Clinic

School health policy to spot kids needing care

The health department will launch a policy that aims to improve the health of pupils, many of whom do not go to clinics and are likely to have undetected problems. Health Minister Manto Tshabalala-Msimang will launch the School Health Policy today at the JM Ntsime Secondary School in Rustenburg. Among the policy's aims are that nurses and other healthcare workers will visit every school over four years to check the health of Grade R and Grade 1 pupils. Nurses visit some South African primary schools, including many in Cape Town, at least once a year to check the health of young children. Health is also taught as part of the lifeskills curriculum. But in too many schools this is not yet happening, said Estelle de Klerk, director of the health department's child and youth health directorate. The Schools Health Policy is part of a broader programme called the Health Promoting Schools programme, which aims to use all school resources to improve children's health. In the first phase: nurses or other healthcare workers will visit the schools once or twice yearly to examine children's eyesight, hearing and mouths and cheek for speech impediments and injuries of all Grade Rs and Grade 1s; health education lessons will become part of all lifeskills programmes, and pupils will be taught to be alert to their health problems and those of peers; and, pupils with problems will be referred to clinics for treatment, and nurses will cheek up, on their following visit, whether the problems have been treated. The aim is that this phase will have been implemented in 30% of all schools by the end of next year, and in every school by the end of 2007. The South African Democratic Teachers' Union (Sadtu) and the national Health and Allied Workers' Union (Nehawu) yesterday welcomed the policy, but warned that the health department would need to allocate a sufficient budget.(Source: Jo-Anne Smetherham: The Cape Times, 22 July 2003)

State better at treating STIs than private doctors

Next time you get a sexually transmitted infection (STI), it may be worth your while to go to your local clinic rather than slinking off to see a private doctor. Researchers have found that the much-maligned government clinics are better at treating STIs than the average general practitioner (GP). GPs see over 50% of STI cases as people prefer the privacy and the anonymity, says Professor Helen Schneider of Wits University’s Centre for Health Policy. But the technical quality of care is relatively poor compared to public health, which has been practicing syndromic management for a number of years and has quite good STI management. The problem, Schneider told the annual Reproductive Health Priorities conference, is that doctors tend to offer a package for R120 which covers a consultation and drugs. In order to profit, many doctors tend to cut back on the drugs, perhaps offering just one antibiotic. But in public health people would get two or three different drugs to wipe out a number of different syndromes or categories of infections. Research in Carletonville found that only 23% of STIs treated in the private sector were treated effectively in comparison to 38% in the public health sector, while a national health department survey found that 64% of rural GPs provided inappropriate STI treatment. In recognition of this problem, both Gauteng and the Western Cape have been trying to work with private doctors to improve STI treatment. Dr Bhavna Patel of the department of health in the Western Cape told the conference that her department had been training two private doctors per health district in areas where STI statistics were high and providing them with free drugs. We have now decided to roll out this programme to 50 doctors, and have provincial cabinet approval for this, said Patel. She said government was aware that the system could be abused, so had introduced strict controls including performance-based contracts for the doctors involved. Schneider said that although her work with Ekhuruleni (East Rand) doctors had been time-consuming and often difficult, we have no option but to engage them, and need to try a range of things to see what works. The national Department of Health’s Dr Eva Gosa said a national study of public health clinics’ STI management was underway in a bid to improve the service, particularly as clinics tended to run out of drugs. STIs are a serious problem in South Africa, and a person with an STI particularly one which causes skin lesions is more at risk of getting infected with HIV as it is easier for the virus to pass into the body. A University of Cape Town study, also reported on at the conference, found that half of the 400 women screened in a study in Gugulethu and 43% of 400 women in Ga-Rankuwa had bacterial vaginosis by Kerry Cullinan, Health-e,07-10-2002

The Role of the Visiting Doctor in Primary Care Clinics

Published by: 
Health Systems Trust
The concept of doctors visiting clinics to support primary health care is well established but the role that these doctors should play is not clear, and varies from area to area.

Rural Doctors Advance Care with Wireless

In the impoverished Transkei, a rural area on the eastern side of South Africa about twice the size of New Jersey, it could take weeks between the time a villager is tested for a disease at a local clinic and the time treatment can begin. But in a pilot project conducted between a wireless application developer and two public-health agencies, three laboratories there are now using Short Message Service (SMS) technology to send test results to six clinics in the region and speed up treatment times. Because doctors and nurses now receive patients' lab results the same day the tests are completed, they can begin treatment immediately instead of letting the patients return to their villages and risking the further spread of disease. Initiated by South African application developer ExactMobile in partnership with the Eastern Cape Department of Health, which runs the clinics, and National Health Laboratories, which runs the labs, the project has overcome the absence of network infrastructure that marks remote areas such as the Transkei. Beyond aiding public health, the pilot also shows the viability of rural communities serving as test beds for wireless applications with a minimal investment. ExactMobile, which donated its services, spent only about $1,250 on software development. The payoff for its support: The Eastern Cape Department of Health is now soliciting funds from the South African government to deploy the ExactMobile application to more clinics and labs in the Transkei region. Project leaders decided to focus on tuberculosis (TB) first because the disease is so highly contagious and rife in the Eastern Cape. Rudi Thetard, who works at Management Sciences for Health, a nonprofit organization that focuses on improving TB treatment, estimates that doctors treat about 15,000 cases each month in the Eastern Cape, with a cure rate of about 50% -- although he says the cure rate is probably even lower in the Transkei region because it's so isolated and poorly served by laboratory services. TB treatment cannot begin without a verified lab result diagnosing the patient as infected, and before this project, laboratory services to rural areas were almost nonexistent and relied on infrequent transport to and from the clinics. In the pilot project, the South African Institute for Medical Research donated motorcycles to deliver the samples every day, with trips taking one to four hours, depending on the quality of the roads. As soon as laboratory personnel enter results into a computer, the application automatically sends them via SMS to a cell phone carried by a doctor or nurse in the outlying clinic (Motorola donated the cell phones). This combination of motorcycles and wireless delivery cut the time to get lab results from weeks to as little as a few hours. National Health Laboratories spokesman Barry Mendelow says that in the three months since the wireless implementation in six clinics, the number of samples referred for TB testing increased by 333%, compared to the three-month period before the project started. Because clinics can get results faster, they can treat more people, which has resulted in more patients and clinic staff seeking the tests. The ExactMobile application could also provide the basis for gathering statistical information on diseases in rural areas. Mendelow says that the prospect and utility of a single national database of lab test results, from which reliable national statistics could be drawn, would be greatly facilitated by the distributed access made possible by the new mobile data communications technologies. (Source: M-Business / CMP Media LLC 9/1/01, issue # 110, page 47.)

Community service net widens

Eight more health professions are to be drawn into the community service net from 2003, Health Minister Manto Tshabalala-Msimang and her provincial counterparts have decided. They are radiographers, physiotherapists, speech and hearing therapists, occupational therapists, environmental health officers, dieticians, clinical psychologists, and professional nurses. The decision was made at a meeting between the minister and MECs in Cape Town at the weekend, ministry spokesman Sibani Mngadi said in a statement on Monday. The new groups will join doctors, dentists and pharmacists, who already do a year of community service on completion of their academic studies. The proposal to bring in the seven so-called scarce skills groups was mooted by the health department in late 1999, the year in which the first doctors began their service. Mngadi said service for the new groups would be phased in from 2003, starting with the clinical psychologists and dieticians. The last group would be professional nurses in 2007. Mngadi also said the minister and MECs met representatives from university medical faculties at the weekend to discuss racial representivity among their students. It said though some progress had been made, attention had to be given to the high level of student dropouts especially in the early years of their studies. This had led to an imbalance in the output of graduates. It had been agreed that faculties would be assessed separately to ensure that progress was made in all the institutions. The minister and MECs also decided universities should reserve space for 100 medical students from Southern African Development Community countries. This programme - meant mainly for Botswana, Lesotho, Mozambique, Mauritius and Namibia, which did not have their own medical schools - would be phased in from next year. (Source: SAPA, 17 September 2001)

Conducting expenditure and resource allocation reviews for effective district health system management - A review of expenditure and resource allocation in the Mmametlhake health district of Mpumalang

Published by: 
Health Systems Trust
Delivering a sustainable health service is a fine balance between the needs of the community and the health resources available. Managers require a clear picture of how resources are allocated, what is driving costs and how efficiently services are being provided. The District Heath Expenditure Review(DHER) provides such a picture. The DHER also empowers health managers to improve service and financial planning and strengthen management support systems. This report contains a DHER conducted in the Mmametlhake Health District in Mpumalanga for the financial year ending 31 March 1999. The process to obtain, verify and report on the data took place during the first six months of 2000 and culminated in a report presented to the MEC for Health in Mpumalanga on 10 October 2000.

Financial Management in Taung Health District: North West Province

Published by: 
Health Systems Trust
This report covers the deliberations during the visit on 30 April 1999 as well as other information gathered during and after the visit. The report aims to assist the district management team to prioritise future activities in financial management and in enhancing their capacity.

District Quality of Care Assessment

Published by: 
Health Systems Trust
The care and management of patients with STDs is inadequate in South Africa. The endemicity of STDs, and the synergy between STDs and HIV, makes rectification of this situation urgent. To improve and sustain the quality of STD care delivery at primary care level, it is essential that district managers are given a method of obtaining quality of care information at regular intervals.

The National Primary Health Care Facilities Survey 2000

Series Name: 
Facilities Survey
Published by: 
Health Systems Trust

The National Primary Health Care Survey 2000 constitutes a follow-up of the 1997 and 1998 surveys as part of an ongoing monitoring exercise of the status of PHC provided in fixed clinics. The 2000 survey also establishes a baseline of data on the status of PHC provided by satellite and mobile clinics. It also mirrors the status of PHC provision in the country, and highlights major differences between provinces and in urban and rural settings.