Preventative/Community/Public Health Medicine (PHM) is recognized as a medical specialty that primarily strives to improve population health while also strengthening health system effectiveness and service delivery through its focus on Comprehensive Primary Health Care and Health Systems Management. Therefore the inclusion in the 2011 national Human Resources for Health Strategy of district and provincial Public Health Units (PHUs) headed by PHM specialists and with other cadres of public health professionals in the health services seems to neatly dovetail into this perspective. This brief narrative explores the experiences of both authors over the last five years culminating in the Ekurhuleni district PHU.
Collaboration to provide Public Health expertise to a provincial health department: The Western Cape story
The aim of the Healthcare 2010 strategy in the Western Cape was to substantially improve the quality of the health service to impact on population health outcomes. It proposed the establishment of a Public Health Unit (PHU) within the Division: District Health Services (DHS) and Programmes. The aim of this unit was to plan, lead, organize and coordinate the provision of Public Health expertise to the entire department in line with key strategic objectives and priorities. This article discusses the engagement of the department with academic institutions leading to setting up the PHU as well as the successes and challenges of this project.
The options for additional ‘innovative financing’ that could be considered in South Africa, covering both raising new funds and linking funds to results, are discussed here. New funds could come from: the private sector, including the mining and mobile phone industry; voluntary sources, through charities and foundations; and through further expanding health (‘sin’) levies on products such as tobacco, alcohol and unhealthy food and drinks. As in other countries, South Africa could earmark some of these additional sources for investment in interventions and research to reduce unhealthy behaviours and influence the determinants of health. South Africa could also expand innovative linking of funds to results to improve overall performance of the health sector, including mitigating the risks for non-state investment and exploring different forms of financial incentives for providers and patients. All such innovations would require rigorous monitoring and evaluation to assess whether intended benefits are achieved and to look for unintended consequences.
Inequality is apparent throughout our health system and our society, to a greater degree than is found in many other societies. Inequality is also apparent in the quality of the care we provide and these differences again reinforce further differences in that care. This paper focuses on two specific aspects of quality care which are often not given much attention: care that is acceptable to patients and meets their expectations, and safe care that does not harm. Furthermore, the paper will discuss how the proposed “Office of Health Standards Compliance” (a regulator of quality) could impact this.
From recent pronouncements made by the Department of Health (DOH) it would appear that the DOH has recently discovered primary health care (PHC), or at worst recently re-discovered PHC. The work to strengthen PHC builds on the good practices that existed in the past but also provides greater focus as well as greater political support for PHC.A three stream priority approach to re-engineering of PHC was adapted. These three streams are: Deployment of ward based PHC outreach teams; Strengthening school health services; and Deployment of district based clinical specialist teams. The latest development on the PHC re-engineering projects are presented here.
To achieve the goal of a long and healthy life for all South Africans the health system must be overhauled to produce better health outcomes. The National Health Council has given clear direction to the health system around primary health care (PHC) re-engineering, and the associated three streams. These three streams, which will be discussed in this article, are a ward based PHC outreach team for each electoral ward; strengthening school health services; and district based clinical specialist teams with an initial focus on improving maternal and child health. All stakeholders will have to work in partnership and unison to achieve these results.
Health Systems Trust is seeking to appoint a full-time Project Manager on a fixed term 1 year (renewable) contract to coordinate and manage the Health Systems Strengthening project and to provide support to other HST projects.