Issued by: North West Communication Service
IMPLEMENTATION PLAN FOR RESTRUCTURING THE NATIONAL HEALTH SYSTEM FOR UNIVERSAL PRIMARY HEALTH CARE
The MEC for the Department of Health and Developmental Social Welfare for the North West Province, Dr MP Sefularo, announced today that the first phase of the new Health System will be implemented from the 1st April 1996. Several elements of the proposed changes to the PHC delivery system are already an integral part of the current health sector restructuring process being undertaken by the Department of Health and the Provincial health administrations. A phased approach will be adopted in the implementation process. This will allow for the required discussion, consultation and negotiation around the PHC delivery model.
Initial changes will therefore take the form of a series of fast track implementation steps, which are regarded as essential pre-requisites for the full operation of the national PHC delivery system. The plan for restructuring the National Health System depends on a phased implementation starting in April 1996. These are aimed at rapid improvements to several of the critical problems facing the public health system.
All public health facilities such as local authority and provin- cial clinics, community health centres, day hospitals and district hospital outpatient departments (OPD) should therefore implement the following list of PHC deliverables from the 1st April 1996.
While the legislative process continues, it will be essential to demonstrate immediate and visible improvements in primary health care, particularly to those in living in under-served areas. The following list of PHC deliverables should be implemented at all public PHC facilities:
Elimination of user charges
Fees at all clinics and community health centres must be elimi- nated as from 1 April 1996. At the same time a "bypass fee" should be introduced at all hospitals, over and above the normal charge for whatever hospital service is used.
Patients who are referred to hospital from a primary health care facility must not be charged a "Bypass fee".
Extended hours of operation
From 1 April 1996, all public PHC facilities must be open from 07hOO 19hOO. During peak hours all staff should be attending patients and lunch hours should be readjusted to enable swift care of patients.
Provision of EDL medicines
All the essential drugs contained in the EDL must be available at all PHC facilities from 15 April 1996. If patients are to be successfully diverted away from hspitals, it will not be acceptable for clinics to run out of medicines at any time.
Disposable medical products (syringes, needles, etc) must be made available in the same way as medicines. An essential minimum list must be drawn up.
Maintenance of facilities and equipment
Basic maintenance of all PHC facilities must be carried out as a priority. A fresh coat of paint will project a new image of the PHC service.
Broken equipment must be repaired or replaced.
Every clinic must be equipped with the minimum list of equipment, as determined by the Department of Health.
Record keeping and administration
A minimum set of records must be kept for every PHC facility. The number of attendances by type of patient (maternity, child, adult) will be an important measure of usage of the new system. Statistics must be collated on a Provincial and- National basis. A simple record keeping system must be in place by 1 May 1996.
A simple system of stock control must be implemented at every clinic, primarily to prevent the theft of medicines and unexpected shortage.
Temporary clinic structures
Temporary clinic structures must be erected in areas where PHC facilities are under provided. Mobile clinics or container clinics can be used. Alternatively, buildings can be loaned from schools, churches and shops.
All under served areas must be identified and corrected by April 1997.
Transport
Transport arrangements should be put in place for all patients referred from PHC facilities to hospitals. All ambulances should be repaired and be ready to transport emergency cases. At least one ambulance should be stationed at the clinic serving any given community. This will reduce the reaction time in emergency situations.
Staffing requirements,
Elimination of user fees, diversion of patients away from hospi- tals and changes in the hours of access will have a dramatic impact on the staffing requirements of all public hospitals and PHC facili- ties. The changes in demand should be anticipated and appropriate staffing plans must be drawnup. Reallocation (redistribution) of staff and filling of vacant posts will be an essential means of coping with the changes.
At least one professional nurse trained in primary health care must be allocated to each clinic.
Arrangements should be made for a doctor to carry out a session at every clinic on weekdays. Regional and District managers have been mandated to start negotiations with private practitioners regarding sessions and referral services.
Community members or retired nurses should be recruited as volunteers to cope with sudden increase of patients. If possible, temporary staff should be hired for the first six months.
Logistics
Following a list of all the requirements of the various clinics and health centres, the Department has ordered all the equipment that was lacking at health facilities throughout the North West Province. We should be able to deliver the equipment by the 29th March 1996. All the drugs on the new Essential Drug List will be in the clinics by the 15th April 1996.
The policy emerges from the work of the Committee of Inquiry into a National Health Insurance System, which was appointed by the Minister of Health, Dr NC Dlamini Zuma, in January.
A total of 249 written responses to the Report were received from private individuals and organisations, portfolio committees of the National Assembly and provincial legislatures, and other Government Department. These were analysed in detail prior to the preparation of the policy document.
THE NEED FOR RESTRUCTURING OF THE NATIONAL HEALTH SYSTEM.
Health problems will become increasingly serious as the burden on the health services increase over time due to the rapidly expanding HIV/AIDS epidemic, the ageing of the population and other epidemiological shifts being experienced by our country.
Addressing these problems effectively will require a significant level of restructuring of both public and private sectors and of their interactions. Some elements of this restructuring can be undertaken in the short term, while other elements will require at least fie to ten years to implement.
One of the critical elements of the policy framework is a significant expansion of Primary Health Care Services (PHC) over the next 5-10 years.
THE ORGANISATION OF THE PHC DELIVERY SYSTEM.
The National Health System should be based on a comprehensive primary health care approach which incorporates a broad definition of health, of the nature and role of health services, and of the relationship between health service and other interventions which improve health status. Health services encompass promotive, preventive and curative services; and the crucial role of environmental factors such as clean water and sanitation; housing and education.
THE PRIMARY HEALTH CARE (PHC) PACKAGE.
The publicly funded PHC system will, over time, provide a comprehensive package of PHC services to the entire population of the country. This package will include district hospital services, environmental health services and other preventive, promotive and monitoring services, and comprehensive personal ambulatory services, including access to essential medicines for PHC.
List of PHC Services Personal PHC Services - Personal p~omotive and preventive services, including health education, nutrition/dietetic services, family planning, immunisation and screening for common diseases, HIV/AIDS education and pre-and post-test counselling .
Personal curative services for acute minor ailments, trauma, endemic diseases, other communicable diseases and some chronic diseases
Maternal and child health services such as antenatal care, deliveries, post natal and neonatal care, and care of children up to 18 years of age.
Provision of essential medicines PHC level investigative services, including radiology and pathology Basic oral health services, including treatment of pain and sepsis. Basic rehabilitation and physical therapy services, including services for people with disabilities
Basic optometry services
Mental health services
Community nursing and hame care services, including care of terminally ill and geriatric patients (with community organisations and relevant NGOs)
District hospital services
Non personal PHC Services
Health education and promotion activities aimed at groups and communities
Health related nutritional support with the Departments of Education, Agriculture, Land Affairs and relevant NGO's Control of communicable, non communicable and endemic diseases
School and institutional health services, including basic oral health services, audiology and vision screening, immunisation, and screening/referral for disabilities
Health related water and sanitation services, and other environmental health services (with the Departments of Water Affairs and Forestry and Environmental Affairs)
Community mental health services, and substance abuse support services (with Department of Welfare, and relevant NGOs)
Occupational Health and Safety Services (with Departments of Labour and Mineral and Energy Affairs) Essential accident and emergency services Health support services, including epidemiological services, health informatics and monitoring, and health planning and administrative capacity
Basic medico-legal services
These changes are in line with the policy of the National Department of Health and the other eight provincial health administrations, on the restructuring of the public and private health sectors, with the aim of developing an equitable and efficient national health system for the country.
ISSUED ON THE 26TH MARCH 1996.