Table 1. Recommendations to address challenges in Health Systems Strengthening.
Symposium
theme
Quality
Improvement
PHC Reengineering
Challenges
Recommendations
Healthcare worker buy-in to ensure the success and
sustainability of QI intervention strategies
Inefficiencies and structural problems in public health
facilities
Resistance from key stakeholders
- Promote training of healthcare workers to increase knowledge of their roles in QI strategies
- Build greater awareness among healthcare workers of the importance of their participation in the QI process
- Use QI strategies such as the Ideal Clinic Model to reorganise and streamline facilities, and to identify and address
resource constraints which affect operational efficiency and health outcomes
- Ensure buy-in of District Managers from the outset to ensure political involvement and strong leadership
- Engage the community through traditional authorities to ensure they avail themselves for household visits
- Lobby for funding from the DoH while balancing available resources
- Engage Development Partners for support with implementation
- Identify NGOs to absorb additional CHWs and conduct training of NGOs regarding Treasury Regulations for the
payment of CHWs
- Allocate professional nurses at PHC facilities to perform outreach work with WBOTs on a relief basis
- Ongoing training of CHWs and professional nurses
Limited funding to strengthen the establishment of
WBOTs and late or non-payment of existing CHWs
Limited human resources (team leaders: professional
nurses and skilled CHWs) and high turnover
Pharmacy and
Supply Chain
Engagement regarding roles and priorities
Feedback to CHWs regarding referrals to care
Familiarity of CHWs with mobile health technology
Inefficiencies in the supply chain management
system, resulting in interrupted supply of medicines
Inequitable distribution of pharmaceutical services,
particularly in rural areas and low-income urban areas
Strategic
Information
Information is not accessible and is not being used to
guide programme planning
Sustainable
Health Systems
Appropriate platforms to capture and store
information
Difficulty in creating a sustainable system for quality
healthcare
- DoH to engage NGOs through consultations to clarify roles and involve NGOs in continued collaboration
- Improve communication and strengthen working relationships between referral centres and CHWs
- Provide training and continued mentorship
- Increase access to and visibility of stock and consumption data to inform and enhance supply chain processes such as
procurement and distribution.
- Move away from manual stock management systems and utilise wide-networked electronic stock management systems
which can be integrated with other existing systems such as RxSolution.
- Change current policy and legislation to increase the presence of community pharmacies and pharmaceutical services
in rural and marginalised urban areas. In particular, lift the ban on section 22A (15) permits to enhance access to
pharmaceutical services in these areas.
- Develop strategies which encourage growth in the pharmaceutical workforce
- Take time to understand the needs of different end-users and present information accordingly, in a simple format that
the user can relate to
- Report on process indicators in addition to outcome indicators to provide information regarding how programmes are
working
- Invest in technology - connectivity and mobile health
- Consider using integrated systems with comprehensive patient information such as theHealthSource
- Ensure-buy in from leaders and all stakeholders
- Create effective and efficient public-private partnerships:
* Integrated models including both infrastructure-based and service delivery models
* Government to demonstrate long-term political will by establishing national PPP frameworks, investing in skilled
resources and incentivising performance
- Address insufficient and inequitable distribution of human resources for health:
* Invest in community health workers
* Increase production of doctors and nurses by increasing intake at universities and exploring options such as
eLearning and private sector engagement
- Ensure that District Health Plans are effective tools to guide sustained improvements in healthcare, such as the webbased Plan2Plan Project from Foundation for Professional Development
Source
presentations
Dr N Mkhondo
and Prof E
Seekoe
Dr G
Marincowitz and
Ms S Motau
Mr J de Vos
Dr K Ward
Dr C Chikanda
Dr J Pienaar
Mr T Hurter
Mr J Gibbs
Dr J Fieno
Ms J Snyman
CHW, Community Health Worker; DoH, Department of Health; NGO, Non-Governmental Organisation; PHC, Primary Healthcare; PPP, Public Private Partnership; QI, Quality Improvement; WBOT, Ward Based Outreach Team
Based on presentations delivered at the HSS Symposium (available at: http://www.anovahealth.co.za/anovas-third-hss-symposium/) and satellite session discussions.