HEALTH MILESTONES SINCE 2009 - Western Cape · Overview State of Health in the Province - 5 years...

HEALTH MILESTONES SINCE 2009

Cape Town | Minister Theuns Botha|

Professor Craig Househam

© Western Cape Government 2012 |

Overview

State of Health in the Province - 5 years later

Introduction

Mapping the strategic objective to “Create Wellness”

Expanding health infrastructure to redress past inequalities

Strengthening our health EMS

Bringing the private sector on board

2


Causes of death

1. Chronic diseases including mental health

2. Injuries (violence, road traffic)

3. Infections (HIV and TB)

4. Maternal & perinatal, childhood causes

Major causes of death in the Western Cape

State of Health in the Province - 5 years later 3


Specific issues [1]: Service pressures:

Emergency Centre headcounts for acute Metro hospitals

2014 PG MTEC 2 Meeting: Department of Health 4


Service outputs

5 State of Health in the Province - 5 years later

Primary Health Care (PHC):

• See approximately 14,7 million PHC patients per year.

• In addition 4,5 million home visits.

Hospitals:

• Admit approximately 500 000 patients annually to acute hospitals

• Attend to around 1,9 million outpatient visits

Chronic Dispensing Unit (CDU):

• Increased from 1,47 million packages in 2009/10 to 2,2 million packages in 2012/13

• Will extend to the whole province in 2014.

HIV/TB:

• Total clients on ART up from 75,000 (2009/10) to over150, 000 by end of 2014

• PMTCT down from 3.6% (2009/10) to 1.9% (2011/12) – the lowest in SA

• TB Cure rate increased from 79.4% (2009/10) to 81.7% (2012/13) – the highest in the country

• Male condom distribution coverage increased from 38.8% (2009/10) to 54.1% (2012/13). The Western Cape has the highest distribution rate in SA for 2013-14 (Institute of Race Relations study).


PMTCT in WC: Success Story


Service outputs (2)


Maternal and Women’s Health

• The rate of 1st Antenatal visits before 20 weeks has increased from 46.4%

(2009/10) to 58.1% (2012/13)

• Maternal deaths per 100 000 in facilities decreased from 107.69 (2009/10) to 60

(2012/13).

• WC has the highest life expectancy rate for both males and females in the

country

• Cervical cancer screening coverage increased from 40.7% (2009/10) to 55.0 % in

2012/13


Overview


Introduction





8


Provincial Strategic Plan

Strategic Objective 1: Creating opportunities for growth and jobs

Strategic Objective 2: Improving education outcomes

Strategic Objective 3: Increasing access to safe and efficient transport

Strategic Objective 4: Increasing wellness Strategic Objective 5: Increasing safety

Strategic Objective 6: Developing integrated and sustainable human

settlements

Strategic Objective 7: Mainstreaming sustainability and optimising

resource use efficiency

Strategic Objective 8 &9: Promoting social inclusion and reducing poverty

Strategic Objective 10: Integrating service delivery for maximum impact

Strategic Objective 11: Increasing opportunities for growth and

development in rural areas

Strategic Objective 12: Building the best-run provincial government in the

world.



Source: Dalgren and Whitehead framework 1991

Social Determinants

Importance of social determinants

The importance of partnerships - “Whole of society approach”



Strategy for increasing wellness

Prevention and promotion

Requires whole of society approach (other

departments, spheres of government and civil

society)

Premier launched Summit on Wellness in

November 2011 which endorsed the Cape

Town Declaration on Wellness

Created the PTMS Initiative reports back to

provincial cabinet

Addressing the upstream factors that impact on health and wellness

Priority focus areas for intervention

1. Improving healthy lifestyles

2. Preventing injuries and violence

3. Improving maternal and child health

4. Strengthening women’s health

5. Improving Mental Health

6. Reducing Infectious diseases such as HIV/TB using “bulls eye” model



Improving maternal and child health


First 1000 Days of Life

Develop Rapid Assessment and Response tool for early identification of at risk mothers and children

Develop MICH Dashboard for critical services/ interventions

Close links with Early Childhood Development Programmes

Integrated School Health Services

Mobile Health Services

Image Source: Google images

Focus areas


Improving healthy lifestyles


Workplace

Pedometer challenge to create a culture of wellness in the Western Cape

WCG: 4 member teams from departments

Team target = 1 000 000 steps – challenge resets once reached

Plan to expand beyond WCG in 2014

Western Cape Initiatives

Wellness Centres Pilot

Public Private Partnership to provide health screening and education

Screening tests: blood pressure, cholesterol, glucose, body measurements (BMI), HIV and TB

Launch: 11 March’14, Conference Centre, Mitchells Plain Hospital

Sweet Life Magazine

Promoting healthy living for people with chronic disease

Quarterly publication with wide distribution, including at DoH

Adherence Clubs and Wellness Centres

DoH will provide content for 4 pages in 4 consecutive issues

Procurement process being finalised by DoH Communications

13

Partner Area Partner District

Clicks Gugulethu;

Mitchells Plain

ICPA Khayelitsha;

Mowbray

Dis-Chem Tableview; Tokai MHG Cape Town

Station; Somerset

West

EMC Athlone;

Kuilsriver;

Mitchells Plain;

Retreat;

Woodstock

Pebbles

Project Stellenbosch

EOH Mobile TBC Pick n Pay Mitchells Plain;

Tableview


Overview


Introduction





14


Expanding health infrastructure (1)

To redress past inequalities


Focus areas:

Revitalization of the physical infrastructure of hospitals,

ambulance stations and forensic mortuaries

Upgrading and building of a number of PHC facilities

Achievements :

R2.7 billion on health infrastructure over the last four

years:

• 17 primary health facilities,

• 12 ambulance stations or disaster management

centres,

• 8 district hospitals including Khayelitsha and

Mitchell’s Plain hospitals,

• 3 regional and specialised hospital projects,

• 21 central hospital projects,

• 5 pathology labs and

• The Western Cape Nursing College




The Primary Health Care Information System (PHCIS) rolled out to 50 sites in 2012/13

PACS/RIS:

successfully implemented in the three central hospitals

Tender awarded for regional and some large district hospitals

JAC, which is a pharmacy dispensing and stock control system and historically only

implemented in hospitals, was successfully piloted at Michael Mapongwane CDC

and rolled out to a further 27 PHC facilities




ARV treatment centres completed: Crossroads, Gugulethu and Retreat

Repairs and renovations to: Brooklyn Chest Hospital; Harry Comay TB

Hospital; Somerset Hospital; Malmesbury TB Hospital

Worcester Disaster Management and ambulance station

Highlights 2009-2013

2009/10

ARV treatment centres completed: Michael Mapongwana CHC

Repairs and renovations to: Valkenberg Hospital; Eerste River Hospital;

Riversdale Hospital phase 2 ; Vredenburg Hospital phase 1b; GSH; RCWMCH;

Happy Valley Clinic

Construction of New Ceres Ambulance Station

Kwanokuthula: New Ambulance Station and New CHC

2010/11

17




Highlights 2009-2013

Clinic upgrades: new building in Oudtshoorn; Grassy Park; TC Newman;

Melkhoutfontein

District hospitals completed: Khayelitsha Hospital; Vredenburg phase 2 A;

Riversdale phase 3

Regional/central hospitals: Paarl Hospital; PET scan at Tygerberg Hospital;

RCWMCH ward C2.

Ambulance stations: Lamberts Bay and Vredendal

2011/12

Clinics completed: Du Noon Temporary Clinic, Grabouw CDC; Knysna CDC

District Hospitals: Mitchells Plain Hospital

Regional/central hospitals: George Hospital Phase 3, GSH Linear Accelerator

Unit

Ambulance stations: Leeu Gamka, Tulbagh Ambulance Station..

2012/13

18


Khayelitsha and Mitchell’s Plain Hospitals


Khayelitsha District Hospital in the poorest community with the highest BOD is the first hospital to

• Be built on the Cape Flats in decades

• Use green building design principles from inception

• Use Enterprise Content Management from inception to digitally manage and store patient records.

• An analysis of service shifts shows

– Patients have moved from GSH, Mowbray Maternity Hospital, RCWMCH, Karl Bremer and GF Jooste Hospitals to Khayelitsha Hospital and TBH.

– Net increase in the number of Khayelitsha patients accessing the hospital’s services.

Mitchells Plain Hospital was completed and commissioned in 2013/14.

• Another landmark development in the history of the local community and the Department.

Both state of the art and environmental friendly hospitals


Major Infrastructure Replacement


There has been a major focus on medical equipment replacement.

For example :

• CT scanners have now been installed in regional and some of the large district

hospitals (Paarl, Worcester, George, NSH, MPH)

• MRI scanners have been replaced in TBH and RXH

• PET scanner at TBH

• Linear accelerator at GSH (for treatment of cancer patients)

• This made a major difference to the quality of care, waiting times for these

procedures and the morale of clinicians.


Overview


Introduction





21


Strengthening our Emergency Medicine services (1)


Hosting of the FIFA 2010 world cup showcased the capacity

and quality of our pre-hospital services in the province.

Our health systems were strengthened through:

Investment in vehicles, personnel and equipment

Training and coordination of hospital disaster plans

More responsive and resilient operational processes

Performance:

Our greatest achievement is the improvement of

response times to priority 1 (life threatening)

• From 28% to 74% of P1 cases under 15 min in urban

areas

• Currently 84% of P1 incidents responded to in under

40 minutes in rural areas.




Rural initiative:

The project at Leeu Gamka is an example of rural investment and upliftment that

has yielded rich rewards.

The training and appointment of 9 personnel including 2 advanced life support

providers and a rescue technician from within the community.

HealthNET:

The HealthNET service provides a means of access for rural communities to

essential health services.

Online booking system ensures the efficient and coordinated tasking of HealthNET

transporters.

The number of patients transported from the rural towns increase from less than 30

000 per year to more than 70 000 transports to Cape Town alone in a calendar

year.




Personnel:

Exceptional investment in EMS personnel with the appointment of :

• 516 Basic life support providers

• 87 Intermediate Life Support providers and

• 45 Advanced Life Support providers.

This includes the appointment of key rescue technicians in key locations across the

province (in particular the major N1 and N2 transit routes) to ensure that these key

stretches of our road network are covered

Training:

EMS Internship program that resulted in 60 highly trained personnel

During the last five years :




Vehicles:

• Procured 56 additional ambulances, all of which have been built and converted

locally.

• Replaced 393 old ambulances with newer models.

Facilities:

• Built 7 purpose built EMS stations (Plettenberg bay, Khayelitsha, Tulbagh, Ceres,

Vredendal, Leeugamka and the newly completed station at Malmesbury)

• The service extend into the communities of Lambertsbay, Stanford, Murrayburg,

and Bitterfontein.

Communication Centre:

The investment of R256 million into a modern computer aided dispatch system

underlines the departments vision of creating a world class EMS service


Overview


Introduction




Partnering with the Private Sector

26


Partnering with the private sector


Increased access to family planning and baby immunization services

The department provides stock and the private partner renders the service.

About 200 entities now have valid contracts with the department

Pilot Wellness Centres with retail pharmacies.

Western Cape Health Foundation

Alternative funding models

infrastructure upgrade donations amongst others at RCWMCH, Victoria Hospital

Paediatric Ward, as well as a new clinic built in George.

Hospital accommodation

alternative funding models for hospital accommodation - Helderberberg and

Mosselbay Hospital’s as examples.

Well established Public - Private forum

Well established system of licensing private health facilities.

Key Messages


Key Messages (1)


Context :

• Escalating burden of disease especially chronic diseases.

• Health Services are under pressure

• Staff work in a stressed environment.

• Resources are limited.

However the Department has :

• Improved health outcomes.

• Made person-centered experience the focus of our efforts

• Expanded the health service platform

• Commissioned state of the the art facilities

• Increased the staff numbers to current 32,000 staff with less than 4% vacancies

• Prioritized the concern for and care of staff

• Modernized the infrastructure

• Prioritized acquisition of medical equipment

• Embraced advances in ICT technology


Key Messages (2)


Have achieved the above:

• Within the allocated budgets on an annual basis.

• With a track record of unqualified audits for ten years.

• Have developed systems and processes to sustain good practice.

• Built a culture of continuous learning and improvement.

Challenges:

• Will not deny that there are still problems and challenges.

• Limited resources means that “everything cannot be provided to everybody”.

• Have to increasingly shift the focus to prevention and wellness.

• Have to create a culture of health as a “whole of society” responsibility.

Credit to:

• Minister Botha and the Premier for clear political leadership and support.

• Management at all levels of the Department and the dedicated staff.

• Partnerships with HEIs, private sector, unions and NPO’s

• Support and participation of the community at large.

Tel: Fax:

www.westerncape.gov.za

Contact Us

Professor Craig Househam

Western Cape Health

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HEALTH MILESTONES SINCE 2009 - Western Cape · Overview State of Health in the Province - 5 years...

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