Managing the epidemiological & demographic challenges facing hospitals services in Kwa-Zulu-Natal,...
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Managing the epidemiological & demographic challenges facing hospitals services in Kwa-Zulu- Natal, South Africa. CC JINABHAI, PD Ramdas Nelson R Mandela School of Medicine Faculty of Health Sciences, University of Natal
Managing the epidemiological & demographic challenges facing hospitals services in Kwa-Zulu-Natal, South Africa. CC JINABHAI, PD Ramdas Nelson R Mandela
Managing the epidemiological & demographic challenges
facing hospitals services in Kwa-Zulu-Natal, South Africa. CC
JINABHAI, PD Ramdas Nelson R Mandela School of Medicine Faculty of
Health Sciences, University of Natal
Slide 2
Slide 3
KEY CHALLENGES Hospital managers and policy makers faced
considerable challenges after the democratic elections in 1994 to :
promote and protect the health of the South African population,
undergoing rapid epidemiological, cultural, socio-economic and
demographic transitions.
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Slide 5
Dimensions - Health Promoting Hospitals 1.Management,
2.Governance, 3.Changes in the epidemiological and demographic
profiles of patients, 4.Re-orientating staff attitudes to protect
patient rights, 5.Provide cost-effective, high quality care
Slide 6
STRATEGIC & POLICY OBJECTIVES Key to this process of
revitalisation of hospitals was to provide high quality,
cost-effective care, to optimally promote the health of
individuals, communities and health professionals.
Slide 7
There are 62 Provincial Hospitals In KZN
Slide 8
The hospitals are distributed over an area of about 93 000 km
but access is difficult due to poor roads. Although the KZN
Province inherited a number of disadvantaged hospitals from the
previous apartheid government, it is working at improving
them.
Slide 9
HIV/AIDS & TB This epidemics among hospital staff and
communities, has made health promotion a national priority and
radically influenced the form, content and governance of health
service delivery.
Slide 10
EM Irusen, DP Naidoo, D Sebastian, C Stone*, UG Lalloo. Dept of
Medicine & Medical Registry* King Edward VIII Hospital. THE
IMPACT OF HIV AT KING EDWARD VIII HOSPITAL PROFILE OF AN
ESTABLISHED EPIDEMIC
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For all years: more female than male admissions. The
in-hospital mortality was 21.7-24.7% per annum. Mortality in the
medical wards contributed to 73.4% of this mortality. HIV 60% of
total med. mortality RESULTS
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Impact of Maternal HIV/AIDS on Paediatric HIV Infections and
Mortality MTCT > 90% of all perinatal HIV infections MTCT rates
= 9% (no breastfeeding) 34% (breastfeeding)* National IMR42/1000
IMR for HIV uninfected17/1000 (CHBH)# IMR for HIV infected354/1000
(KEH)* * Bobat et al, (1999) SAMJ 89: 646-648 # Gray G, et al.
Petra Study
Slide 13
Workload Workload Health Resource Utilisation at Tertiary
Centre AIDS Patients Patients Displacementof Patients with Other
Medical Disorders or Not Develop Them Teaching Scope of
Medicine
Slide 14
National HIV Seroprevalence Among Antenatal Attendees
Slide 15
HIV AMONG ANTENATAL WOMEN AT KING EDWARD VIII HSP OVER TEN
YEARS
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HIV/AIDS and MORTALITY SA POPULATION STRUCTURE for 2009
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THE IMPACT OF THE HIV/AIDS EPIDEMIC ON HOSPITAL SERVICES IN
SOUTH AFRICA: RESPONSES, COPING STRATEGIES AND BEHAVIOUR OF
MANAGEMENT AND HEALTH PROFESSIONALS JINABHAI CC WHITTAKER S SHASHA
Y GOVENDER M GREEN-THOMPSON RW BOURNE D NOVEMBER 2002 To date, no
studies have been conducted on the impact of the HIV/AIDS epidemic
on South African hospitals and their staff. The following study is
an early attempt to address this gap.
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FINDINGS RELATING TO HOSPITAL MANAGEMENT Since mid-1990s
patients clinical profile changed Managers reported major impact of
epidemic on the hospital services, increases in patient volumes,
crowding out of non- emergency and non-HIV-related conditions
Slide 19
Few policies, guidelines or criteria for admission, treatment
or discharge Clinical policies Hospital management believe: - no
need for an official policy - clinician opinion should be the
deciding factor Factors influencing admission: - availability of
beds - stages of the disease - perceived benefits of
clinical/curative interventions There is a greater integration of
TB and STD services with HIV/AIDS services
Slide 20
Managing patient loads Screening procedures by gateway clinics
which focus on HIV- positive patients Oncology treatments and
certain laboratory services referred to tertiary centres Only very
ill patients admitted to hospital Patients discharged as soon as
conditions are stabilised Patients only rehydrated on an OPD basis
Only admitted if severely ill with complications or
life-threatening conditions
Slide 21
Impact on non-HIV/AIDS patients The epidemic has resulted in: -
the modification of care of non-HIV/AIDS patients - cardiac,
respiratory and endocrine patients treated on an outpatient basis,
unless critically ill Staff pressures have resulted in: - less
monitoring - shorter periods of assessment - greater reliance on
other categories of staff However, because of the long distances
that patients have to travel and the lack of transport, patients
and their families put pressure on staff to be admitted. This
causes conflict.
Slide 22
Pressures on staff as a result of the HIV/AIDS epidemic Staffs
clinical knowledge, skills and acumen challenged by spectrum of HIV
associated conditions Staff have to make life and death decisions
Limited treatment and care options available Staff have to confront
their own fears, prejudices and humanity Staff exposed to the
infection Changes in the job descriptions of staff not ratified
Some staff feel that additional councillors and clinicians are
needed Coping mechanisms for staff have not been developed
Slide 23
Risks to staff Register of staff who are HIV positive Kept by
all hospitals but inaccurate because of stigma. Staff use private
sector. Needle-stick injuries National health policy stipulates
that all hospital staff are eligible for ART and counselling.
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SCHOOL BASED HIV/AIDS PREVENTION School children 27% KZN
population / most vulnerable Key strategies: Target primary school
/ secondary school pupils Health promoting schools prevent
transmission / promote healthy behaviours
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Home Based Care
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Managers : Hospital, Medical, Nursing, Systems & Finances
Specific components clearly defined key performance areas (KRAs) in
performance contracts. The hospital manager : required to establish
the changing morbidity and mortality profile of patients and
communities, to ensure that all resources were aligned to
addressing these needs and priorities. A Charter of Patient Rights
was disseminated at community level to establish a partnership
between patients and hospitals.
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The quantitative and qualitative impact of these
transformations on patients and health professionals, have
important lessons for other middle-income countries; which are
attempting to provide cost- effective, high quality care.
Slide 28
The threat of HIV/AIDS is starting to emerge as a wave of
illness and death among young people.