and care. They will work closely with other community based workers, including home based carers employed by the Department of Social Development.
With respect to the school health programme, which will be launched in October, we will be taking services to schools using mobiles. We will have a set of three mobiles that will visit schools. This includes a mobile that will provide a comprehensive set of PHC services, a fully equipped dental mobile as well as a mobile that will provide optometry services. We will provide more details on the school health programme which we developed with the Department of Basic Education at the launch.
Let me turn now to the work of the District Clinical Specialist Teams (DCST). As we pointed out in the adverts which you all reacted to, your key functions will include:
- Getting to know the district that you will work in: this means getting to understand the demography, the disease trends, the major causes of mortality, as well as the availability of health services in terms of both coverage and quality
- Providing strategic leadership and support to the district with particular emphasis on maternal and child health
- Providing clinical leadership and mentorship to ensure that doctors and nurses especially are adequately trained and supervised.
- Clearly this will require close attention to detail, especially the use of routinely collected data to monitor the various programme areas so that appropriate and early action can be taken to mitigate any clinical risks that may arise.
Practically, this means visiting facilities, doing clinical audits, observing clinical practices, conducting morbidity and mortality reviews (or at least reviewing the minutes of these meetings to see if the correct conclusions were reached and if appropriate action was taken to ensure that medical errors do not recur).
It is also clear that you will have a significant role to play in liaising with the district management teams as well as the school health teams and the ward based PHC teams. I would like these teams and the district management team to work as a single unit. The goal is to reduce maternal, infant and child mortality in each district as rapidly as possible.
In terms of accountability, each team will be accountable to the district manager administratively and clinically to the provincial specialists where these have already been appointed. Where they have not been appointed each province will ensure that there is a defined line of accountability. For example in provinces with a medical school, the teams will be accountable to the head of department. These arrangements will be finalised by the Head of the provincial Department of Health.
Head of Departments (HOD) and district managers, who are also present today, will need to ensure that the DCSTs have all the support that they need to do their work. This is why I also requested provinces to ensure that district managers also attend this induction so that they too fully understand how the DCSTs will operate and what their roles are in ensuring that this is a success.
As you may know the Health Data Advisory and Co-ordination Committee (HDACC), consisting of eminent statisticians, demographers and actuarial scientists, which we established to advise the Department on the life expectancy and mortality rates, reviewed all available data and reported the following data and targets for 2014:
- Life expectancy at birth was 56.5 years (54 for males and 59 for females) in 2009 with a 2014 target of 58.5 years;
- Under 5 mortality in 2009 was 56/1000 live births with a target of 50/1000 in 2014;
- Infant mortality of 40/1000 live births in 2009 with a target of 36/1000 in 2014;
- Neonatal mortality of 14/1000 live births with a target of 12/1000 by 2014; and
- Maternal mortality ratio of 310/100 000 in 2008 with a target of 270/100 000 by 2014.
As you can see from this data, they are much too high and significantly higher than the Millennium Development Goal (MDG) targets.
Clearly, you may not be able to do this alone! We recognise that there are many determinants of health and ill-health. This means that besides working as teams, each team will have to work with all the resources in the district, both those that are in the health sector and those that are outside our sector to ensure that we reach MDGs at least!
So in essence this is your task. Your task is to help the district that you are working in to reach the MDG targets by 2015 and beyond!
So in conclusion, may I say that the hopes of the nation to decrease neonatal, infant, child and maternal mortality rates and to improve the health of women, mothers and children in particular. Clearly the family physicians in the team together with the clinical PHC nurses will also focus on the general health of communities in the districts that you will be serving.
Be sure to consult with the communities that you will work for and with. This includes the leaders in these communities as well as health workers. You will need to lead, inspire and teach where necessary.
I am sure that you are all up to the task and that in a year’s time we will already see the results of your work. I, together with the MECs will be taking a very keen interest in your work and will be closely monitoring the impact of your efforts.
I wish to thank you for accepting these positions and the responsibilities that come with them and wish you good luck in your work.
I thank you!
