Launch: Rural Proofing Guidelines

Response from NDoH

Jeanette R Hunter

29 January 2015

Problem Statement

• Policy limitations and rural realities – Vuyokazi Gonyela

• The difficulty with policy implementation in a rural province - Andrew Robinson

Problem Statement

• Problem statement– Policy formulated to address

statement

– Implementation preparation– Implementation

Applying a systematic approach on a system

Result

Hit and miss - mostly miss

Why ?????

Problem Statement• Policy limitations and rural realities –

Vuyokazi Gonyela– Out of stock medicines– Long queues, resulting in impossible waiting

times– Functionality of CHEs– Problems to information systems– Social Determinants of Health– Systems inability to cope with the demand (CD4

of <500)

• The difficulty with policy implementation in a rural province - Andrew Robinson– A facilitator of services to communities feeling

let down by the system, (peers and principals)

MISS in Hit and Miss

Rural Proofing guidelines

• Daygan: “The Guidelines are not going to propose solutions, its going to enable us to THINK RURAL”

• Thus on its own it will not improve the REAL SITUATION on the ground for communities

• Development MUST be supported where people live

• Health System activities MUST support development

WHY the MISS in Implementation

• No blanket answer that will suffice for the entire health service environment

• In spite of good policies there are very specific problems from setting to setting– Issue of funding is a good example of this

• Ian’s point about Equity – act in terms of specific need

HOW

Ideal DHMT

Adequate Health Services

Ideal Clinic (rural/urban)

Ideal National Health Management

Ideal Provincial Management

Ideal Community Services

Ideal Political Leadership in Health

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 determination is done by the Permanent Perfect Team for Ideal Clinic Realisation and Maintenance (PPTICRM) with the help of a PEPFAR funded implementation partner

• The corrective interventions are done by the PPTICRM under guidance of the acting district manager and the team member from the NDoH who is responsible for Vhembe

The following slides contain the summarised and aggregated results

for the 61 clinics and CHCs in Vhembe

Additional Consultation rooms have been completed for the clinics below

1 Matsheka The additional doctors rooms for these clinics have been completed. Waiting for Municipality to sign off the occupation certificate before it can be practically handed over for use

2 Nghezimane

3 Xhikundu

4 Duvhuledza

5 Tshifudi

6 Mukula

7 Phiphidi

8 Murangoni

9 Thondo Tshivhase

10 Sambandou

11 Mutale

12 Manenzhe

13 Makhado

14 Nkhensani

15 Muila

– Political Commitment

– Pressure from leadership• Premier in KZN now to be followed by premiers in other provinces steered

by the deputy president• Service delivery committee chaired by Minister Gorhan, Task team chaired

by DG Coperative governance with a very specific and practical approach• Minister of Health – Operation Phakisa• NDoH using a population indicator approach (diarrhoea in children under 5)

Social Determinants of Health

• Thank you• Keeping Rural In mind– Educational

– Instructive (Identify rural clinics as part if IC Process)

– Facilitate improvement• But only if we keep our eye on, plan for and make specific

interventions

Value of Rural-Proofing Guidelines

THANK YOU FOR YOUR ATTENTION!

www.doh.gov.za