Health system revolution
The recruitment of retired nurses to promote health schools will kick off in the next week.
Health minister Dr Aaron Motsoaledi returned from a study tour to Brazil last year and announced that he was determined to revitalise the country’s primary health care system, copying some of the successes from the Latin American country.
Dr Yogan Pillay, deputy Director General in the health department, told delegates at the 5th South African AIDS conference yesterday (SUBS: THURS) that by agreeing to delivery targets ‘the minister has signed his life away to the President and by extension our lives’.
Motsoaledi has broadly agreed to increasing life expectancy, decreasing the rate of maternal and child mortality, decreasing the burden of disease from HIV and tuberculosis and improving the effectiveness of the health system.
‘We start from a poor base, so the question is how far we can move by 2014,’ said Pillay.
Pillay unveiled three streams of ‘re-engineering’ the health system:
– A PHC team consisting of a professional nurse supported by at least four community health workers (CHWs) will be assigned to each of the more than 4 000 electoral districts. Depending on the need of the area, an environmental health practitioner and health promotion worker will also join each team.
– School health services will be established with a nurse assigned to a group of schools, possibly kicking off shortly with those schools educating learners from poorer households. Pillay said advertisements would be appearing in the next week calling on retired nurses to apply for these positions.
– The establishment of specialist doctor teams in the health districts.
Pillay said each PHC team would initially be responsible for 8 000 people with the aim to have 35% of households assessed and registered within the first year of the rollout.
Already 14 teams will be up and running by the end of next month with 54 in place by the end of the year. The teams will focus primarily on maternal and child health, HIV, TB and some chronic diseases.
Pillay said an audit of CHWs found that there were currently between 58 000 and 68 000 CHWs in the country, but said they were ‘unco-ordinated, untrained and not well supported’.
He said 5 000 CHWs would be trained or re-trained by the end of the year.
In terms of the schools, Pillay said the vision was to have a health presence in each institution, but in the light of the shortage of nurses it may be more feasible to deploy nurses to a cluster of schools or target the poorer schools.
The specialist doctor teams consisting of among others obstetricians, gynaecologists, family physicians and paediatricians would target the districts and could be assigned to more than one depending on the population sizes.
Pillay said Motsoaledi was already consulting with deans of medical schools as well as the groups representing specialists with a view of getting this off the ground.
‘We can’t afford to have a launch of concepts and policy. We have been tasked with getting this off the ground and when we launch it, it has to be happening already,’ said Pillay, adding that the plans had to be ‘in sync with the National Health Insurance’ plan.
Pillay said National Treasury had given the department R338-m in the current budget to make it happen. A further R400-m and R700-m has been budgeted in 2012/3 and 2013/4 for PHC and R501-m and R700-m for maternal and child health in the same periods.
Professor Helen Schneider, a member of government’s PHC task team, said the policy had political will and money behind it.
Speaking in Durban, Schneider cautioned that major system change took time and that Brazil had implemented and grown its programme over four political terms and three presidents. ‘It won’t happen overnight,’ said Schneider, who is based at the University of the Western Cape’s School of Public Health.
‘The challenge is to ensure this plan goes beyond the 2019 political term,’ she said.
Gerard Payne, of the AIDS Consortium, said they would be pushing for the CHWs to receive R2 500 per month as they formed the backbone of the system.
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