Mountain to climb in primary health care

By Londiwe Buthelezi Time of article published Sep 30, 2013

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Johannesburg - The re-engineering of primary health care in Gauteng has taken place at a disappointing pace. The Johannesburg metro had struggled to attract professionals to form community outreach teams and district specialists and there had been no buy-in to the schools health teams by the communities, it was revealed during the Public Health Association of SA’s conference on Friday.

Budget constraints and scarcity of health-care professionals might have knocked the province’s readiness for the implementation of the National Health Insurance (NHI) system, Phethogo Madisha, a technical advisor at Anova Health Institute, which has been monitoring the progress in Gauteng’s re-engineering of primary health care, said in Cape Town.

Madisha said by the end of August, 73 outreach teams had been formed in Gauteng but the Johannesburg metro, which served the biggest population, had only 11 teams. The outreach teams consist of four to five community health workers led by a primary health-care nurse.

Madisha said with the shortage of primary health-care nurses to lead the teams, it became a challenge to form more. Even among the constituted teams, not all had the required number of personnel.

The re-engineering of the system forms the core part of preparing the public health sector for the full roll-out of NHI in the country as the policy places emphasis on preventative and primary health care.

The national Department of Health began the re-engineering of the system to strengthen the patient referral system in clinics to relieve the overburdened tertiary hospitals.

When the 10 NHI pilot districts were named last year, the department announced re-engineering would take place in three main streams – the district specialists’ teams, the deployment of primary health-care workers’ teams as community health agents, and the schools’ health programme.

“Progress has been made but there is still a mountain to climb. The formation of the primary health care outreach teams, especially in Johannesburg, is going very slow and the population is much bigger.

“The integration of local authorities and province is needed… I’m hoping that will help us form more teams because if teams cannot be formed, it’s going to impede fast-tracking the efficiency of the system,” Madisha said.

Fifty out of the targeted 59 schools’ outreach teams were formed in Gauteng at the end of February, but not all teams had the required personnel.

In district specialist teams, which should be made up of an obstetrician, a paediatrician, a family physician, an advanced midwife and a senior primary care nurse, all five teams established by the end of February were not complete because of scarcity of some specialities.

Agnes Shabalala, a researcher at the Soul City Institute, which looked at the challenges faced by community health workers who are supposed to form the outreach teams, said researchers found the lack of job security and insufficient stipends, which ranged from R1 200 to R1 500 a month, impeded recruitment.

“In KwaZulu-Natal, there are community health workers who have been volunteering for seven to 10 years. They’d like the formalisation of jobs… The stipends are not only insufficient but there is inconsistency. They sometimes go three months without receiving it.” - Business Report

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