SEDIBENG DISTRICT COUNCIL

Re-engineering Public

Health Care in Gauteng

28 February 2013

INTRODUCTION .

It has increasingly becoming apparent that the current

curative focused health system is not suitable in

South Africa, even though much has been done since

1994 to strengthen Primary Health Care and integrate

health services.

Therefore the Community Oriented Primary Care

(COPC) model was identified to address the above

challenges. The COPC is tailored and structured by

the Community Health Diagnosis.

BACKGROUND

The turnaround strategy of the Department of Health

has identified the improvement of quality of services

as a major priority in order to meet the health needs of

the public.

To give effect to the Minister of Health Dr. Aaron

Motsoaledi’s instructions and directives, Sedibeng

District in Gauteng Province took a lead to pilot the

Ward Based PHC Outreach model. The model was

launched in Sedibeng District at Boipatong area, one

of the twenty priority townships by MEC of Health Ms.

Ntombi Mekgwe on the 11th March 2011.

BACKGROUND CONT.

The central core of NHI is the re-engineering of PHC,

which consists of teams namely:

1. Ward Based PHC Outreach

2. School Health Services Team

3. District Clinical Specialist Team

Community Oriented Primary Care (COPC) which is

implemented through community Health Diagnosis

(CHD) is a continuous multi-levelled, holistic,

interventional and participatory epidemiology and

public health tool which aims to reach all individuals

and families and elicits their health needs.

Current status in Sedibeng District Council

c Sub-district Total

populat

ion

Uninsured

population

Municipal

wards

clinics CHC CDC Hospitals Satellite

clinics

Mobile

Units

Ward

Based

PHC

sites/t

eams

Emfuleni 825,

851

725, 190 45 19 4 2 2 0 5 12

Lesedi 89, 979 79, 256 14 8 0 0 1 0 3 0

Midvaal 87, 251 75, 908 13 3 0 1 0 0 4 3

Sedibeng

total

1, 007,

580

880,354 72 30 4 3 3 0 12 15

OBJECTIVES

• To improve quality of care i.e.

- Accessibility

- Compliance

- Promotion

- Prevention

- Primary Curative care

- Rehabilitation

• To reduce long queues and overcrowding at facilities

• To improve community participation

• To improve referral system

Sedibeng District Map

CURRENT STATUS

Sedibeng District PHC Ward Based Outreach report Sub-

district

No. of

teams

No. of

wards per

district

No. of

wards

covered

No. of

wards

sharing

PN

No. of

CHW

per

team

No. of

househo

ld

registrati

on

No. of

Home

visits

No. of

follow up

visits

No. of

supervis

ed visits

Emfuleni 12 3, 8,

28, 26,

21,39,

36

7 0 10x12

= 120 6158 20725 125 988

Midvaal

3

1 & 6

2

0

3x10

=30

20

2660

91

250

Lesedi 3 proposed

5, 11 &

12

3 proposed

0 3x10

=30

0 0 0 0

Sedibeng Ward Based PHC outreach

Sub-district No. of

5

years

seen

No. of

Home

based

Care

seen

No. of

ANC/Pre

gnancy

seen

No. of

PNC

seen

No. of

Patients

on

adheren

ce seen

No. of

referrals

from

each

HBC

No. of

referrals

to CHC/

Hospital

s

No. of

Social

workers/

Home

Affairs

referrals

No. of

referrals

to

Educatio

n Dept.

Emfuleni

6742

12848

428

288

1584

4855

451

95

14

Midvaal

460

175

85

40

229

55

37

30

5

Lesedi

0

0

0

0

0

0

0

0

0

Sedibeng District PHC Ward Based report Cont..

• Sedibeng District started in 2011 in different sub-

districts, currently has 15 PHC teams/sites. Health

Posts were established part with donations.

• Some more companies donating to build

structures(different)

• Emfuleni = 12 (wards big and vast, Boipatong CHC,

Empilisweni CDC, mobile points, Beverly Hills clinic,

Levai Mbatha CHC)

• Midvaal = 3 Wards covered

• Lesedi = 3 Proposed for roll out

2. SCHOOL HEALTH

• Sedibeng District has 10 teams which

comprises of retired Professional Nurses and

Enrolled Nursing Assistant per team. Each

facility has two teams – one for High Schools

and one for Primary Schools.

The allocation of the teams Sub-

district

No.

of

team

s

Attach

ed

facility

High Schools Primary Schools Quintile

schools

No. Vis

ite

d

enrol evalua

ted

referr

ed

No. Vis

ite

d

enrol evalua

ted

refere

ed

1 2

Emfuleni 2

2

2

Levai

Mbatha

Johan

Heyns

Empilis

weni

0

53

0

0

33

0

0

51094

0

0

17782

0

0

53

0

0

113

0

0

71

0

0

80227

0

0

27228

0

0

1444

0

51

21

Midvaal 2 Meyerto

n CDC

14 13 7319 474 1011 24 20 10069 5901 1628 10 2

Lesedi 2 Heidelb

erg

clinic

9 5 8120 556 24 18 73 6510 4279 255

Total 10 76 51 96806 37408 3327 61 23

District Clinical Specialist Team

• Sedibeng District established a District Clinical Specialist

team which was appointed in September 2012. The team

consists of the following members:

- PHC trained Nurse x1

- Paediatric Nurse x1

- Principal Obstetrician x1

ACHIEVEMENTS

• 38 Retired Professional Nurses in-serviced on PHC

• 320 CHWs trained on Ward Based PHC Outreach

• Increased number of PHC clinician nurses trainees

• Overcrowding and long queues at Mother Clinics reduced

• Decreased defaulter rate within covered Wards

• Detection rate for Chronic Disease has increased

• Increased detection of TB and HCT

• Increased utilisation rate due to increased access to

services (Boipatong from 2000 to 7000 consults/month)

• Improved nurse patient personal relationship 9complaints

reduced)

ACHIEVEMENTS CONT…

• Improvement of social justice to disadvantage households

• Increased distribution of assistive devises

• Creation of Health Teams and Clinical Teams

• Eradication of malnutrition in children in 2 Health Posts in

Boipatong

• Improved liaison with hospital services (continuity of care)

CHALLENGES

• Delay in the creation of professional nurses posts/ utilising

more retired nurses.

• Poor community participation maybe still very little

understanding by clinic committees

• Lack of understanding of the recruitment process of the

CHWs

• Lack of guidance in terms of contracting the CHWs

• Delayed training of the CHWs

Challenges

• Inadequate resources:

– Poor infrastructure with lack of access to basic

amenities like water, sanitation and electricity

– Lack of transport for visits

– No dedicated budget (perhaps the district needs to

budget)

• Different implementation process

• Incomplete DCST and the delay in appointing

RECOMMENDATION

• Community participation needs enhancement

• Creation of the required numbers of professional nurses

posts

• Support the process of increasing PHC nurses training

• Adjustment of Mother Clinics Budget to cater their Ward

Based PHC Outreach teams.

• Procurement of the needed vehicles

• Robust community engagement processes

• Engagement of political leader at different levels

• Coordination to be done by PHC

Midvaal: Mamelo and Bantubonke

Emfuleni: Eatonside and CHWs at work

Retired Sisters in consultation

Boipatong Health Posts

Health Post 1 Boipatong

Kitchenette

Interior of the health post

Food garden

CONCLUSION

“It is time for us to stand and cheer for

the doer, the achiever and the one who

recognises the challenge and does

something about it”