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KWAZULU NATAL DOH PRIORITIES

DR V MUBAIWA

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POVERTY SCORE : 2007 (Source PGDS)

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COMPOSITE SOCIAL NEEDS (Source PGDS)

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PROVINCIAL GROWTH AND DEVELOPMENT STRATEGY –

KZN VISION

KwaZulu-Natal, a prosperous Province with a healthy, secure and skilled

population, acting as a gateway to Africa and the World.

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VISIONOptimal health for all persons in KwaZulu-Natal

» MISSION» To develop and deliver a sustainable, coordinated,

integrated and comprehensive health system at all levels of care based on the Primary Health Care Approach

Paradigm Shift for staff and clients“NONE BUT OURSELVES”

Provincial Strategic Goals

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• An efficient and well functioning health care system with the potential to respond to the burden of disease and health needs in the Province.

1. Overhaul Provincial Health Services.

• Improved compliance with legislative/ policy requirements and Core Standards for quality service delivery in order to improve clinical/ health outcomes.

2. Improve the efficiency and quality of health services.

• Reduction of preventable/ modifiable causes of morbidity and mortality at community and facility level contributing to a reduction in morbidity and mortality rates.

3. Reduce morbidity and mortality due to

communicable diseases and non-communicable conditions

and illnesses.

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Strategic Outputs for Outcome 2: A long and healthy life for all South Africans

» Output 1: Increasing Life Expectancy

» Output 2: Decreasing Maternal and Child mortality

» Output 3: Combating HIV and AIDS and decreasing the burden of diseases from Tuberculosis

» Output 4: Strengthening Health System Effectiveness

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Strategic Outputs for Outcome 2: A long and healthy life for all South Africans

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NSDA Priority 1: Increase life expectancyAll MDG's

NSDA Priority 2: Decrease child &

maternal mortality

MDG 4 and 5

NSDA Priority 3: Combat HIV, AIDS,

STI & burden of disease from TB

MDG 6

NSDA Priority 4: Strengthen

health system effectiveness

Reduce HIV incidence

Manage HIV prevalence

Scale up integration of HIV and TB

Improve TB outcomes

Health care financing & management

Human resources for health

Quality & accreditation of health facilities

Health infrastructure

IT and Health Information systems

Revitalisation of PHC

Reduce Child morbidity & mortality

Reduce neonatal and maternal morbidity & mortality

Improve women’s health

Reduce non-communicable diseases

Prevent intentional/ unintentional injuries

Maintain strategies to prevent malaria & cholera

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Provincial Strategic Goals

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Strategic Goal Rationale

1. Overhaul Provincial Health Services.

An efficient and well functioning health care system with the potential to respond to the burden of disease and health needs in the Province.

2. Improve the efficiency and quality of health services.

Improved compliance with legislative/ policy requirements and Core Standards for quality service delivery in order to improve clinical/ health outcomes.

3. Reduce morbidity and mortality due to communicable diseases and non-communicable conditions and illnesses.

Reduction of preventable/ modifiable causes of morbidity and mortality at community and facility level contributing to a reduction in morbidity and mortality rates. 

PRIORITIZATION

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rational criteria include: » the extent of the disease burden; » the availability of interventions to alleviate this

burden; » the potential to reduce or alleviate poverty; » the cost (affordability) and cost-effectiveness

(value-for money) of available interventions;» the social, economic and political consequences of

failing to implement the interventions.

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Indicators Current Status Provincial Target for 2014/15

Life expectancy Male: 47.3 yearsFemale: 51.0 yearsStatistical Release P0302 Mid-Year Population Estimates 2009

70 years 70 years(National)

Maternal Mortality Ratio (MMR

210 per 100,000 live births National Confidential Enquiries into Maternal – 2008, Deaths 2004-2007 (KZN Data)

135 (or less) per 100,000 live births

Under-5 mortality rates 87.7 deaths per 1,000 (ASSA, 2010) AIDS Committee of Actuarial Society of South Africa

37 deaths per 1,000

Infant Mortality Rate 55,8/1 000 live births 18 per 1,000 (NSDA)

The TB cure rate 62.9% (output for 08/09 cases) 85%

Access to antiretroviral treatment.

74% (2010/11)APP 2011/12

90% of eligible people

New HIV infections National = 52 000 annually1 450 per day

Reduced by 50%.

Key Activities to Increase Life Expectancy {Output 1}

1. Improve clinical governance2. Respond appropriately to the burden of disease and

consequent health needs3. Manage HIV prevalence & decrease HIV incidence4. Strengthen HIV/TB integration5. Reduce and improve the management of non-communicable

diseases;6. Reduce and manage intentional & unintentional injuries;7. Reduce maternal and child mortality and morbidity8. Reduce TB incidence and Improve TB outcomes

Key Activities to Increase Life Expectancy {Output 1 - continued}

1. Reduce the incidence of cervical cancer2. Maintain preventative strategies for malaria control e.g.

malaria spraying coverage3. Prevention of illness and promotion of health4. Accelerate implementation of the integrated School Health

and Health Promoting Schools Programme.5. Strengthen Mental Health, Disability & Rehabilitative Care

and address substance abuse & violence6. Engage in Behavioural Change Campaigns for staff and

communities7. Enhance capacity within the Youth Ambassador Programme

for improved promotive and preventive activities

Key Activities to decrease Maternal Mortality {Output 2}

1. Social mobilization, civil society and engagement in Sukuma Sakhe (flagship programme ) to improve early booking, reduce teenage pregnancy (through the Contraceptive Strategy and youth programmes), improve low risk pregnancies and reduce morbidity and mortality

2. Increase access to safe delivery through establishment of basic emergency obstetric care (BEOC or MOUs) in key strategic areas

3. Improve the referral and transport by introducing dedicated or specialized ambulances for maternity and paediatric care

4. Scaling up Highly Active Anti-Retroviral Therapy (HAART) access for pregnant women by increasing capacity of PN to initiate ARV

5. Improving staff competency and skills and improving quality of clinical care through the introduction of mentorship teams including district obstetrician and paediatrician

6. Establishing waiting mothers lodges in all district hospitals7. Strengthen Mortality Reviews at Hospitals

Key Activities to decrease Child Mortality {Output 2 continued}

1. Implement community based Maternal & Child Health Framework

2. Integrate Sukuma Sakhe activities into Primary Health Care3. Back to the basics of GOBI-FFF through Sukuma Sakhe

(Growth monitoring; Oral rehydration therapy; Breast-feeding; Immunization; Family Spacing (planning); Female Education; Food Supplementation)

4. Establish a neonatal experiential learning sites and outreach programme per Area

5. Strengthen Mortality Reviews at Hospitals

Key Activities to decrease Child Mortality {Output 2 continued}

1. Implement community based Maternal & Child Health Framework

2. Integrate Sukuma Sakhe activities into Primary Health Care3. Back to the basics of GOBI-FFF through Sukuma Sakhe

(Growth monitoring; Oral rehydration therapy; Breast-feeding; Immunization; Family Spacing (planning); Female Education; Food Supplementation)

4. Establish a neonatal experiential learning sites and outreach programme per Area

5. Strengthen Mortality Reviews at Hospitals

Key Activities to decrease Child Mortality {Output 2 continued}

1. Improve neonatal facilities and care at all hospitals2. Scale up interventions for early detection of under nutrition3. Monitor implementation of the IYCF Policy adopted-focusing

on breastfeeding promotion (Infant and Young Child Feeding)

4. Scale up implementation of Integrate Management of Childhood illness

5. Improve immunisation coverage6. Reduce trends in morbidity affecting children

Key Activities for Combating HIV and AIDS and decreasing the burden of diseases from TB {Output 3}

1. Inter-sector collaboration for interventions in High Transmission Areas

2. Accelerate implementation of the National Strategic Plan (NSP) for HIV and AIDS – including new policy changes

3. Intensify the Voluntary Male Medical Circumcision Campaign4. Extend the HIV Counselling and Testing Campaign5. Scale up implementation of the Accelerated Plan for PMTCT

including early booking strategy for ANC.

Key Activities for Combating HIV and AIDS and decreasing the burden of diseases from TB {Output 3

1. Continue to implement the TB Crisis Plan2. Expand the Community management of MDR TB3. Strengthen TB ACSM (advocacy, communication & social

mobilization) to increase awareness in communities about TB4. Integrate TB DOTS support, surveillance for early detection of

TB, and follow up of defaulters into the activities of Sukuma Sakhe

Key Activities for Strengthening Health System Effectiveness {Output 4}

1. Implementation of the Community Based Model 2. Signed Negotiated Service Delivery Agreements 3. Align Provincial macro plans (within funding envelope) with the

NHS and MTEF priorities4. To finalise and implement the 2010-2020 Service

Transformation Plan5. Strengthen Governance Structures 6. Implementation of National Core Standards towards

accreditation of health facilities in preparation for National Health Insurance

7. Revitalisation of PHC services as per STP Implementation Plan (including Provincialisation of Local Govt clinics)

Key Activities for Strengthening Health System Effectiveness {Output 4 continued}

1. To continue with the Finance & SCM Turn-Around Strategy2. Review Performance Management Systems and outdated

Policies3. Improved Human Resource Management Services including

reconfiguration of organizational structure4. Decentralize appropriate delegations, controls and

accountability5. Develop and implement a Management Training Strategy

including succession training, mentoring and team building programmes

6. Strengthen collaboration with public, private and civil society entities, including Labour

Key Activities for Strengthening Health System Effectiveness {Output 4 continued}

1. Promulgation of the KZN Health Act (1 of 2009) Regulations2. Increase investment in Information, Communication and

Technology3. To deliver new clinical infrastructure in line with the STP and

approved Infrastructure Programme Implementation Plan (IPIP) as well as address Infrastructure backlogs

4. Revitalisation of EMS services 5. Strengthen Pharmaceutical Services6. Revitalise the Health Technology Services with a focus on

Telemedicine7. Regular engagement by MEC with District Managers

» National consultation processes for critical Policy areas.

» Strengthen dedicated capacity for critical functions.

» Develop focus on policy-making and resource allocation

» Decentralize operational functions within the context of clear National Policy Framework

Key Activities for Strengthening Health System Effectiveness {Output 4 continued}

CONCLUSION

» Keeping the collective healthy is complex

» Involvement of all stakeholders is crucial , to improve overall health outcomes of our people

» Members of our community have to take charge of their own health as “NONE BUT OURSELVES” are responsible

CONCLUSION continued

» Collective strategic leadership at all levels of service delivery is necessary

» Mechanisms will be in place to monitor the performance of Department to ensure accountability with appropriate incentives and sanctions instituted.

» The specific strategies for the four outcomes are comprehensive and ambitious but there is Political and Administrative will & commitment to realise Government’s expected outcome of “A Long and Healthy Life for All South Africans”