Minister Botha on Health Care 2020
As we are moving towards the end of 2011, it is appropriate and significant to take a retrospect look at the past decade and to turn the lens in the direction of our next milestone - Health Care 2020.
Retrospect: Health Care 2010
When I entered the realm of the health sector in 2009, I stepped into a department tying up the last strings of Health Care 2010, based on a primary healthcare system, with District Health Services management as a support - and the whole system working on a patient referral system. A triage system was established treating patients at emergency units in accordance with the intensity of the urgency of the case. With the exception of a management structure that needed some tweaking, the infrastructure and systems have been put in place under the excellent leadership of Professor Craig Househam, and I commend him for that.
In the past year, primary health care in this province has been tested and applauded all round for its success as a structure that is nurse-driven and provides basic medical services to the more than 4 million people who depend on public health services. And this number is ever increasing as a result of migration, because of the quality of health services provided in this province, exceeding the services delivered in neighbouring provinces and neighbouring countries.
Primary Health Care Approach
The planned outcomes of Healthcare 2010 were a primary health care approach, rooting services in communities at clinics, community health centres and through home-based care.
The district health system is based on population numbers, living within clearly defined geographical areas. The goal is that patients are treated at the lowest appropriate level and that the primary healthcare facility should be within average walking distance within a radius of 3-4 km. The basic staffing unit is 18 staff members per 30 000 population. The service is then supported through a referral system. Each clinic is linked to a community health centre, which in turn is linked to a district hospital.
Specialised hospitals include psychiatric hospitals, the Western Cape Rehabilitation Centre as a centre of excellence for rehabilitation, TB hospitals, emergency services and forensic pathology services.
The functioning of Western Cape Government Health as reflected in its annual reports for the last several years show areas of excellence in service delivery with an overall functioning health system, capable financial management with year-on-year unqualified audit reports and expenditure within 1-2% of the allocated budget. By this measure, the department has and continues to meet its mandate of the provision of health services to around 78% of the population of the Western Cape. In certain areas, the province has led the country amongst which are the following to mention only a few:
- Through triple therapy, the prevention of mother-to-child transmission of HIV has the current transmission rate of below 3% while the number of patients placed on anti-retroviral therapy is exceeding 100 000.
- New smear cure rates for tuberculosis of 80.5%, which is the highest TB cure rate achieved in South Africa. The department is making significant progress in addressing the epidemic through the Enhanced TB Response Strategy.
- A total of 2 584 home-based carers were appointed via 145 non-profit organisations with a CBS headcount of 4.65 million.
- Regional general specialist services at all regional hospitals, staffed by adequate numbers of general specialists providing outreach and support, with in addition a family physician training program that has enabled the deployment of an increasing number of specialist family physicians at district level.
- A chronic dispensing unit that allowed for the pre-packing of 1.7 million prescriptions for ease of dispensing at primary healthcare facilities and thus reducing waiting times at these facilities.
- Undertook a successful mass measles immunisation campaign that ended an outbreak of measles in the province.
- The prevalence of diarrhoea and the associated mortality rate, decreased with the addition of zinc and oral rehydration therapy, improvement of environmental factors and the introduction of the Rotarix vaccine.
- Since the introduction of the hand washing campaign in the Western Cape, the provincial Department of Health has recorded a remarkable decrease in diarrhoeal disease hospital deaths in children under five years old in the metro. Compared to last season, which reported 37 in-hospital deaths in metro hospitals, there have been only four during the same period (January to March) of this year.
- The only dedicated stand-alone children's hospital in South Africa that provides a wide spectrum of highly specialised healthcare services for children which is supported by a unique trust that has raised millions of rands in donor funding from corporate and public donors to equip and refurbish the hospital.
Health and Wellness Summit
When this DA-led government was given the mandate by the people of the Western Cape to govern this province, we knew that this is the opportunity to demonstrate to the people of this country what it means to be an open opportunity society where people can live they life they value. We knew the change had to be visible and tangible. People needed to see and experience the change in their everyday lives - when they delivered their children to school, when they sat in traffic, when they visited their local clinic. And so we agreed on 12 strategic objectives for this provincial government - the fourth being strategic objective number four: increasing wellness.
On the road towards wellness, the Premier this week hosted a Wellness Summit - a first of its kind, certainly in this country. She invited all role players and opinion leaders from the private health sector to voice their opinions on the current status of health care in the province, and their vision for health care in future. Conversations spanned from infectious diseases and communicable diseases to woman and child health, violence and injuries. Conversations were sometimes heated, compromises were made, but the declaration that all participants committed to was that the cycle of disease is a sphere of destruction and that the path of prevention is the road to wellness and that wellness needs to be facilitated by behavioural change across all sectors of society. Government has a major role to play in this facilitation.
Following the declaration made at the summit, and the strategic planning to follow from that, the details of the planning towards Health Care 2020 will be formulated in due course. It is clear that there will be a shift away from government carrying all the responsibility for the health of its citizens, but that individuals will be encouraged and challenged to take responsibility for their own health and for the risks they take in making irresponsible decisions affecting their own health. In this regard I refer to drug and alcohol abuse, unprotected sex, unhealthy eating habits and a passive lifestyle.
What Should the Department Do Differently in 2020?
- Current departmental structures result in significantly fragmented services. Primary health care and district hospitals are within one division, while EMS, regional and central hospitals and forensic pathology services are in another division. There needs to be more attention to a functional arrangement to improve the coordination of services and respond to services needs in a more cohesive manner within defined geographic areas, and also inter-governmental with SAPS, disaster management and transport authorities.
- Modeling will have to be done to determine the staff numbers required per geographic area.
- Community-based care workers should function in primary healthcare teams for a specific number of households in designated geographic areas.
- Non-profit organisations will be contracted to achieve specific outcomes as part of the "care pathways approach".
- The target bed utilisation rate in acute hospitals is 85%. Specialist-led teams will ensure referral to higher levels of care and outreach and support to district health services. Home-based carers can play a role in after care. In the envisaged service delivery platform for 2020, the avoidance of hospitals will be a marker of qood quality primary health care and community-based services.
- There needs to be a review of intellectual disability services. Many of the long-stay clients in these hospitals are not ill and their care pathway needs to be strengthened. Residential care should be managed within a broader social network rather than health service.
- The implementation of upstream interventions will positively impact on reducing injuries and non-communicable diseases. However, the EMS fleet in the metro needs to be expanded for improved access, distribution and quality of contacts.
Health Care 2010 has been evaluated. Patient experiences and perceptions have been measured. Outcomes have been compared. We have statistics and information. Now is the time for Western Cape Government Health to draw the pathways towards Health Care 2020. The goal is not difficult. The goal is our patients and their experience when interfacing with our staff, when visiting our facilities, and the outcome of the treatment they receive.
Wellness is what we are debating in the House today. It spans not only health. It spans across all departments and all sectors - Education, Social Development, Community Safety, Housing, Transport, Environment, and Planning. Wellness is not a department, neither a philosophy. It is a state of being, the state of being that we have set our goal to achieve through Health Care 2020 in the Department of Health, but also through our linkages with other departments and all spheres of government. It will not be easy, we face many challenges, but as long as keep the patient, the individual, at the heart of the challenge, we are bound to achieve a state of quality health care - because the end goal is not a task but an individual who deserves to live the life he or she values. Our goal is a better healthier society with happy patients.
Health Care 2020 represents a shift from only treating illness to the prevention of disease and creating a state of wellness.
What Will be the Envisaged Service Delivery Platform by 2020?
- There will be an integrated and transversal whole of society approach.
- Valid and reliable data will be available to monitor health outcomes against five-year targets.
- The patient will be at the centre of the system and treated according to their individual needs.
Health through Design
In this context I would like to share with you an idea presented by Rae Pentecost at the recent Design and Health Africa Indaba here in Cape Town. He said that design should help people achieve health. In urban planning it should be achieved through a different approach to transportation - providing areas that promote cycling and walking.
In the workplace - special attention to ventilation, light and creating a safe environment. In health care, well-designed facilities facilitates happy staff that results in better outcomes for patients. In education, the design of schools plays an important role to create a safe and secure environment for learners and staff. In our homes, a clean, safe, ventilated, pest-free design that will lead to an improved state-of-mind.
I would like to single out the new Mitchell's Plain Hospital as an example of a positive healing environment which will result in reduced medication, shorter hospital stays, decreased operational costs, enhanced patient satisfaction and higher staff retention. Developers believe that the hospital will be one of the most naturally beautiful in the country. The location and the design of the hospital are such that only 15% of the highly conservation-worthy area will be lost. The conservation area creates a traffic noise buffer, and it also creates a positive natural landscape within Mitchell's Plain.
Cornerstones of Quality Improvement in 2020
Client-centred quality of care is at the core of the vision of 2020. Particularly in the eyes of the patient, the patient experience is as important as the outcome of the treatment, and the respectful treatment of the patient. The department will put multi-level interventions in place to address staff behaviour and approach towards patients.
Health and wellness is an all-encompassing state, and as a government it is our duty to ensure the efficient implementation of strategies and plans towards that goal. I believe that the path of wellness we have chosen is a path that challenges us, but it will lead to transformation towards a better life and action a healthier society with a higher level of satisfaction by patients due to a more pleasant experience.