As can be seen from 7, there is variation in the reported implementation of the selected PHC package indicators. Reasonably good progress has been made with implementation in the eight provinces that responded, but there is better reported progress in the urban provinces of Gauteng and the Western Cape. All provinces reported that human resource constraints were the most common reason that hampers PHC package implementation, followed by infrastructure challenges. Functioning clinic committees, a measure of accountability to users of services and communities, needs to be addressed, and in the North West it was reported that there is not a single functioning clinic committee. SECTION 5: A NATIONAL PHC PACKAGE FOR SOUTH AFRICA 5.1 Introduction This section proposes an essential package of interventions for South Africa, based on the literature review and information presented in previous sections. The proposed services have not been costed. Prior to formal adoption of the PHC service package, accurate costing should be done to ensure affordability and feasibility of implementation. This next sub-section presents a set of generic norms and core standards for clinics and community health centres. This is then followed by the key assumptions about staff categories, a generic list of community-based services, and the criteria and components of the proposed PHC package of services and interventions. 5.2 Norms for clinics and community health centres Clinics should provide comprehensive integrated PHC services using a one-stop approach for at least 8 hours a day, five days a week. The clinic should receive a supportive monitoring visit at least once a month to support personnel, monitor the quality of service and identify needs and priorities. The clinic will have at one member of staff who has completed an accredited PHC course. Clinic managers should receive training in facilitation skills and PHC management. An annual plan should be developed for each facility, based on a situation analysis of the community’s health needs, the routine health information data collected at the clinic and an on an evaluation of the provision of PHC services. There should be a mechanism for monitoring services and quality assurance and at least one annual service audit.
Vector control services Pollution control services, inspection and monitoring Monitor management services: litter control, waste storage and collection Environmental health services in respect of pauper burials Monitor food safety services 5.19 Health education Health education activities should be integrated into all services provided at primary health care level. All clients should receive appropriate health education, information and support. Services should be provided through: Face to face meetings Health education campaigns in high risk areas Social mobilization for different health programmes Health education material Specific attention should be paid to a number of areas Reduce the use of illegal substances Reduce the consumption of alcohol and other drugs 5.20 Clinical support services 5.20.1 Equipment Community health centres may have X ray and ultrasound facilities in order to support the delivery of effective health care. Operating theatres would allow minor operations to be performed. 5.20.2 Essential Medicines A list of essential medicines at each level is available from the Department of Health. It is expected that all medicines are available at all times, in adequate amounts.
5.20.3 Diagnostic Services Community health centres access to laboratory services. Haematology film Haemoglobin Haematocrit Red Blood Cell Count Blood cell count and platelet count Differential count Erythrocyte Sedimentation Rate Coagulation screening tests Reticulocyte Blood grouping and RH factor Serology Widal test Rose Bengal C Reactive protein ASOT Rheumatoid factor Toxoplasmosis RPR TPHA Infectious Mononucleosis SLE G6PD assay Cooms Iron and TIBC Biochemistry Blood glucose Renal function tests Liver function tests Lipid profile Hormonal assays Bacteriology Direct Microscopy General urine examination General examination Staining Smears Gram stain Zeil Nelson stain KLB Culture Urine Swabs Stool Throat Sputum Blood CSF STD culture bacteriological tests Anti microbial susceptibility Parasitology Malaria parasite General Stool examination
2.3 Secure finances to fund the HR from treasury √ DG and Heads of Health 2.3 Recruit and/or Contract staff √ Establish PHC in the 18 priority districts Conduct a HR audit determines the gap between the number of staff needed and those available. √ Provincial team 2.2 Develop a HR recruitment strategy and plan for each priority district √ Provincial team 2.3 Secure finances to fund the HR from treasury √ DG and Heads of Health 2.3 Recruit and/or Contract staff √ District management team Have an enabling Regulatory framework 4.1 Nurse Partially 4.1.1 Publish new of practice regulations √ HR Directorate & Legal unit
qualification on revised scope of practice 4.2.3 Constitute an expert midwifery reference group √ SANC 4.3 Nurse Partially 4.3.1 Publish education and training regulations √ HR Directorate & Legal unit 4.3.2 Support training institutions through a generic training curriculum and training resources that can be adapted by individual training institutions √ HR Directorate & SANC 4.3.3 Develop a national strategy to provide support provinces and education institutions to implement √ HR Directorate and SANC
Provincial ISSUE ACTIONS term 12 months Medium Term Between 1-2 Years Long Term Between 2-3 Years Responsible authority Scale up production and recruitment to address shortage of health professionals 2.1.1 Conduct an audit to assess production capacity of the training institutions in the province √ Provincial HRD unit and training institutions 2.1.2 Identify resources required to increase provincial training capacity √ Provincial HRD unit and training institutions 2.1.3 Identify annual training and recruitment targets for all categories of health professionals required √ √ √ HOD Provincial HRD unit 2.1.4 Identify funding mechanisms for supporting training of health professionals (training post, bursaries, scholarships) √ HOD Provincial HRD unit 2.1.5 Determine mix and training targets for each category of health professional √ HOD Provincial HRD unit 2.1.6 Develop and implement a short term training strategy and outsourced training, bursary and training posts) √ √ HOD Provincial HRD unit 2.1.7 Secure resources and funding for implementing the training and skill development strategy √ √ √ HOD Provincial HRD unit
District/Facility Level ISSUE Actions STM MTM LTM authority Mismatch between skills and of health and for the delivery of the primary health care package 4.1 Skills and competence assessment and development 4.1.1 Conduct an annual/ periodic audit of the level of skills and competence of the staff of the facility against the required set of skills to determine the skills and competence deficit in the facility √ 4.1.2 Develop and implement a facility based skills development plan √ Team manager 4.1.3 Develop a mentorship/support programme for staff that do not the requisite skills and competence √ Team manager 4.2 Supervision and performance of PHC teams 3.2.1 Put in place a performance and personal development plans for each employee √ Team manager 3.2.2 Put in place team performance targets √ Team manager 3.2.3 Compile policies, procedures, SOP, and protocols for implementing the primary health package at the facility √ Team manager 3.2.4 Conduct regular review meetings to assess progress with performance targets √ √ Team manager