Transcript NDoH Response to Rural-Proofing Guidelines

Launch: Rural Proofing Guidelines
Response from NDoH
Jeanette R Hunter
29 January 2015
Problem Statement
• Policy limitations and rural realities – Vuyokazi Gonyela
• The difficulty with policy implementation in a rural province
- Andrew Robinson
Problem Statement
• Problem statement
– Policy formulated to address
statement
– Implementation preparation
– Implementation
Applying a systematic approach
on a system
Result
Hit and miss mostly miss
Why ?????
Problem Statement
MISS in Hit and
Miss
• Policy limitations and rural realities –
Vuyokazi Gonyela
– Out of stock medicines
– Long queues, resulting in impossible waiting
times
– Functionality of CHEs
– Problems to information systems
– Social Determinants of Health
– Systems inability to cope with the demand (CD4
of <500)
• The difficulty with policy implementation
in a rural province - Andrew Robinson
– A facilitator of services to communities feeling
let down by the system, (peers and principals)
Rural Proofing guidelines
• Daygan: “The Guidelines are not going to
propose solutions, its going to enable us to
THINK RURAL”
• Thus on its own it will not improve the REAL
SITUATION on the ground for communities
• Development MUST be supported where people live
• Health System activities MUST support development
WHY the MISS in Implementation
• No blanket answer that will suffice for the entire health
service environment
• In spite of good policies there are very specific
problems from setting to setting
– Issue of funding is a good example of this
• Ian’s point about Equity – act in terms of specific need
HOW
Ideal Clinic (rural/urban)
Ideal Community Services
Ideal DHMT
Ideal Provincial Management
Ideal National Health Management
Ideal Political Leadership in Health
Adequate
Health
Services
Vhembe District Ideal Clinic Status
• Total of 120 clinics and CHCs in Vhembe health district
• Of these 61 have determined their Ideal Clinic status between April and
October 2014
• The remaining 59 will be done by end January 2015
• The status determination is done by the Permanent Perfect Team for Ideal
Clinic Realisation and Maintenance (PPTICRM) with the help of a PEPFAR
funded implementation partner
• The corrective interventions are done by the PPTICRM under guidance of
the acting district manager and the team member from the NDoH who is
responsible for Vhembe
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Beaconsfield
Wayeni
Muledane
Helderwater
Makhado
Mphephu
Madombidzha
Ntlhaveni D
Tshiombo
Tshiungani
Mavambe
Makonde Clinic
Olifantshoek
Malamulele Clinic
Vhufuli Tshitereke
80%
74%
68%
66%
65%
63%
61%
60%
60%
60%
59%
58%
57%
56%
55%
Facililities
32
33
34
35
36
37
38
39
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43
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46
Tshixwadza
Waterval
Folovhodwe
Sterkstroom
Masisi
Shayandima Clinic
Madala
Marseilles
Levubu
Shingwedzi
Manavhela
Khakhu
Mulenzhe
Tshimbupfe
Mbilwi
SCORE %
SCORE %
Facililities
45%
45%
44%
44%
44%
43%
43%
43%
42%
42%
42%
42%
41%
40%
40%
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Gondeni
Pfanani
Mhinga Clinic
Rumani
Mphambo
Shigalo
Mukula
Matsheka
Makuleke
Guyuni
Ha-mutsha
Tiyani CHC
Makahlule
Ntlhaveni C
Tswinga
Matiyani
54%
53%
52%
52%
49%
49%
48%
48%
47%
47%
46%
46%
46%
46%
46%
46%
Facililities
47
48
49
50
51
52
53
54
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56
57
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60
61
Davhana
Magwedzha Clinic
Damani
Mashau
Shikundu
Lwamondo Clinic
Tshisaulu
Mtititi
Peninghotsa
Tshikundamalema
Thengwe
Ntlhaveni E
Nghezimani
Masakona
Nkhensani Clinic
SCORE %
SCORE %
Facililities
38%
38%
38%
37%
37%
36%
34%
29%
28%
28%
27%
27%
26%
25%
22%
The following slides contain the
summarised and aggregated results for
the 61 clinics and CHCs in Vhembe
Additional Consultation rooms have been completed for the clinics below
1
Matsheka
The additional doctors rooms for these clinics
2
Nghezimane
have been completed. Waiting for Municipality to
3
Xhikundu
sign off the occupation certificate before it can be
4
Duvhuledza
practically handed over for use
5
Tshifudi
6
Mukula
7
Phiphidi
8
Murangoni
9
Thondo Tshivhase
10
Sambandou
11
Mutale
12
Manenzhe
13
Makhado
14
Nkhensani
15
Muila
Social Determinants of Health
– Political Commitment
– Pressure from leadership
• Premier in KZN now to be followed by premiers in other provinces steered
by the deputy president
• Service delivery committee chaired by Minister Gorhan, Task team chaired
by DG Coperative governance with a very specific and practical approach
• Minister of Health – Operation Phakisa
• NDoH using a population indicator approach (diarrhoea in children under 5)
Value of Rural-Proofing Guidelines
• Thank you
• Keeping Rural In mind
– Educational
– Instructive (Identify rural clinics as part if IC Process)
– Facilitate improvement
• But only if we keep our eye on, plan for and make specific
interventions
THANK YOU FOR YOUR
ATTENTION!
www.doh.gov.za