PHC re-engineering: Challenges...Helen Schneider School of Public Health, University of Western Cape...
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Helen Schneider School of Public Health, University of Western Cape Building partnerships to implement community based health services in PHC, 20 Sep 2011 PHC re-engineering: challenges
Transcript of PHC re-engineering: Challenges...Helen Schneider School of Public Health, University of Western Cape...
Helen Schneider
School of Public Health, University of Western Cape
Building partnerships to implement community based health services in PHC, 20 Sep 2011
PHC re-engineering: challenges
Too hasty, less speed
National Service Delivery Agreement
2010-2014
Outcome 2: a long and healthy life for all South Africans Output 1: Increasing life expectancy
Output 2: Decreasing maternal and child mortality rates
Output 3: Combating HIV and AIDS and decreasing the burden of disease from TB
Output 4: Strengthening health system effectiveness
2000
1998
% of the population covered by health family teams – Brazil, 1998 –2009
0% 0 a 25% 25 a 50% 50 a 75% 75 a 100%FONTE: SIAB - Sistema de Informação da Atenção Básica
Brazil: PHC team coverage
2000 2002
2004 2006 2009
Not keeping the whole system in
focus
PHC re-engineering
Leadership &
partnershipStrengthen DHS
District based support teams
Programs
MCH specialist
teams
Hospitals Rehab
PHC package & team
Strengthen PHC
facilities
Community based services (household, community, schools)
ReferralSupervisi
onTransport
Appoint, induct and train teams
Train CHWs
Appoint school nurses
Information
PHC and District Health System
Uneven DHS implementation
Growing nursing crisis
Weak support/supervision, transport, drug
supplies, etc. etc.
Role of counsellors (CHW audit report)
Not keeping everyone on the same
page (or at least in the same book)
Other Municipalities
Other Provinces
National
Sphere
Provincial
Sphere
Local
Sphere
Provincial DoH
National DoH
Local Government DoH
Extra-
Governmental
NGOs
Private
Sector
Women
CBOs
Trade
Unions
Youth
Churches
PLWAs
Other
Provincial
Departments
Other
Local Govt
Departments
Other National
Departments
Municipal
Council
Provincial
Legislature
National
Legislature
Legislative
Executive
Committee
Cabinet
Executive
Council
Executive
HIV/AIDS
Programme
HIV/AIDS
Programme
HIV/AIDS
Programme
Other
Programmes
Support
Departments
Line
Managers
Other
Programmes
Support
Departments
Line
Managers
Other
Programmes
Support
Departments
Line
Managers
ClinicsHospitals
Hospitals
Clinics
Stakeholders
Provincial coordination
GP WC EC FS LP KZN NW NC MP SASA Incl
PEPFAR
Ratio 80 91 107 131 176 197 223 243 270 153 176
00
50
100
150
200
250
300
CH
W p
er
100,0
00 p
op
ula
tio
n*
Distribution of CHWs/100,000 population (un-
insured) (CHW audit 2011)
NPO-government coordination
0 50 100 150 200 250 300 350 400 450
KZN
N Cape
E Cape
N West
Mpumalanga
Free State
W Cape
Gauteng
Limpopo
Health related NPOs contracted to provincial governments (CHW audit, 2011)
(+1,700 NPOs contracted too provincial governments; +1,000 donor
funded)
Local coordination:
Terminology for CHWs in Khayelitsha
Abanalekeli
Care aids
Carer
CDC facilitators
Child Care Worker Coach
Community Care workers
Community carers
Community Health Advocate (CHA)
Community Health Care Workers
Community Health workers
Community workers
Counsellor
Educators
Facilitators
Field worker
Hlanganani Facilitator and Hlanganani Recruiter (based in Khayelitsha)
Home based carers
Home carers
Lay counsellors
Mentors
Peace workers
PTC
Student Volunteers
Trainers
Treatment Literacy and Prevention Practitioners
Volunteer
Youth Worker
Preventing unintended
consequences
Falling role of non-state actors
Short and long term roles of
NPOs:
Employment
Service delivery
Support systems
NPOs:
CBOs, national, international
Civil society
Unions
NGO network, Botshabelo, Free State
N=37
Botshabelo, Free State, pop +/- 175,000
Conflict rather than coordination
across sectors
Relationship of health sector strategy
To:
Home and Community Based Care, Dept
Social Development
Community Development Workers
Early Childhood Development…
Issues
Service delivery
Workers
M&E systems
Local operational challenges
Capacity building for:
Fomalisation, reorientation and integration of
community based services
Shift from a referral system to a proactive
approach to households
Strengthening support systems
Establish monitoring and evaluation systems
Preparing other services and providers
Thank you!
