the state of academic health complexes: case studies from the western cape and free state faculties...

The State of Academic Health Complexes: Case Studies from

the Western Cape and Free State

Faculties of Health SciencesUniversity of Cape Town, University of the Free State, University of the Western Cape,

and Stellenbosch University

Recommendations (1)

• An inclusive process needs to be embarked upon to address the state of Academic Health Complexes in the interests of a sustainable health system which is able to train the professionals for all levels of care

• A national governance structure and an integrated framework funding for Academic Health Complexes are required

• A process to determine number of health professionals to be trained, the infrastructure and human resource requirements, and the funding enevelope

Recommendations (2)

• The proposed governance structures and funding mechanisms may be formalised through section 51 on ‘Establishment of Academic Health Complexes’ in the National Health Act of 2004

• Urgent intervention is required to address the crisis in Academic Health Complexes in the Western Cape, Free State, and other parts of the country

• Academic Health Complexes need to be treated as national assets rather than provincial liabilities

What is an Academic Health Complex?

• Academic Health Complexes consist of health facilities at all levels of care (primary, secondary and tertiary) and an educational institution working together to provide healthcare, to educate and train health care personnel and to conduct health research

• There are at least 9 such complexes which have developed around the following University Health Sciences Faculties: Cape Town, Free State, KwaZulu Natal, Limpopo, Stellenbosch, Walter Sisulu, Western Cape, Wits, Pretoria

Academic Health Complex concept

Academic Health Complexes have a central role in NDoH 10-Point Plan

1. Provision of Strategic Leadership and Creation of a Social Compact for Better Health Outcomes

2. Implementation of the National Health Insurance3. Improving the Quality of Health Services4. Overhauling the Health Care System and Improving its Management

a) Do a feasibility study for the establishment of a leadership academy for health managers

5. Improved Human Resource Planning, Development and Managementa) Review the accessibility and training output of academic health complexes

6. Revitalisation of Infrastructure7. Acceleration of Implementation of HIV & AIDS and STI National Strategic Plan 2007-2011

and Increase Focus on TB and Other Communicable Diseases8. Mass Mobilisation for Better Health for the Population9. Review of Drug Policy10. Strengthen Research and Development

a) Improve the research output, especially from formerly disadvantaged health training institutions

b) Review the research capacity of academic health complexes

What is the Mandate of Academic Health Complexes?

• To educate and train health care personnel– All the Academic Health Complexes are involved in

the production of human resources for health– These include nurses, doctors, pharmacists,

physiotherapists, clinical associates, and others

• To conduct health research – Research is a tool for improving health and health

care– The production of new knowledge, patents, and

other production contributes to the health and wealth of the nation

Joint Mandate

• Universities and Departments of Health share a joint mandate for the training of health care professionals and provide health services

• This relationship is governed by joint agreements that vary from institution to institution throughout the country

• There is a need for a uniform national framework to govern the joint mandate

What is the performace of the Academic Health Complexes?

Health Research: Types and Prioritisation

• Health research may be divided into laboratory (on animals or human tissues), clinical (on patients), epidemiological (on populations), and health systems (on the organised response to health and disease) components

• Priority setting is in terms of the Essential National Health Research process

The Mixed Fortunes of Health Research in South Africa

• Positive trends:– There has been an appropriate increase in

research focussing on primary health care– Appropriate response to the health priorities of

HIV/AIDS and TB

• Negative trends:– Neglect of injuries, chronic diseases and health

systems research– Persisting geographical inequalities– Falling outputs in clinical research– Ageing cohort of researchers

Lutge E et al. A Review of Health Research in South Africa from 1994 to 2007. In: Barron P, Roma-Reardon J, editors. South African HealthReview 2008. Durban: Health Systems Trust; 2008.

RESEARCH WITH A PRIMARY HEALTH CARE FOCUS IS INCREASING


RESEARCH ON HIV/AIDS IS DOMINANT


‘INEQUALITIES IN HEALTH RESEARCH CONTRIBUTE TO INEQUALITIES IN HEALTH’

RESEARCH OUTPUT IS FALLING IN CLINICAL CATEGORY OF HEALTH

RESEARCH

0

200

400

600

800

1000

1200

1400

1600

Clinical health 900 1099 1088 1170 1422 1334 1290 1374 1231 1084

Basic health 302 320 340 376 457 436 444 432 510 485

Public/community health 131 244 267 296 320 280 272 287 282 313

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Mouton & Boshoff 2008

SOUTH AFRICAN COHORT OF RESEARCHERS IS AGEING

DST 2005

The Academy of Science of South Africa (ASSAf)

Has Commissioned An Expert Panel to Conduct a

Consensus Study on

“CLINICAL RESEARCH AND RELATED TRAINING IN SOUTH AFRICA”

For Publication in early 2010

WHAT IS THE HEALTH STATUS OF SOUTH AFRICANS ?

Chopra M et al. Lancet 2009;374:1023

EVIDENCE OF UNDERFUNDING OF PUBLIC HEALTH SECTOR…..

Coovadia H et al. Lancet 2009;374:817

….IN THE FACE OF RISING DEMAND FOR ACUTE AND CHRONIC CARE …..

Tollman Set al. Lancet 2008: 372:893

Age-standardised death rates by health-care categories in Agincourt subdistrict, 1992–2005

Pressure on Acute Services is leading to Unacceptable Delays in Provision of Care

Impact of under-funding on tertiary services

• Reduction in surgical lists in many centres, resulting in reduced access to health services and dimisihed opportunities for training

• Basic equipment is old, outdated, and a general failure to keep up with modern technology

• Reduction in tertiary level beds over the past 15 years is hampering access to care and limiting the capacity to train specialists and sub-specialists

Human Resources for Health: Vital Investment for Improving Health Outcomes

Country Doctors/1000 pop

GNP/capita ($)

Health exp as % of GDP

IMR/1000 YLL – Infections(%)

YLL – NCDs(%)

Lesotho 0.05 1,810 6.7 102 90 7

S Africa 0.57 8,900 8.6 56 77 15

Brazil 1.85 8,700 7.5 19 30 50

Mexico 1.98 11,990 6.2 29 27 54

USA 2.56 44,070 15.3 7 9 75

Greece 5.00 30,870 9.9 4 4 83

UK 2.3 33,650 8.4 5 10 82

Australia 2.47 33,840 8.7 5 5 77

WHO 2008; CMSA Project

IMR, Infant Mortality rate; YLL, Years of life lost; GNP, gross national pduct; GDP, gross domestic product

Nursing Act 33 of 2005 vs DoH Human Resource direction

• The Act stipulates the entry level to professional nursing as a Bachelor of Nursing, whereas DoH talks of increasing and revitalising nursing colleges.

• At the moment most nursing colleges do not fall under DoE, but DoH and so cannot prepare professional nurses as stated in the Act.

• Diploma in Nursing (2 years) as stipulated in the Act – fits within FET band and therefore cannot be offered by universities

• A balanced view is needed with regards to nursing education and training at universities and colleges at both undergraduate and postgraduate level (at the moment most post-basic clinical nursing programmes are offered by colleges and ARE NOT recognised according to the NQF)

Human Resources for Health for Health Plan of the NDoH

WHO 2008

• Calls for the increase in the production of all types of health care workers

• Calls for the production of new cadres of health wokers, including clinical associates and community health workers

• Production requires the availability of adequate health services and sufficient trainers and supervisors

Health Service Planning Framework in the Western Cape

• ‘Healthcare 2010’: The Western Cape in 2003 tables it planning framework to ensure equal access to quality care (with financial stability)

• ‘Healthcare 2010’ seeks to re-shape services through 4 integrated plans– Comprehensive Service delivery plan (CSP);

Infrastructure Plan; Human Resource Plan; Financial Implementation Plan

• The Department of Health is implementing the CSP; other plans in development stage

• Full realisation of Healthcare 2010&full package of care of CSP is constrained by available funding– Provincial Equitable Share (used for District Health System&Regional

Hospitals) & National Funding (NTSG) for tertiary (total estimates of underfunding R1.5billion)

• Not adequately addressing the increasing health need due to the rising ‘quadruple burden’ of disease

• Not addressing the national demand for increased human resource production including specialists and subspecialists (R500million estimated underfunding of HPTDG)

• Does not fully address the resources required for the optimal provision of national and provincial specialised, highly specialised services and unique services; and the needs of national referral hospital centres

Health Service Planning Framework in the Western Cape: Concerns and Challenges

Critical Shortage of Health Therapists Illustrates the Funding Gap

Health Therapists Cape Metropole(1: 30 000 therapist to patient)

Physio Physio OT OT Speech Speech AudioAudio

CurrentCurrent(District)(District)

2828 99 00 00

NEED NEED

GAPGAP

9797

6969

9797

8888

9797

9797

9797

9797

Key Points• Under investment in Academic Health

Complexes is hamparing the ability of the country to produce healthcare prersonell, to provide highly specialised services, and is hindering clinical research

• There is a lack of a coherent national framework for the governance, planning and funding of Academic Health complexes

• Academic Health Complexes serve a national function, but are dependent on provincial administrations for their service and staff requirements

Recommendations (1)

• An inclusive process needs to be embarked upon to address the state of Academic Health Complexes in the interests of a sustainable health system which is able to train the professionals for all levels of care

• A national governance structure and an integrated framework funding for Academic Health Complexes are required

• A process to determine number of health professionals to be trained, the infrastructure and human resource requirements, and the funding enevelope

Recommendations (2)

• The proposed governance structures and funding mechanisms may be formalised through section 51 on ‘Establishment of Academic Health Complexes’ in the National Health Act of 2004

• Urgent intervention is required to address the crisis in Academic Health Complexes in the Western Cape, Free State, and other parts of the country

• Academic Health Complexes need to be treated as national assets rather than provincial liabilities

“”” "Knowing is not enough, we must apply.Willing is not enough,

we must do"

Goethe

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