district health in south africa appropriate response to current health issues: how do we measure? dr...
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District Health in South Africa
Appropriate response to current health issues: How do we
measure?
Dr Kebogile Mokwena
Department of Social and Behavioural Health SciencesNational School of Public Health
MEDUNSA
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Aim of Presentation
• Use the National Health Plan and the District Health System Plan as references to measure the success in implementing health care
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Weaknesses of previous health system
• Highly fragmented system• Biased towards curative care and the private sector
– Inefficient and inequitable
• Team work was been emphasised, and the doctor has played a dominant role within the hierarchy.
• There has been little or no emphasis on health and its achievement and maintenance, but there has been great emphasis on medical care.
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Premise
• Promotion of health, using the Primary Health Care Approach
• Integration of the country's health system, and the overall social and economic development of the community
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Expected outcomes of the Implementation of the NHP
• Ensuring that the emphasis is on health and not only on medical care.
• Encouraging and developing comprehensive health care practises
• Emphasising that all health workers have an equally important role to play in the health system
• Ensuring that team work is a central component of the health system.
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Expected outcomes of the implementation of the NHP
• Ensuring that mechanisms are created for effective community participation, involvement and control– Development of the District Health System
• Introducing management practices that are aimed at efficient and compassionate health care delivery.
• Ensuring respect for human rights, and accountability to the users of health facilities and the public at large.
• Reducing the burden and risk of disease affecting the health of all South Africans.
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Success Indicators
• How will it be, what will be happening, what will we be doing if our health care system uses the Primary Health Approach as the underlying approach?
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Yardsticks for service delivery
• Access to health care for all, especially the vulnerable
• Ensure services that put the emphasis is on health and not only on medical care.
• Reducing the burden and risk of disease affecting the health of all South Africans
• Responding effectively to the most pressing health issues:– e.g. HIV, Diabetes, heart disease, obesity, drug use
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Training according to identified needs
• Continuous assessment of health and development needs– Promoting good health and preventing disease as they
emerge
– Health promotion combines diverse approaches such as legislation, fiscal measures such as taxation, controls on advertising, community action and development, inter-sectoral Programmes, environmental monitoring and education.
• Require training that integrates these approaches
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Features of a Health System that is driven by the Primary Health care
Philosophy• Health promotion practices that utilise the skills of a multi-
disciplinary team of workers from many different sectors e.g. education, health, industry etc– Has this happened?
• Health promotion is central to the health care service– Reference for all aspects of care, e.g. prevention, adherence to
treatment, maintenace of optimal health etc
• Health promotion is one of the health policy priorities – Policy across the wide spectrum of health care, e.g. funding,
training, services
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What is required to implement the DHS?
• Health care professionals appropriately trained for the needs of the communities– Re-orientation of existing personnel and fuller use of their present
skills
• Evenly distributed in relation to health and health care needs.
• In-service training and acquisition of new skills to enable them to play a more effective role in promoting, maintaining and restoring health.
• There will also need to be changes in basic training– Curriculum modification
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Integration of demand and supply• Access to health care for all, specially the poor
and vulnerable– Access Life style diseases require services to all
• Ensuring that the emphasis is on health and not only on medical care– Medical care is expensive and not accessible to all – Increase training for public health professionals
• Reducing the burden and risk of disease affecting the health of all South Africans.– Prevention is better than cure
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Radical Approach
• Basic health training to include primary health care and health promotion for all health care categories
• Set standards for Primary health training• Training in Health Systems Management
– District health system requires special and specific training for effective implementation
– Lessons learnt from Mexico, Sweden, Norway and Gambia identified a need for strong management training programs (financial, administration etc)
• Substantial increase in public health training– Health Systems management– Socio-behavioural– Quantitative disciplines (epidemiology and biostatistics) – Environmental health
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Radical Approach
• Change the focus of professional training– Balance between training for promotion of health and curative care– Substantial transformation in human resource training for the health sector
(quality and quantity)
• Substantial increase in the functionality of Community Health Centers– Resource centers to support optimal health and not only curative– Well trained professionals– Multi-disciplinary approach to health issues
• Increase in funding for Community health centers• Change the culture of health care
– People responsible for their health– Discourage the culture of providers and recipients