Understanding NHI Pilot and review of achievements so far

27-02-2014

Presenter: Dr. Uma Nagpalunagpal@nwpg.gov.za

NHI and what it means to common man• To provide improved access to quality health services for

all South Africans irrespective of their capacity to contribute.

• To pool risks and funds so that equity and social solidarity will be achieved through the creation of a single fund.

• To procure services on behalf of the entire population and efficiently mobilize and control key financial resources. This will obviate the weak purchasing power that has been demonstrated to have been a major limitation of some of the medical schemes resulting in spiralling costs.

• To strengthen the under-resourced and strained public sector so as to improve health systems performance.”

Understanding what is being pilotedObjectives relating to service delivery • Reduce high maternal and child mortality• Strengthen the performance of the public health

system• Strengthen the District Health System• To assess whether the District health service

package, PHC teams and strengthened referral system will improve access to quality health services - particularly in rural areas

• To assess ways of engaging private sector resources for public purpose.

Understanding what is being pilotedObjectives related to pooling and purchasing, with

implications for future funding of PHC:• To examine extent to which communities are

protected from financial risks by introducing a district mechanism of funding

• To test ability of districts to assume greater responsibilities - the purchaser-provider split

• To assess the costs of District Health Authority as contracting agency

• Implications for scaling-up throughout the country• To assess utilization patterns, costs and affordability

of implementing a PHC service package.

prerequisites to success of NHI• Improving the quality of public health care,• Lowering the relative cost of private care• Recruiting more professionals in both the public

and private sectors, and • Developing a health information system that

spans public and private health providers.• These reforms will take time, require cooperation

between the public and private sectors, and demand significant resources.

BACK TO BASICSWHAT NEEDS TO BE PILOTED

A defined service package of PHC services• Ward-based PHC outreach teams(WBOT)• District Clinical Specialist Support teams(DCST)• School health services• Sessional General Practitioners• Linkages to Emergency Medical Services.• A referral system to and from the district hospital.

Gate-keeping and compliance with the referral system need to be piloted.

BACK TO BASICSTwelve principles with which planners must comply in the

development of the District Health System: • Overcoming fragmentation • Equity • Comprehensive services • Effectiveness • Efficiency • Quality • Access to services • Local accountability • Community participation • Decentralisation • Developmental and inter sectoral approach • Sustainability

CHALLENGES

There are insufficient professional nurses, trained midwives and PHC trained nurses in the public health service to implement the re-engineered PHC system.”

Without large-scale leadership development activities which move beyond training, efforts to re-engineer PHC, improve quality or implement steps towards NHI will most likely achieve less than what is intended

Improving Health care infrastructurePhysical infrastructure: This includes • Clinics having adequate space, electricity and running

water• Hospitals with enough beds and working equipment• Roads and Vehicles to allow access to health care• Laboratory service for conducting basic investigationsHuman infrastructure of :• Appropriate staffing levels• Basic standard of clinical and public health competency • A level of morale, motivation and commitment to the

job.

Improving Health care infrastructureOrganisational infrastructure :that ensures, for

example, good working relationships between:• clinics and hospitals• nurses and doctors • provincial and local government and• for prevention of mother- to-child transmission in

particular, between maternal health programmes and HIV programmes.

Improving Health care infrastructure• Good health care infrastructure also means a

health system that allows multi- disciplinary front-line health workers to work as an integrated team to address the specific health needs of a particular area.

• A system capable of ensuring that the basic logistics of a health service, such as medicine supply and distribution, are in place.

BACK TO BASICS IN HIV & AIDS• The health system's response to HIV includes

more than just anti-retroviral drugs. There are many preventative strategies and vital treatment requirements for HIV patients, and good basic primary health care is in itself good for our HIV health sector programme.

• Emphasis on “prevention is better than cure” is required without undermining the need for ART that will improve the life expectancy and quality of life of our people living with HIV infection.

BACK TO BASICS• Tuberculosis is not only an opportunistic condition

of HIV but one of the most potent accelerators of the progression from infection to full-blown Aids while sexually transmitted infections are considered to be a potent co-factor for HIV transmission. And yet on neither front can we say that the health-care system is performing adequately. Despite improvements seen in the former we are far from the target. We should be striving towards the general implementation of mother-to-child-transmission prevention keeping equity high on the agenda.

HIV & AIDS BACK TO BASICS

• To prevent the spread of the epidemic through the promotion of safer sexual behaviour, adequate provision of condoms and control of STDs, promote male medical circumcision.

• to protect and promote the rights of people living with HIV or AIDS by ensuring that discrimination against such people is outlawed

• to use the mass media to popularise key prevention concepts and develop life skills education for youth in and out of school;

• to reduce the personal and social impact of HIV/AIDS through the provision of counselling, care and social support, including social welfare services for persons with HIV/AIDS, their families and the community; and

• to mobilise and unify local, provincial, national and international resources to prevent and reduce the impact of HIV/AIDS.

MCWH: BACK TO BASICS• Maternal, child and women's health (MCWH) services should be accessible to

mothers, children, adolescents and women of all ages, the focus being on the rural and urban poor and farm workers.

• MCWH services should be comprehensive and integrated.

• Individuals, households and communities should have adequate knowledge and skills to promote positive behavioural related to maternal, child and reproductive health.

• MCWH services should be efficient, cost-effective and of a good quality.

• Women and men be provided with services which will enable them to achieve optimal reproductive and sexual health.

• District health teams' capacity for monitoring and evaluating MCWH services will be built through training, and streamlining the health information system. The focus will be on the use of data at all levels, especially at the point of collection.

Nutrition programmes

• Nutrition programmes should be integrated, sustainable, environmentally sound, people and community-driven, and should target at most vulnerable groups, especially children and women.

• Nutritional well-being should be promoted and monitored within nationally-defined goals. There should be clear nutrition information strategy.

Improving Delivery of Health Care• This implies the need to move from one-size-fits-all

policies and plans to more appropriately targeted planning and upliftment of health care from the bottom up, rather than a top-down imposition of development.

• We also need to raise the technical level of debate through better analysis and understanding of resource allocation and the relative costs and benefits of different interventions within the health care system.

I THANK YOU