Launch: Rural Proofing Guidelines Response from NDoH Jeanette R Hunter 29 January 2015 Problem Statement •  Policy limita+ons and rural reali+es – Vuyokazi Gonyela •  The diﬃculty with policy implementa+on in a rural province -‐ Andrew Robinson Problem Statement •  Problem statement –  Policy formulated to address statement –  Implementa>on prepara>on –  Implementa>on Applying a systema+c approach on a system Result Hit and miss -‐ mostly miss Why ????? Problem Statement MISS in Hit and Miss •  Policy limita+ons and rural reali+es – Vuyokazi Gonyela –  Out of stock medicines –  Long queues, resul>ng in impossible wai>ng >mes –  Func>onality of CHEs –  Problems to informa>on systems –  Social Determinants of Health –  Systems inability to cope with the demand (CD4 of <500) •  The diﬃculty with policy implementa+on in a rural province -‐ Andrew Robinson –  A facilitator of services to communi>es feeling let down by the system, (peers and principals) Rural Prooﬁng guidelines •  Daygan: “The Guidelines are not going to propose solu>ons, its going to enable us to THINK RURAL” •  Thus on its own it will not improve the REAL SITUATION on the ground for communi>es •  Development MUST be supported where people live •  Health System ac>vi>es MUST support development WHY the MISS in Implementa>on •  No blanket answer that will suﬃce for the en>re health service environment •  In spite of good policies there are very speciﬁc problems from se^ng to se^ng –  Issue of funding is a good example of this •  Ian’s point about Equity – act in terms of speciﬁc need HOW Ideal Clinic (rural/urban) Ideal Community Services Ideal DHMT Provincial Management Ideal Ideal Na+onal Health Management Ideal Poli+cal Leadership in Health Adequate Health Services Vhembe District Ideal Clinic Status •  Total of 120 clinics and CHCs in Vhembe health district •  Of these 61 have determined their Ideal Clinic status between April and October 2014 •  The remaining 59 will be done by end January 2015 •  The status determina>on is done by the Permanent Perfect Team for Ideal Clinic Realisa>on and Maintenance (PPTICRM) with the help of a PEPFAR funded implementa>on partner •  The correc>ve interven>ons are done by the PPTICRM under guidance of the ac>ng district manager and the team member from the NDoH who is responsible for Vhembe 1! 2! 3! 4! 5! 6! 7! 8! 9! 10! 11! 12! 13! 14! 15! ! Beaconsfield! Wayeni! Muledane! Helderwater! Makhado! Mphephu! Madombidzha! Ntlhaveni!D! Tshiombo! Tshiungani! Mavambe! Makonde!Clinic! Olifantshoek! Malamulele!Clinic! Vhufuli!Tshitereke! ! 80% 32! 33! 34! 35! 36! 37! 38! 39! 40! 41! 42! 43! 44! 45! 46! 74% 68% 66% 65% 63% 61% 60% 60% 60% 59% 58% 57% 56% 55% Facililities! Tshixwadza! Waterval! Folovhodwe! Sterkstroom! Masisi! Shayandima!Clinic! Madala! Marseilles! Levubu! Shingwedzi! Manavhela! Khakhu! Mulenzhe! Tshimbupfe! Mbilwi! SCORE&%& Facililities! SCORE&%& ! 45% 45% 44% 44% 44% 43% 43% 43% 42% 42% 42% 42% 41% 40% 40% 16! 17! 18! 19! 20! 21! 22! 23! 24! 25! 26! 27! 28! 29! 30! 31! ! Gondeni! Pfanani! Mhinga!Clinic! Rumani! Mphambo! Shigalo! Mukula! Matsheka! Makuleke! Guyuni! HaMmutsha! Tiyani!CHC! Makahlule! Ntlhaveni!C! Tswinga! Matiyani! ! 54% 47! 48! 49! 50! 51! 52! 53! 54! 55! 56! 57! 58! 59! 60! 61! ! 53% 52% 52% 49% 49% 48% 48% 47% 47% 46% 46% 46% 46% 46% 46% SCORE&%& Facililities! SCORE&%& ! Facililities! Davhana! Magwedzha!Clinic! Damani! Mashau! Shikundu! Lwamondo!Clinic! Tshisaulu! Mtititi! Peninghotsa! Tshikundamalema! Thengwe! Ntlhaveni!E! Nghezimani! Masakona! Nkhensani!Clinic! !! 38% 38% 38% 37% 37% 36% 34% 29% 28% 28% 27% 27% 26% 25% 22% !! The following slides contain the summarised and aggregated results for the 61 clinics and CHCs in Vhembe Addi+onal Consulta+on rooms have been completed for the clinics below 1 Matsheka The addi>onal doctors rooms for these clinics 2 Nghezimane have been completed. Wai>ng for Municipality to 3 Xhikundu sign oﬀ the occupa>on cer>ﬁcate before it can be 4 Duvhuledza prac>cally handed over for use 5 Tshifudi 6 Mukula 7 Phiphidi 8 Murangoni 9 Thondo Tshivhase 10 Sambandou 11 Mutale 12 Manenzhe 13 Makhado 14 Nkhensani 15 Muila Social Determinants of Health –  Poli+cal Commitment –  Pressure from leadership •  Premier in KZN now to be followed by premiers in other provinces steered by the deputy president •  Service delivery commimee chaired by Minister Gorhan, Task team chaired by DG Copera>ve governance with a very speciﬁc and prac>cal approach •  Minister of Health – Opera>on Phakisa •  NDoH using a popula>on indicator approach (diarrhoea in children under 5) Value of Rural-‐Prooﬁng Guidelines •  Thank you •  Keeping Rural In mind –  Educa>onal –  Instruc>ve (Iden>fy rural clinics as part if IC Process) –  Facilitate improvement •  But only if we keep our eye on, plan for and make speciﬁc interven>ons THANK YOU FOR YOUR ATTENTION! www.doh.gov.za