(wbot). - Anova Health

ADDRESSING LEADERSHIP &
MANAGEMENT CHALLENGES AT
DISTRICT LEVEL WITH THE WARD
BASED OUTREACH TEAMS (WBOT).
PROF CC JINABHAI
UNIVERSITY OF FORT HARE
THE SIX (6) BUILDING BLOCKS OF A
HEALTH CARE SYSTEM
According to WHO (World Health Organisation) a
health care system has six (6) building blocks:
1. Leadership and governance;
2. Access to essential medicines and other
Commodities;
3. Health workforce (Human Resources)
4. Health systems financing
5. Health information systems
6. Health service delivery
2
CONTEXT: The Ten Point Plan
1. Provision of strategic leadership and creation of a social
compact for better health outcomes
2. Implementation of National Health Insurance (NHI)
3. Improving Quality of Services
4. Overhauling the health care system and improve its
management
5. Improving Human Resources Management
6. Revitalization of physical infrastructure
7. Accelerated implementation of HIV and AIDS Plan and
reduction of mortality due to TB and other communicable
diseases
8. Mass mobilization for better health for the population
9. Review of the Drug Policy
10. Strengthening Research and Development
3
National Development Plan.
The recently released South Africa National
Development Plan (NDP) 2030 (2013: 332) states
• The national health system as a whole needs
to be strengthened by improving governance
and eliminating infrastructure backlogs.
• Human capacity is key.
• Managers, doctors, nurses and community
health workers need to be appropriately
trained and managed, produced in adequate
numbers, and deployed where they are most
needed.
National Development Plan(Cont.)
GOAL 6: Complete health systems reforms
• Integrate the different parts of the health system.
• Develop an information system for managing
diseases.
• Separate policy-making from oversight and
operations.
• Decentralise authority and devolve
administration to the lowest levels.
• Rationalise clinical processes and systematise the
use of data, incorporating community health,
prevention and environmental concerns.
Policy, Legislative & Strategy Drivers
• HRH strategy:
– “leadership and management are required across the
health workforce and at all levels of the health care
system”
• Gov’t gazette August 2011:
–
–
–
–
improve hospital function
Ensure appointment of competent, skilled managers
Provide for accountability frameworks
Ensure training of managers in leadership, management
and governance
Policy drivers
•
•
•
•
•
•
Re-engineering PHC
Quality assurance and OHSC
Improved financial management
Nursing strategy
Strengthening AHCs
Expanding health professions
An effective health system
from a “quality” perspective
• Professionals and health care providers who
are:
– Competent, knowledgeable, respectful and ethical
– Continuous learning and solution-focused
… and who work in a ….
• Health establishment / a hospital where
–
–
–
–
Managers are effective, efficient and accountable
Support systems function
Staff do their jobs and follow the basic “rules”
Focus on core business
Strategic Goals of the National Health Grant – NHI
Component
• Strengthen aspects of the public healthcare
system in preparation for National Health
Insurance
• Strengthen the design of NHI based on innovating
and testing of new reforms in pilot sites
• A public health care system that is better
prepared to implement reforms necessary for NHI
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RE-ENGINEERING PRIMARY HEALTH CARE FOR SOUTH
AFRICA
Focus on Ward Based Primary Health Care Outreach Teams
7 June 2012
THE MAIN FOCUS OF THE PHC
RE-ENGINEERING
LITERATURE REVIEW
• Strengthen the district health system (DHS)
and do the basics better
• Place greater emphasis on population based
health and outcomes
– a new strategy for strengthening communitybased services
– a team approach which includes community
health workers (CHWs) as members of the team
WARD BASED PHC OUTREACH TEAMS
PHC OUTREACH TEAM
Team Responsible for health of 1500 Families
No. of teams in a Ward (determined by population size)
HBC
Preventative,
promotive, curative and rehabilitative services (work
Community Services
with EHOs)
CHW
CHW
Professional Nurse
250
families
CHW
250
Families
(Team leader)
Health Promoter
Environmental Health Officer
CHW
250
Families
CHW
250 Families
CHW
250
Families
250
families
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NHI Pilot District
Amajuba DM
Dr K Kaunda DM
WBOT Required based Number of WBOT
on 1:1500 households
registered
74
10
139
49
G Sibande DM
182
9
O Tambo DM
199
223
Pixley ka Seme DM
33
41
T Mofutsanyane DM
145
29
Tshwane MM
608
19
uMgungundlovu DM
182
17
Umzinyathi DM
76
20
Vhembe DM
Eden
229
109
17
0
Grand Total
1976
568
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WBPHCOT members provided with cell phones
and trained on collecting and sending patient
information by cell phone
Advantages:
This improves turnaround time for required
patient interventions
Improves data quality for monitoring and
evaluation of the WBPHCOT programme
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WARD BASED PHC OUTREACH TEAM SERVICES
Offer an Integrated health service at a community, household
& individual level
Core components of the integrated service
1. Promote health (child, adolescent and women’s health)
2. Prevent ill health
3. Ante and post natal community based support and interventions
that reduce maternal mortality
4. Provide information and education to communities and households
on a range of health and related matters
5. Offer psychosocial support
6. Screen for early detection and intervention of health problems and
illnesses
7. Provide follow-up and support to persons with health problems
including adherence to treatment
8. Provide treatment for minor ailments
9. Basic first aid and emergency interventions
PROFESSIONAL NURSE ROLE IN PHC OUTREACH TEAM
SERVICES
Plan, implement and evaluate health and wellness
services to the catchment population
Promotion, prevention, early detection, curative,
rehabilitative and palliative service
Develop a targeted plan to address the health needs of
those that are vulnerable
Act as an advocate for improving health services
Deliver community component -PHC package of services
IMPLEMENTATION OF PHC
OUTREACH TEAMS
PHASE 1
ORIENTATION & TRAINING
WHAT IS REQUIRED ?
Scope of
Production
Education and
Training
Work
Enabling
Employment
Framework
CHWS
Appropriate
Qualifications
Practice
Health
Services
Competence
Orientation
and training
Recruitment
Selection and
Appointment
Scope of CHW
• Conduct community, household and individual health assessments and
identify if there any potential or actual health seeks and facilitate the
family or an individual to seek the appropriate health service;
• Promote the health of the households and the individuals within these
households
• Refer persons for further assessment and testing after performing simple
basic screening tests;
• Provide limited health interventions in a household (basic first aid, oral
rehydration and any other basic intervention that she or he is trained to
provide)
• CHWs will also provide psycho-social support and manage interventions
such as treatment defaulter tracing and adherence support.
KEY DIFFERENCES BETWEEN CURRENT AND
PROPOSED MODEL for CHW
Current role community based health workers
Provide a varied range of services in communities
Home based care, DOTS, Adherence counselling, lay counselling, peer
education, Tracing of defaulters
New role of the category CHWs
Fulfill a role as a formal member of the PHC team Main focus
prevention, promotion and support to communities and households;
and
Identify health needs of families and individuals
Facilitate access to health and other services
Integrated services based on quadruple burden of disease
Report to and supervised by the PHC Outreach team leader
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COMMUNITY BASED
PHC OUTREACH WORK
DEVELOPMENT &
REVIEW OF
IMPLEMENTATION
TOOLS
HOUSEHOLD & COMMUNITY
IMPLEMENTATION TOOLS
EPIDEMIOLOGICAL & DEMOGRAPHIC
PROFILES
•
•
•
•
CHW booklet
Key message booklet
CHW household tools
Kit bag
Monitoring & Evaluation for HSS
–
–
–
–
–
Household registration tool
Individual record
CHW Weekly check list
PHC Team Leader monthly checklist
Referral Forms
CURRENT RESEARCH PROJECT
WBOT Peer Review Provinces/
Districts - NHI Pilot Sites
•
•
•
•
•
•
•
NW-Dr Kenneth Kaunda Health district
LP -Vhembe Health District
EC -OR Tambo Health District
MP -Gert Sibande Health district
GP -Tshwane Health District
FS -Thabo Mofutsanyana Health District
NC -Francis Bard Health District
Review Commissioned for NDOH,
Provincial, District Health Authorities
1. National Department of Health – assess
implementation and expand roll out
2. Province/District – assess and improve
performance, prepare for roll out
3. WBOT Site Teams – assess and improve
performance
Method:
District-WBOT Self Assessment Report (SAR)
• A District/WBOT describes its own practices
and assesses its performance against the
WBOT Review Bench Mark (questionnaire).
• The SAR can also describe the context in
which it is working.
• It should include any protocols, directives,
plans, agreements, reports or other working
documents (content) as Appendices.
Method:
Peer Review Benchmarks
1. Framework/mindset/paradigm for taking
primary health into the community, as per the
Re-Engineering & other PHC / DHS policies
2. Preparation for taking primary health through
WBOT into the community & Households
3. Implementation of primary care through WBOT
4. Relationships of primary care through WBOT.
5. The ways achievements are known, measured
and used
Methods Phase II:
Desk review:
• The Peer Review Team critically read and review
the Self-Assessment Reports as well as any
accompanying documentation prepared by the
District WBOTS.
• This Team includes PEERs who are experiences
and knowledgeable about the WBOT, PHC REENGINEERING & HOUSEHOLD DYNAMICS.
• They will asses Progress, challenges, resource
issues & Health impacts.
Methods Phase III:
Peer Learning Site Visit:
• A team of Researchers & Peers are hosted by a District
WBOT.
• The purpose of the visit is to understand how the WBOT
approach & process is working on the ground
• During a 3 day visit the members of the peer review team
– Meet and interview between 15-20 local stakeholders from the
host District (district managers, WBOT leaders, CHWs, NGOs.);
– Accompany CHW on her/his daily work
– Present what they have seen and heard back to stake holders
in a peer exchange Seminar
Peer exchange Seminar
Thematic Analysis, Evaluation & Future
Planning:
Peer Learning Site Visit Report
• The team prepares a site visit report.
• Submitted to the Stakeholder coordination
team for Review, Corrections & comments.
• Consider Follow-up site Visits to address
mutually identified Key Themes to Accelerate
& Fast Track WBOT Implementation
Methods: Key Informants
1.
2.
3.
4.
5.
6.
7.
8.
Province
District
Team Leaders
CHWs
Local government services
Community organisations/households
NGOs
Other services/sectors
CONCLUSION
PHC RE-ENGINEERING &
THE WBOT OFFER A
CO-ORDINATED STRATEGY FOR
STRENGTHENING ACCESS
TO PRIMARY HEALTH CARE SERVICES