THE IMPACT AND USEFULNESSOF CONDITIONAL GRANTS

1. THE IMPACT AND USEFULNESSOF CONDITIONAL GRANTS • PSNP • 1,5 learners are being fed. • 2000 Schools have been reached • Children are fed for 196 school days. • Stunting have been been reduced from 34% to 23% I.e by 11% poverty alleviation

2. USEFULNESS CONDITIONAL GRANTS • V.C.T grant 1.9 million managed to buy 500 rapid test kids • which will be help to diagnose people living with HIV AIDS • Managed to train 280 included were social workers health • professionals and religions people in counselling. • Managed to purchase home based care kits. • 25 trainers were trained to cascade in the Province. POVERTY ALLEVIATION PROJECT • 117 project have been approved for the year 2001/2002 • The beneficiaries are 76 pregnant women. • 206 mothers from poor household • 417 mixed group • 34% of 23% I.e. by 11%. • Job creation to the poor • 25 stunting growth of children of the poor was reduced from • 34% of 23% I.e. by 11%.

3. INTEGRATED HOME BASED CARE GRANT (1.5 MILLION) • At present the grant is benefiting identified orphans in the different pilot sites I.e. (Pietersburg • Westernburg and Seshego, Maraba and Mashashane as well as Thohoyandou. • 205 orphans have been bought school uniforms. • School fund have been paid for the same 205 orphans. • R378 738-00 have been utilised to buy food parcels worth R300.00 per family. • 521 families are benefiting from the grant. • An amount of 814 325 have been spent to purchase Home Based Care kits.

4. NGO FUNDING • 15 Non governmental organisation were funded each • benefit R100 000.00 an amount of R1.5 million benefited the above NGO. • The NGO are charged with the responsibility to render Home Based Care.

5. RECOMMENDATIONS • 5.2 PRIMARY HEALTH CARE • Integration of service approach should be strengthened in 474 clinics. • 24 hours services should be rendered to the communities to increase access to health services. • Priority with regard to transport should be given to PHC services. • A mobile ambulance which should be connected to clinics in each district should be purchased f or • speedy referral to the next level. • Periodic clinic inspection should be conducted to lessen problems at the clinics • The present grant to as mentioned above are very useful and should be continued. • The issue of security at our clinics should be strengthened. • 5.3 SIGNIFICANT PROBLEMS • Transport • Capacity • Laboratory services • Quality of equipments • Security • Car hijack at Sekhukhune district • Theft and Burglary

6. 5.4 MENTAL HEALTH • Victim Empowerment • There must be a specific budget allocated for mental Mental Health Programme. • There is a need for resource centres for victim empowerment and substance abuse • There is a need for psychiatric nurses to be trained in advance psychiatric to curb up the problems • of psychiatric doctors. • Appointment of psychologist and psychiatrist • 5.5 TB SERVICES • Strengthening of Health Education to new cases. • Establishing effective community participation in dots strategy. • Strengthening the referral system in line with the National Health System Framework • TB programme be given its own grant which will be utilised to build capacity for volunteers (DOTS • volunteers) • There is a need for MDR TB Unit in the Province to curb the MDRD problem as reflected below.

7. Service Areas Strategies Achievements Policy Interventions Impacts/ Constraints HIV/AIDS o       Intensify awareness campaigns. ØCampaigns Ø      Interdepartmental collaboration at all levels. Ø      Stakeholders involved i.e. traditional healers, church leaders, business, chief and academic institutions CBOs and NGOs. Ø      Mass Media vNational policy Guidelines for HIV/AIDS. v       VCT v       MTCT v       HBC v       Integrated Home Based Care. • Drug implications • ·   Cost to treat HIV/AIDS related infections. • ·    Increased workload due to VCT. • ·        Waiting time for clients to be counselled. (Since time flow study had revealed reduction in patients’ waiting time, with the introduction of integrated approach we are now beginning to observe an increase in waiting time from 30minutes to 2hours due to counselling. 7. KEY HEALTH PROBLEMS.

8. Service Areas Strategies Achievements Policy Interventions Impacts/Constraints vTraining for workers on workers for change. Strengthen intervention at high transmission areas. oEstablished services along the N1 Road Truck Inn as well as the boarder posts. (Used as condoms distribution points). vShortage of manpower especially males. vShortage of transport. vIncreased cost in capacity building. oImplementation of Maternal Child Transmission Programme. Community Awareness done as well as briefing to professionals about MTCT. ØSites identified: Siloam and its surrounding clinics and Pietersburg Mankweng Complex and its clinics. ØNeed assessment was done. vNational Policy on MTCT. ·High infant mortality rate. (Refer to statistics) ·Increased maternal mortality rate. (Refer to statistics) ·Increased number of orphans affecting the budget. oImplementation of Integrated Home Based Care. ØJoint Business Plan drawn and implemented for R1,5m.

9. Service Areas Strategies Achievements Policy Interventions Impacts/Constraints vTraining for workers on workers for change. Strengthen intervention at high transmission areas. oEstablished services along the N1 Road Truck Inn as well as the boarder posts. (Used as condoms distribution points). vShortage of manpower especially males. vShortage of transport. vIncreased cost in capacity building. oImplementation of Maternal Child Transmission Programme. Community Awareness done as well as briefing to professionals about MTCT. ØSites identified: Siloam and its surrounding clinics and Pietersburg Mankweng Complex and its clinics. ØNeed assessment was done. vNational Policy on MTCT. ·High infant mortality rate. (Refer to statistics) ·Increased maternal mortality rate. (Refer to statistics) ·Increased number of orphans affecting the budget. oImplementation of Integrated Home Based Care. ØJoint Business Plan drawn and implemented for R1,5m.

10. Service Areas Strategies Achievements Policy Interventions Impacts/Constraints ØSites identified are Maraba, Mashashane, Pietersburg, Westernburg and Seshego. ØMeeting were held with different communities and stakeholders at the different sites. ØSteering committees have been established. Ø205 Orphans have been bought school uniform and school fund have been paid for them. ØFood parcels worth R300 per family, purchased at R110, 000, 00 and delivered on the 02nd April 2001. ØA joint business plan for 2001/02 for the amount of R2,9m was drawn and submitted to National. ·Reduced workload from professional. ·Effective community participation. ·Increased cost on capacity building. ·Prone to abuse by stakeholders.

11. Service Areas Strategies Achievements Policy Interventions Impacts/Constraints ØHome Based Kits were purchased. TB oCapacity building to professionals. Ø14 Trainers were trained i.e. 2 per region. ØTraining was cascaded to all the regions 120 doctors, 3000 nurses and 2000 DOTS supporters. vNational TB Guideline. vTraining manual. vDOTS support Booklets. ·Increased cost for training service taken to the community. ·Cure rate increased from 45% to 58%. ·Sputum conversion rate from 45% to 65%. ·DDTs Programme is now rolled out to 17 districts of the Province. oDOTS strategy. ØCommunity Based Strategy. vDOTS manual. ·Increase patients centredness, ·Improved political commitment. ·Reduced TB stigma. ·Effective monitoring strategy. ·Reduced workload from the clinics and other health facilities.

12. Service Areas Strategies Achievements Policy Interventions Impacts/Constraints Multiple Drug Resistance TB oReduction of multiple drug resistance TB. ØEstablished a Multiple Drug Resistance TB clinic in Pietersburg/ Mankweng Complex. ØDeveloped provincial referral network. ØSufficient second line drugs for management. vNational Multiple Drug Resistance TB Policy. ·52% of 120 MDR patients are cured, 12% are lost, and a failure of 4%. ·Not sure of the number prevailing in the Province. TB/HIV Co-infection oReduction of TB/HIV co-infection. ØService was piloted in one district and rolled out to the second district. ØBusiness plan developed and drawn. vTB/HIV collaboration National Policy. ·Increased Voluntary Counselling and Testing Services from 10 people per day now the demand is so much that more than 100 people are seen.

13. Service Areas Strategies Achievements Policy Interventions Impacts/Constraints Termination of Pregnancy (TOP) oReduction of Back street abortions strengthening the Rights of Women. Ø76 Midwives have been trained. Ø6 Doctors have been trained in TOP. ØTOP Services are rendered at the following hospitals: §Siloam started in November 2000, §CN Phatudi in January 2001, §Letaba and Sekororo started in February 2001. Ø7% of the clinics provide TOP Services. Ø6 Health Centres are ready to start and have trained staff and equipments are available i.e. 4 in Vhembe and 2 in Waterburg Districts. vNational Policy Guideline ·In 1999, 4% of all Maternal Deaths were due to abortion. Hopefully the 2000 figures will show a reduction when published. ·There is still a negative attitude especially in Religious Sectors resulting in mothers dying.

14. INTEGRATED PRIMARY HEALTH CARE SERVICES • 5.1 PRIMARY HEALTH CARE POLICIES • These policy have been distributed to the service delivery areas and will be utilised for the year. • Integrated PHC package is the relevant policy document to be utilised. • At present communicable disease control, HIV/AIDS, Environment falls within PHC unit and all these policies will be utilised for this year. • The provincial policy guideline are just about to be completed • 5.2 MTEF • This is the policy guideline designed by the department and will be utilised for all the PHC Programmes as proposed by the policy. • 5.3 SIGNIFICANT PROBLEM • Transport • Capacity • Laboratory services • Quality of equipments • Security • Car hijack at Sekhukhune district • Theft and Burglary

15. Service Areas Strategies Achievements Policy Interventions Impacts/Constraints Mental Health oImprove Mental Health and Substance Abuse problems. ØMental Health is integrated into Primary Health Care. ØThe new Mental Health Policy is implemented in all facilities. vNational Policy Guidelines. vProvincial Policy Guidelines. ·Lack of substantial budget allocated specifically for Mental Health. ·Shortage of resource centre for substance abuse in our communities. oCapacity building to generalist doctors and nurses and also to dedicated psychiatric nurse. ØIn-service education done to generalist doctors. 23 Were trained in the Northern Province. Ø7 Psychiatric nurses had exposure visits to integrated approach at Bloemfontein Mental Institution. Ø3 Generalist nurses in-services fort PHC approach from each clinic. Ø12 Psychiatric Nurses trained in Advanced Diploma in Psychiatric Nursing. vManual for integration of services. ·Lack of capacity for integrating mental health into PHC.