1 KWAZULU NATAL DOH PRIORITIES DR V MUBAIWA

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4 POVERTY SCORE : 2007 (Source PGDS)

5 COMPOSITE SOCIAL NEEDS (Source PGDS)

8 PROVINCIAL GROWTH AND DEVELOPMENT STRATEGY – KZN VISION KwaZulu-Natal, a prosperous Province with a healthy, secure and skilled population, acting as a gateway to Africa and the World.

9 » MISSION » To develop and deliver a sustainable, coordinated, integrated and comprehensive health system at all levels of care based on the Primary Health Care Approach Paradigm Shift for staff and clients “NONE BUT OURSELVES”

10 An efficient and well functioning health care system with the potential to respond to the burden of disease and health needs in the Province. 1. Overhaul Provincial Health Services. Improved compliance with legislative/ policy requirements and Core Standards for quality service delivery in order to improve clinical/ health outcomes. 2. Improve the efficiency and quality of health services. Reduction of preventable/ modifiable causes of morbidity and mortality at community and facility level contributing to a reduction in morbidity and mortality rates. 3. Reduce morbidity and mortality due to communicable diseases and non-communicable conditions and illnesses. 10

» Output 1: Increasing Life Expectancy » Output 2: Decreasing Maternal and Child mortality » Output 3: Combating HIV and AIDS and decreasing the burden of diseases from Tuberculosis » Output 4: Strengthening Health System Effectiveness 11

12 NSDA Priority 1: Increase life expectancy All MDG's NSDA Priority 2: Decrease child & maternal mortality MDG 4 and 5 NSDA Priority 3: Combat HIV, AIDS, STI & burden of disease from TB MDG 6 NSDA Priority 4: Strengthen health system effectiveness  Reduce HIV incidence  Manage HIV prevalence  Scale up integration of HIV and TB  Improve TB outcomes  Health care financing & management  Human resources for health  Quality & accreditation of health facilities  Health infrastructure  IT and Health Information systems  Revitalisation of PHC  Reduce Child morbidity & mortality  Reduce neonatal and maternal morbidity & mortality  Improve women’s health  Reduce non- communicable diseases  Prevent intentional/ unintentional injuries  Maintain strategies to prevent malaria & cholera 12

13 Strategic GoalRationale 1. Overhaul Provincial Health Services. An efficient and well functioning health care system with the potential to respond to the burden of disease and health needs in the Province. 2. Improve the efficiency and quality of health services. Improved compliance with legislative/ policy requirements and Core Standards for quality service delivery in order to improve clinical/ health outcomes. 3. Reduce morbidity and mortality due to communicable diseases and non-communicable conditions and illnesses. Reduction of preventable/ modifiable causes of morbidity and mortality at community and facility level contributing to a reduction in morbidity and mortality rates.

14 rational criteria include: » the extent of the disease burden; » the availability of interventions to alleviate this burden; » the potential to reduce or alleviate poverty; » the cost (affordability) and cost-effectiveness (value-for money) of available interventions; » the social, economic and political consequences of failing to implement the interventions.

15 IndicatorsCurrent StatusProvincial Target for 2014/15 Life expectancyMale: 47.3 years Female: 51.0 years Statistical Release P0302 Mid-Year Population Estimates years (National) Maternal Mortality Ratio (MMR 210 per 100,000 live births National Confidential Enquiries into Maternal – 2008, Deaths (KZN Data) 135 (or less) per 100,000 live births Under-5 mortality rates87.7 deaths per 1,000 (ASSA, 2010) AIDS Committee of Actuarial Society of South Africa 37 deaths per 1,000 Infant Mortality Rate55,8/1 000 live births 18 per 1,000 (NSDA) The TB cure rate62.9% (output for 08/09 cases) 85% Access to antiretroviral treatment. 74% (2010/11) APP 2011/12 90% of eligible people New HIV infectionsNational = annually per day Reduced by 50%.

1.Improve clinical governance 2.Respond appropriately to the burden of disease and consequent health needs 3.Manage HIV prevalence & decrease HIV incidence 4.Strengthen HIV/TB integration 5.Reduce and improve the management of non-communicable diseases; 6.Reduce and manage intentional & unintentional injuries; 7.Reduce maternal and child mortality and morbidity 8.Reduce TB incidence and Improve TB outcomes

1.Reduce the incidence of cervical cancer 2.Maintain preventative strategies for malaria control e.g. malaria spraying coverage 3.Prevention of illness and promotion of health 4.Accelerate implementation of the integrated School Health and Health Promoting Schools Programme. 5.Strengthen Mental Health, Disability & Rehabilitative Care and address substance abuse & violence 6.Engage in Behavioural Change Campaigns for staff and communities 7.Enhance capacity within the Youth Ambassador Programme for improved promotive and preventive activities

1.Social mobilization, civil society and engagement in Sukuma Sakhe (flagship programme ) to improve early booking, reduce teenage pregnancy (through the Contraceptive Strategy and youth programmes), improve low risk pregnancies and reduce morbidity and mortality 2.Increase access to safe delivery through establishment of basic emergency obstetric care (BEOC or MOUs) in key strategic areas 3.Improve the referral and transport by introducing dedicated or specialized ambulances for maternity and paediatric care 4.Scaling up Highly Active Anti-Retroviral Therapy (HAART) access for pregnant women by increasing capacity of PN to initiate ARV 5.Improving staff competency and skills and improving quality of clinical care through the introduction of mentorship teams including district obstetrician and paediatrician 6.Establishing waiting mothers lodges in all district hospitals 7.Strengthen Mortality Reviews at Hospitals

1.Implement community based Maternal & Child Health Framework 2.Integrate Sukuma Sakhe activities into Primary Health Care 3.Back to the basics of GOBI-FFF through Sukuma Sakhe (Growth monitoring; Oral rehydration therapy; Breast- feeding; Immunization; Family Spacing (planning); Female Education; Food Supplementation) 4.Establish a neonatal experiential learning sites and outreach programme per Area 5.Strengthen Mortality Reviews at Hospitals

1.Implement community based Maternal & Child Health Framework 2.Integrate Sukuma Sakhe activities into Primary Health Care 3.Back to the basics of GOBI-FFF through Sukuma Sakhe (Growth monitoring; Oral rehydration therapy; Breast- feeding; Immunization; Family Spacing (planning); Female Education; Food Supplementation) 4.Establish a neonatal experiential learning sites and outreach programme per Area 5.Strengthen Mortality Reviews at Hospitals

1.Improve neonatal facilities and care at all hospitals 2.Scale up interventions for early detection of under nutrition 3.Monitor implementation of the IYCF Policy adopted-focusing on breastfeeding promotion (Infant and Young Child Feeding) 4.Scale up implementation of Integrate Management of Childhood illness 5.Improve immunisation coverage 6.Reduce trends in morbidity affecting children

1.Inter-sector collaboration for interventions in High Transmission Areas 2.Accelerate implementation of the National Strategic Plan (NSP) for HIV and AIDS – including new policy changes 3.Intensify the Voluntary Male Medical Circumcision Campaign 4.Extend the HIV Counselling and Testing Campaign 5.Scale up implementation of the Accelerated Plan for PMTCT including early booking strategy for ANC.

1.Continue to implement the TB Crisis Plan 2. Expand the Community management of MDR TB 3.Strengthen TB ACSM (advocacy, communication & social mobilization) to increase awareness in communities about TB 4.Integrate TB DOTS support, surveillance for early detection of TB, and follow up of defaulters into the activities of Sukuma Sakhe

1.Implementation of the Community Based Model 2.Signed Negotiated Service Delivery Agreements 3.Align Provincial macro plans (within funding envelope) with the NHS and MTEF priorities 4.To finalise and implement the Service Transformation Plan 5.Strengthen Governance Structures 6.Implementation of National Core Standards towards accreditation of health facilities in preparation for National Health Insurance 7.Revitalisation of PHC services as per STP Implementation Plan (including Provincialisation of Local Govt clinics)

1.To continue with the Finance & SCM Turn-Around Strategy 2.Review Performance Management Systems and outdated Policies 3.Improved Human Resource Management Services including reconfiguration of organizational structure 4.Decentralize appropriate delegations, controls and accountability 5.Develop and implement a Management Training Strategy including succession training, mentoring and team building programmes 6.Strengthen collaboration with public, private and civil society entities, including Labour

1.Promulgation of the KZN Health Act (1 of 2009) Regulations 2.Increase investment in Information, Communication and Technology 3.To deliver new clinical infrastructure in line with the STP and approved Infrastructure Programme Implementation Plan (IPIP) as well as address Infrastructure backlogs 4.Revitalisation of EMS services 5.Strengthen Pharmaceutical Services 6.Revitalise the Health Technology Services with a focus on Telemedicine 7.Regular engagement by MEC with District Managers

» National consultation processes for critical Policy areas. » Strengthen dedicated capacity for critical functions. » Develop focus on policy-making and resource allocation » Decentralize operational functions within the context of clear National Policy Framework

» Keeping the collective healthy is complex » Involvement of all stakeholders is crucial, to improve overall health outcomes of our people » Members of our community have to take charge of their own health as “NONE BUT OURSELVES” are responsible

» Collective strategic leadership at all levels of service delivery is necessary » Mechanisms will be in place to monitor the performance of Department to ensure accountability with appropriate incentives and sanctions instituted. » The specific strategies for the four outcomes are comprehensive and ambitious but there is Political and Administrative will & commitment to realise Government’s expected outcome of “A Long and Healthy Life for All South Africans”