The Department of Health has embarked on a process of strengthening the health system which focuses on the implementation of an effective Primary Health Care (PHC) approach in order, inter alia, to reduce maternal and child mortality rates. One of the core elements of the PHC approach is the introduction of District based Clinical Specialist Teams (DCSTs).
The DCSTs are intended to improve the quality of health care and outcomes for mothers, newborns and children. A Ministerial Task Team which was established to support the Department of Health in setting up the DCSTs prepared this report, which documents progress to date as well as a number of recommendations to help guide the national and provincial departments of Health in their implementation of the PHC Re-Engineering process and the establishment of the DCSTs.
The report makes ten sets of recommendations to the Minister of Health. These include the following:
Composition of the DCST: A DCST should be located in each district and include a family physician, a primary health care nurse, an obstetrician and gynaecologist, an advanced midwife, a paediatrician and a paediatric nurse. As a short-term intervention, until such time as a full team is possible in all districts, the following minimum team should be available: (1) A nurse-doctor dyad from a single discipline. For example, an obstetrician and gynaecologist and advanced midwife), or (2) a family physician and PHC nurse, plus an advanced midwife or paediatric nurse on site and an obstetrician or paediatrician providing support from a DCST in an adjacent district. If a minimum team is not in place, then no sessional appointments of specialists should be allowed. Specialist family physicians should be appointed at all community health centres and district hospitals as the most senior clinician.
Roles of the DCST: The DCST ought to be responsible for the quality of clinical services, clinical training, monitoring, evaluating and improving clinical services, supporting district level organisational activities, supporting health systems and logistics, collaboration, communication and reporting, and teaching and research activities.
Training/Resource centres: Each district should have a training / resource centre to allow the DCST to carry out training. Resources for this should be provided by the national Department of Health under its infrastructure budget.
Human resources for health in rural areas: Human resource policies must be revised to improve rural retention and coverage of specialists in rural areas. This could include a requirement for community service for specialist registration, rotation as part of registrar training and periods of specialist deployment in regional hospitals in underserved areas.
WEB LINKS FOR THIS ARTICLE