Strengthening district
leadership, clinical
governance and ward based
outreach teams
Presentation overview
“Health Systems Trust’s role in the programme is to lead activities under
Output 1 of the programme to Enable Districts to Oversee Improvement of
RMCH Services and provide technical input under components in Output
2 of the programme for Strengthening Ward-Based PHC and Obstetric
Neonatal Emergency Care Services”
1. National Coordination and Induction and Orientation
Training of DCSTs - Ms Fiorenza Monticelli (HST)
2. The RMCH Technical Advisory (TA) Package - Ms
Susan Naude (HST)
National DCST coordination
and functionality
National RMCH Steercom Meeting, Pretoria
29 January 2015
Legacy of the national coordination
• Recruitment (58.8%), updated national database
• Stakeholder engagements (Universities, professional
organisations)
• DCST reporting framework
• Case studies for best practices in districts
• Strengthened link between levels of management
(district, province and national)
• DCST representation in strategic planning committees.
• A DCST handbook (continued orientation of new DCST
members and clarifies the roles of DCSTs to the new
district managers). tm
What should be carried on into the future
• Mentoring plan for DCSTs and by DCSTs
• System refinement of DCST role and functionality
(performance management) to suit the new cadre of
employee who is neither direct clinician or manager.
• Full engagement of universities/ roles to explore additional
resources available in the academic field.
National Induction and
Orientation Training of DCSTs
Fiorenza Monticelli (HST)
National RMCH Steercom Meeting,Pretoria
29 January 2015
Objectives and background
Main Objective
To conduct the national DCST Induction and Orientation Training
– minutes of the special Steering Committee meeting on the DCST
Orientation and Induction programme, held 24 August 2012
confirmed that the RMCH project would train DCSTs nationally
(excl. KZN),
– the MTT guidelines* provided a broad framework for the induction
and orientation training of the DCSTs,
– the national training would link in to what was being done in KZN.
*National Department of Health. District Clinical Specialist Teams in South Africa. Ministerial Task Team Report to the Honourable Minister of Health, Dr
Aaron Motsoaledi. October 2012. http://www.doh.gov.za/docs/reports/2012/District_Clinical_Specialist_Teams_in_South_Africa_Report.pdf
Legacy
• 5 DCST Induction and Orientation Training modules, resources and
DCST toolkit. Also available on HST and RMCH websites.
• Tailor-made training videos on Post-Partum Haemorrhage and
difficult Caesarean sections (YouTube)
• A moderated online e-discussion list for DCSTs
• A Clinical Governance handbook for DCSTs and other clinical
leaders
• A national DCST database
• A DCST steering committee
• Training materials and SOPs on family planning for WBOTs, facility
staff in maternity units and PHC facilities
• External review of the DCST stream.
Impact - Was the training successful?
•
An objective external evaluation of the DCSTs is in process and guided by a
national Steercom. Results and recommendations will advise on sustainability,
challenges and way forward.
•
Feedback obtained through the workshop evaluation process transformed from
ambivalence and negativity in earlier workshops to overall positive responses
and appreciation.
•
A Focus group discussion with consultant developers and trainers, facilitators and
district specialists who participated throughout, considered the I&O training as
having achieved its overall objectives.
•
Improvement in national impact indicators is premature to assess, however
improvements in outcome and impact indicators are evident in a number of
facilities and some districts as a result of DCST efforts.
Theme
Discussion
Context specific
training
DCST function is understood and applied
differently in various provinces and districts, thus
training and content is adapted to speak directly to
the needs of the province whilst still covering the
required content overall.
Provincial MNCWH
forum
Establishing a forum which is resourced at
provincial level and supported by an academic
institution is essential for peer learning.
Replication of
training
The National Induction and Orientation training
approach, methodology and content can be
adapted for national training of MNCWH
coordinators and managers and other PHC
streams such as contracted GPs, School health
management teams and WBOT leaders.
Lessons learnt
Theme
Discussion
Content
development
•Involving local experts in content development
increases the relevance and practical application of
contents and promotes local buy-in.
•Sufficient time should be made available to make
allowance for several consultative meetings at
province and district level with relevant
stakeholders and to identify and meet with local
experts before training and orientating of a new
cadre is done.
Recommendations
1. Continued professional development and training of DCSTs
DCSTs require on-going clinical and leadership training
•
•
•
•
The I&O training focused on leadership, health systems, M&E, management and
strengthening of MCH. (no clinical training).
Through the DCST SteerCom, the NDOH can guide provincial specialists to ensure
provincial oversight by coordinating provincial RTC structures and academic
institutions in providing consistent clinical training for DCSTs.
This equally applies to training to optimise the leadership role of the DCSTs. (their
leadership is constrained by lack of direct line management and financial control).
This can be coordinated through linking up with existing leadership courses offered
by NGOs (MSH, HST, FPD) in provinces/districts.
Continuous on-site accompaniment, mentoring and coaching is required, to achieve
sustained skill development. To this end dedicated work by the provincial specialists
for mentoring and coaching activities is required as is currently being done in in KZN
and Free State districts.
Recommendations
2. Central coordination and monitoring for sustainability
The RMCH project has aptly demonstrated the worth of a national DCST coordinator:
–
facilitated and guided the functionality of DCSTs,
–
supported and guided appointment of DCSTs,
–
liaised with provincial coordinators in order to create an enabling environment
for the DCSTs
–
created guidelines for the monitoring and evaluation of DCST activities
The formal post for a national DCST coordinator needs to be created and filled as a
matter of urgency to ensure sustainability of the work done by the RMCH national DCST
coordinator.
.
Technical Assistance (TA)
Package and ward based
outreach teams
Susan Naude (HST)
National RMCH Steercom Meeting, Pretoria
29 January 2015
Objectives
• Development of a tailored TA package for each district to address
coverage gaps
• Assist RMCH teams to report on MNCWH mortality audits and
support teams to use data for planning and implementing RMCH
strategies
• Improve routine health information use for quality data and
monitoring of key health indicators.
Technical assistance approach
• Advocacy and capacity building of DMTs and DCSTs through
training and technical assistance along the continuum of care
• Support data utilisation to plan intervention and conduct mortality
and morbidity audits
• Improve service delivery through support and Technical
Assistance package to DM, DCST and MNCWH coordinators.
Technical assistance package
Sexual reproductive
health (SRH)
Family Planning
SRH Policy rollout and dissemination of Primary
Health Care and Maternity operating units
Standard Operating Procedures
Increase Uptake of FP Services
Capacity Building for Health Care Workers
Antenatal care
Early antenatal care
Basic antenatal care
Intra-partum care
Monitoring of intra-partum care (ESMOE and Fire
Drills)
Partogram implementation (interpretation and
action)
Postpartum care (maternal): prevent and manage
PPH
Postnatal and
newborn care
Essential new born care
Maternal-New born care: visit within 6 days
(creating demand through CSO grantees work and
strengthening client friendly services)
Childhood
Infant and Child care: prevent case fatality from
and management of diarrhoea, pneumonia and
malnutrition
Impact of TA interventions
1.Support to the District Management Team
Improved data usage and interpretation - M&E dashboards with maternal
neonatal and child health indicators have been created and are being used by
districts to monitor progress.
2.Support implementation of CARMMA
• The District Health Plans of 25 RMCH priority districts, which in previous years
had none or little mention of CARMMA activities or indicators, included
CARMMA indicators in the 2014/15 plans. This indicates that the districts have
begun planning the monitoring of the implementation of CARMMA
• In eThekwini (KZN), Capricorn (Limpopo), and Ekurhuleni South (Gauteng),
Kangaroo Mother Care is now practised in all birthing facilities thus reducing
the early neonatal death rates in these facilities
Impact of TA interventions
3. Key interventions along the continuum of care
•
An active roving team on Family Planning for post training mentorship and
on-site training was created in Ekurhuleni District (Gauteng), resulting in
observable increase in demand for MNCWH services such as uptake of family
planning, antenatal care and post-natal visits.
•
DCST are taking the lead in mortality and morbidity reviews in many districts.
Northern Cape DCSTs completed protocols on clinical guidelines for referral of
newborns.
•
Intrapartum care focused on plotting and interpretation of partograms to
promote care and appropriate referral (with DCST)
WBOT impact
•
Ward Based Outreach Team leaders (WBOT’s) and other relevant managers were
trained in the 9 provinces including the 25 RMCH districts on family planning and
MNCWH messages.
•
Awareness was created of their worth, impact that they could have, need for a
dedicated team leader and linkage to a PHC facility and school health teams.
•
WBOT linkages were created for postpartum follow-up in households, e.g.
Thusanong hospital has WBOT teams attached to it to assist in post-partum followup.
•
In some districts where WBOTs activities were combined with the work of civil
society organisations, this led to early observable demand for MNCWH services,
especially the uptake of family planning, antenatal care and post-natal visits.
Legacy
• DHPs changed to include CARMMA and MNCWH indicators and
related activites.
• Improved interrogation and utilisation of data to plan interventions
and monitor progress (dashboards and district reporting tool).
• Auditing of partogram and other cards (BANC & child records) to
address with DCSTs
• Family planning flipchart for WBOTs (also being used in clinics)
Recommendations
•
Provide leadership development for provincial managers, DMTs, hospital and
PHC managers through leadership programmes offered by universities,
business schools and NGOs (MSH, HST and FPD).
•
Human resource departments should have a recruitment and retention
strategy in place for critical posts (MNCWH coordinators, doctors, anaethetist,
advanced midwives etc.) to render quality care at district level
•
Clinical mentors need to be appointed by Province as part of the RTC to
mentor and evaluate health care workers post-training to ensure skills have
been acquired and applied.
Recommendations
• MNCWH directorate at NDOH should put a
communication strategy in place to make sure that
policies and information reach facilities.(utilising DCSTs
and academic institutions).
• District and/or facility management should consult with
community leaders to ensure community participation to
foster ownership and commitment for support and
sustainability of interventions.(e.g. Zithulele hospital).
Recommendations
• DCST should be an integral part of quality assurance
committee and other clinical governance structures.
• District/sub district Primary Health Care Coordinator
should link each WBOT to a PHC facility to improve
continuity of care for women and children, referral from
and back to community and track cases that are lost to
follow up.
Conclusion:
Requirements for sustainability
• A dedicated national DCST coordinator.
• Provide leadership development for DCSTs, provincial managers,
DMTs, hospital and PHC managers through engagement with
universities business schools and NGOs (MSH, HST and FPD).
• Ensure a provincial recruitment and retention strategy to fill critical
posts (DCSTs, MNCWH coordinators, doctors, anaesthetists,
advanced midwives etc.) at provincial and district level as a priority
to render quality care.
THANK YOU