Monitoring and Evaluating Partnerships Between NPOs and the DOH for the Delivery of Primary Health Care in

South Africa.

FP Netshipale, Dr JF Aguilera

PDPHC Programme (EU funded Programme)

Department of Health, South Africa

NPOs PHC delivery in SA

• Often hampered by poor NPO management, coordination and lack of skills

• Poor norms and standards for NPO’s• Lack of

– proper coordination by departments

– M&E, quality assessment and measure of service delivered

– sustainable funding for NPOs

– employment opportunities in certain areas

Partnerships for Delivery of PHC

• Six-year programme, started April 2003

• Developed by the EU in collaboration with the SA Government

• The total grant is 50 million euros

• Operational in 16 districts in 5 provinces

Overall Objective

To provide more accessible and affordable

quality PHC for the poorest communities in SA

Specific Objectives

• To strengthen cooperation between NPO’s & GVT

• To create formalized partnerships for the delivery of PHC

• To train NPOs and DOH staff• To monitor and evaluate PHC services

delivered to the community

Methods

• Selected NPOs delivering PHC are contracted and funded

• National, provincial and district management units support:– Institutional and management strengthening

– Staff and caregivers accredited training

– Implementation of an M&E system integrated into the national District Health Information System

– Operational Research

Methods: M&E Components

• Annual M&E workplan, aligned with programme workplan

• Routine data collection– PHC Data collection tools and guidelines– Programme activities (Gantt’s charts)

• Periodic data collection– NPO organizational information– NPO supervision manual (in preparation)– Baseline studies– Impact study (in preparation)

• Ad hoc research

ResultsNo. of NPOs funded, by Province

Total Funded

Limpopo 88

KZN 52

EC 55

Gauteng 65

WC 79

Total 339

Service Delivery

No. Benef Median No. Median Median

per day daily No. Benef carers* No. carers daily No. benef

per NPO per NPO per carer

EC 55 3,559 40 1,161 14 2.9

Limpopo 84 7,43 44 742 17 2.6

KZN 44 5,848 70 685 20 5.5

Gauteng 66 7,003 29 994 12 2.4

WC 68 6,366 65 364 16 4.1

Overall 317 11,129 49 3,946 15 3.3

*paid + volunteer

No. NPOs

HBC

Monthly Number of Patients, by categories

0

5000

10000

15000

20000

25000

JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC

Cat 1 Cat 2 Cat 3

N

Visits to patients cat 1 75 473 55%

Visits to patients cat 2 41 438 30%

Visits to patients cat 3 21 030 15%

Total Visits 137 941

HBC Distribution of Categories of Visits

HBC Disease Profiles Distribution, National, 2006

Hypertension21%

Diabetes9%

Cancer2%

Cardiac Diseases3%TB

17%

HIV/AIDS21%

Other27%

TB

Monthly No. of TB Patients Supported on DOT

0 0 0 0 33 32250

1074896

2378

1756 1684

0

500

1000

1500

2000

2500

JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC

N

Suspected Cases 5 507

Defaulters 667

Contacts 677

Total 6 851

TB Tracing and Referral

OVC

Monthly No. of OVCs Supported, 2006

0 0 0509

1 150851

1 308

1 964

977

4 808

6 126 6 060

0

1 000

2 000

3 000

4 000

5 000

6 000

7 000

JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC

Monthly No. of household visits to OVCs, 2006

0 0 0

2 3921 898

1 179

4 853

3 822

2 867

5 767 5 9495 459

0

1 000

2 000

3 000

4 000

5 000

6 000

7 000

JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC

Services to OVCs, 2006

N

Child care forums established 167

Counseling Sessions 4 236

Education on memory box 2 702

Link to Food Programme 9 086

Placement in alternative care 667

Referral to relevant institution 2 593

Health Promotion

HP Activities, 2006N

No. persons reached by HP campaigns 66 722

No. of children educated 46 130

No. of Health education sessions 56 014

Condoms Received and Distributed, 2006

785 814

645 619

6 834 10 2500

200 000

400 000

600 000

800 000

1 000 000

Male Condomsreceived

Male Condomsdistributed

Female Condomsreceived

Female Condomsdistributed

No

.

VCT

VCT Activities, 2006

1 348

6 8476 621

22 555

24 694

0

10 000

20 000

30 000

Persons motivatedfor VCT

Clients pre-counseled

Clients testedpositive

Clients + post-counseled

Clients referredfor HIV

management

Conclusions

• Mainly monitoring activities implemented– Service delivery– Organizational NPO data

• Evaluation tools are being developed – Quality assessment– Impact study– Cost-effectiveness of the programme remains to

be demonstrated

Way Forward

• Extension to the whole country

• Strengthen M&E skills in NPOs and DOH staff

• Integration of data into the District Health Information System

• Assess and ensure quality of service provided

Thank You