HARMONY HEALTH: TB/HIV MANAGEMENT

STRATEGIES

Dr Bosele Ramantsi

25 October 2019

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DISCUSSION POINTS

About Harmony Health – South African operations

The health journey

TB/HIV Program – The journey

Program Strategies

Program Outcomes

Challenges

Conclusion

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83

•40 000 employees

•10 South African operations

HARMONY LANDSCAPE - SOUTH AFRICAN OPERATIONS

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84 HEALTH MODEL – THE JOURNEY

PAST

Reactive

Curative

Wait for employees to get sick

▪ Centralized team, reactive,

▪ Not integrated,

▪ Reactive and disease orientated

▪ Management by specialized

teams

Approach REACTIVECurative Hospital driven, centralised

occupational health and nurse driven

primary health care

PRESENT

Fit for work

Proactive-Current

Early detection and treatment of

ailments

▪ Health education

▪ Health awareness and promotions

▪ Disease management

▪ Disability management (at work)

Approach PROACTIVEPreventative one stop health hub / taking

health care close to 98% of employees

Employees back to work as soon as

possible

FUTURE

Fit for life

Resilience

Take responsibility for own health

▪ Employees initiating medical

assessments, health education &

testing

▪ Exercise, health eating, not

smoking, no substance abuse (eg

alcohol, drugs)

Approach RESILIENT EMPLOYEEOne stop health hub , extensive health

education and incentive programs

4Cure Diseases Wellness Disease Free & Fit

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85 EMPLOYEE IS OUR VALUABLE ASSET

Employee

PRODUCTIVITY

at a family level

PRODUCTIVITY

at personal level

PRODUCTIVITY

at work

PRODUCTIVITY

at a social level

Risk ID &

elimination

Beyond

compliance

Aligned

stakeholders

Informed

& engaged

employee

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86 EMPLOYEE HEALTH BEYOND COMPLIANCE

Medical

Surveill

ance

SafetyEAP Environ-

ment

Promotion

Prevention

Curative

Rehabilitation

PHCWellness

Occ

Hygiene

PILLARS

Addresses: Other health risks affecting the

employee and the workplaceAddresses: Occupational Health Risk

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Employee

Multi-disciplinary risk management

Leadership

Collaborations

Partnerships

Health Care packages

ComprehensiveIntegrated

Aligned with national and international

strategies

Health InterventionsPro-active

Focused

Evidence-based

Best-practice

Innovative

EMPLOYEE HEALTH BEYOND COMPLIANCE

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88 TB/HIV PROGRAM STRATEGY – THE JOURNEY

8Cure Diseases Wellness Disease Free & Fit

Current Proactive

2016 to current : with

HATS Manager

Past Curative

2009 and before:

TB / HIV Program

• Full collaboration with

Hygiene /

Environmental / HR /

Organised labour /

Community

• Comprehensive health

risk management

• Integrated Health

information Systems

Wellness Promotion

• Wellness promotion

environment

• Employee – driven

• Resilient employee

TB / HIV Program

• Focused on compliance.

• Dis-integrated ( Working in

Silos)

Health / Wellness

Promotion

• HIV Campaigns and

testing done by external

service provider

• Only provided statistics.

• No active follow up of

identified cases.

Past Proactive

2010 to 2015 : From

Hospital to HUBS

Health delivery model

• De-centralized teams from Hospital to HUBS.

• Pro-active and preventative approach

TB / HIV Program

• Incentive programs.

• Integrated TB and HIV services

Health / Wellness Promotion

• Campaigns run by dedicated teams internally.

• Follow up of all positive employees

Future : Occupational

and Societal- Behaviour

driven

HATS manager

• Program steward

• Align the program with NSP

• Training , coaching and

mentoring of clinicians.

• Capacitation of health and

safety teams

• Collaborations with internal

and external stakeholders.

• Monitoring and evaluation of

clinical outcomes and audits.

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89 STRATEGY - SERVICE DELIVERY MODEL

Employee

Free of

TB/HIV

Diseased

TB/HIV

Primary Prevention

: Remain Free of chronic diseases

• Promote health and wellness (Out reach

officers – Shaft, hostel, training centers and

community campaigns)

• Ongoing medical surveillance and risk

profiling - Annual HIV and TB Screening

• Early identification and intervention

• Contact tracing

• Compulsory HIV counselling.

• Voluntary testing.

• Occupational Risk management

Team

• HATS manager

• Health

coordinators

• Peer educators

• OMP

• Nursing

• Hygiene

• HR

Secondary Prevention

: Clinical disease management and

treatment

• Test and Treat

• Monitoring Compliance on medication

• Monitoring clinical progress - HIV

controlled and TB cured

• TB contact tracing

• Prevent complications and disability

Team

• HATS manager

• GP

• Nursing

• Pharmacists

• Social Workers

• Specialists

• OT

• Health educators

Controlled HIV and cured TB

Remain free of TB/HIV

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810 PROGRAM PILLARS

PILLARS Health Promotion and

awareness.

Disease Prevention

and risk management

Clinical Intervention

(treatment programs)

Continuous e-risk

profiling

OBJECTIVES • Health education

program

•E-learning

program and

regular

communication

Health and Peer

educator programs

•Occupational health

centres incl PHC

•Compulsory HIV

counselling (100%)

and voluntary testing

And referral

•TB contact tracing

•Medical surveillance

•Campaigns

•Interventions – Flu

Vaccinations, IPT

•Chronic disease

management

programs (HIV and

TB)

•Disease Risk

management

•Monitoring and

evaluation – In-depth

data analysis and

reporting

RESPONSIBLE

TEAMS

• HATS manager

• Health coordinators

• Peer educator

• NGO partners

• Dream – Health

Promotion

environment

•HATS manager

•OMP

•GP

•Nursing

•HATS manager

•Clinical team

•GP

•Nursing

•Social worker

•Pharmacists

•Case manager

•HATS Manager

•Business Analyst

•Health Risk Manager

•OH Data Quality

Officer

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811 KEY STRATEGIC INTERVENTIONS

1. Integrated HIV/AIDS, SILICOSIS & TB (HAST) policy alignment

2. Integrated Health Promotion initiatives

− Health

− Hygiene

− Safety

− Organised labour

− HR

3. Infection control measures

− Ventilation

− Personal hygiene

4. Intensified Health Promotion and Disease Prevention and Programs

- Revitalise Peer Educator Programme

− Improved IEC material and Health communication platforms

− Enhanced Contact tracing program

− Optimised Isoniazid Preventative Therapy for high risk groups

− Partnership with DOH on community TB/HIV outreach programs

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812 KEY STRATEGIC INTERVENTIONS

− Intensified employee education and training programs

− Review and improving TB “E-learning” and training material

− Capacitation of key internal stakeholders

- Employees – Traditional healers, religious leaders - Align and train to the DoH programme

- Organised labour – Regional structures Quartely meetings and reports.

- Workshops health and safety structures on occupational health issues

- Health and safety committee meetings

- Capacitation of safety officers and representatives – Workshops and training

- Occupational Hygienists – Joint OMP meetings – Topical health issues

- Environmental officers – Infection control program in liaison with DoH forum (Outbreak response)

- Leadership /Management – Capacitate executive and operational management (Dialogue), Business

reviews - monthly, quarterly and annually

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813 KEY STRATEGIC INTERVENTIONS

- External Stakeholder engagements

The role of the HAST MANAGER in this aspect is key -

- Understanding the South African context

- Harmony participates actively at the local AIDS (TB/HIV) Councils in Lejweleputswa, West Rand, Dr KK

Kaunda Municipal and Ngaka Modiri Molema Districts

- MOUs with the NW, FS and Gauteng Provincial DoH

- Collaborative relationships with district DoH

Private clinical stakeholders – HIV Clinicians Society

Non-governmental organisations

Masoyise Program participation

BENEFITS

- Participation at multi sectoral platforms where issues of TB HIV are dealt with at community level

- Partnerships with relevant stake holders – NGOs - Political

- Access to funded programs via DOH in different avenues – Training, research,

- Alignment and linkage of the TB/HIV programme activities and outcomes to the NSP

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814 STAKEHOLDER MANAGEMENT

SafetyS

Employee

HATS manager

Nursing

Health educator

Unit manager

GP

OMP

NIOH

Organised labour

DMR / MHSCDOH

INTERNAL

EXTERNAL

Operational

management

Executive

management

MBODMinerals

Council

TEBA

Medical

Specialists

Medical facilities e.g.

Hospitals, Laboratories

Peer educators

Hygiene /

Safety

HR Community Leaders / Municipality

NGO’s

Environmental

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815 MONITORING AND EVALUATION

DATA Management

• Data collection and input

• Data analysis and profiling

• Information dissemination

– within the Health facility/ Centre

- profiling helps identify “hot spots” within the Mine

- Statutory and Business Reporting

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Data quality

controller

DATA MANAGEMENT AND INFORMATION

Known

status: Pivot

On

treatment:

Pharmacy

scripts

Controlled:

Laboratory

indicators

Screening:

Tier.net/

Pivot

On

treatment:

Tier.net

Cure &

Success

rate:

Tier.net

Business

Analyst

Information

Information used for example• Monthly review• Monitoring of outcomes• Strategic Interventions

Health Risk Manager

HATS manager

Operational manager

Data base

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817 OUTCOMES - HIV MANAGEMENT

20%

32%

60%

73%78%

82% 82%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2013 2014 2015 2016 2017 2018 2019

Known status Target

2015 2016 2017 2018 2019

Known status 60% 73% 78% 82% 82%

On treatment 72% 71% 78% 80% 88%

Controlled 71% 70% 71% 73%

Target 90% 90% 90% 90% 90%

0%10%20%30%40%50%60%70%80%90%

100%

FY2005

FY2009

FY2012

FY2016

FY2017

Jun2018

June2019

On Treatment 318 4,255 4,066 4,520 5,295 5,596 6,582

Total Labour 46,598 37,316 33,935 25,861 26,478 26,009 31,607

Treatment % oflabour

1% 11% 12% 17% 20% 22% 21%

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

318

4255 4066 4,520 5,295 5,596

6582

886889

1,045 1268

1442

2,098 1,654

1,476 1,244

923

7050 7,063

7,816 8,108

8,947

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

2005 2009 2012 2016 2017 2018 2019

On Treatment Medical aid Not on treatment

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818 OUTCOMES - TB

18

3.0%

2.8%

2.0%1.8%

1.6%

1.9%

1.5%1.4%

1.1%0.8%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

3,024 2,776

2,019 1,834

1,620 1,887

1,524 1,366 1,063

841

-

500

1,000

1,500

2,000

2,500

3,000

3,500

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Tuberculosis Incidence per 100 000

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819 OUTCOMES - TB

78%

80%79%

86%87%

88%

90% 90%

70%

72%

74%

76%

78%

80%

82%

84%

86%

88%

90%

92%

2011 2012 2013 2014 2015 2016 2017 2018

Cure rate

72%

80%85%

91% 92% 93% 91%94%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 2012 2013 2014 2015 2016 2017 2018

Success rate

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820

HIV Adherence / Compliance to Treatment (interruptions) due to cultural beliefs / stigma /

denial

❑ HIV STIGMA

• Integrated chronic disease management team – All chronic disease are managed holistically by

the same team in the same clinic

• All consulting PHC PNs offer Provider Initiated Councelling and Testing

• Compulsory councelling station in the Occ Health

• Establish chronic support groups for all chronic disease

❑ CULTURAL BELIEFS

Involvement and participation of traditional healers during campaigns, form part of dialogues

Collaborations with DoH to train traditional healers/practitioners

Involvement of the social worker

❑ TRUST DEFICIT

• Non disclosure of medical information.

• Stigma – Fear of discrimination

Role of the MHSA Sec 13.3(a) / OMP – Independent practitioner

Stakeholder engagements

CHALLENGES

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821 ACKNOWLEGEMENTS

Teams behind the success stories

- Management

- Health teams

QUESTIONS?