1. Launch: Rural Proofing Guidelines Response from NDoH Jeanette R Hunter 29 January 2015

2. Problem Statement Policy limitations and rural realities – Vuyokazi Gonyela The difficulty with policy implementation in a rural province - Andrew Robinson

3. 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 ????? Result Hit and miss - mostly miss Why ?????

4. 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

5. 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

6. Development MUST be supported where people live Health System activities MUST support development

7. 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

8. 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

9. 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

12. The following slides contain the summarised and aggregated results for the 61 clinics and CHCs in Vhembe

18. – 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

19. 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

20. THANK YOU FOR YOUR ATTENTION! www.doh.gov.za