1. THE IMPACT AND USEFULNESSOF CONDITIONAL GRANTS PSNP 1,5 learners are being fed. 2000 Schools have been reached Children are fed for 196 school days. Stunting have been been reduced from 34% to 23% I.e by 11% poverty alleviation

2. USEFULNESS CONDITIONAL GRANTS V.C.T grant 1.9 million managed to buy 500 rapid test kids which will be help to diagnose people living with HIV AIDS Managed to train 280 included were social workers health professionals and religions people in counselling. Managed to purchase home based care kits. 25 trainers were trained to cascade in the Province. POVERTY ALLEVIATION PROJECT  117 project have been approved for the year 2001/2002 The beneficiaries are 76 pregnant women. 206 mothers from poor household 417 mixed group 34% of 23% I.e. by 11%. Job creation to the poor 25 stunting growth of children of the poor was reduced from 34% of 23% I.e. by 11%.

3. INTEGRATED HOME BASED CARE GRANT (1.5 MILLION) At present the grant is benefiting identified orphans in the different pilot sites I.e. (Pietersburg Westernburg and Seshego, Maraba and Mashashane as well as Thohoyandou. 205 orphans have been bought school uniforms. School fund have been paid for the same 205 orphans. R378 738-00 have been utilised to buy food parcels worth R300.00 per family. 521 families are benefiting from the grant. An amount of 814 325 have been spent to purchase Home Based Care kits.

4. NGO FUNDING 15 Non governmental organisation were funded each benefit R100 000.00 an amount of R1.5 million benefited the above NGO. The NGO are charged with the responsibility to render Home Based Care.

5. RECOMMENDATIONS 5.2 PRIMARY HEALTH CARE Integration of service approach should be strengthened in 474 clinics. 24 hours services should be rendered to the communities to increase access to health services. Priority with regard to transport should be given to PHC services. A mobile ambulance which should be connected to clinics in each district should be purchased f or speedy referral to the next level. Periodic clinic inspection should be conducted to lessen problems at the clinics The present grant to as mentioned above are very useful and should be continued. The issue of security at our clinics should be strengthened. 5.3 SIGNIFICANT PROBLEMS Transport Capacity Laboratory services Quality of equipments Security Car hijack at Sekhukhune district Theft and Burglary

6. 5.4 MENTAL HEALTH Victim Empowerment There must be a specific budget allocated for mental Mental Health Programme. There is a need for resource centres for victim empowerment and substance abuse There is a need for psychiatric nurses to be trained in advance psychiatric to curb up the problems of psychiatric doctors. Appointment of psychologist and psychiatrist 5.5 TB SERVICES Strengthening of Health Education to new cases. Establishing effective community participation in dots strategy. Strengthening the referral system in line with the National Health System Framework TB programme be given its own grant which will be utilised to build capacity for volunteers (DOTS volunteers) There is a need for MDR TB Unit in the Province to curb the MDRD problem as reflected below.

7. 7. KEY HEALTH PROBLEMS. Service Areas StrategiesAchievementsPolicy Interventions Impacts/ Constraints HIV/AIDS o Intensify awareness campaigns.  Campaigns Ø Interdepartmental collaboration at all levels. Ø Stakeholders involved i.e. traditional healers, church leaders, business, chief and academic institutions CBOs and NGOs. Ø Mass Media  National policy Guidelines for HIV/AIDS. v VCT v MTCT v HBC v Integrated Home Based Care. Drug implications · Cost to treat HIV/AIDS related infections. · Increased workload due to VCT. · Waiting time for clients to be counselled. (Since time flow study had revealed reduction in patients’ waiting time, with the introduction of integrated approach we are now beginning to observe an increase in waiting time from 30minutes to 2hours due to counselling.

8. Service AreasStrategiesAchievementsPolicy InterventionsImpacts/Constraints  Training for workers on workers for change. Strengthen intervention at high transmission areas. o Established services along the N1 Road Truck Inn as well as the boarder posts. (Used as condoms distribution points).  Shortage of manpower especially males.  Shortage of transport.  Increased cost in capacity building. o Implementation of Maternal Child Transmission Programme. Community Awareness done as well as briefing to professionals about MTCT.  Sites identified: Siloam and its surrounding clinics and Pietersburg Mankweng Complex and its clinics.  Need assessment was done.  National Policy on MTCT.  High infant mortality rate. (Refer to statistics)  Increased maternal mortality rate. (Refer to statistics)  Increased number of orphans affecting the budget. o Implementation of Integrated Home Based Care.  Joint Business Plan drawn and implemented for R1,5m.

9. Service AreasStrategiesAchievementsPolicy InterventionsImpacts/Constraints  Training for workers on workers for change. Strengthen intervention at high transmission areas. o Established services along the N1 Road Truck Inn as well as the boarder posts. (Used as condoms distribution points).  Shortage of manpower especially males.  Shortage of transport.  Increased cost in capacity building. o Implementation of Maternal Child Transmission Programme. Community Awareness done as well as briefing to professionals about MTCT.  Sites identified: Siloam and its surrounding clinics and Pietersburg Mankweng Complex and its clinics.  Need assessment was done.  National Policy on MTCT.  High infant mortality rate. (Refer to statistics)  Increased maternal mortality rate. (Refer to statistics)  Increased number of orphans affecting the budget. o Implementation of Integrated Home Based Care.  Joint Business Plan drawn and implemented for R1,5m.

10. Service AreasStrategiesAchievementsPolicy InterventionsImpacts/Constraints  Sites identified are Maraba, Mashashane, Pietersburg, Westernburg and Seshego.  Meeting were held with different communities and stakeholders at the different sites.  Steering committees have been established.  205 Orphans have been bought school uniform and school fund have been paid for them.  Food parcels worth R300 per family, purchased at R110, 000, 00 and delivered on the 02 nd April 2001.  A joint business plan for 2001/02 for the amount of R2,9m was drawn and submitted to National.  Reduced workload from professional.  Effective community participation.  Increased cost on capacity building.  Prone to abuse by stakeholders.

11. Service AreasStrategiesAchievementsPolicy InterventionsImpacts/Constraints  Home Based Kits were purchased. TB o Capacity building to professionals.  14 Trainers were trained i.e. 2 per region.  Training was cascaded to all the regions 120 doctors, 3000 nurses and 2000 DOTS supporters.  National TB Guideline.  Training manual.  DOTS support Booklets.  Increased cost for training service taken to the community.  Cure rate increased from 45% to 58%.  Sputum conversion rate from 45% to 65%.  DDTs Programme is now rolled out to 17 districts of the Province. o DOTS strategy.  Community Based Strategy.  DOTS manual.  Increase patients centredness,  Improved political commitment.  Reduced TB stigma.  Effective monitoring strategy.  Reduced workload from the clinics and other health facilities.

12. Service AreasStrategiesAchievementsPolicy InterventionsImpacts/Constraints Multiple Drug Resistance TB o Reduction of multiple drug resistance TB.  Established a Multiple Drug Resistance TB clinic in Pietersburg/ Mankweng Complex.  Developed provincial referral network.  Sufficient second line drugs for management.  National Multiple Drug Resistance TB Policy.  52% of 120 MDR patients are cured, 12% are lost, and a failure of 4%.  Not sure of the number prevailing in the Province. TB/HIV Co- infection o Reduction of TB/HIV co- infection.  Service was piloted in one district and rolled out to the second district.  Business plan developed and drawn.  TB/HIV collaboration National Policy.  Increased Voluntary Counselling and Testing Services from 10 people per day now the demand is so much that more than 100 people are seen.

13. Service AreasStrategiesAchievementsPolicy InterventionsImpacts/Constraints Termination of Pregnancy (TOP) o Reduction of Back street abortions strengthening the Rights of Women.  76 Midwives have been trained.  6 Doctors have been trained in TOP.  TOP Services are rendered at the following hospitals:  Siloam started in November 2000,  CN Phatudi in January 2001,  Letaba and Sekororo started in February 2001.  7% of the clinics provide TOP Services.  6 Health Centres are ready to start and have trained staff and equipments are available i.e. 4 in Vhembe and 2 in Waterburg Districts.  National Policy Guideline  In 1999, 4% of all Maternal Deaths were due to abortion. Hopefully the 2000 figures will show a reduction when published.  There is still a negative attitude especially in Religious Sectors resulting in mothers dying.

14. INTEGRATED PRIMARY HEALTH CARE SERVICES 5.1 PRIMARY HEALTH CARE POLICIES These policy have been distributed to the service delivery areas and will be utilised for the year. Integrated PHC package is the relevant policy document to be utilised. At present communicable disease control, HIV/AIDS, Environment falls within PHC unit and all these policies will be utilised for this year. The provincial policy guideline are just about to be completed 5.2 MTEF This is the policy guideline designed by the department and will be utilised for all the PHC Programmes as proposed by the policy. 5.3 SIGNIFICANT PROBLEM Transport Capacity Laboratory services Quality of equipments Security Car hijack at Sekhukhune district Theft and Burglary

15. Service AreasStrategiesAchievementsPolicy Interventions Impacts/Constraints Mental Health o Improve Mental Health and Substance Abuse problems.  Mental Health is integrated into Primary Health Care.  The new Mental Health Policy is implemented in all facilities.  National Policy Guidelines.  Provincial Policy Guidelines.  Lack of substantial budget allocated specifically for Mental Health.  Shortage of resource centre for substance abuse in our communities. o Capacity building to generalist doctors and nurses and also to dedicated psychiatric nurse.  In-service education done to generalist doctors. 23 Were trained in the Northern Province.  7 Psychiatric nurses had exposure visits to integrated approach at Bloemfontein Mental Institution.  3 Generalist nurses in- services fort PHC approach from each clinic.  12 Psychiatric Nurses trained in Advanced Diploma in Psychiatric Nursing.  Manual for integration of services.  Lack of capacity for integrating mental health into PHC.