07 July 2011

EFFECTIVE EMPLOYEE HEALTH AND WELLNESS PROGRAMME-

HCT Service Delivery Model

SABCOHA CONFERENCESun City –N.West

Ms Morero E. Leseka

Introduction

DPSA context for the HIV&AIDS response and HCT

• Coordination of HIV&AIDS and TB responseDPSA is responsible for the coordination of HIV&AIDS and TB

response activities within the Public Service and to monitor, evaluate and report on such responses to SANAC

• Policy pronouncements• HIV&AIDS and TB Management in the Public Service-with

HCT as an entry-point to treatment care and support

Introduction...3

• The burden of HIV&AIDS and TB in the Public Service

• HIV Prevalence was 17,8% among those aged 15-49 years with the prevalence being higher in women 25-29 years and men aged 30-34 years (UNAIDS:2010; HSRC:2008

• These are the age groups which are likely to dominate the Public Service world of work.

Key Health Trends• The Key Health trends reported by GEMS

– TB and HIV related claims among the top 10 cost drivers

– Public Servants accessing treatment at a very advance stage of HIV infection, resulting in poor treatment outcomes

• Several research studies – 12,7% prevalence among educators (ELRC:2005)– Lower income and non-professionals had higher

prevalence rate than in higher income and professional groups

– The latter findings same in Health and in Correctional Services

*

VISION FOR EH&WA Healthy, Dedicated, Responsive and Productive Public

Service

Occupational Health Quality of Work LifeResearch, Monitoring and Evaluation

Occupational Health Education and Promotion

Occupational Health and Safety Management

Individual Wellness Physical

Work life Balance

Organizational Wellness

Individual Wellness Psycho-SocialHuman Rights and

Access to Justice

Treatment Care and Support

Prevention

Injury on Duty & Incapacity due to ILL Health

Mental Health /Psychosomatic Illnesses

Disease Management and Chronic Illnesses

Environmental Management

Risk and Quality Assurance

HIV and AIDS & TB MANAGEMENT

Pillar 1

HEALTH and PRODUCTIVITY MANAGEMENTPillar 2

SHERQ MANAGEMENT

Pillar 3

WELLNESS MANAGEMENT

Pillar 4

4 KEY INITIATIVES FOR HIGH PERFORMANCE IN THE PUBLIC SERVICE THROUGH HEALTH AND PRODUCTIVITY MANAGEMENT

CORE PRINCIPLES INFORMING IMPLEMENTATION OF EHW STRATEGY

LEGISLATIVE FRAMEWORK AS A FOUNDATION

Policy Objectives:

• To provide HIV&AIDS and TB Prevention

• To provide Treatment, Care and Support for those infected and affected by TB and HIV infections

• To manage compliance to Human and Legal Rights; and

ensure access to Justice

• To ensure Monitoring, Research and Surveillance on HIV&AIDS and TB

Presentation Outline HIV&AIDS AND TB MANAGEMENT

• Poor HCT Uptake against the set targerts (14%) 86 324 vs 637 000.

• Low reporting rate from entities (58%

national and 87 % Provincial)

• Poor data quality

• Non compliance to reporting templates

Challenges for EH&W- an HCT Perspective

Project / Program Level

Efficiency

PopulationLevel

Effectiveness

Resourcese.g.

FinanceStaff

Drugs, Supplies

Equipment

Functions,Activities

e.g.TrainingLogistics

IEC

Servicese.g. Facilities offering

ServiceTrained staffUtilization:New clients

Return clients

Intermediate

e.g.HIV+ on GEMS

Disease Management

Inputs Processes/Activities Outputs Outcomes Impact

Long-terme.g.

Infection rateMortality

Disability and attrition

Results Based Management Approach Int RBM(2)

• Base line (Before HCT)- did not exist• Process:

– Policy Implementation Readiness Assessment and EH&W System Monitoring Tool

- HCT Operational Planning - HCT M&E Plan – Result Framework– Training and Workshops– Resource Mobilization– Partnerships with GEMS et al.

HCT as an example (Efficiency issues)

• Base line (Before HCT)- did not exist• Outputs:

– HCT Coverage – 58 % estimates from reporting rate ( National 58% and Provinces 87%)

– HCT Uptake – 14 % of the set target– TB screening rate – 19%

• Outcome Evaluation- Change in attitude and behavior

• Impact (Evaluation)- IHRA

HCT as an example (Efficiency issues)

• Is at developmental stage• Goal- Improve Coverage and Uptake of

HCT services• Coverage-

– service broadly available and accessible beyond workplace (site) and outside working hours (time)

• Uptake- – more employees consume HCT services

Improving HCT Service Delivery Model

Process:• DPSA sign MoU with SAMA to implement

HCT intensification project beyond June 30th

• Technical Task team formed comprising DPSA, GEMS, DOH and SAMA ( discussions to include other Public Sector Unions vs bilateral engagements)

• TOR developed to define individual responsibilities

Service Delivery Model…2

New opportunities:• DPSA will mobilize its employees to know

their HIV status• Negotiate options of testing in the

workplace and/or at the General Practitioner’s Network of SAMA

• A referral form will be issued for those choosing option 2

• Those not covered will be encouraged to join GEMS

Service Delivery Model…3

SAMA• Mobilize their GP-network to participate in

the Project• Provide free HCT services and screening

for other non-communicable diseases to employees and their dependents via the GP-network

• Document services offered and report to DPSA

Service Deliver Level…4

DOH• Provide diagnostic packs and condoms to

the GP’s under the project• Provide technical support and HCT

guidelines as required• Support monitoring and evaluation at local

level where possible• Include the Workplace HCT indicators in

the DHIS

Service Delivery Model…5

• Increased no of facilities where employees and their dependents can go for screening

• Increased number of hours available for employees to access the services

• Standardized reporting and referral tools between GP’s and Public Service

Anticipated HCT Intensification Outputs

• Improved tracking of HCT uptake, from members of other medical aid schemes and accurate HCT data.

• Reduced chances of loss to follow-up, and improved linkage to care and support

• Ongoing documentation of best practice for possible roll-out of the model

Anticipated outputs…2