1. 1 District Health System Briefing to Portfolio Committee 16 August 2005 Dr Tim Wilson, Dept. of Health

2. 2 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

3. 3 Outline (cont) District Health Information System (DHIS) Use to plan, monitor & report Funding MHS Personal PHC Rural Health Strategy Plans for Directorate PHC

4. 4 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

5. 5 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

6. 6 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

7. 7 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

8. 8 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

9. 9 FUNDING

10. 10 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)

11. 11 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

12. 12 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 220330440550 Provinces: Personal PHC in metros 300550700 Provinces: Personal PHC in non-metros 300550700 TOTAL 22093015401950

13. 13 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

14. 14 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

15. 15 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

16. 16 PHC funding Requirements Initial 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

17. 17 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

18. 18 Rural Health Strategy

19. 19 Rural Health Strategy Goals 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

20. 20 Rural Health Strategy Actions 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

21. 21 Rural Health Strategy Draft 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

22. 22 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