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SEDIBENG DISTRICT COUNCIL
Re-engineering Public
Health Care in Gauteng
28 February 2013
INTRODUCTION .
It has increasingly becoming apparent that the current
curative focused health system is not suitable in
South Africa, even though much has been done since
1994 to strengthen Primary Health Care and integrate
health services.
Therefore the Community Oriented Primary Care
(COPC) model was identified to address the above
challenges. The COPC is tailored and structured by
the Community Health Diagnosis.
BACKGROUND
The turnaround strategy of the Department of Health
has identified the improvement of quality of services
as a major priority in order to meet the health needs of
the public.
To give effect to the Minister of Health Dr. Aaron
Motsoaledi’s instructions and directives, Sedibeng
District in Gauteng Province took a lead to pilot the
Ward Based PHC Outreach model. The model was
launched in Sedibeng District at Boipatong area, one
of the twenty priority townships by MEC of Health Ms.
Ntombi Mekgwe on the 11th March 2011.
BACKGROUND CONT.
The central core of NHI is the re-engineering of PHC,
which consists of teams namely:
1. Ward Based PHC Outreach
2. School Health Services Team
3. District Clinical Specialist Team
Community Oriented Primary Care (COPC) which is
implemented through community Health Diagnosis
(CHD) is a continuous multi-levelled, holistic,
interventional and participatory epidemiology and
public health tool which aims to reach all individuals
and families and elicits their health needs.
Current status in Sedibeng District Council
c Sub-district Total
populat
ion
Uninsured
population
Municipal
wards
clinics CHC CDC Hospitals Satellite
clinics
Mobile
Units
Ward
Based
PHC
sites/t
eams
Emfuleni 825,
851
725, 190 45 19 4 2 2 0 5 12
Lesedi 89, 979 79, 256 14 8 0 0 1 0 3 0
Midvaal 87, 251 75, 908 13 3 0 1 0 0 4 3
Sedibeng
total
1, 007,
580
880,354 72 30 4 3 3 0 12 15
OBJECTIVES
• To improve quality of care i.e.
- Accessibility
- Compliance
- Promotion
- Prevention
- Primary Curative care
- Rehabilitation
• To reduce long queues and overcrowding at facilities
• To improve community participation
• To improve referral system
Sedibeng District Map
CURRENT STATUS
Sedibeng District PHC Ward Based Outreach report Sub-
district
No. of
teams
No. of
wards per
district
No. of
wards
covered
No. of
wards
sharing
PN
No. of
CHW
per
team
No. of
househo
ld
registrati
on
No. of
Home
visits
No. of
follow up
visits
No. of
supervis
ed visits
Emfuleni 12 3, 8,
28, 26,
21,39,
36
7 0 10x12
= 120 6158 20725 125 988
Midvaal
3
1 & 6
2
0
3x10
=30
20
2660
91
250
Lesedi 3 proposed
5, 11 &
12
3 proposed
0 3x10
=30
0 0 0 0
Sedibeng Ward Based PHC outreach
Sub-district No. of
5
years
seen
No. of
Home
based
Care
seen
No. of
ANC/Pre
gnancy
seen
No. of
PNC
seen
No. of
Patients
on
adheren
ce seen
No. of
referrals
from
each
HBC
No. of
referrals
to CHC/
Hospital
s
No. of
Social
workers/
Home
Affairs
referrals
No. of
referrals
to
Educatio
n Dept.
Emfuleni
6742
12848
428
288
1584
4855
451
95
14
Midvaal
460
175
85
40
229
55
37
30
5
Lesedi
0
0
0
0
0
0
0
0
0
Sedibeng District PHC Ward Based report Cont..
• Sedibeng District started in 2011 in different sub-
districts, currently has 15 PHC teams/sites. Health
Posts were established part with donations.
• Some more companies donating to build
structures(different)
• Emfuleni = 12 (wards big and vast, Boipatong CHC,
Empilisweni CDC, mobile points, Beverly Hills clinic,
Levai Mbatha CHC)
• Midvaal = 3 Wards covered
• Lesedi = 3 Proposed for roll out
2. SCHOOL HEALTH
• Sedibeng District has 10 teams which
comprises of retired Professional Nurses and
Enrolled Nursing Assistant per team. Each
facility has two teams – one for High Schools
and one for Primary Schools.
The allocation of the teams Sub-
district
No.
of
team
s
Attach
ed
facility
High Schools Primary Schools Quintile
schools
No. Vis
ite
d
enrol evalua
ted
referr
ed
No. Vis
ite
d
enrol evalua
ted
refere
ed
1 2
Emfuleni 2
2
2
Levai
Mbatha
Johan
Heyns
Empilis
weni
0
53
0
0
33
0
0
51094
0
0
17782
0
0
53
0
0
113
0
0
71
0
0
80227
0
0
27228
0
0
1444
0
51
21
Midvaal 2 Meyerto
n CDC
14 13 7319 474 1011 24 20 10069 5901 1628 10 2
Lesedi 2 Heidelb
erg
clinic
9 5 8120 556 24 18 73 6510 4279 255
Total 10 76 51 96806 37408 3327 61 23
District Clinical Specialist Team
• Sedibeng District established a District Clinical Specialist
team which was appointed in September 2012. The team
consists of the following members:
- PHC trained Nurse x1
- Paediatric Nurse x1
- Principal Obstetrician x1
ACHIEVEMENTS
• 38 Retired Professional Nurses in-serviced on PHC
• 320 CHWs trained on Ward Based PHC Outreach
• Increased number of PHC clinician nurses trainees
• Overcrowding and long queues at Mother Clinics reduced
• Decreased defaulter rate within covered Wards
• Detection rate for Chronic Disease has increased
• Increased detection of TB and HCT
• Increased utilisation rate due to increased access to
services (Boipatong from 2000 to 7000 consults/month)
• Improved nurse patient personal relationship 9complaints
reduced)
ACHIEVEMENTS CONT…
• Improvement of social justice to disadvantage households
• Increased distribution of assistive devises
• Creation of Health Teams and Clinical Teams
• Eradication of malnutrition in children in 2 Health Posts in
Boipatong
• Improved liaison with hospital services (continuity of care)
CHALLENGES
• Delay in the creation of professional nurses posts/ utilising
more retired nurses.
• Poor community participation maybe still very little
understanding by clinic committees
• Lack of understanding of the recruitment process of the
CHWs
• Lack of guidance in terms of contracting the CHWs
• Delayed training of the CHWs
Challenges
• Inadequate resources:
– Poor infrastructure with lack of access to basic
amenities like water, sanitation and electricity
– Lack of transport for visits
– No dedicated budget (perhaps the district needs to
budget)
• Different implementation process
• Incomplete DCST and the delay in appointing
RECOMMENDATION
• Community participation needs enhancement
• Creation of the required numbers of professional nurses
posts
• Support the process of increasing PHC nurses training
• Adjustment of Mother Clinics Budget to cater their Ward
Based PHC Outreach teams.
• Procurement of the needed vehicles
• Robust community engagement processes
• Engagement of political leader at different levels
• Coordination to be done by PHC
Midvaal: Mamelo and Bantubonke
Emfuleni: Eatonside and CHWs at work
Retired Sisters in consultation
Boipatong Health Posts
Health Post 1 Boipatong
Kitchenette
Interior of the health post
Food garden
CONCLUSION
“It is time for us to stand and cheer for
the doer, the achiever and the one who
recognises the challenge and does
something about it”