File for quick reference Health Promotion accepted was as apriority by the district effective healthpromotion inthehealth district. Although gaveThese findings aclearindication the need for of ➢ ➢ ➢ ➢ ➢ ➢ were: Frere healthdistrict of Cape.Someof theEastern thefindings of maternal andchildhealthwas carriedout intheMount In July1997 Introduction strategy andwork planfor theHealthPromotion Section. and effective, bydescribingtheprocess of developing a health promotion activities canbemade more efficient Frere presented heregives someuseful onhow pointers managers andcoordinators. Theexperience from Mount Promotion relates to thework otherprogramme of activities, there isalsoconfusionabouthow Health Because HealthPromotion cuts across allprogramme do,andhow theyto shouldprioritisetheiractivities. clear what aHealthPromotion coordinator isactually meant coordinators have beenappointed. Butitisnot always Primary HealthCare. Inmanydistricts, HealthPromotion Health Promotion isrecognised as acriticalcomponentof The Issue HIV istransmitted. respondentsOne infive aged 15-49 didnot know how recentmost episodeofdiarrhoea;and 40%ofOver children were given enemas duringthe thecorrect24% knew formula for makingSSS; timetheirchildhad(SSS) thelast diarrhoea,andonly caretakersOnly 20%of hadusedsugar-salt-solution diarrhoea; deaths 3years40% ofinfant inthepast were dueto immunised at theageof oneyear; childrenOnly 36%of aged 1-4 years were fully of allcaretakers;fifths The child’shealthcard couldonlybeproduced by three Health PromotioninaRuralDistrict , a survey of600householdsonvarious, asurvey aspects Making itMoreEffectiveandEfficient 1 Diploma inHealth Education. as “Healtheducators”, andgraduated from Unitra witha all formerly employed by theTranskei Departmentof Health Promotion Sectionthat of consists three HPOs.They were The MountFrere DistrictHealthTeam hasadiscrete Health promotion directly. activities as implementingsome specific“vertical” well as health should work throughother programmes anddepartments, in 1995 concludedthat HealthPromotion Officers (HPOs) Educators”. Aprovincial conference onHealthPromotion known as “HealthPromotion or“Health Officers” promotion Thesehealthworkers activities. are sometimes responsibility managing of health andimplementingcertain health workers whoare specially delegated the However, withinthehealthsystem there are categories of promoters. midwives andnursesshouldallseethemselves as health all healthworkers inthehealthsystem. Therefore, doctors, element of allPHCservices.Itisanactivity that belongs to Describe the Context: Health Promotion in the in promotion Promotion Health Health Context: the Describe Step 1: effectiveness HealthSystem withintheDistrict framework. Health Promotion Sectionstrengthening position and its common inmanyother Italsoillustrates healthdistricts. a issues inHealthPromotion planningthat are likely to be Promotion Sectionwhichhighlights thestrategic someof This isareport written by theMountFrere District Health they couldimprove thesituation. officers heldameeting inFebruary 1998 to discusshow Management Team and thedistrict’s HealthPromotion problems. District Asaresult, members oftheInterim time andresources, andalack of skillswere seenas health workers, alack ofcoordination, theshortage of Eastern is a pillar of PrimaryHealthCare isapillarof andan Kwik-Skwiz #11 May 1998 Diagrammatic representation of Health Nonceba Nomabunga Promotion Most of the time, Nonceba is part of the Kwabhaca School full scope of health promotion activities Health Team, and works closely with Momelezi. However, she will accompany the mobile clinic nurse team if there is space available in the vehicle. Other duties are to work with the EHOs if there is a disease outbreak. At a recent Shigella outbreak she accompanied a team to the area concerned and gave health education talks on water and health promotion activities sanitation. Nonceba is also part of the Mary Theresa Hospital of Health Promotion HIV Counselling team, as well as the Mary Theresa Hospital Section Infection Control Group. She was part of the research team that conducted a recent household survey on Maternal and Child Health. health promotion activities in health sector Sakhi Ntayiya Sakhi is the overall coordinator of the Health Promotion Health promotion is also an important activity in Section. He is responsible for preparing the annual reports other non-health sectors, eg. teachers play an and action plans for the Section, and for liaising with the important role in the promotion of health amongst Regional Health Promotion and the District PHC school children. Others who can act to improve Coordinators. He is part of the Interim District Management the community’s understanding of health issues Team, and attends regional Health Promotion meetings in include local tribal leaders, agricultural extension . He also coordinates the involvement of the Health officers, church leaders and NGOs. Promotion Section in the various “Health Campaigns” of the Department of Health, in collaboration with the relevant PHC programme coordinator. (The Health Promotion Step 2: Section helped to organise Mental Health Awareness Day, World Aids Day, TB Day, Child Protection Week and Describe the Current Activities of the Health Breastfeeding Day in 1997.) He has been coordinating the Promotion Section “Culture of Caring” Project and is a member of the Research Team that conducted the household survey on Personnel MCH. Having discussed the broad principles and context of He has also been responsible for spearheading health care Health Promotion and having stressed the importance of for the elderly by setting up “Geriatric Health Clubs” in Mntwana, Lugangeni, Mhlotsheni, Mnceba and Sigidi all cadres of health workers to consider themselves as clinics. These clubs are designed to provide a mix of clinical, health promoters, the next step focussed on the specific social and welfare support to the elderly members of the Health Promotion Section of the district. community. Community Health Workers are involved and provide home visits and help collect information about the Distribution of Health Personnel type of illness and disability that the clients suffer from. In Distribution of Health Personnel addition, during mass immunisation and EPI campaigns, the All three HPOs are based in the town of Mount Frere and HPOs adopt a “hands-off-everything-else” attitude, and primarily serve the magisterial district of Kwabhaca. There help implement the campaign. are no HPOs based in Sipetu Hospital or in the sub-district. Half the district is therefore under-served by Step 3: the Health Promotion Section. Assess the Current Situation and Identify the Key Problems of the Health Promotion The Activities of the Health Promotion Officers Section Momelezi Mntuyedwa Following this description of the Health Promotion Section’s current activities, the next step was to assess the situation Main activity: Helping to develop the School Health Promotion activities of the district. After attending a course and identify the key problems which need to be addressed. on School Health Promotion, Momelezi organised a regional workshop on the concept of the ‘Health Promoting School’. Unequal coverage Following this, he helped the district form a multi-disciplinary ➢ The Tabankulu sub-district is not adequately serviced school health team for the Kwabhaca sub-district composed of two nursing sisters, one staff nurse, one nursing by Health Promotion Section. assistant, an Environmental Health Officer (EHO), a Social Prioritisation and planning of activities Worker and Momelezi himself (sometimes accompanied by another HPO). The team visits one school each day, five ➢ On assessing the existing scope of activities, it was times a week. At the school, the HPOs give health education concluded that the HPOs are trying to do too much. talks covering topics such as AIDS/HIV education, oral There is a danger of the three HPOs are being expected health, sexuality, STDs and Family Planning. to do too much with too little, resulting in stress and Other responsibilities: Momelezi is part of the Mary Theresa low effectiveness. It was therefore resolved that, on Hospital HIV Counselling team, and is the Treasurer for the local NACOSA committee which works with the district HIV/ principle, they should do few things well, rather than AIDS Programme. Last year, he helped to prepare the World to do many things badly. The time spent on different Aids Day activities which were held in Zinyosini, in Tabankulu. Health Promotion activities should be based according

2 to the priority health problems of the district. Irregular district management meetings ➢ The allocation of time to certain activities may be ➢ While the Regional Office has a timetable of regular inappropriate. For example, it was thought that the meetings with all District Health Promotion Sections HPOs were spending too much time on School Health on the first Tuesday of every month, regular meetings activities, and not enough on other Health Promotion with the Interim District Management Team do not activities. happen. This makes forward planning, time Support to other Programmes and health facilities management and the coordination of district activities difficult. ➢ There is not enough interaction with other health workers and with the health facilities of the district. Step 4: Clinic nurses feel unsupported by the Health Promotion Section, and the paediatric wards in the hospitals have Planning the Way Forward a lack of appropriate health promotion materials which Having identified the key problems and loopholes, the indicate that there is room for the Health Promotion next step was to make a number of policy decisions and Section to provide more support to the MCH to formulate a “way forward”. Programme and the hospitals Increase Health Promotion activities in the The cost-effectiveness of the School Health Team Tabankulu sub-district ➢ The School Health Team is composed of four nurses, It was agreed that the three HPOs must jointly work to one EHO, one Social Worker and one or two HPOs. share the load of supporting Health Promotion activities This is a large School Health Team, and it was in the Tabankulu sub-district: questioned whether so many health workers needed ➢ Momelezi to support the development of the Tabankulu to be involved visiting one school. School Health team as he has done in the Kwabhaca The effectiveness of the periodic “Health Campaigns” sub-district. ➢ A large amount of time and resources are invested in ➢ Nonceba will become part of the Sipetu Hospital organising the various “Health Days” and other health Infection Control Team instead of there being two HPOs campaigns. One HPO suggested that this simply on the Mary Theresa Hospital Infection Control Team. amounted to people turning up to a function to “eat, ➢ All three HPOs will share in providing support to Sipetu drink, dance and go home”, without any improvement Hospital and the mobile and fixed clinics of Tabankulu in their knowledge or behaviour. At one such “Health (see below). Day”, the Regional Coordinator complained that three- Improve the impact of health promotion activities quarters of the participants were health workers. Improve the impact of health promotion activities by supporting other health workers However, other HPOs felt that these health campaigns were important mechanisms for getting health The HPOs can develop and improve health promotion messages across to the community and for involving activities in the district by providing support to other health the community in health activities. After a long workers. This support could consist of providing training discussion, it was agreed that these periodic “health in giving “health education talks”, developing appropriate campaigns” were important activities to organise as health promotion materials (eg. posters and pamphlets in long as they were carefully planned and done in a the local language), acquiring health promotion materials way that truly involves the community in meaningful from outside the district and encouraging health workers activities. to make health promotion an integral part of their interaction with patients and the community. Personnel issues ➢ The 2 hospitals, 17 clinics, 2 mobile teams and 2 School There are only three HPOs to serve the entire district, and Health teams will be divided amongst the three HPOs this is much less than other districts in the region. In so that there will be one HPO responsible for providing addition, one of the HPOs is working as an “untranslated support to each of these facilities and services. officer”, and has been paid the salary of a student officer ➢ The HPOs will visit the clinics to which they have been for the past three years. allocated to support once every four to six weeks. Lack of resources ➢ Nonceba will provide regular support to the paediatric ➢ Although the Regional Office has a resource centre and maternity wards of both hospitals. which has a tele-video combination, an overhead ➢ Momelezi will provide regular support to both School projector, a video camera, flip charts, loud speakers, Health Teams. Rather than being a regular member of and large screens which we can borrow when the School Health Team, he will act more as a support necessary, this is not enough to go round the whole person to the School Health nurses, and only join the region. School Health Team periodically.

3 ➢ Nonceba and Sakhi will provide regular support to Address the personnel issues of the HPOs the mobile Health Teams. All the working HPOs should be paid the full salary that is Improve the coordination of activities with other due to them. programmes programmes ➢ The Regional Health Promotion Coordinator and the The HPOs need to develop a more structured working District Manager have agreed to be responsible for relationship with the district’s programme coordinators. these personnel issues. To begin with, they could focus on the MCH and HIV programme. Critically evaluate the composition of the School Health Team and its Activities ➢ Nonceba to work with the MCH programme ➢ coordinator in developing joint action plans for The District will obtain external support to conduct a supporting the health promotion activities in the structured evaluation of the School Health team. paediatric and maternity wards of both hospitals. Develop a District Health Promotion Resource ➢ Momelezi will continue to work closely with NACOSA Centre and the District HIV programme in developing joint ➢ Funds and support will be sought from the private action plans for supporting the health promotion sector and the National Health Promotion Forum (NHPF) activities of the clinics and mobile health teams. of to purchase equipment for the district. ➢ The District Manager will develop a timetable for having ➢ regular District Management meetings. The Regional Office has already motivated the province for the purchase of equipment, and the follow-up of Develop monthly and weekly work-plans this was deemed to be the responsibility of the Regional ➢ To improve efficiency and to help with the coordination Health Promotion Coordinator. ■ of activities, each HPO will develop monthly and weekly work plans (see below).

Example of a Monthly Workplan for Sakhi Monday Tuesday Wednesday Thursday Friday 1 2 3 4 Regional office Visit Lugangeni Clinic Meeting with other Meet with other meeting, Kokstad programme officers HPOs Office work7 8 Visit Mnceba Clinic9 10 Meeting with 11 Tabankulu mobile team Office work (write 14 Draft local health 15 Visit Sigidi clinic16 District management 17 18 funding proposals) promotion activities meeting/Office work

Office work (plan & 21 22 Visit Mntwana Clinic23 Plan and organise for 24 “TB Action Day” 25 organise for “TB Action Day”) “TB Action Day” (in Sigidi)

Meeting with other 28 Office work (monthly 29 Visit Mhlotsheni 30 Accompany 31 HPOs report) Clinic Tabankulu mobile team

Written by Sakhi Ntayiya, Momelezi Mntuyedwa, Nonceba Nomabunga, Litha Klaas, Florence Gogo and Hanson Magaqa

Comments or criticism? Contact: David McCoy Tel: 021 686 8621 Fax: 021 686 8635 Email: [email protected] Initiative for Sub-District Support Health Systems Trust Tel: 031 307 2954 PO Box 808 Fax: 031 304 0775 Durban 4000 Email: [email protected]

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