The future of the role of workplace wellness programmes in ...
Transcript of The future of the role of workplace wellness programmes in ...
05 May 2010
The future of the role of workplace wellness programmes
in South Africa's changing healthcare landscape
Introduction• Introduction
• Vision for EH&W in the Public Service
• Functional Pillars (Current Objectives)
• Process Pillar for Implementation
• Structure/Levels of Implementation in the Public Service
• RBM and related indicators
• 12 Components of a functional M&E system
• Futures use of evidence and strengthened theoretical underpinnings of interventions, evidence for policy development and programme efficiency (HIV Example)
Presentation Outline
Introduction• EHW policy environment and programm es in the Public Service
have rapidly transformed and linked to part of 10 point health plan (HR for health, HIV&AIDS etc.)
• The EHWSF was launched in November 2008 and four related policies approved for implementation in the Public Service with effect form 1st April 2010.
• The four policies form the Specific areas of focus as key components (objectives) of EHW to be implemented uniformly across the entire public Service
• Strategic influence of the WHO Global Plan of Action on Workers Health 2008-2017, the ILO Decent Work Agenda in Africa 2007-2015, WHO Social Determinants of Health 2008, and Existing Legislation
Introduction
VISION CRAFTING FOR EH&W
§ AIDS free Public Service
§Assessment, Identification and
Management of Occupational Hazards
and Risks
§Comprehensive Wellness and its Healthy
impact on Service Delivery
§ Health Education, Promotion and
Management in the work place
§Meeting Government’s Developmental Agenda
Healthy and Productive Public Servants as
individuals and as a collective
Enhanced Productivity in the Public Service as
a sector of the SA Economy
Integrating EHW Vision in Plans and Activities
STRATEGIC FOCUS AREAS
STRATEGIC INTENT
VISION FOR
EH&W
ELEMENTS OF EH&W VISION
Vision for EH&W in Public Sector
*
VISION FOR EH&WA Healthy, Dedicated, Responsive and Productive Public
Service
Occupational Health Quality of Work LifeResearch, Monitoring andEvaluation
Occupational Health Education and Promotion
Occupational Health and Safety Management
Individual Wellness Physical
Work life Balance
Organizational Wellness
Individual Wellness Psycho-SocialHuman Rights and
Access to Justice
Treatment Care and Support
Prevention
Injury on Duty & Incapacity due to ILL Health
Mental Health /Psychosomatic Illnesses
Disease Management and Chronic Illnesses
Environmental Management
Risk and Quality Assurance
HIV and AIDS & TB MANAGEMENT
Pillar 1
HEALTH and PRODUCTIVITY MANAGEMENTPillar 2
SHERQ MANAGEMENT
Pillar 3
WELLNESS MANAGEMENT
Pillar 4
4 KEY INITIATIVES FOR HIGH PERFORMANCE IN THE PUBLIC SERVICE THROUGH HEALTH AND PRODUCTIVITY MANAGEMENT
CORE PRINCIPLES INFORMING IMPLEMENTATION OF EHW STRATEGY
LEGISLATIVE FRAMEWORK AS A FOUNDATION
• Capacity Development (Individual)
• Individual Employees• Managers (General, HR)• EH&W Practitioners (Entry level EH&W and Multi-skilled, non-professional)• OMPs, ONHPs, Occupational Hygienists, Specialists etc. (Professionals,
Specialists)• Centers of Excellence (Institutional Infrastructure, Schools of Public Health, WHO
Collaboration Centers)
• Organizational S ystems Support Initiatives (w ithin the department)
• Tools for implementation (Generic Implementation Guides, Systems Monitoring Tools)
• Integrated HIV&AIDS &TB Toolkit• HIV&AIDS Costing Tool• Guidelines on Child Care Facilities in work place• Return to work guidelines for temporary to permanently disabled persons • M&E Tools• OHASIS, IFMS, HR Connect
Process Pillars
• Governance Initiative s (Inter Departmental/ Other Stakeholders)
• Inter Departmental/Steering Committees• Network for Technical Expertise (NIOH, DoHE, Schools of Public Health)• Public Sector Summit agreements on Improvement of Working Conditions
(PSCBC Endorsement)• NEDLAC (National HIV&AIDS Work Place Plan)• Inspectorate/ PSC (DoL, PSC)
• Economic and Devel opment Initiatives ( AU, SADC, Bi-National, UN, ILO, WHO)
• Country Reports (UNGASS, SADC Prevention Report, ILO Recommendation on HIV&AIDS and World of Work)
• WHO Modules on Occupational Health (NIOH, University of Illinois)• Piloting of OHASIS In DoH and DoE (University of British Columbia, DOH)• AU (Africa Peer Review Mechanisms)• SADC (Simultaneous Mainstreaming of HIV&AIDS) Gender, Disability, Youth
Development into Public Service and Administration)
Process Pillars
HIV&AIDS
MANAGEMENT
Reduce Burden of Disease Enhance Productivity
inPublic Service
Provincial Coordination of Programme Implementation, M&E and Province specific
Impact assessments.Provincial Capacity Building
(HRA) anticipating, recognizing, evaluating and Controlling
health hazards in the Public Service toprotect employee
health and well-being and safeguard
the community at large
Implementation of HRA by an approved
Entity and Implementation of Controls(engineering, administrative &personal protective equipment
HEALTH & PRODUCTIVITYMANAGEMENT
SHERQWELLNESS
MANAGEMENT
Comprehensive identification of
psychosocial health risk, and use of evidence based
practices to ensure individual and
organizational wellness
Reduce Number of Infections
Reduce impact on Individual Employees, families, communities
and Society
•Macro level Governance
•National Institutions
•Meso level Governance
•Provincial Institutions
•Micro level Governance
•Depts & Institutions
•Policy, Implementation Guide, M&E and Impact Assessment Framework .Mainstreamed Public Sector Response to NSP 2007-2011. National Steering Committee& SANAC coordination
•Frameworks for Estimation of Disease Burden, Policy Implementation M&E, ImpAs. National Steering Committee Coordination. Coordination of National Flue Pandemic Preparedness Plan
•National Policy Framework and OHS Standards guided by legislation and SABS
•Coordination by Steering Committee
•Comprehensive Policy covering (EAP and WLB & Wellness)
•Coordination by National Steering Committee
National Frameworks for delivery
Provincial Frameworks for delivery adapted for Prov. customs & trends
Departmental Framework& Processes
•Provincial Coordination of Programme Implementation, M&E and Province specific Impact assessments.
•Provincial Capacity Building
Provincial Coordination of Programme Implementation, M&E
and Province specific Impact assessments.
Provincial Capacity Building
•Implementation of Costed, Mainstreamed, Comprehensive, HIV&AIDS dept. specific Programs. As part of EHW Committee and Plan
Provincial Coordination of Programme Implementation, M&E and Province specific
Impact assessments.Provincial Capacity Building
•Departmental Surveys Registries of Exposure to Risks, Injuries and Diseases. Early Detection and reporting diseases within legal framework Health Education, Promotion Treatment Support
•Wellness (EAP+WLB) Program Planning and Implementations Based on Id of risk for individual and organizational wellness
PILLAR 1 PILLAR 2 PILLAR 3 PILLAR 4
Levels of Implementation-Possible SPS Implications
Project / Program LevelPopulation
Level
Resourcese.g.
FinanceStaff
Drugs, Supplies
Equipment
Functions,Activities
e.g.TrainingLogistics
IEC
Servicese.g. Facilities offering
ServiceTrained staffUtilization:New clients
Return clients
Intermediate
e.g.HIV+ on ART
ART Adherence
Inputs Processes/Activities Outputs Outcomes Impact
Long-terme.g.
Infection rateMortalityFertility
Results Based Management Approach Int RBM(2)
• Objectives are implemented through 4 Policies
• Each Policy has strategic objectives of its own (e.g. Prevention of HIV&AIDS)
• Each Objective has pol icy measures (e.g. reduce vulnerabil ity to HIV infection - Evidence based )
• All Policies have Implementation guide with RBM Modelwith indicators of input, process, output, outcome and impact.
Indicators and Measures
*Step 1:Conduct stake holder review
Implementing Cycle for EHW
Step 2:Design Conceptual Framework
Step 3:Design StrategicFramework
Step 10:Annual PerformanceReview Reports
Step 4:Design guidelines toImplement Step by step
Step 5:Annual PerformancePlans
Step 6:Monitoring and Evaluation Tools
Step 9:Annual INDABAConference
Step 8:EHW Steering Committee
Step 7:
Quarterly Reviews
Legal and Political mandate
Implementat ion Cycle
12 Components of an Effective M&E System
• Programmes
• People reached with services
• Behaviours change
• Fewer new infections/injuries/ diseases
Theory of change (traditional)Future: Towards Better use of evidence and
understanding of disease and health promotion -HIV&AIDS Example
Theory of Change (traditional)
• HIV is an infectious disease• Basic measure of spread is the
number of secondary infectio ns from one primary infection (index case)
• R0 = βcD– β probability of transmission per contact
– c number of contacts with infected persons per time unit
– D duration of time infected
Theory of change (suggested new)Theory of Change (suggested new)
• Reduce β, c, or D– Cannot reduce D (in fact, ART increases survival time and thus
increase the number of years an individual lives with HIV, and thus increase the duration of infection (D))
• Therefore, we need to reduce β (transmission rate) or c ()in order to reduce Ro
• HOW?– Reduced contacts with inf ected persons– Reduced risk of infecti on, if contact has taken place
THEREFORE….….
To reduce new infections from an index case (i.e. to reduce Ro), we need to ei ther
Theory of change (traditional)New Prevention Paradigm
Better use of evidence for policy consideration
• What constitutes ‘what works’ in prevention ?
• Different levels of evidence – at the individual, research setting and population levels, ranging from…
– Randomized control trials – higher incidence in control arm than in intervention arm: can estimate infections averted
– Modeling of number of infections averted by specific programmes – e.g. male circumcision and PMTCT
– Estimation of infections averted by comparing with results from unlinked prevalence surveys
– Move away from traditional theory of change, with ‘guesses’ that the one will lead to the other
– Quasi-experimental designs– Laboratory testing (e.g. condoms)
• What may be effective at the individual level, may not be efficacious at the population level
Better use of evidence of interventions that work
– At individual level: 60% efficacy at individual level (research data, empirical data)
– At population level: 4 circumcisions needed to avert one new infection (modeling data – see next slide)
– At population level: Evidence based Communication to avert risk compensation, and to encourage multiple interventions
Better use of evidenc e of interventions that work- Male circumcision example
51.2
25.6
12.8
6.4
3.2
1.6
0.8
0.4
0.2
0.1
Number of circumcisions needed to avert one HIV infection
Source:Williams et al, 2006
SwazilandBotswanaZimbabweZambia
Malawi
South AfricaLesotho
TanzaniaMozambique
Better use of evidenc e of interventions that work- Male circumcision example
• Cost-effectiveness (the choice of the mix of interventions – averting the most infections) – are we doing the right things?
• Technical efficiency (the delivery of prevention services at least cost) – are we doing them right?
• Targeting (the choice of the mix of target populations) - are we doing them to large enough scale focusing on the most appropriate populations?
Source: Bertozzi, et al. 2008; and Rugg et al, 2005
Future consideration of other dimensions of Programme Efficiency
• EH&WSF and Policies approved ad currently being implemented across all departments
• Implemented as part of HRMD
• 4 Priorities based on current evidence of what are the major pri orities
• Results based methodology guides implementation
In Conclusion