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District Health System

Briefing to Portfolio Committee

16 August 2005

Dr Tim Wilson, Dept. of Health

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Outline of presentation

• Implementing Chap 5 of National H. Act• Clarify policy.

• Key role of District Health Councils

• Expand Municipal Health Services• Environmental Health Services

• District Health Plans• Planning guidelines

• Community & mid-level workers

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Outline (cont)

• District Health Information System (DHIS)• Use to plan, monitor & report

• Funding • MHS

• Personal PHC

• Rural Health Strategy

• Plans for Directorate PHC

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Chap 5 & Clarifying Policy(District Health System 2005: Annexure A)

• Vision for DHS in each health district

• Boundaries

• District Health Councils• Non executive. Monitor plans, reality, quality, etc

• District Health & HR Plans

• Providing MHS & Personal PHC

• Funding & overcoming fragmentation

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Expand Municipal Health Services (Environmental)

• Great deficit, esp. in rural areas• Water, sanitation & waste

• Cholera & typhoid & ?? • Health Care Waste

• Air pollution• Indoor & outdoor

• Pesticicdes• Community Service EHPs are available

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District Health Plans

• Planning guidelines approved by DG– Use DHIS data for 2003/04 & 2004/05

• nutrition, immunization, women’s health, STI, etc.

– A planning day in each district in Sept• Plans for 2005/06 & 2006/7 by 1 Oct 2005

– Health component of IDP• Link with IDP consultation process

• District HR planning guidelines • Tool developed. Need training & link to HR Plan

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Community & mid-level workers

• SA commitment to expand• Pharmacy & radiography assistants, medical

assistants, community-based rehab assistants• CHWs or Community Care Givers• Role of NPOs (often funded by provinces)

• Massive expansion in UK• Issues to be resolved

• Stipends / salaries. Career structures. Etc• Support & supervision

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DHIS

• Project to support DHIS in 2005/06

• Use own data for each district’s H Plan– List of indicators & suggested ranges– Some examples

• To improve quality of data– Managers must USE it– Will need on-going support

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FUNDING

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PHC Funding for:

• Personal PHC• Clinics & CHCs

• Community Health Workers & other Outreach

• Laboratories & other support services

• Environmental Health Services• Port Health, malaria, hazardous substances

• Municipal Health Services (MHS)

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BACKGROUND

• Have clarity on responsibilities• Personal PHC & 3 environmental …. Provinces

• Municipal (environmental) Services …Districts

• Consolidating services• Eliminating fragmentation & duplication

• Budget Council 3 Feb 2005• Additional funding from 2005/06 for provinces to

fund all personal PHC in non-metro areas

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Requests for 2005/06 & MTEF

2005/06

Adjust-ment B.

06/07

R million

07/08

R million

08/09

R million

District municipalites for MHS

220 330 440 550

Provinces: Personal PHC in metros

300 550 700

Provinces: Personal PHC in non-metros

300 550 700

TOTAL 220 930 1540 1950

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DMs: Funds for MHS

• Consolidate & expand preventive services• Especially in rural areas

• Prevent or limit outbreaks eg. Cholera, typhoid

• Avoid expensive admissions & treatment

• New EHPs available for community service

• Stop “war” about funding: LMs vs DMs • It is communities that suffer

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Personal PHC in metros

• Consolidate services: single management• By 2008, Eliminate duplication & fragmentation

• Seamless planning & services

• Community services, PHC facilities, hospitals

• If co-funding is to continue, need• Political decision

• Consensus at cabinet, PCC, Metro Councils

• If no consensus, provinces must fund

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Personal PHC in non-metro areas

• Severe & chronic under-funding• Inequity between provinces & between districts

• Some districts as low as R30 - R40 p.c. p.a.

• Strengthen services in clinics & CHCs• To realize rights to health care & dignity

• To protect hospitals from overcrowding & queues, unnecessary admissions, more expensive treatment

• Work in progress to quantify full deficit

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PHC funding RequirementsInitial results from HEU study

• Data on real expenditure from 37 studies– All costs converted to 2003/04 prices

• 84% PHC visits to clinics & CHCs– 16% to district hospital OPDs

• Average cost per visit (in 2003/04)

– R63 at clinic or CHC (IGFR R68 in 04/05)

– R232 at a district hospital

• Must strengthen CHCs – 24 hour services & access to doctors– Enable patients to get good services & not go to hospitl

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HEU study (cont)

• PHC utilization rate for uninsured– Currently 2.5

• Low by international standards

– Estimate needs to rise to 3.85

• To provide PHC package for all

• + VCT + care for HIV+ve people not on ARTs

• Must add costs of:– Municipal (most environmental) H. services

– Community Health Workers & other outreach

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Rural Health Strategy

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Rural Health StrategyGoals under discussion

Clear definition • Must be agreed across all depts and StatsSA.

• ? Metro, Other urban, Close rural, deep rural

– Access & EMS & drugs & consumables

– Referral system

– Community participation

– Staffing and support & supervision

– Accommodation & incentives

– District plan, + implementation monitored & reviewed

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Rural Health StrategyActions under discussion

• Develop agreed definition• Make rural areas more visible• Mobilize financial & other non-human resources• Train, recruit & retain human resources• Appropriate supervision & management support• Develop support systems• Focus on priority programmes• Develop partnerships• Mobilize academic & training institutions• Monitor & evaluate service delivery and progress

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Rural Health StrategyDraft Responsibilities

• Community responsibilities• Welcome & support & protect staff

• Mobilize community & serve on clinic committees

• District level responsibilities• District level staff

• District Health Council

• Provincial Responsibilities (Budget & support)

• Academic & Training …. & National

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Directorate PHC

• Budget allocated in 2005/06

• Restructuring of Dept has delayed advertising & filling posts– Advocates for front-line PHC staff– Good knowledge of reality– Practical support