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DEPARTMENT OF HEALTH Progress Report on Implementation of the Ten Point Plan April 2003

This report highlights the achievements and progress made by Mpumalanga Department of Health in implementing their Ten Point Plan, focusing on improving access to quality healthcare and reducing inequity. Key achievements include legislative reform, reorganization of support services, and improvements in quality of care.

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DEPARTMENT OF HEALTH Progress Report on Implementation of the Ten Point Plan April 2003

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  1. MPUMALANGA PROVINCE DEPARTMENT OF HEALTH Progress Report on Implementation of the Ten Point Plan April 2003

  2. Vision: A caring and humane society in which all the inhabitants of Mpumalanga have access to affordable, good quality health services.

  3. Mission: To provide and improve access to health care for all, and reduce inequity and to focus on working in partnership with other stakeholders to improve the quality of care of all levels of the health system especially preventive and promotive health and to improve the overall efficiency of the health care delivery system.

  4. Achievements against the key strategic points: Much has been achieved against the key strategic points, such as:

  5. Legislative Reform: • Draft Provincial Health Bill was developed. • - Consultation Process planned • - We intend to pass the provincial Health Bill by the end of 2003 • With respect to colleges we need to align the various legislation of the former homelands. • Mental Health Act – Health Workers trained.

  6. Reorganization support services • Strengthen the Health Information System. • Telemedicine • Phase 1 of the telemedicine project (Philadelphia, Witbank, Ermelo and Themba hospitals) has been completed . Technical support has been integrated to the department’s IT unit. • A further 3 sites has been added for PHC testbed research purposes, Tonga Hospital - Naas, Mangweni and Mbuzini clinics. This is the first PHC telemedicine system piloted in the country. • The Department is considering the inclusion of addional sites to the existing PHC testbed research project to balance the democratic representation of the testbed. The sites are Shongwe Hospital, Komatipoort, Langeloop and Malelane Clinics.

  7. Reorganization support services • NHIS/MIS • Tender specifications for the NHC/MIS tender have been completed and adopted by the Revenue Collection Task Team. • The infrastructure for the implementation of the NHC/MIS is in place in all hospitals • The core modules of the NHC/MIS will commence in the second quarter of the 2003/2004 financial year. • PAAB 2 and computerized UPFS have been implemented in Witbank, Groblersdal, Themba, Ermelo and Rob Ferreira hospitals. • A framework to implement PAAB and UPFS in the remaining hospitals has been developed and is currently being piloted.

  8. Reorganization support services • The District Health Information System • The DHIS is being implemented in all three Districts in the Province • Two Provincial information officers trained in monitoring, evaluation and epidemiology • 17 District information officers and 30 facility managers trained on DHIS. • Public Health Indicators and geographical information systems (GIS) completed and implemented in the Province.

  9. Reorganization support services • Transformation of Laboratory Services • Transfer of staff has been effected to the NHLS • Transfer of assets is in process

  10. Reorganization support services Transfer the mortuaries services: Currently: +/- 4 500 post mortems per annum Need 8 full time MO’s to cover the whole Province with 1 specialist for referrals and training. Take over: One year preparatory period to transfer assets, and staff implement forensic services organogram. Target date: April 2004 Incremental budget with increases from year 1 to year 6.

  11. Improving Quality of Care: • Quality Assurance • The department along with the USAID-funded Quality Assurance Project and the Equity Project has developed a strategy for this programme within the district health system. • The Quality assurance pilot was implemented in Piet Retief, Philadelphia, Rob Ferreira and Themba Hospitals. It has now been rolled out to other hospitals and some CHC’s in the Province. • A Quality Framework was developed and distributed. • QualityAssurance Units and committees have been established in the three districts and facilities. The committees are responsible for building awareness regarding quality assurance, for identifying quality improvement activities, and for monitoring progress. • Quality Audits were done at all hospitals throughout the Province.

  12. Improving Quality of Care: • Batho Pele and Patients Rights Charter • The Patient’s Right Charter was launched in April 2000 . • Health Promotion co-ordinators were trained as Master Trainers who • in turn train health workers and mobilise communities on an on-going basis. New posters and information booklets are being developed. • In-service training on Batho Pele and the Patient’s Charter • was conducted by the Quality Assurance Unit. • Patient Right Charter and Batho Pele is available in all health facilities. • Complaint procedure in place and help desks have been set up in hospitals and clinics. Service standards have been set out.

  13. Improving Quality of Care: • Clinical management guidelines have been developed and are implemented as well as peer reviews are conducted. • Provincial Health Council and District Health Councils were established in 2001 • Hospital Management Boards and Clinic Committees are in the process of being established to replace the health forums • Process to be finalised by March 2004

  14. Improving Quality of Care: • Province received a number of Awards to reward good Performance namely: • Tongareceived a Certificate for best practices as a rural area with external support. • Lydenburgas a rural area without external support. • Middelburg received a certificate for participation as a urban area without external support. • Lydenburg received a trophy for the Best Managed HIV/AIDS Programme nationally. • Ehlanzeni Districtawards for best managed HIV/AIDS & TB Programme nationally. • Piet Retiefcertificate for best practice in Quality Assurance.

  15. Improving Quality of Care: Three prizeswere received in the Cecilia Makiwane Awards. • Premier Service Excellence Awards awarded 6 trophies for service excellence of which the Mpumalanga Department of Health received three • Gold Award – Thaba Chweu Sub-District - Lydenburg team • Silver Award – Ermelo Eye Care Team • Bronze Award – Standerton Hospital • The Provincial Rehabilitation Programme was awarded the National Disability Trophy by the National Department of health

  16. Revitalisation of Public hospitals National Planning Framework Targets for Mpumalanga - 2010 Bed Number: Level 1 decrease from 3692 to 3362 (-330) Level 2 increase from 594 to 1083 (+489) Level 3 increase from 26 to 231 (+205) Step down increase from 0 to 535 (+535) The plans with the University of Pretoria and Medunsa are well underway.

  17. Revitalisation of Public hospitals • There was an on going process of upgrading of hospitals in the Province. • Hospital Upgrades since 1999: • Kwamhlanga Rob Ferreira hospital • Philadelphia Witbank • Embuleni Themba • Ermelo Mmamethlake • Commencement of construction of main building of new • Piet Retief Hospital.

  18. Revitalisation of Public Hospitals Medical Equipment for hospitals was purchased: R 19 million for the 2002/2003 financial year. Radiography equipment to the amount of +/- R 18 million as purchased for Standerton,Embhuleni,Bethal, Elsie Ballot, Carolina,Evander,H.A. Grove, Impungwe, Amajuba, Shongwe, Sabie, Themba, Rob Ferreira, Witbank, Philadelphia and Kwamhlanga Hospitals

  19. Revitalisation of Public hospitals Hospital Information Systems – a data set and software is being developed with assistance from consultants funded by the Equity Project. This will augment the DHIS and minimum data set projects in hospitals.

  20. Revitalisation of Public hospitals • Decentralization of Hospital Management: • 8 CEO’s appointed: 80% of posts filled • 15 Medical Managers appointed: 62.4% posts filled • 25 NSM appointed: 89.3% posts filled • 25 Hospital Secretaries appointed: 89.3% post filled. • Training on cost center accounting at Witbank and Rob Ferreira Hospital finalised and systems will be alive at the beginning of the 2003/2004 financial year. • Plan for capacitating hospital managers is in place

  21. Comprehensive PHC Services: • The primary health care package is being implemented in all clinics according to available resources and capacity. • To enable the province to deliver comprehensive • PHC Package at health facilities the following activities were embarked on: • 158 Nurses trained on PHC so as to implement • Supermarket approach to health care • 32 Mobile clinic purchased • 288 Health professionals were trained in generic • courses.

  22. Comprehensive PHC Services: • New Clinics and CHC’s Completed since 1999 Kabokweni CHC, Verena, Lefiso, Mmametlhake CHC, Moloto, Perdekop, Seabe, Nokaneng, Amsterdam CHC, Moutse-West, • Following clinics are in the planning phase Iswepe,Moutse-East CHC,Buffelspruit, Bhuga, Silindile

  23. Comprehensive PHC Services: • Patients bypasses clinics and go directly to hospitals where it is perceived that they would receive a better quality of service. • Much still needs to be done on the provision of an Essential PHC Package. Although the availability of drugs has improved, availability of drugs and staff at clinics are some of the challenges facing the Provision of PHC. • Standard PHC Treatment guidelines have been distributed to all health facilities in the province • Basic equipment requirements have been developed for all clinics and we are in the process of equipping clinics accordingly

  24. District Health System • Preparation are underway for the devolvement of Environmental health service to District municipalities awaiting enabling legislation • Health boundaries have been aligned to municipal boundaries

  25. Decreasing morbidity and mortality through strategic interventions: • Child, Youth and Adolescent Health • There is a high level of EPI coverage in the province. • A successful Immunization campaign was conductedin which districts reached an average of 90% coverage.. • An enhanced measles surveillance system was initiated and implemented to ensure rapid notification. • There has been no confirmed cases of polio since 1990.

  26. Child, Youth and AdolescentHealth • IMCI • IMCI Case Management courses were held throughout the Province. 599 Health Workers were trained on IMCI case management since 1999 as well as 84 supervisors ,85 facilitators, 8 course directors and 20 clinical instructors. • The Household and Community component of IMCI is fully implemented at Philadelphia. It has been further rolled out to Standerton, Witbank and Kabokweni. • IMCI meetings held with community, councilors and other stakeholders at pilot sites in Witbank and Kabokweni Community IMCI Forum established at Witbank.

  27. Child, Youth and AdolescentHealth • Assessment of 6 hospitals for Baby Friendly Hospital Intervention 3 hospitals awarded: Shongwe, Witbank and Delmas and 3 hospitals received certificates of commitments: Impungwe, KwaMhlanga and Philadelphia. Inauguration of Barberton and Bethal as Baby Friendly Hospitals. • Peri-Natal Problem Identification programme is being implemented at 14 of the 27 Hospitals and 2 CHC’s.

  28. Youth and Adolescent Health: • Substance abuse • Awareness campaigns were held at targeted high schools in the province. Two awareness campaigns in Piet Retief in June and radio Ligwalagwala FM was used to sensitize the communities. Health talks given to school children in 10 schools throughout the Province. Health talks and handout on Fetal Alcohol Syndrome held in Nkangala. Life skills module implementation monitored in 8 schools in the province. • 32 Social Workers trained in alcohol abuse assessment and treatment • Suicide prevention programme developed.

  29. Youth and Adolescent Health: • National Guidelines for Youth and Adolescents Health were launched on 19th April 2002 at Witbank and distributed to Health Facilities in the Province. • In order to sensitise communities about teenage pregnancies, group discussions are held whereby an average of 2 850 teenagers are educated annually, • Teenage Pregnancies campaigns are conducted at Piet Retief and Nkangala. • Youth Friendly Services are implemented at 4 clinics • Family Planning materials and reproductive health guidelines are developed and distributed to health facilities for on-going in service training. • Monitoring the implementation of Sexuality Programmes at schools.

  30. HIV/AIDS and STI’s: • To sensitise the communities on HIV/AIDS, STI’s and TB, • 8 Youth Prayer meetings were held as part of the Social • Awareness campaigns. • 303 condom distribution sites have been established as part • of the prevention campaign. • 53 Condom Sites committees have been established. • The following groups are involved in condom distribution: Peer Educators, Caregivers, Traditional Healers, Youth (Mpumalanga Youth Commission) and NGO’s / CBO’s.

  31. HIV/AIDS and STI`s: • 4 District AIDS Councils and 14 Local Aids Councils were launched • 154 Community members were capacitated on Home Based Care in all three districts. • Training of Professionals is on-going and 200 Nurses were trained to perform VCT. • 90 Sites are delivering VCT services of which 4 are non-medical sites

  32. HIV/AIDS and STI’s: • Prevention of Mother to Child Transmission • Pilot Sites: Evander, Shongwe and Feeder Clinics. • The Province will roll out the programme in three phases. • Phase I – Completed 31 December 2002 • Commence at the major referral hospitals which will also function as training and support facilities. • Themba, Rob Ferreira, Standerton, Ermelo, Witbank, Philadelphia

  33. HIV/AIDS and STI’s: Phase II This phase will include all remaining hospitals: Amajuba, Shongwe,Evander,Volksrust,Carolina, Lydenburg,Mpungwe, Waterval Boven,Embuleni, Middelburg, Tonga, Belfast, Groblersdal, Kwamhalanga, Lydenburg,Delmas,Bernice Samuel,Matibidi, Mmamethlake, Piet Retief,Sabie Phase III The phase will include all health centres and clinics that are offering peri-natal care to be completed 31 March 2004.

  34. HIV/AIDS and STI’s: • Life skills programme: 30 Master Trainers from Health Promotion are responsible for the rollout of life skill programmes in schools • STI’s - Syndromic management of STI’s implemented in all public health facilities

  35. Tuberculosis: • The National TB Training manual has been used to develop the skills of health workers throughout the Province. This included three accredited training days for doctors, four three-day training courses on TB/HIV for professional nurses and training of supervision of DOTS supporters. • Integrated Plan for the management of TB Developed whereby 33 home based care workers were trained in DOT’s support. Coordination of TB, HIV/AIDS and VCT is taking place.

  36. Tuberculosis: • The laboratory turn-around time for sputum smears on average remains below 48 hours average, with most of the clinics receiving their results within 24 hours. • The availability of TB Drugs was secured. • Electronic TB Registers are implemented throughout the Province to monitor patients. • DOTS supporters have been trained in every district in the Province, for expansion of the DOTS programme in NESPRUIT/ BARBERTON, Tonga/Shongwe, Lydenburg, Piet Retief and Philadelphia.

  37. Tuberculosis: • An Isolation Facility was established at Standerton Correctional Services to ensure that prisoners with sputum positive TB are treated separately. Prisoners have been trained as DOTS Supporters. • International recognition with the implementation of the cough register in the Lydenburg area has been obtained. The register facilitates health care workers to recognise the importance and possibility of TB for any client presenting with an incidental cough. A marked increase in case finding has occurred.

  38. Tuberculosis: • With only 29 MDR TB patients out of the 4 788 patients registered during the past year, the current rate is well below 1%. • TB Management has been identified as a National Priority and to that regard a Medium Term Strategy was launched at Standerton for the period 2002 to 2005. • However the doubling of the mortality ratio within 2 years a finding reflected in the National TB Statistics does indicate the maturing of HIV Epidemic and the urgent need for adequate palliative care provision and dedicated TB facilities.

  39. Cholera: • The Department has been active through the Provincial Medical JOC in the containment of the spread of cholera over the last 12 months. In that time a total of 127 cases have been reported with four confirmed deaths. Close working relations exist at the provincial and district levels across sectors with key support to district through technical assistance, distribution of bleach and provincial stocking of essential clinical items.

  40. Cholera: • To ensure safe water supplies in high risk areas prone to cholera the following was purchased and distributed: • 30 water test kits supplied for domestic water quality monitoring. • 4 residual chorine test kits supplied and demonstrated. • Guidelines distributed on the use of safe water.

  41. Cholera: • Training is on-going and 8 Environmental Health Officers and Provincial and District CDC co-ordinators trained, as well as communities in high- risk areas. • Radio slots were obtained for health promotion. Health Promotion Material, water sanitizing materials were distributed.

  42. Malaria: • The province has conducted various training courses for district health staff. • SP (Fansidar) was introduced successfully for malaria treatment following an in vivo study indicating serious levels of cholorquine resistance. • Update Guidelines for malaria treatment with SP (Fansidar) were distributed to all facilities in malarious areas. A follow up in Vivo study confirmed its efficacy but due to resistance it was decided to combine it with Artesunate in future. • The malaria cases fatality rate remains at 0.5% in line with the national objective due to good disease management.

  43. Malaria: • 13 000 Bed nets were purchased and distributed for malaria control at Albertsnek, Steenbok, Mbuzini Thambokhulu, and Mananga • 168 211structures were sprayed with residual insecticides annually. • A field based evaluation of local mosquito plant repellents demonstrated that fever tea plant (Lippia javanica) provides effective protection against malaria mosquito bites.

  44. Women’s Health • Maternal Mortality • The Province distributed guidelines on management of the main causes of maternal deaths. In addition, management protocols for labour and hypertension have been distributed to all facilities, and 66 midwives orientated and trained. • Community awareness on the major causes of maternal deaths were addressed during the Pregnancy Education week on local radio stations. • There is improved reporting of maternal mortality .The analysis of cause of death is delayed due to lack of capacity. In terms of maternal mortality most of the deaths are attributed to HIV and AIDS, hypertension during pregnancy.

  45. Women’s Health • Mpumalanga has been identified as one of the pilot sites for the Cervical Cancer Screening and Colposcopy Clinic Project. The following sites have been identified: Philadelphia and Themba Hospital. • National Policy Guidelines launched on genetics, cervical cancer screening, contraception and youth and adolescent health.

  46. Women’s Health • TOP • TOP services are provided at 08 hospitals in the province (including private facilities) • Manual vacuum aspiration equipment was purchased. • Various factors contributes towards conscientious objection of Health Workers in the provision of TOP services.

  47. Mental Health and Substance Abuse: • An audit on mental health patients was conducted. • 36 000 mental health patients in the Province • Verified patients in Gauteng is 300. • The following needs were identified for the Province • - 240 acute and 440 chronic beds required • currently only 26 dedicated acute beds. • Human Resource needs were determined.

  48. Mental Health and Substance Abuse: • Integration of Mental Health in to PHC services: • 60% of the clinics have integrated mental health care into PHC. • 70% of district hospitals have integrated mental health into their services package . • 216 PHC Nurses have been trained in mental health care, assessment, diagnosis and management. • 30 PHC nurses trained in child-psychiatry • 120 medical officers attended workshops conducted by psychiatrist in mental health care. • 40 medical officers trained in medical assessment, diagnosis and management of psychiatric conditions. • 16 Nurses trained in advanced diagnosis and prescription

  49. Mental Health and Substance Abuse Management of Sexual Assault • Treatment guidelines for sexual assault is implemented in all health facilities • Sexual Assault support rooms established in 10 Hospitals • On-going monitoring of skills implementation amongst those trained in Victim Empowerment. • The Othandweni Violence Referral Centre is progressing well counseling and supporting an average of 80 clients per month. Clients seen presented with rape, other sexual offences and domestic violence.

  50. Mental Health and substance abuse: • Suicide prevention campaigns were held at targeted high schools in the province. Two awareness campaigns in Piet Retief in June and radio Ligwalagwala FM were used to sensitize the communities. Health talks given to school children in 10 schools throughout the Province. • Health talks and handout on Fetal Alcohol Syndrome held in Nkangala. • Developed and provided all hospitals with treatment protocols and reproduced 70 training manuals for training of health care personnel.

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