THE JOURNEY SO FAR-PROGRESS
ON PHC RE-ENGINERING (WBOT)
Dr Khethisa Taole PHC Re-engineering Workshop
16 March 2015
School of Public Health
University of Witwatersrand
• Purpose
• Vision
• Mission
• Background
• Progress
• Challenges
• Wayforward
• Conclusion
PRESENTATION OUTLINE
• To present an overview on progress on
PHC re-engineering (WBOTs).
• To highlight challenges of implementation;
• To present way forward
PURPOSE
To improve health status through the prevention
of illness and the promotion of health lifestyles
and consistently to improve the health care
delivery systems by focusing on access, equity,
efficiency, quality and sustainability.
MISSION OF THE HEALTH SECTOR
• Internationally, Primary Health Care is being emphasized
increasingly (WHO, 2008)
• SA Health Sector Reform- Primary Health Care Re-
engineering, 2010
• Rwanda, Liberia, India, Brazil, Zambia-Strong Community
Health Orientation
• Need to invest in primary health care reforms
BACKGROUND
Update on Ward Based PHC
Outreach Teams Q3
Province
Number of team
needed (Based on
1500 households/
team norm)
Established
(Registered in DHIS)
up to Dec 2014
Number of Reporting
teams Oct-Dec (Q3)
2014
Reporting Rate (based
on teams needed)
Oct-Dec (Q3) 2014
Eastern Cape 1,125 781 525 47%
Free State 549 124 75 14%
Gauteng 2,606 303 199 8%
KwaZulu-Natal 1,693 160 70 4%
Limpopo 945 237 147 16%
Mpumalanga 717 95 43 6%
Northern Cape 201 348 242 34%
North West 708 87 42 21%
Western Cape 1,089 0 0 0%
Total / Av 9,633 2135 1343 14%
• Provincial Guidelines of the implementation of PHC re-engineering
streams including WBOTs;
• Training modules (Phase 1, Phase 11), supported by Foundation for
Professional Development.
• Developed and distributed monitoring and reporting tools:
• Supported the development of the CHW accredited qualification by
QCTO, due to commence in 2015.
• Continuous training and orientation interventions, supported by
BroachReach Health Care-OTL, CHW and ToTs.
PROGRESS….1
• There are 4,277 municipal wards in the country and according to
policy each municipal ward should at least have one Ward –base
Primary Health Care Outreach Team (WBPHCOTs).
• Presently, there are 2135 WPHCOTs and of these 1343 reporting on
the District Health Information System (DHIS).
• Piloted mobile technology in NHI pilots and trained 79 CHWs
• Draft CHW /WBOT Policy Framework, 2014?
• Initiated Rapid Appraisal of WBOT, ASLEPH, 2014
PROGRESS….2
• Shortage of Professional Nurses
• Attrition of health care personnel
• Inadequate poor reporting rates due to poor data
capturing capability
• Unsustainable budget allocation
• Number of Teams (4,277) vs Number of Teams
Needed (9,633)
• Norms: high income, urban residents versus rural,
sparsely populated areas
CHALLENGES
• Fastrack the implementation of the revised supervisory
model:• Enrolled Nurses
• Enrolled Nursing Assistant
• PHC facility supervisor/local health area manager
• Rationalise and synchronise information management
systems-reconfiguration of WBOT module on the DHIS
• Identify and orientate data capturers;
• Review population norm-CHW policy process underway
• High-level leadership to support budget allocation
• Ensure appropriate responses by district development
partners
WAYFORWARD
The delivery of health service through a Primary Health Care
approach remains the most cost effective way in promoting
health, preventing illnesses and saving lives thereby
improving health status and increasing life expectancies of
South Africans.
CONCLUSION