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CurrentHSR (Research)2.0
The DHB is a flagship publication of HST produced annually. It provides a summary of socioeconomic, health and health-related data for each district in South Africa.
CurrentHSR (Research)1.0
The first draft of the report for the National Good Practice Project entitled “Documenting Good Practices in the Public Health Sector of South Africa” is complete. The report is being prepared for dissemination and provides the reader with successes, challenges and lessons learnt from a compendium of 16 Good Practices across South Africa.  In light of the current PHC re-engineering policy, this document highlights some of the achievements made at the “coalface” of PHC service delivery. The Good Practices included in this publication have been grouped into three areas of practice, namely; clinical services, quality improvements and corporate governance. The project has unveiled a number of lessons for provincial departments of health and researchers practicing within these areas. This report is aimed at enabling the replication of successful practices by avoiding the mistakes of others. As we prepare for the formal presentation of this project, we hope that the documenting and sharing of good practices will create momentum towards improved excellence in health care service delivery.
ArchivedHSR (Research)2.0
This exciting project explores a new avenue of research for HST as the team aims to conduct an in-depth health sector market needs and implementer landscape analysis of four pre-selected Southern African countries. The project lasts a period of 60 days and the project team is conducting fieldwork which entails visiting the four countries for face-to-face key informant meetings. The relevant implementers and donors will be greeted by an ACHAP project team member who seeks to understand more about the constraints in the market and just what it takes to create an enabling environment for private-public partnerships’ to flourish. The ACHAP project team will provide interesting and useful information on how one can partner with ACHAP.
CurrentHSR (Research)1.0
In July 2013, the Ideal Clinic Realisation and Maintenance (ICRM) initiative was launched as a way of systematically improving the deficiencies in South Africa’s public sector primary health care (PHC) clinics. The Ideal Clinic is envisaged to offer a comprehensive range of integrated diagnostic, curative, rehabilitative and palliative services. Using existing clinic functions and staff duties in a different and systematic manner, the goal of this initiative is to ensure universally available high-quality PHC services.

To transition clinics from their current state to an ‘ideal’ state, a set of almost 200 items needed to be improved to an acceptable level of functionality. Progress within these 200 items is monitored through the Ideal Clinic Dashboard which scores the item as either Green (achieved), Amber (partially achieved) or Red (not achieved). Identification of the standards and indicators helps to convey a sense of what is required, but does little to support and catalyse the change necessary to transition clinics from their current state to the envisaged ideal state.

Various change and/or Lean Management models are currently implemented within the public health sector. Some health facilities are supported by development partners that use different Change and/or Lean Management models. Ensuring that there is understanding of the National Department of Health (NDoH) standards for health service delivery and compliance to protocol across the entire health system is critical.

Health Systems Trust (HST) serves as the co-ordinating body for the development and implementation of the Change Management model that would facilitate the success of the ICRM initiative.
CurrentHSR (Research)1.0
This is a rapid assessment (RA) of injury morbidity presenting at district-level health services in six facilities across two out of five previously identified high-violence communities in the Western Cape Province, with the aim of establishing a risk profile of injuries presenting in these areas. The study entails a series of six-monthly RAs conducted over three years (between September 2013 and October 2015) in order to identify high-risk population sub-groups and high-risk areas for injury, and to monitor trends over time. The areas covered in this assessment are Khayelitsha and Nyanga, and the facilities comprise district-level hospitals and community health centres (CHCs).

This study builds on findings of a previous study A Rapid Assessment of the Injury Morbidity Burden at the Health Services in three High Violence Communities in the Western Cape conducted in 2012 that also included Elsies River.

The repeat surveillance also forms part of two IDRC-funded studies: Evaluating the effectiveness of urban upgrading for violence prevention in selected low-income communities in the Western Cape Province, South Africa and Evaluating the effectiveness of the Western Cape Liquor Act in Khayelitsha, a large low-income community in Cape Town, South Africa.
CurrentHSR (Research)1.0
Developed by HST in collaboration with the National Department of Health (NDoH), the National Health Research Database (NHRD) is a web-based tool for use by the National Health Research Committee (PHRC) to monitor and track health research being conducted in South Africa. In the last financial year (2014/15), HST consolidated refinements to the database and piloted it in three provinces, namely KwaZulu-Natal, Western Cape and Free State. The official launch took place on 29 October 2015; since then, the database has been used nationally by the Provincial Health Research Committees.

Through ongoing funding in the 2015/16 financial year, HST will continue to train PHRC administrators and maintain the database whilst preparing for the next phase of NHRD development for use by National Health Research Ethics Committees (NHRCs).

An evaluation of the NHRD has been concluded with the analysis of the findings being written into a report.
ArchivedHSR (Research)3.0
Evidence informed guidance is needed for decision makers. PEECHi lays out the framework to develop a South African initiative to make the connection between evidence and decisions on public spending that would spell out the opportunity costs of one decision versus another. HST’s role is to conduct a systematic literature review. The PEECHi team will follow this with a literature review of cost-effectiveness data pertaining to maternal and child health, selection of interventions for costing, collection and modelling of data required for costing related to maternal and child health interventions in South Africa, development of costing models, costing of interventions and cost-effectiveness analysis of selected interventions. This step wise approach fulfils the over-arching objective to develop a South African initiative to make the connection between evidence and decisions on public spending that would spell out the opportunity costs of one decision versus another.
CurrentHSR (Research)2.0
As part of the dialogue on improving public expenditure management and spending for results in South Africa, the World Bank is coordinating a public expenditure tracking survey and quantitative service delivery survey (PETS-QSDS) in the Gauteng Province for HIV and AIDS spending. The PETS component tracks the flow of finances from treasury to the final destination i.e. health facilities, highlighting the leakages, bottlenecks or diversion in finances. The QSDS component collects information (inputs, outputs, quality, incentives, challenges, etc.) to understand facility level performance and associated factors.

The aim of the study is to conduct the PETS-QSDS study in approximately 200 public primary health clinics and a number of public hospitals in Gauteng, including administrative levels within the supply chain of public health facilities. It is expected that the study will contribute to improving efficiencies in the use of public resources for health.
CurrentHSR (Research)1.0
The Quality Improvement Co-ordination Project focuses on the provision of technical assistance for co-ordination and learning, enabling: the National Department of Health (NDoH) and the Office of Health Standards Compliance (OHSC) to conduct visits to the provinces; the co-ordination of meetings on behalf of the NDoH; the development of OHSC video material; and the documentation of relevant resources and good practices.

Health Systems Trust has documented and analysed the outcomes of a series of district and provincial workshops where QI and core standards work was discussed, and challenges and potential solutions identified. A workshop was held to review all activities conducted by the participant non-governmental organisations (NGOs).
CurrentHSR (Research)1.0
Implementation of RoR scale-up began on 2 February 2015 in Lejweleputswa District, Free State Province. The aim of the project is to reduce the existing number of registers used in primary health care (PHC) facilities to a maximum of six standardised registers, namely:
• PHC Daily Tick Register plus Headcount Register
• TB Registers (for ETR.Net)
• ART Register (for TIER.Net)
• Delivery Register
• Theatre Register (for medical male circumcision [MMC] and TOPs)
• Midnight Census Register

The scale-up component of the RoR Project paved the way for full implementation of the six rationalised registers across the Free State, Eastern Cape, North West, Northern Cape, Mpumalanga and Limpopo Provinces; Gauteng and KwaZulu-Natal will be involved in the scale-up once the finalisation of each of these provinces’ Provincial Indicator Data Set (PIDS) has been incorporated into the registers.

Monitoring the compliance of facilities in the use of the six rationalised registers is being conducted in Northern Cape Province. Ultimately, compliance monitoring will be implemented nationally.
CurrentHSR (Research)1.0
The South African Health Review (SAHR), an annual publication of HST since 1995, provides a South African perspective on prevailing local and international public health issues. It has rapidly become a flagship product that is widely read, used and quoted as an authoritative reference work in South Africa and abroad. It provides a combination of detailed information on health status and care, coupled with in-depth analysis of policies and practices affecting the provision of health services, as well as insight into the degree of success that has been achieved in policy implementation.
CurrentHSR (Research)1.0
This project aims to develop a framework for District Health System management, clinical and support staffing. It includes the development of a standardised structure, job profiles and competency assessment tools – tailored to the local South African setting – for relevant district and sub-district staff.

This work builds on a previous study concluded by HST in 2013, Assessment of the General Management and Public Health Competencies of Facility and Other Sub-district Managers, which revealed gaps in leadership and management capacity-building in the country, as well as the need to refine competency assessment techniques and processes, and to extend this intervention to other categories of staff working within the District Health System.

The project will contribute to a strong evidence base underpinning the interventions that will subsequently be implemented to improve the level of competence of all levels of staff functioning with the District Health System.
CurrentHSR (Research)1.0
The Eastern Cape Department of Health (ECDoH) requested Health Systems Trust (HST) through the SA SURE project to provide support with quality improvement initiatives at two district hospitals in OR Tambo.  In collaboration with ECDoH Epidemiology and Research Directorate, the HST SA SURE Evaluations Unit will principally provide evaluation support to assess the quality of maternal and child health services rendered in two of the hospitals.
CurrentHSS (Strengthening)1.0
In October 2014, the Waterberg District HIV and AIDS/STI/TB Unit (HAST) Programme Manager requested the District Co-ordinator of Health Systems Trust’s SA SURE project (South Africa Sustainable Response to HIV/AIDS) for assistance in exploring the causes of poor adherence to chronic medication and retention in care rates in the district. The district is under pressure to improve performance, but managers know little about the district-specific causes of these problems, and the lack of information is hampering the development of suitable remedial strategies.

Community Dialogues – one of the methods employed by the SA SURE Project to support health systems strengthening is – was pursued to provide the District with a means of investigating these causes and identifying solutions in collaboration with stakeholders in civil society. On 17, 18 and 20 March 2015, the Waterberg SA SURE team, in collaboration with HST colleagues and Department of Health partners, facilitated Community Dialogues to this end.

The dialogues were enthusiastically received and well attended, with more than 100 stakeholders participating over the three days. At the end of each dialogue, a task team of stakeholders was appointed in each of the three sub-districts to work on further development of remedial strategies suggested during the dialogues. Write-up of the community dialogue content is in progress and feedback will be provided to each sub-district by the end of July 2015.
CurrentHSS (Strengthening)1.0
Over the past decade, South Africa has experienced an unprecedented growth in patients requiring access to long-term therapies. Not only has South Africa introduced universal access to antiretroviral therapy (ART) for patients living with HIV and AIDS, but there has also been a steady increase in the number of patients with non-communicable diseases (NCDs), requiring chronic therapy. 

South Africa’s changing epidemiological profile has led to an over-extension of public sector healthcare facilities including primary health care (PHC) clinics. This has placed enormous strain on available resources and has contributed towards medicine shortages and declining quality of care.

Typically, a patient with a chronic disease is issued with a repeat prescription for six months. Between six-monthly clinical assessments, the patient needs to visit the healthcare facility merely to collect medication. On a daily basis, as much as 70% of a facility’s prescription load will be devoted to servicing repeat prescriptions.

The patient experience tends to be one of long waiting times and, occasionally, repeat visits to facilities in order to collect medicines that were not available during the routine visit. This poses potential adherence barriers which may lead to poor health outcomes, and places strain on the patient in terms of transport costs and loss of income.

Private sector pharmacies and health facilities are able to offer longer hours of operation than do public sector facilities, including weekends. In addition, private sector outlets are often more accessible from patients’ places of employment which, when coupled with shorter waiting times, allows for the collection of medicines without the need to taking a day's leave or forgoing a day's income.
CurrentHSS (Strengthening)1.0
This project is a collaboration between HST, CDC SA and CDC Atlanta and looks at the impact of different implementation models on improved partner and couples HIV counselling and testing services within the antenatal / maternal and child health (MCH) platform to facilitate early linkage to care and treatment for HIV-infected persons and couples, and improve access to HIV prevention services throughout the continuum of care.

Optimizing Prevention and Referrals within the Antenatal (ANC) Platform: Strengthening Partner Testing and Facilitating Early Linkage to HIV Care and Treatment in Bojanala District, South Africa.

Recruitment for the pre-intervention phase commenced in November 2014. As per February 2015 recruitment was taking place at the following sites: Anna Legoale, Hartebeesfontein, Tlhabane and Bafokeng.
CurrentHSS (Strengthening)1.0
The VCT II Project seeks to develop new private sector concepts for the provision of efficient and effective HIV counselling and testing (HCT) and supplemental services. This is a three-year initiative (October 2014 – September 2017), endorsed by the National Department of Health (NDoH). The project is designed to promote formal collaboration among public, private and non-governmental sectors in order to increase HCT uptake in two provinces: Northern Cape and Limpopo. To achieve this goal, Health Systems Trust (HST) is using an “HCT Franchise Model” as the service modality. The project has been branded as The Power of Knowing, and is providing free HCT services through a franchise network of private service providers (NGOs, general practitioners, nurses and pharmacies).
ArchivedHSS (Strengthening)2.0
Through the support of the Millennium Challenge Account, the Lesotho Ministry of Health and Social Welfare (MOHSW) has engaged a Health Systems Strengthening (HSS) firm to augment the Ministry’s efforts in implementing the ongoing National Health Sector Reform Programme. The design of the HSS-Technical Assistance serves to mitigate the negative economic impacts of poor maternal health, HIV and AIDS, Tuberculosis, and other diseases by substantially strengthening the country’s health-care infrastructure and its ability to deliver quality health services to the Basotho.
CurrentHSS (Strengthening)1.0
The National Health Council (NHC) resolved to reduce the number of registers used in primary health care (PHC) facilities for the collection of health programme data and to optimise patient administration systems. This project aims to establish a standardised patient administration system through the following activities:
• Filing systems, patient folder number, patient folder and records management.
• Reception services and appointment systems
• Reorganisation of patient flows

Implementation was initiated in the 10 districts designated as National Health Insurance (NHI) pilot sites, covering 700 PHC facilities (hence the name).

Various components of the RoR project are being conducted concurrently.  On 1 June 2015, testing of Waiting Time Surveys commenced within the 700 Beta and Alpha sites. The finalisation of the patient folders was made possible through rigorous consultation with the Department of Health to target groups across the provinces.
ArchivedHSS (Strengthening)2.0
Rx Solution is a software programme that supports regulation of stock control within public health facilities in addressing the perennial issue of drug stock-outs in South Africa.

Poor stock management leads to inefficiencies in the health service delivery cycle and value chain. These inefficiencies contribute to inadequate care of patients, especially those diagnosed with HIV, AIDS and TB, and to dissatisfaction among related support groups. Drug stock-outs result in patients having to travel to other health facilities or private sector institutions, thus incurring undue and often unaffordable expense. Patients may not receive the medicines they need, or they may obtain alternative medication that is not necessarily effective or appropriate, all of which undermines their health status. Such circumstances result in society losing confidence in the public health system’s capacity to meet the needs of patients.

The Rx Solution system is implemented by Health Systems Trust (HST) in the following districts:
• Pixley ka Seme (Northern Cape Province)
• Fezile Dabi, Xhariep, Mangaung, Lejweleputswa and Thabo Mofutsanyana (Free State Province)
• eThekwini, uMgungundlovu, Amajuba and uMzinyathi  (KwaZulu-Natal Province)
• OR Tambo (Eastern Cape Province)
• Waterberg (Limpopo Province)
ArchivedHSS (Strengthening)2.0
The Soul City Institute of Health and Development Communication (Soul City Institute) is a social change project which uses mass media combined with social mobilisation and advocacy to bring about social change and improved health outcomes.

The Soul City Institute was awarded a grant to develop programme interventions to strengthen the demand for quality health services by the South African population in order to increase access to improved quality health care.

A literature review on the Revitalisation of Primary Health Care was commissioned, with a key focus on the role of communities in strengthening PHC and improving quality of care.  This literature review will contribute towards the development of the Soul City series 12, and the Soul  Buddyz Clubs. The purpose of the drama series is to model greater engagement of  communities with PHC delivery, and to promote accountability.
CurrentHSS (Strengthening)1.0
The SA SURE project strengthens local capacity to provide sustainable HIV and TB-related care and treatment service delivery in South Africa through training, mentoring and coaching. Currently, the project has deploys over 300 staff members to support 13 districts (including over 800 facilities) spread over five provinces (Northern Cape, Free State, Limpopo, KwaZulu-Natal and Eastern Cape).
CurrentHSR (Research)1.0
The National Department of Health has funded Health Systems Trust’s research activities for many years and since 2011, there has been a renewed commitment to fund our research outputs, including the District Health Barometer and the South African Health Review. This has enabled HST’s Health Systems Research (HSR) Unit to conduct a number of key studies generating a strong body of evidence relating to all health system building blocks that can inform policymaking. 

An assessment of these efforts and outputs will demonstrate how Health Systems Trust has established a unique and important contributory presence in priority research fields through stipulating and supporting innovative programmes to address research priorities. The project will synthesise key research findings and determine how our investigations have helped to inform the development of policies and strategies, and the implementation thereof.

Collection of data on the various projects and research activities included collation and extraction of relevant documents and consultations with authors. The synthesis project database has been developed and updated with key documents. Using a research methodology framework, data have been extracted from all project-related documents. Authors (project managers and researchers) have been consulted to validate extracted data elements for data analysis.

Data analysis and report-writing are underway. The synthesis project report will document key research findings and evidence across the building blocks of the health system, highlighting information on research efforts and expertise for policy implementation, whilst indicating cross-cutting issues and trends that provide insight to national health strategies.
CurrentHSR (Research)1.0
One of the key performance areas of the National Department of Health (NDoH) is to publish a regular report containing key health indicators. Together with key external contributors, HST has been commissioned by the NDoH to produce an Annual National Health Statistics publication in electronic format which will serve as authoritative resource on national health statistics. These data comprehensively reflect service delivery and are disaggregated into national, provincial, district and sub-district levels. This requires in-depth mining of the available health statistics, as well as packaging and presenting them in an informative and accessible manner.
CurrentHSR (Research)1.0
Since 2010, HST has led work in the area of competency assessments focusing on sub-district and PHC facility managers. The Assessment of the General Management and Public Health Competencies of Facility and other Sub-district Managers was concluded in 2012/13; this study revealed gaps in leadership and management capacity-building in the country, as well as the need to enhance competency assessment techniques and processes and extend this to other categories of staff working within the district health system. HST has been working closely with the National Department of Health (NDoH) and the US Centers for Disease Control and Prevention (CDC) in pursuit of expanding this work. The study now continues as a CDC-funded project aimed at honing the competency assessment tools and up-scaling competency assessments in additional HST-supported districts using refined competency assessment techniques.
CurrentHSR (Research)1.0
The National Department of Health (NDoH) in collaboration with HST is undertaking a study to assess progress towards implementing the PHC re-engineering model in South Africa. In addition the study aims to assess barriers and facilitators to the implementation of this policy primarily at provincial and district levels. Fieldwork has already been carried out in the North West and KZN provinces and is in the process of being analysed. Planning for data collection in the other seven provinces is currently underway. HST and UWC along with other partners have formed a Consortium, known as the Outreach Team Rapid Assessment (OTRA). Together these organisations will focus on collecting in-depth information on the progress of implementing ward-based outreach teams. HST will continue its focus at the provincial and partly on the district levels, and UWC will focus on the district, sub-district and lower levels.
CurrentHSR (Research)1.0
uMzinyathi Health District in KwaZulu-Natal, as an NHI pilot district implemented the Benguela Referral method since January 2013, in an effort to strengthen the PHC approach in the district and to realize the outputs of the Department of Health’s (DoH) Negotiated Service Delivery Agreement (NSDA) and to meet its Millennium Development Goals (MDGs). The District’s aim to strengthen the referral system within the district, in line with the Primary Health care re-engineering framework, is part of its NHI planned activities to improve service provision through ensuring that all residents of the district have access to appropriate, efficient and quality health services. It is envisaged that the strengthened referral system will result in improved access to quality healthcare services.

This project aims to qualitatively assess the referral system at district level for equity, accessibility, efficiency and effectiveness.
CurrentHSR (Research)1.0
The project will encompass a cross-sectional, descriptive study utilising a mix of quantitative and qualitative research methods.
The Eastern Cape Department of Health embarked on a long-term strategic vision and planning process called the “Service Development Plan”. HST was contracted by the Department to provide technical assistance. The first phase of this project, the completion of an “Issues Paper” and a consultative process to capture the public’s views and aspirations regarding their health status and service delivery, ended in 2007/08. In the second phase a comprehensive report presenting a 2020 Health Vision Statement, linked to the Health Care Plan for the Eastern Cape Province was prepared. These reports were presented and discussed at the Eastern Cape Department of Health Extended Executive Committee in March 2009.
To develop a guiding framework on how to coordinate, regulate and facilitate NGOs and CBOs activities in the public health sector in a manner that is efficient, effective and transparent and which recognises the dynamism of the sector and the need to constantly ensure relevance and quality service delivery at community level.  The project also involves developing a code of ethics and conduct for NPOs working in the health sector in South Africa to promote best practice in organizational governance and health systems strengthening.
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