TSHWANE DISTRICT WBOT PRESENTATION

Presenter: Mrs Lekwetji Komane

Date: 9 November 2016

Burgerspark Hotel

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ECD KBS 2016 ©Lekwetji Komane

Introduction

Ward Based Outreach Team is one of the 4 streams of PHC Reengineering strategy that provides services to communities, families and individuals at community-based institutions and at a household level within a ward

WBOT serve as the cornerstone of community based PHC services and spearhead primary health activities, while providing links to referral networks, thereby helping to ensure the provision of services, care and support at local or municipal level.

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AIMS

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Strengthen the district health system (DHS) and do the basics better

Team approach including community health

workers (CHWs)

Improvement of health outcomes

Strengthening school health services

Ensures that outreach services are provided to communities door to door

Ward based PHC outreach team for each electoral ward

Benefits of WBOT

• Health promotion and preventive activities• Early diagnosis and referral of patients identified• Follow up of patients discharged from the Hospitals

different levels• Outreach into communities and homes of families

with family census• Early identification of individuals within families at

risk• Community involvement • Greater interaction with communities to get their

support

WBOT Structure

• WBOT Operational Manager per sub district

• Team Leader can be Professional Nurse or Enrolled Nurse

• Community Health Workers (CHW’s)

WBOT Team

Team Leader

CHW270

CHW270

CHW 270

CHW270

CHW 270

CHW270

WBOT Operational Manager

WBOT Structure

• WBOT DD

WBOT AD

WBOT OPS MANAGERS

WBOT OPS MANAGERS

WBOT OPS MANAGERS

WBOT OPS MANAGERS/CLUSTER

WBOT OPS MANAGER

TEAM LEADER TEAM LEADER TEAM LEADER TEAM LEADER TEAM LEADER

CHW CHW CHW CHW CHW

FACILITY MANAGERS

AREA MANAGERS AREA MANAGERS

Activities

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Team Leader allocate 250 to 270 households to CHW

CHW’s visits households as per allocated number

DOTS for TB patients

Monitor treatment compliance

Data collected from all family members using standardised tool

Data collected is analysed and intervention strategies put in place by the team

Activities

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Data is shared with the PHC facility

Delivery of medications

HBC

Follow up of PCR Pos Babies

Individuals are referred to different departments such as Social Department, Home Affairs

Awareness campaigns are conducted to address poor performance

Implementation of WBOT

• Community mobilization was conducted• Involvement of Ward councillors• Identification of Gov funded NGO’s• Appointment of Team Leaders• NGO management and CHW’s orientation• Mapping in the identified sites• Conducting institutional analysis• Allocation of 270 households to CHW• Training of CHW’s and Team Leaders data collection• 10 days training for CHW’s was conducted from April

2012 in partnership with FPD• CHW’s are in serviced on different topic in each site

Implementation of WBOT

• Tshwane District and City of Tshwane outreach programme are integrated

• Mapping was conducted and wards were shared by CoT and Tshwane

• An integration and Mapping document was compiled awaiting to be signed

• Institutional Analysis was conducted by Team Leaders

• Combined WBOT reporting since January 2015

Referral Route

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Community Based Health Services

Health related activities organized by community leaders community health workers and other community based workers

Community Health Centre / Clinic

Organization by qualified personnel of Community Health Activities and supervision of Health Clinics and Health Post

District Hospital

WBOT Expansion

Year Team Leaders Teams Wards

2011 7 7 9

2012 8 9 14

2013 18 24 33

2014 46 43 47

2015 ( August) 103 118 68

2016 (August) 243 243 72

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140

50

100

150

200

250

2011 2012 2013 2014 2015 ( August) 2016 (August)

7 8

18

46

103

243

7 9

24

43

118

243

914

33

47

6872

Team Leaders

Teams

Wards

WBOT Expansion from 2011 – 2016 (August)

Teams per Sub District

Sub District

Teams

1 86

2 31

3 28

4 14

5 10

6 57

7 17

Totals 243

15

160

50

100

150

200

250

1 2 3 4 5 6 7 Totals

86

31 28

1410

57

17

243

Teams per Sub District

Teams

Ward Coverage

Sub District Total Wards Wards Covered

1 28 23

2 12 10

3 23 13

4 11 2

5 3 3

6 23 16

7 5 5

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Ward Coverage

180

20

40

60

80

100

120

1 2 3 4 5 6 7 Total

28

12

23

11

3

23

5

105

23

1013

2 3

16

5

72

Total Wards

Wards Covered

Training progress 2013 -2015

19

481

977

2541

0 0

571

0

500

1000

1500

2000

2500

3000

3500

4000

2013 2014 2015

CHWs phase 1 CHWs phase 2 Target

CHW Competency Rate

20

321

214

79

18

970

752

156

62

0

200

400

600

800

1000

1200

CHWs Assessed Competent Re-Assessment Incompetent

76% passed ; 20,7% Re-exam ;04% Failed

2014 2015

WBOT Perfomance 2015 -2016

• Household Registration – 360,651

• Follow Up – 299,248

• Supervised Visit – 20,899

• Pregnant Mothers referred – 21,939

• Postnatal seen – 21,263

• Ref to Clinic – 95,464

• Ref Social Services – 155,176

• Vit A given – 53,773

• HCT – 41,620

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Narratives

• Total coverage 72/105 = 68.6 %

• Sub District 3 & 4 are the elite areas and thus not yet covered by teams

• Coverage of Disadvantaged areas is 89 %

• Wards covered are not entirely covered

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NUTRITION Target 201516 201617 (1ST Q)

Vitamin A dose 12-59

months coverage

(annualised) 50 % 36.5% 50.2 %

Antenatal 1st visit

before 20 weeks rate 70 % 46.7 % 57.2 %

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Improved performance

Improved performance through WBOT

240%

10%

20%

30%

40%

50%

60%

70%

Target 201516 201617 (1ST Q)

50%

36.50%

50.20%

70%

46.70%

57.20%

Vitamin A dose 12-59 months coverage(annualised)

Antenatal 1st visit before 20 weeks rate

Improved Performance

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• Vit A :

Training of CHW’s on Vit A , RTH Booklet and Administration of Vit A

Collection of Vit A from the PHC Facility

Provision of Vit A at household level

Submission of data to facility managers

Community awareness and campaigns

Improvement Performance

• Early ANC Booking:

History taking at household level

Identification of Pregnant mothers

Referral for ANC booking

Follow up of referred pregnant mothers per facilities

Comparison of referred vs those referred who booked at PHC facilities

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WBOT Intervention

• Identified challenges are addressed differently eg Referral to different department such as Home affairs, Social workers etc

• Health challenges can be addressed through awareness campaigns

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