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The State of Academic Health Complexes: Case Studies from the Western Cape and Free State

This report presents case studies from various faculties of health sciences in South Africa to address the state of academic health complexes and provides recommendations for a sustainable health system. It highlights the need for national governance structures, integrated funding mechanisms, and urgent interventions to treat academic health complexes as national assets.

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The State of Academic Health Complexes: Case Studies from the Western Cape and Free State

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  1. The State of Academic Health Complexes: Case Studies from the Western Cape and Free State Faculties of Health Sciences University of Cape Town, University of the Free State, University of the Western Cape, and Stellenbosch University

  2. Recommendations (1) • An inclusive process needs to be embarked upon to address the state of Academic Health Complexes in the interests of a sustainable health system which is able to train the professionals for all levels of care • A national governance structure and an integrated framework funding for Academic Health Complexes are required • A process to determine number of health professionals to be trained, the infrastructure and human resource requirements, and the funding enevelope

  3. Recommendations (2) • The proposed governance structures and funding mechanisms may be formalised through section 51 on ‘Establishment of Academic Health Complexes’ in the National Health Act of 2004 • Urgent intervention is required to address the crisis in Academic Health Complexes in the Western Cape, Free State, and other parts of the country • Academic Health Complexes need to be treated as national assets rather than provincial liabilities

  4. What is an Academic Health Complex? • Academic Health Complexes consist of health facilities at all levels of care (primary, secondary and tertiary) and an educational institution working together to provide healthcare, to educate and train health care personnel and to conduct health research • There are at least 9 such complexes which have developed around the following University Health Sciences Faculties: Cape Town, Free State, KwaZulu Natal, Limpopo, Stellenbosch, Walter Sisulu, Western Cape, Wits, Pretoria

  5. Academic Health Complex concept

  6. Academic Health Complexes have a central role in NDoH 10-Point Plan • Provision of Strategic Leadership and Creation of a Social Compact for Better Health Outcomes • Implementation of the National Health Insurance • Improving the Quality of Health Services • Overhauling the Health Care System and Improving its Management • Do a feasibility study for the establishment of a leadership academy for health managers • Improved Human Resource Planning, Development and Management • Review the accessibility and training output of academic health complexes • Revitalisation of Infrastructure • Acceleration of Implementation of HIV & AIDS and STI National Strategic Plan 2007-2011 and Increase Focus on TB and Other Communicable Diseases • Mass Mobilisation for Better Health for the Population • Review of Drug Policy • Strengthen Research and Development • Improve the research output, especially from formerly disadvantaged health training institutions • Review the research capacity of academic health complexes

  7. What is the Mandate of Academic Health Complexes? • To educate and train health care personnel • All the Academic Health Complexes are involved in the production of human resources for health • These include nurses, doctors, pharmacists, physiotherapists, clinical associates, and others • To conduct health research • Research is a tool for improving health and health care • The production of new knowledge, patents, and other production contributes to the health and wealth of the nation

  8. Joint Mandate • Universities and Departments of Health share a joint mandate for the training of health care professionals and provide health services • This relationship is governed by joint agreements that vary from institution to institution throughout the country • There is a need for a uniform national framework to govern the joint mandate

  9. What is the performace of the Academic Health Complexes?

  10. Health Research: Types and Prioritisation • Health research may be divided into laboratory (on animals or human tissues), clinical (on patients), epidemiological (on populations), and health systems (on the organised response to health and disease) components • Priority setting is in terms of the Essential National Health Research process

  11. The Mixed Fortunes of Health Research in South Africa • Positive trends: • There has been an appropriate increase in research focussing on primary health care • Appropriate response to the health priorities of HIV/AIDS and TB • Negative trends: • Neglect of injuries, chronic diseases and health systems research • Persisting geographical inequalities • Falling outputs in clinical research • Ageing cohort of researchers

  12. RESEARCH WITH A PRIMARY HEALTH CARE FOCUS IS INCREASING Lutge E et al. A Review of Health Research in South Africa from 1994 to 2007. In: Barron P, Roma-Reardon J, editors. South African HealthReview 2008. Durban: Health Systems Trust; 2008.

  13. RESEARCH ON HIV/AIDS IS DOMINANT Lutge E et al. A Review of Health Research in South Africa from 1994 to 2007. In: Barron P, Roma-Reardon J, editors. South African HealthReview 2008. Durban: Health Systems Trust; 2008.

  14. ‘INEQUALITIES IN HEALTH RESEARCH CONTRIBUTE TO INEQUALITIES IN HEALTH’ Lutge E et al. A Review of Health Research in South Africa from 1994 to 2007. In: Barron P, Roma-Reardon J, editors. South African HealthReview 2008. Durban: Health Systems Trust; 2008.

  15. RESEARCH OUTPUT IS FALLING IN CLINICAL CATEGORY OF HEALTH RESEARCH Mouton & Boshoff 2008

  16. SOUTH AFRICAN COHORT OF RESEARCHERS IS AGEING DST 2005

  17. The Academy of Science of South Africa (ASSAf) Has Commissioned An Expert Panel to Conduct a Consensus Study on “CLINICAL RESEARCH AND RELATED TRAINING IN SOUTH AFRICA” For Publication in early 2010

  18. WHAT IS THE HEALTH STATUS OF SOUTH AFRICANS ? Chopra M et al. Lancet 2009;374:1023

  19. EVIDENCE OF UNDERFUNDING OF PUBLIC HEALTH SECTOR….. Coovadia H et al. Lancet 2009;374:817

  20. ….IN THE FACE OF RISING DEMAND FOR ACUTE AND CHRONIC CARE ….. Age-standardised death rates by health-care categories in Agincourt subdistrict, 1992–2005 Tollman Set al. Lancet 2008: 372:893

  21. Pressure on Acute Services is leading to Unacceptable Delays in Provision of Care

  22. Impact of under-funding on tertiary services • Reduction in surgical lists in many centres, resulting in reduced access to health services and dimisihed opportunities for training • Basic equipment is old, outdated, and a general failure to keep up with modern technology • Reduction in tertiary level beds over the past 15 years is hampering access to care and limiting the capacity to train specialists and sub-specialists

  23. Human Resources for Health: Vital Investment for Improving Health Outcomes IMR, Infant Mortality rate; YLL, Years of life lost; GNP, gross national pduct; GDP, gross domestic product WHO 2008; CMSA Project

  24. Nursing Act 33 of 2005 vs DoH Human Resource direction • The Act stipulates the entry level to professional nursing as a Bachelor of Nursing, whereas DoH talks of increasing and revitalising nursing colleges. • At the moment most nursing colleges do not fall under DoE, but DoH and so cannot prepare professional nurses as stated in the Act. • Diploma in Nursing (2 years) as stipulated in the Act – fits within FET band and therefore cannot be offered by universities • A balanced view is needed with regards to nursing education and training at universities and colleges at both undergraduate and postgraduate level (at the moment most post-basic clinical nursing programmes are offered by colleges and ARE NOT recognised according to the NQF)

  25. Human Resources for Health for Health Plan of the NDoH • Calls for the increase in the production of all types of health care workers • Calls for the production of new cadres of health wokers, including clinical associates and community health workers • Production requires the availability of adequate health services and sufficient trainers and supervisors WHO 2008

  26. Health Service Planning Framework in the Western Cape • ‘Healthcare 2010’: The Western Cape in 2003 tables it planning framework to ensure equal access to quality care (with financial stability) • ‘Healthcare 2010’ seeks to re-shape services through 4 integrated plans • Comprehensive Service delivery plan (CSP); Infrastructure Plan; Human Resource Plan; Financial Implementation Plan • The Department of Health is implementing the CSP; other plans in development stage

  27. Health Service Planning Framework in the Western Cape: Concerns and Challenges • Full realisation of Healthcare 2010&full package of care of CSP is constrained by available funding • Provincial Equitable Share (used for District Health System&Regional Hospitals) & National Funding (NTSG) for tertiary (total estimates of underfunding R1.5billion) • Not adequately addressing the increasing health need due to the rising ‘quadruple burden’ of disease • Not addressing the national demand for increased human resource production including specialists and subspecialists (R500million estimated underfunding of HPTDG) • Does not fully address the resources required for the optimal provision of national and provincial specialised, highly specialised services and unique services; and the needs of national referral hospital centres

  28. Critical Shortage of Health Therapists Illustrates the Funding Gap Health Therapists Cape Metropole(1: 30 000 therapist to patient)

  29. Key Points • Under investment in Academic Health Complexes is hamparing the ability of the country to produce healthcare prersonell, to provide highly specialised services, and is hindering clinical research • There is a lack of a coherent national framework for the governance, planning and funding of Academic Health complexes • Academic Health Complexes serve a national function, but are dependent on provincial administrations for their service and staff requirements

  30. Recommendations (1) • An inclusive process needs to be embarked upon to address the state of Academic Health Complexes in the interests of a sustainable health system which is able to train the professionals for all levels of care • A national governance structure and an integrated framework funding for Academic Health Complexes are required • A process to determine number of health professionals to be trained, the infrastructure and human resource requirements, and the funding enevelope

  31. Recommendations (2) • The proposed governance structures and funding mechanisms may be formalised through section 51 on ‘Establishment of Academic Health Complexes’ in the National Health Act of 2004 • Urgent intervention is required to address the crisis in Academic Health Complexes in the Western Cape, Free State, and other parts of the country • Academic Health Complexes need to be treated as national assets rather than provincial liabilities

  32. “”” "Knowing is not enough, we must apply.Willing is not enough, we must do" Goethe

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