Dates: 16-18 September
Location: College of Cape Town, Athlone, Cape Town
About the conference
PHASA advocates equitable access to the basic conditions necessary to achieve health for all South African as well as equitable access to effective health care. PHASA provides a space for researchers and policy makers to share knowledge on ways to improve the South African public health system. In 2019, the conference theme was ’25 years into our constitutional democracy: the right to health’. The conference focussed on the trajectory of health in South Africa over the past 25 years and highlighted key areas for research and focus in the coming years and with respect to the incoming National Health Insurance.
1. Jodi Wishnia
Presentation title: “Milking the cow that’s called the department of health”: a multidimensional approach to reducing medicolegal claims
Presentation topic: The presentation focussed on rising medicolegal claims in the public health sector and their impact on public financial management. It explored one provincial department of health’s attempt to curtail and control claims by working collaboratively within the department, with its provincial treasury and by hiring a private law firm to support the state attorney. The private law firm managed to save the department 54% during its first six months. The other interventions will only show results in the longer term given the long lag time for these cases. Recommendations from the research include ring-fenced hospital budgets to reduce budget uncertainty, the use of the district clinical specialist teams for improved clinical governance and longer-term systems changes such as a re-interpretation of the Public Finance Management Act and the introduction of payment ceilings for medicolegal cases.
2. Witness Mapanga
Presentation title: Strategies to strengthen the provision of mental health care at the primary care setting: an Evidence Map
Presentation topic: The presentation focussed on describing an Evidence Map of nine different strategies to strengthen the provision of mental health care at the PHC setting. The top three strategies that were reported the most, included strategies to empower families, carers and patients; integration of care or collaborative interventions; and e-health interventions. The least reported strategy was task shifting. The Evidence Map further shows the amount and quality of evidence supporting each of the listed strategies, and this helps to inform policy design and research priorities around mental health. This is the first systematic Evidence Map to show the different strategies that strengthen the provision of mental healthcare at PHC setting and the impact these strategies have on patient, hospital and societal level indicators.
3. Teurai Rwafa
Presentation 1 Title (Oral): Health promotion capacity and institutional systems: An assessment across three levels of the South African Department
Awarded Best PHASA 2019 Oral Presentation!!!
Theme: Health Systems Strengthening - The presentation focused on assessing organizational capacity and institutional systems to implement health promotion across three levels of the South African Department of Health (national, provincial and district levels). It highlighted how organizational health promotion capacity gaps across all three-levels of the Department of Health understudy, and domains investigated. The research demonstrated structural divides between national and provincial levels. This included limited priority setting, monitoring and evaluation of health promotion activities. Emphasis was made on how reporting focuses on counting health promotion activities as required by the district health information system. Institutional constraints such as budgetary and resource limitations emerged as a major challenge, with participants reporting limited resources to conduct HP activities at any level. Therefore, reducing the full potential of health promotion in the system. Recommendations from the research include accentuating that in order for HP governance, policy and strategic plans to be fully realized in South Africa, organizational health promotion capacity developments are needed. The presentation generated interesting questions among those present, including receiving a recommendation that a submission to the Human Resource for Health Inter-ministerial committee be made regarding designated health promotion practitioners in the country.
Presentation 2 Title (Poster): “They call us ‘straat meit’, like we are always on the street. So you don’t belong here with us”: ‘Us, Them and Others’- Insider and Outsider views of health promotion within the Department of Health
Theme: Health Systems Strengthening - The poster focused on insider and outsider views of health promotion practice within the South African Department of Health among three groups: “Us”- the designated health promotion practitioners themselves: “Them”- facility managers and other nursing staff; and “Others” Civil Society representatives. It highlighted how the majority of health promoters (“Us”) believe that they play an important role in communities where they spend 80% of their time (for example, doing household visits, formulating support groups and supporting healthy lifestyles). However, the concept of health promoters spending most of their time “outside the clinic-facility” was met with mixed reactions, especially among facility managers (“Them”), some who preferred health promoters to be based at the clinic throughout the day providing health education. We presented that feelings of resentment and uncertainty about the role and current model of health promotion within the Department of Health were common. In addition, civil society (“Others”) felt HP should not necessarily be a directorate within the DoH. Recommendations from the research include that health promotion needs to happen both inside and outside the Department of Health, and that the role of health promotion in the health system needs to be better understood.
4. Hlologelo Malatji
Presentation title: Factors enabling and disenabling the services provided by community health workers: Case study of two provinces in South Africa
Presentation topic: The presentation focused on the factors that enables and disenables the services provided by community health workers (CHWs) under the ward-based outreach team (WBOT) in Gauteng and Mpumalanga provinces. It was presented that CHWs with regular supervision, enough supply of equipment (e.g. BP machine), stationary and good working relationship with clinic staff members were found to be motivated in performing their duties. However, CHWs that did not have enough supervision, evidenced by lack of supervisor during household visits struggled and as a result kept their visits short with less health information being given to householders. It was recommended that for the services of CHWs to be maximised, steps should be taken to strengthen CHW supervision and supply them with enough resources.