2012/13 sahr overview

2012/13SAHR

OverviewRené English,

Ashnie PadarathSAHR Launch

2 April 2013

Acknowledgements

Co-editor – Ashnie Padarath

Authors

Overview of presentation Introduction

Theme of 2012/13 SAHR

Overview of chapters

SAHR 2012/131995 1996 1997 1998 1999

2000 2001 2002 2003/04 2005

2006 2007 2008 2010 2011

• First launched on 4 October 1995

• SAHR 2012/13 - 16th edition

Introduction Repository of information on prevailing

public health issues Widely used by policy and decision

makers, academics, media and inform donor priorities

Flagship HST publication which is eagerly awaited each year, and widely accessed and referenced=>8,244 downloads for SAHR 2011 since launch in 2012

Context 18 years into democracy; 3 years into

new national health leadership: 10 Point Plan Negotiated Service Delivery Agreement PHC re-engineering Universal coverage

Aim: Strengthen and transform the public and

private health landscapes Overcoming ever-increasing inequities

Focus of 2012/13 SAHR

Health system

Building blocks of health system

Social determinants of health

WHO Building Blocks

Service Delivery

Health workforce

Information

Medical products, vaccines & technologies

Financing

Leadership / governance

WHO 2007. Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action.

Leadership

Health Workforc

e

Service Delivery

Health Financin

g

Community

ownership

Health Informati

on

Health technolo

gy

Research for

health

Partnerships for health

THE OUAGADOUGOU DECLARATION ON PRIMARY HEALTH CARE AND HEALTH SYSTEMS IN AFRICA

WHO AFRO 2010. The Ouagadougou Declaration on primary health care and health systems in Africa: achieving better health for Africa in the new millennium

Social construction of the health system

Systems ‘Hardware’

Human resources, medicines & technology,

organisational structure, service

infrastructure, information systems

Systems ‘Software’

Ideas and interests, relationships and power, values and

norms

Policy decisions

Social and political context

Sheikh et al. PLoS 2011. Building the Field of Health Policy and Systems Research: Framing the Questions

17 chapters Legislation and Financing Service Delivery Social and Environmental Determinants of

Health Leadership and Governance Medicines, Vaccines and Technology Emerging Public Health Practitioner

Awards Health information

Overview of each chapter

Health Policy and Legislation (Andy Gray, Yousuf Vawda, Caron Jack)

No new health-related legislation passed 2 Health-related Bills before Parliament

National Health Amendment Bill (Bill 24 of 2011) Office of Health Standards Compliance – independent structure outside of

the Department of Health Mental Health Care Amendment Bill (Bill 39 of 2012)

No progress in implementing Medicines and Related Substances Amendment Act (Act 72 of 2008)

Secondary Legislation Draft Regulations on Tobacco Control Amendment Act (Act 83

of 1993)

Review of primary, secondary and tertiary legislation - 2012

Health Policy and Legislation (Andy Gray, Yousuf Vawda, Caron Jack)

Statutory Health Councils Health Professions Council of South Africa South African Pharmacy Council South African Nursing Council Allied Health Professions Council of South Africa Interim Traditional Health Practitioners Council of South Africa

Telemedicine Intellectual property Suggests that cost of developing health legislation be

explored

Review of primary, secondary and tertiary legislation - 2012

National Health Insurance: The first 18 months (Malebona Precious Matsoso, Robert (Bob) Fryatt)

Intended to be phased in over a 14-year period

Will require significant overhaul of existing service delivery, administrative and management systems

Summary of the progress made and future plans to prepare for the NHI since the launch of the Green

Paper in 2011


Key feature Progress1. Legislative Processes White Paper Launch final NHI document Commencement of NHI legislative

processes

• Widespread consultation with many stakeholders.

• >100 submissions made to NDoH• MoH ‘road-shows’ to NHI districts

(15,300 stakeholders) • White Paper expected 2013

2. Management reforms and Designation of Hospitals

Regulations on designations of hospitals & Hospital management policy

Appointment of managers

• Regulations released in 2012• CEO Posts - 102/118 (86%) filled

3. Hospital Reimbursement reform Regulations Development of a coding system

• Various hospital reimbursement initiatives progressing

• Task Team to advise on diagnostic coding changes

• Case-based hospital payment system is being piloted in several hospitals

Key Feature Progress

4. OHSC Parliamentary Processes Appointment of Staff

• National Health Amendment Bill – national assembly to vote shortly

• OHSC established 2013• Inspectors appointed

5. Facility Audit and Quality Improvement Audited completed Facility Audit Teams Inspections by OHSC Initiation of certification

• 3,880 health facilities - completed

• Facility Improvement Teams (FITs) – NHI pilot districts; strengthen supervision of services, address identified problems; 1,000 facilities covered

• Inspectors recruited and trained • 171 facilities inspected (‘mock’)

against national standards atend Jan 2013; 80 planned in 2013.

• Inspection of 8 NHI pilot districts; 4 district offices



6. District Clinical Specialists Support Advertisement of posts Appointment Rotational scheme with academic institutions

• 3000 applications• 43% positions filled – Dec

2012• Induction and orientation

programmes underway (5 modules to be completed in 1 year)

7. Municipal ward-based PHC Agents Training 5000 PHC agents Appointment of agents Appointment of PHC teams

• 25% of 40,000 community health workers re-trained in new national approach to community-orientated PHC

8. School-based PHC services Database of school health nurses Identification of Q1 and Q2 schools Appointment of school-based teams

• New Integrated School Health Policy launched Oct 2012

• Database established• 30 mobile clinics

deployed; 60 being purchased



9. Public Hospital Infrastructure and Equipment 72 nursing colleges refurbished 6 Flagship Hospitals Refurbishment of public sector facilities

• Health and nursing infrastructure grants established

• >70 nursing colleges being refurbished

• Feasibility studies for major infrastructure projects in tertiary centres underway (5 centres)

• Pre-qualification – bidding for design work

10.Human Resources for Health Launch of the HRH strategy Increase supply of medical doctors and

specialists, nurses, pharmacies, and allied health professionals.

• Launched in Oct 2011• Norms and staffing needs

work started• Leadership and

Management Academy launched Oct 2012; Prepared for induction and training of new CEOs (Feb 2013)

• Increased doctors trained• Strategic Plan for nursing

education, training and practice – Feb 2013



11. Information Management and Systems Support Establish NHIRD (National Information Repository

and Database) Provincial and district roll-out Appointment of Information Officers and Data

Capturers

• Development of NHIRD commenced July 2011

• Provincial roll-out commenced in Feb 2012

• 2011/12 – 1,721 DC appointed + 550 Dec 2012

• 2012/13 – 503 will continue to work inn public sector; 900 added in 2013

12. Strengthen District Health Authorities Create NHI district management and governance

structures Selection of pilot sites Test service package Extension of pilots from 10 to 20 districts

• U Pretoria, Fort Hare and Harvard, NDoH – South African Executive Leadership Programme – 90 trained (Transformation and leadership in districts)

• Business Plans developed



13.NHI Conditional Grant to support pilot districts Piloting of service package Piloting fund administration

• Conditional grant established in Feb 2012

• R150 million made available to develop new systems and capacities

• Fund NHI business plan implementation

• Increased allocations in next years

• R5 million – revenue management and systems

14.Costing model Refinement of costing model Revised estimates

• Number of costing models comprehensive benefits presented

• NDoH and Treasury doing more detailed costing



15.Population RegistrationDeveloping partnerships for population identification and registration mechanism

• Dept Science and Technology and Council for Scientific and Industrial Research (CSIR), NDoH partnership – population enrolment for NHI and linkages to facilities

• Data from Home Affairs available

• Strategies for acquisition of a population register underway



Future Consultation and communication

Ongoing discussions to enhance relevance and responsiveness Harnessing cost-effective health technology

Cost-effective HT to be reviewed and implemented; with legislation

Making change happen Provincial Facility Improvement Project Managers; implementation

of business plans Building up our knowledge on what works

Monitoring and evaluation, and assessment “Experimentation, evaluation and expansion” – MoH, China

Retaining the focus on equity Must ensure that underserved benefit from reforms

Summary of the progress made to prepare for the NHI since the launch of the Green Paper in

2011

HIV treatment in South Africa: The challenges of an increasingly successful antiretroviral programme (Francois Venter)

Examines the political, policy, programmatic and other issues surrounding the initiation and expansion

of the ART programme.

Largest antiretroviral programme in the world and most people on treatment

3 politically-related era’s Pre-2004: ART not available in public sector 2004-2008: implementation >2008: new political dispensation; reorientation and

scale-up of programme

HIV treatment in South Africa: The challenges of an increasingly successful antiretroviral programme (Francois Venter)

Examines the political, policy, programmatic and other issues surrounding the initiation and expansion

of the ART programme.

Ongoing Challenges Cost and scale of programme Evolving treatment guidelines Integration of HIV with TB and antenatal services Failure of past and current prevention programmes Implications of adapting treatment as prevention

programme Poor medicines supply and service delivery systems -

can threaten ongoing expansion of the programme

Maternal, Newborn and Child Health (Lesley Bamford)

Overview of global and national commitments and strategies for MNC; reviews progress towards

implementing priority interventions

Overview of mortality rates and trends and causes of mortality

Despite unacceptably high rates of MNC mortality, a decline in under-5 and Maternal Mortality has been observed.

Mortality in children attributed to under-nutrition Increasing disparity between poorest and most

advantaged; interventions should be aimed at this group

Maternal, Newborn and Child Health (Lesley Bamford)

Priority maternal and child health interventions as outlined in the MNCWH&N Strategic Plan Highlights 56 essential interventions most likely to save lives An equity-focused approach is also recommended

Key challenges: Human resources Poor monitoring and evaluation systems How to adopt a more explicit equity approach Management of children with long-term health conditions

(health services)

Overview of global and national commitments and strategies for MNC; reviews progress towards

implementing priority interventions

Occupational health challenges facing the Department of Health: protecting employees against tuberculosis and caring for former mineworkers with occupational health disease (Shahieda Adams, Rodney Ehrlich, Nabeel Ismail, Zara Quail, Mohamed F Jeebhay)

Review of two occupational populations for which the NDOH has legal responsibility

Healthcare workers at risk of contracting TB – responsibility of state in terms of doctrine of duty of care, national policy and occupational health and safety legislation

Former mineworkers - medical surveillance and compensation for occupational lung disease due to hazardous dust exposure in mines

Occupational health challenges facing the Department of Health: protecting employees against tuberculosis and caring for former mineworkers with occupational health disease (Shahieda Adams, Rodney Ehrlich, Nabeel Ismail, Zara Quail, Mohamed F Jeebhay)

Review of two occupational populations for which the NDOH has legal responsibility

Healthworkers Despite global and local policies, statutory provisions and

local institutional frameworks for managing TB among healthcare workers – no uniform national strategy that actively supports TB risk management and limited active enforcement of current regulations exist.

Former mineworkers Failure of statutory examination and compensation systems

for occupational lung disease Institute measures to hold the mining industry accountable

for reducing the root causes of the epidemic and for legal, financial and managerial reforms of compensation systems

Citizen reporting on District Health Services (Kerry Cullinan)

Describes an innovative pilot project whereby citizen’s report on health conditions at the district level in order to

improve service provision

OurHealth pilot project – aims at reporting on and ultimately improving health conditions at district level

Started by Health-e News Service Based in 5 NHI pilot districts Collective action (“social accountability”) to improve

policymaker/service provider accountability Aims

Expose health issues and challenges Obtain reports from public sector health facilities users Hold district service providers and municipalities accountable

(conditions and services) Report on inspirational people and projects that improve the

health of ordinary people

Mainstreaming the social determinants of health in South Africa: Rhetoric or reality? (Laetitia Rispel, Sara Nieuwoudt)

Provide an analytical perspective on the discourse and action within the health sector with regards to SDH

Analysis of government health policy documents and budget speeches; interviews of 10 key informants (national and provincial)

Interviews explored: Knowledge of key global developments in SDH Has sufficient attention been paid to SDH over the past few

years in terms of improving population health and reducing health inequities?



Key issues - analysis of the budget speeches Institutionalisation of the NSDA (which is seen as a

mechanisms for encouraging intersectoral action) Recognition of the linkages between current disease

burden and SDH Existence of numerous intersectoral structures

SDH not consistently included



Ingredients for mainstreaming

Legislation and/or policy design and structural interventions High-level political stewardship and leadership Intersectoral collaboration in government Dedicated financial and human resources

Violence, alcohol misuse and mental health. Gaps in the health system’s response (Joanne Corrigal, Richard Matzopolous)

Discussion of the interrelationship between alcohol, mental health and violence

Continue the discussion for the need for better intersectoral collaboration and that violence, mental health and alcohol misuse are interlinked.

The interrelationship is underpinned by lack of strategy of the multi-directional links between the ‘triad’

Key gaps are Under-resourcing of the health system Under-detection and inadequate management of these

conditions within the healthcare setting Decreased access that results from a range of logistic,

cultural and knowledge related barriers Surveillance - key component in supporting the

identification and management of these

Chronic non-communicable diseases in South Africa: progress and challenges (Thandi Puoane, Lungiswa P Tsolekile, Sam Caldbick, Ehimario U Igumbor, Kashmeera Meghnath, David Sanders)

Describe current status and key drivers in SA; 5-year overview of local policies and practices

SA has shown commitment in that it convened a summit in 2011; Strategic plan is under development

Focus on ‘big four’, including risk factors Heart disease Cancer Type II diabetes mellitus Chronic obstructive pulmonary disease

Framed within risk factor/determinants Biological Behavioural Societal Structural/environmental

Chronic non-communicable diseases in South Africa: progress and challenges (Thandi Puoane, Lungiswa P Tsolekile, Sam Caldbick, Ehimario U Igumbor, Kashmeera Meghnath, David Sanders)

Describe current status and key drivers in SA; 5-year overview of local policies and practices

Presents list of population-wide interventions to promote healthy diet, physical activity, healthy environment, no smoking and harmful alcohol use.

Recommendations Multi-faceted, multisectoral approach Focus on policy responses to address structural environment Surveillance systems Research (surveys, cohort studies)

Public health impact of and response to climate change in South Africa (Jonathan Elliot Myers, Hanna-Andrea Rother)

Reflect on key concepts and the potential impact of climate change on health in the country

Link between climate change and health – increasing concern Pay attention to South African public sector responses to climate

change; presents a vocabulary on subject Present a set of barriers and enablers to climate change

interventions Underline the need for enhanced knowledge and understanding

of the impacts of climate change on health and on the existing burden of disease

Call for modelling of local climatological data; development of climate scenarios; transversal and cross-sectoral collaboration; and successful policy development

Dialogue between academics and public sector Universally there is agreement that it needs to be part of the

post-2015 agenda

The state of the national health research system in South Africa (Flavia Senkubuge, Bongani M Mayosi)

Economic returns can be envisaged when medical research is invested at country level

Global commissions have shown that health research is not given its rightful place in improving health, equity and development in LMICs

At least 2% of health budget be spent on research with donors adding at least 5%

Assessment of the performance of the national health research system as envisaged in the Health Research Policy

of 2001

The state of the national health research system in South Africa (Flavia Senkubuge, Bongani M Mayosi)

Challenges and recommendations for revitalising presented Increasing financial allocation Increasing funding to increase the number of relevant HR Investing in health research facilities and infrastructure Creating a national priority research fund to stimulate new

and innovative research and address key health system priorities

Developing a national regulatory framework Establishing a planning, coordination and translation of

research findings body Ensuring the institution of national mechanisms for M&E of

research is conducted in the country

Assessment of the performance of the national health research systems as envisaged by the Health Research

Policy of 2001

Health Policy and Systems Research: Needs, challenges and opportunities in South Africa – a university perspective (Marsha Orgill, Nonhlanhla Mxumalo, Woldekidan Amde, Ermin Erasmus, Uta Lehmann, Jane Goudge, Lucy Gilson)

Provides a higher education perspective on the growth of the field of HPSR

Seek to frame health policy and systems research within a broader research terrain

HPSR – addresses systemic challenges to improved service delivery; support implementation of priority programmes

Approach Comparative analysis of 3 HPSR groups in HEI Findings of pre-conference PHASA workshop

Health Policy and Systems Research: Needs, challenges and opportunities in South Africa – a university perspective (Marsha Orgill, Nonhlanhla Mxumalo, Woldekidan Amde, Ermin Erasmus, Uta Lehmann, Jane Goudge, Lucy Gilson)

Provides a higher education perspective on the growth of the field of HPSR

Asks? Why implementation fails? What guides implementation at service delivery levels Role and influence of power and politics and role of actors

other than technical capacity Recommends

More research with a systems focus required Large-scale domestic scholarship support – post-graduate

training Positions required in government for those with HPSR skills Increased longer-term funding

Crises, routines and innovations: the complexities and possibility of sub-district management (Soraya Elloker, Patti Olkers, Lucy Gilson, Uta Lehmann)

Exploration of the routines, activities, relationships that represent complexities and challenges of managing a sub-

district

Case study - sub-district based action learning project - focus on leadership and management

Uses systems thinking and management theory Focuses on intangible software and role in determining

behaviours of health system actors, and location of organisational practices and routines

Reflects on managing: Behind the frontline of service delivery Multiple actors Meeting and planning processes

Crises, routines and innovations: the complexities and possibility of sub-district management (Soraya Elloker, Patti Olkers, Lucy Gilson, Uta Lehmann)

Exploration of the routines, activities, relationships that represent complexities and challenges of managing a sub-

district

Three innovations for galvanising actors in the sub-district and for building capacity to improve routines and relationships are presented: developing pro-active management developing local service-improvement priorities generating local knowledge, priorities and action.

Preliminary signs of these innovation impacts are also presented

Competing demands, actors, existing organisational cultures and legacies undermine progress towards decentralisation – managing in ‘calculated chaos’

L&M training to be tailored accordingly

Medicines, selection and procurement in South Africa (Bada Pharasi, Jacqui Miot)

Focuses on medicines selection and procurement as presented in the 1996 National Drug Policy

Discussion on medicines selection in the private sector Medicine formularies and guidelines Selection of medicines - prescribed minimum benefits

Public sector Standard treatment guidelines Essential medicines list Role of pharmacy and therapeutics committees

Centralisation of medicines procurement Establishment of Central Procurement Agency 2011 NDoH taking over medicine tender management from

National Treasury Early gains perceived

Medicines, selection and procurement in South Africa (Bada Pharasi, Jacqui Miot)

Focuses on medicines selection and procurement as presented in the 1996 National Drug Policy

Emphasise Evidence-based medicine selection Pharmacoeconomics Budget impact analysis when selecting medicine Medicines supply chain management at district level to be

improved M&E and national review of National Drug Policy

Emerging Public Health Practitioner Awards The language barrier: the overlooked

challenge to equitable health care (Nadia Hussey)

Barriers to the implementation of tuberculosis infection control among South African healthcare workers (Oluwatoyin Adeleke)

Health and Related Indicators (Candy Day, Andy Gray)

Presents a comprehensive range of routine and non-routine data from a wide variety of national and international

sources

Demographic Socioeconomic Health services Health financing

SAHR 2012/13

Policy decisions Social and political context

Intangible ‘Software’Ideas and interests, relationships and power,

values and norms

Tangible ‘Software’

Management and knowledge skills

Organisational systems and procedures

Hardware

Hardware

LeadershipHealth workforceService deliveryHealth financing

Community ownershipHealth informationHealth technology

Research for HealthPartnerships for Health

Thank you

History forbids us to hope this side of the grave. Once in a lifetime the longed for tide

of justice can arise and hope and history rhyme (Seamus Heaney)

THANK YOU Please add contact details: Dr René [email protected]: 072 566 8713http://www.hst.org.za

mailto:[email protected]

2012/13 sahr overview

Documents

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