07 July 2011 EFFECTIVE EMPLOYEE HEALTH AND WELLNESS PROGRAMME- HCT Service Delivery Model SABCOHA CONFERENCE Sun City –N.West Ms Morero E. Leseka

Introduction DPSA context for the HIV&AIDS response and HCT Coordination of HIV&AIDS and TB response DPSA is responsible for the coordination of HIV&AIDS and TB response activities within the Public Service and to monitor, evaluate and report on such responses to SANAC Policy pronouncements HIV&AIDS and TB Management in the Public Service-with HCT as an entry-point to treatment care and support

Introduction...3 The burden of HIV&AIDS and TB in the Public Service HIV Prevalence was 17,8% among those aged years with the prevalence being higher in women years and men aged years (UNAIDS:2010; HSRC:2008 These are the age groups which are likely to dominate the Public Service world of work.

Key Health Trends The Key Health trends reported by GEMS –TB and HIV related claims among the top 10 cost drivers –Public Servants accessing treatment at a very advance stage of HIV infection, resulting in poor treatment outcomes Several research studies –12,7% prevalence among educators (ELRC:2005) –Lower income and non-professionals had higher prevalence rate than in higher income and professional groups –The latter findings same in Health and in Correctional Services

* VISION FOR EH&W A Healthy, Dedicated, Responsive and Productive Public Service Occupational Health Quality of Work Life Research, Monitoring and Evaluation Occupational Health Education and Promotion Occupational Health and Safety Management Individual Wellness Physical Work life Balance Organizational Wellness Individual Wellness Psycho-Social Human Rights and Access to Justice Treatment Care and Support Prevention Injury on Duty & Incapacity due to ILL Health Mental Health /Psychosomatic Illnesses Disease Management and Chronic Illnesses Environmental Management Risk and Quality Assurance HIV and AIDS & TB MANAGEMENT Pillar 1 HEALTH and PRODUCTIVITY MANAGEMENT Pillar 2 SHERQ MANAGEMENT Pillar 3 WELLNESS MANAGEMENT Pillar 4 4 KEY INITIATIVES FOR HIGH PERFORMANCE IN THE PUBLIC SERVICE THROUGH HEALTH AND PRODUCTIVITY MANAGEMENT CORE PRINCIPLES INFORMING IMPLEMENTATION OF EHW STRATEGY LEGISLATIVE FRAMEWORK AS A FOUNDATION

Policy Objectives: To provide HIV&AIDS and TB Prevention To provide Treatment, Care and Support for those infected and affected by TB and HIV infections To manage compliance to Human and Legal Rights; and ensure access to Justice To ensure Monitoring, Research and Surveillance on HIV&AIDS and TB Presentation Outline HIV&AIDS AND TB MANAGEMENT

Poor HCT Uptake against the set targerts (14%) vs Low reporting rate from entities (58% national and 87 % Provincial) Poor data quality Non compliance to reporting templates Challenges for EH&W- an HCT Perspective

Project / Program Level Efficiency Population Level Effectiveness Resources e.g. Finance Staff Drugs, Supplies Equipment Functions, Activities e.g. Training Logistics IEC Services e.g. Facilities offering Service Trained staff Utilization: New clients Return clients Intermediate e.g. HIV+ on GEMS Disease Management Inputs Processes/ Activities Outputs OutcomesImpact Long-term e.g. Infection rate Mortality Disability and attrition Results Based Management Approach Int RBM(2)

Base line (Before HCT)- did not exist Process: –Policy Implementation Readiness Assessment and EH&W System Monitoring Tool - HCT Operational Planning - HCT M&E Plan – Result Framework –Training and Workshops –Resource Mobilization –Partnerships with GEMS et al. HCT as an example (Efficiency issues)

Base line (Before HCT)- did not exist Outputs: –HCT Coverage – 58 % estimates from reporting rate ( National 58% and Provinces 87%) –HCT Uptake – 14 % of the set target –TB screening rate – 19% Outcome Evaluation- Change in attitude and behavior Impact (Evaluation)- IHRA HCT as an example (Efficiency issues)

Is at developmental stage Goal- Improve Coverage and Uptake of HCT services Coverage- –service broadly available and accessible beyond workplace (site) and outside working hours (time) Uptake- –more employees consume HCT services Improving HCT Service Delivery Model

Process: DPSA sign MoU with SAMA to implement HCT intensification project beyond June 30 th Technical Task team formed comprising DPSA, GEMS, DOH and SAMA ( discussions to include other Public Sector Unions vs bilateral engagements) TOR developed to define individual responsibilities Service Delivery Model…2

New opportunities: DPSA will mobilize its employees to know their HIV status Negotiate options of testing in the workplace and/or at the General Practitioner’s Network of SAMA A referral form will be issued for those choosing option 2 Those not covered will be encouraged to join GEMS Service Delivery Model…3

SAMA Mobilize their GP-network to participate in the Project Provide free HCT services and screening for other non-communicable diseases to employees and their dependents via the GP-network Document services offered and report to DPSA Service Deliver Level…4

DOH Provide diagnostic packs and condoms to the GP’s under the project Provide technical support and HCT guidelines as required Support monitoring and evaluation at local level where possible Include the Workplace HCT indicators in the DHIS Service Delivery Model…5

Increased no of facilities where employees and their dependents can go for screening Increased number of hours available for employees to access the services Standardized reporting and referral tools between GP’s and Public Service Anticipated HCT Intensification Outputs

Improved tracking of HCT uptake, from members of other medical aid schemes and accurate HCT data. Reduced chances of loss to follow-up, and improved linkage to care and support Ongoing documentation of best practice for possible roll-out of the model Anticipated outputs…2