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Access to health care is a basic human right that is The above is done with a view to ensuring a greater entrenched in the Constitution of South Africa. In degree of efficiency and to improve the quality of health addition, access to basic healthcare is a critical measure service. Consequently the Gauteng Provincial of the quality of life, more so for a developmental city Government (GPG) is currently implementing initiatives like Johannesburg. Health is a critical measure of the such as the capitalisation and revitalisation of public extent to which transformation within South Africa has health facilities aimed at public hospitals. The am is to made a significant impact on the lives of the majority lay a firm foundation for improved service delivery, of South Africans. To this end, access to health is a especially among the most vulnerable sectors of our high priority for national, provincial and local society. Further initiatives, aimed at developing and offering an internationally competitive health service andworld-class medical facilities, will be pursued over the The national Department of Health (DoH) formulates health policy, legislation, norms and standards forhealthcare. Furthermore the DoH has the following The local government sphere is critical for ensuring that the overall health strategic framework is achieved. The City has given full effect to the overall national and Ensures appropriate use of health resources; provincial framework by ensuring that its delivery of Co-ordinates health-related information systems; environmental health services and primary health carecomplies with national requirements. In this context, the major role of the City’s Health Regulates public and private healthcare sectors; Department is that of coordinating, facilitating and Ensures access to cost-effective and appropriate acting as a catalyst to ensure that the delivery of health services occurs at a local government level. Its specific Liaises with international agencies and health The Gauteng Provincial Department of Health is Developing a City-wide health service delivery Coordinating the development of a service delivery Formulating and implementing provincial health Monitoring and reporting on service delivery; and Planning and managing a provincial health- Developing norms and service level standards.
The Health Department of the City of Johannesburg (CoJ) provides primary healthcare, management of Controlling quality in health services and facilities; communicable, non-communicable diseases and HIV/AIDS, monitors and manages environmental healthservices, provides pharmaceutical services as well as Screening applications for licensing and inspecting maintains and manages healthcare information.
Chapter 5 /
The 11 partnerships between the City’s HealthDepartment and various organisations and This section highlights the City’s performance in the 2005/06 financial year, against set targets that shouldtranslate to the achievement of national and provincial The Glenanda satellite clinic started operating as a health objectives. These in turn address the national fully-fledged clinic, offering services for five days a priorities and mandate. In the past financial year the Overall, the City-wide ‘average time spent’ bypatients in clinics has improved to 114 minutes, while time spent at clinics for clinician services As previously mentioned, the City’s main thrust has been to ensure that the delivery of health services The City scored 92,6% in the customer satisfaction occurs at local government level. Some of the index, thereby increasing the number of satisfied challenges of this process are the following: customers that interact with and depend on the Staff shortages, especially of PHC-trained nurses 85% of all health personnel were trained on Long waiting times that are aggravated by staff customer care in an effort to improve the quality of interaction between the City’s health providersand our people; High levels of staff turnover that often necessitateon-going training/updates; The City successfully implemented yet anotherWorld AIDS Day Awareness campaign; Fragmentation in health delivery processes, mainlydue to some functions being performed by other A total of 3 300 community volunteers were recruited, trained and participated in the 2005World AIDS Day campaign and this was instrumental in assisting the City to reach its goals; comprehensive package of primary health careservices including ART; The immunisation of children under one yearincreased from 83,4% to 85%; The need to increase the availability of services ininformal settlements; for example in Zevenfontein, Confirmed cases of measles declined from 243 (in Braamfischerville, Sweetwaters and Mountainview; the 2004/05 period) to 10 cases in the year underreview; The non-availability of service providers for primary The default rate in the New Smear Positive sterilisation; for example there is only one service improving the cure rate from 59% to 66%; Service hours being limited to working hours only, A total of 29 581 pap smears were done in the thereby impacting on access to healthcare as there are no extended clinic business hours due to A partnership between the City’s Health Limited human resource capacity in regions for Department and the Wits School of Pharmacy was concluded – it continues to be active and effective; Lack of health promoters to assist in conducting At least 22 additional Environmental Health campaigns (e.g. cervical and breast cancer, Practitioners (EHPs) were employed and extra funds maternal health, teenage pregnancy) inhibits the were allocated for resources to be used by EHPs; The ‘Jozi Ihlomile’ programme aimed at Low cure rate of New Smear Positive TB cases; encouraging voluntary HIV/AIDS testing and Inadequate transport for Multi Drug Resistant counselling, was expanded to six new areas – it created 150 jobs for out of school youths,especially women; The need to improve EMS transport for patients; A total of 3 000 needy families and orphans benefited from the Mayoral AIDS Fund project; ineffective liaison with referral hospitals; / Chapter 5
A limited amount of chronic care at local The City observed the World Environment Day and conducted numerous activities in support of the day,which included the distribution of information There is a challenge to establish a fully functional pamphlets offering environmental awareness. A number of programmes, presented at schools and Inadequate funding and staff resources for community workshops, focused on issues like the impact of dumping on environmental health. Correctional Service facilities visit
Practitioners on law enforcement is still posing achallenge; and Two visits were conducted to the Johannesburg and There is a challenge in sustaining community Leeuwkop Correctional Services facilities during the members who volunteer in the implementation of 2005/06 financial year. The visits sought to create ‘Jozi Ihlomile’ project and voluntary counselling awareness in the authorities regarding the by-law requirements and compliance with health regulations.
Environmental health at hostels
A total of 10 hostels were identified and included in Health service delivery
the clean-up campaign for the 2005/06 financial year.
These campaigns were aimed at improving healthy A total of 28 complaints/service requests were recorded lifestyles at hostels as well as creating awareness at the Centre for the financial year and all were regarding the City’s by-laws as they affect residents.
responded to within the stipulated timeframe of two Activities included picking up litter at hostels, removal days. There were a total of 9 235 requests for services of waste by Pikitup, painting of walls and the recorded in the regions. The requests ranged from air education of informal food traders on the legislative pollution, noise management and vector control. Most of the complaints were related to vector control. Theseneeded to be attended to by other departments in the Environmental health notices and fines
About 29 336 statistical notices were served until April.
Partnerships
In total, 278 fines were served for illegal dumping onpavements and undeveloped properties. 10 558 Various active partnerships that contributed to the requests for services were attended to by Environmental Health of the City were concluded. One Environmental Health Officers (EHOs). There were such partnership is the World Health Organisation 106 public toilets on our database, which are inspected (WHO) Collaborating Centre for Urban Health involving (a minimum of) twice during the year. Where problems the South African Medical Research Council (MRC), the were identified (e.g. broken taps, damaged toilet seat City and the universities of the Witwatersrand and covers and toilets out of order), notices were issued to Johannesburg respectively. The Doornkop study on Air relevant Council Department (i.e. facilities and Pollution and lead poisoning in children are two maintenance department). Many have subsequently Informal food traders
A total of 1 912 notices appeared before the courtsuntil 31 May 2006. None of them were rejected on the During the 2005/06 financial year an educational basis of technical errors. The citation printout indicates awareness programme was launched on World Food that there is a 99,74% success rate in notices Day. It provided education on the legislative appearing before the court. The court as well as JMPD requirements, food hygiene, food preparation, food is not in a position to give reasons as to why the handling and storage to Informal food traders. At least magistrate decides not to prosecute.
Training
City-wide campaigns
The 22 newly appointed Environmental Health Officers All regions of the City conducted awareness campaigns (EHOs) were trained. In addition another 10 EHOs from on the dangers of tobacco products. As part of the the regions were included in this training. The training campaign, pamphlets were distributed, education is primarily around legislation as well as by-law programmes were offered at schools, and law- implementation. The other 134 EHOs have already enforcement activities at public places and health talks been through the training last year. The training is and tips on how to quit smoking were offered.
tailored to the needs of our EHOs in the City. Chapter 5 /
A certificate is awarded to each successful candidate.
There are five MOUs that have been signed with All other EHOs are going through specific topics General Practitioners Associations (referred to as presented by JMPD, and other departments. There is an Independent Practitioners Associations). Various ongoing need for more training for all the EHOs in the activities agreed upon between the Health Department and the IPAs that would be beneficial to thecommunities were planned.
Essential data set
Physical upgrading and infrastructure
A total of 8 724 evaluations were conducted at formalfood premises resulting in 1 619 statutory notices being Eight clinics were upgraded and renovated in 2005/06.
served. A total of 191 evaluations were done at food These were in Orlando East, Zondi, Klipspruit West, factories and 33 statutory notices were served. A total Tshepisong, Eldorado Park Ext 2, and Mountainview of 2 329 evaluations were carried out at informal food and porta cabins for Thulamntwana and Ennerdale. In premises resulting in 259 statutory notices being addition, the Hugh Solomon Building has been cleaned served. There were also evaluations recorded for waste and secured. The landscaping at the Hillbrow Hospital disposal premises (63) and vacant premises (3 570). It is has also been completed. The upgrading of Hospital, worth noting that 325 evaluations were conducted at Smith and Klein streets has also been completed. The hospitals, clinics and nursing homes that resulted in Glenanda satellite clinic was activated to operate for 50 statutory notices being served. In the Inner City five days thus becoming a fixed clinic.
Clean Up campaign since April 2006 where two EHOs Promotional focus for health for the 2005/06 financial from each Region were brought in to assist, the year was placed on National Measles and Polio following were achieved: A total of 1 183 fines were campaign, HIV/Aids, VCT promotion, STI, cervical and issued as at 23 June 2006. 5 797 premises were breast cancer awareness, Mental health, TB, Women evaluated with 75 statutory notices served. 1 176 trouble and Child abuse, World Food Day, Informal food tickets (internal memorandum via the Pega System) handlers, Diabetes, Rodent control blitz, paraffin safety, were written to other departments for corrective contraception, World No Tobacco Day. Activities such ashealth education through distribution of posters and pamphlets, talks at schools, immunisation at crèches,baby competitions, drama, health stalls, open day Health service delivery
activities, planting of tress, tracing defaulters, homevisits, radio talk shows, group discussions, workshops, The Customer Satisfaction survey conducted for role plays, demonstrations, bill boards were utilised to 2005/06 produced a 92,6% satisfaction result.
communicate healthy living/lifestyle messages and Correctional measures were developed by the Quality promote health. Through these promotions and Assurance Team and continuously reviewed and education and information activities, a total of monitored. A checklist of 42 elements for all clinics was 136 701 people were reached, 106 823 pamphlets developed, based on the results and suggestions from issued, 1 311 posters put up, 12 281 homes visited and the initial customer satisfaction survey in October 2004.
These correctional measures are implemented in all theregions and are monitored by Quality Assurance. The All facilities have the patients’ right charter in two drug stocks out in the City’s health facilities have official languages which are clearly signposted outside consistently remained below 5% throughout the year.
the facilities. There are also signs depicting clearly theservice hours and services provided by the facilities.
A system is in place to monitor all complaints receivedfrom regions, resulting in 98% of all complaints Two community workshops targeted at all ward received being resolved. Complaints that could not be Councillors and ward committee members responsible resolved needed other parties to be involved and those for health in the various wards were held. They focused that required structural changes posed challenges for primarily on key health programmes. The workshops also raised discussion on environmental healthchallenges facing communities at local level, such as A system was put in place to monitor the waiting time unlicensed businesses, dumping, noise pollution of patients in all facilities. The overall Citywide average time spent by patients in the clinic for the 2005/06financial year is 114 minutes, while the time spent for Training
clinician services at the clinic averages 103 minutes asper the baseline survey undertaken in all fixed Four (4) training sessions were held for clinicians from healthcare facilities. Compliance to response time was the clinics. This training was necessitated by the at 98% adherence, with average resolution rate increasing number of emergencies identified through the routine incidence reporting system. A total of / Chapter 5
91 clinicians (33%) have been trained in emergency child health services provided in the primary health care care. This had not been done before as our nurses facilities, presented finding highlighting long waiting were primarily involved in basic primary (preventative) times, incomplete clinical examination of children at times, satisfactory clinical assessments, inadequate useof Road to Health Cards and implementation of Essential data set
cotrimoxazole prophylaxis in children. Relevantintervention will be developed from the findings to A headcount was undertaken and a total of 2 191 176 people were enumerated for the period July 2005 toApril 2006, of which 23,8% were children under the A research study on drug items that are the main cost age of five years. The percentage increase in the total drivers in the COJ was undertaken. The research headcount from 2004/2005 to 2005/2006 (July to outline was presented at the research conference in April) was 6,2%. There were a total of 2 135 786 June 2006 and the expected outcome is better consultations for the same period, and the percentage efficiencies in containing drug expenditure. With the increase in the total consultations from the previous IPA’s approximately 2 659 patients who needed the contraceptive pill, had been seen by the GeneralPractitioners till April 2006. With Wits University, A new growth monitoring register was developed for 40 staff members (including EHOs) have been trained the clinicians who see children under the age of five.
in health promotional activities. This resulted in 26 health Also, it was important to monitor if training had taken promotional projects being initiated across the City.
place to fill in the register for children not gaining Medical students have also been assisting in these weight, especially those who are severely projects. The Cardiac Rehabilitation partnership has malnourished. All these children had been closely resulted in two staff members being employed by Wits to supplement the existing staff complement. Child health and immunisation
The department developed a number of campaigns on Substance abuse awareness programme
Child Health issues during the 2005/06 financial year.
Substance abuse continues to be a challenge to us in Campaigns on child safety and protection were the City. The relative ease with which drugs (including conducted in all regions which included activities such alcohol) are available is certainly beginning to affect as distribution of information leaflets to communities much younger children, even as young as 10 years old.
and child minders; door-to-door campaigns; poster Dagga, “crack” cocaine and “tik” are just some of the exhibitions at different venues and facilities and specific more popular and frequently used hallucinogenic drugs education on paraffin and poisoning safety. that are available to the youth. Educational campaigns All regions also conducted immunisation awareness, focusing on substance abuse were held in 20 high mainly through the use of outreach programmes to schools in all the regions. The campaign was conducted reach un-immunised children as well as to create in conjunction with the Gauteng Education Department awareness in the community. The activities varied, with campaigns tailored to the peculiar requirements ofeach of the communities targeted. Included in the Partnerships
immunisation campaign are activities during the PolioEradication Week in all the City’s regions. Partnership between the City’s Health Department,Wits School of Public Health, TB Care Centre The campaign was driven by activities that included the partnership and Chris Hani Baragwanath Hospital resulted in improved inpatient and outpatient care. It Placing of reminder slip on Road to Health Cards also assisted in training General Practitioners on aspects to remind mothers of the next vaccinations; of TB treatment and management of dually infected TBand HIV patients and the training of medical and Reviewing records for defaulters and home visits to nursing practitioners about managing TB in children. A research project to investigate aspects of the Sharing the latest developments with Private laboratory diagnosis of tuberculosis, which includes an investigation of long turnaround times for sputum Visiting crèches and homecare institutions; microscopy, has been completed and a final report isawaited. A research study was conducted at nine Giving Vitamin A and additional Polio drops on randomly selected facilities in the City on the quality of Chapter 5 /
Displaying psosters and distribution of pamphlets; infections were the leading indirect causes (30,9%) of maternal deaths in Gauteng, with HIV/Aids being themain contributor to these deaths. Using print and electronic media to engage andmobilise the community.
The report also identified factors that could decreasethe number of maternal deaths. These include Teachers and volunteers were trained to read Road to improved access to antenatal care, reproductive health Health Cards and educated about eradication and (contraceptive methods) and CTOP a service, early booking during pregnancy, decreasing the number of All children identified to be severely malnourished self-induces and illegal abortions, and decreasing the (children under 60% of the expected weight for age) were followed up by the regions. There were a total of All regions conducted Health Awareness education 255 children monitored over the 2005/06 period. campaigns on preventable causes of maternal deaths A new growth monitoring register was developed for and safe motherhood. Different stakeholders including the clinicians who see children under the age of five years, and training had taken place to fill in the register A range of organisations were involved in the for children not gaining weight, especially those who campaigns that were conducted in different regions: are severely malnourished. All these children had been obstetric units from hospitals, pharmaceutical companies, NGOs; ward Councillors and local media;stakeholders and partners from provincial departments.
Women’s health
The campaigns were on health education, focusing onissues of maternal health and the importance of pap Cervical cancer is one of the leading cancers in women smears. There were motivational talks by pregnant in South Africa. It comprises 17% of all female cancers women themselves to others, discussing the and represents a lifetime risk of developing cancer of importance of early booking during pregnancy.
the cervix is 1 out of 31 females (Cancer Registry:1999). Opportunistic screening of those without any As part of World TB Day Health Promotion, educational symptoms can lead to early identification of women campaigns were embarked upon by all the regions for with abnormalities so that appropriate interventions social mobilisation and advocacy during 2005/06 can be implemented. Cancer of the breast in females financial year. Most regions conducted door-to-door comprised 19,4% of all cancers in 1998 and was the campaigns and defaulter tracing. Extensive and varied leading cancer in women in South Africa. Early health education activities conducted included: identification through self-examination can markedly delivering key messages through local radio stations; decrease the morbidity and mortality due to breast press releases to the media; door to door campaigns cancer. The lifetime risk of developing breast cancer in for the purpose of providing education and information women was estimated to be 1 in 27 in females.
and searching for TB treatment interrupters;information sessions for private doctors; distribution of As part of the City’s drive to improve the quality of lives reading materials such as posters and pamphlets at and health of women, targeted campaigns were libraries, shopping malls (information stalls), recreation conducted in all regions. The activities included leaflets centres; and health talks and dramas were conducted distribution; poster exhibition; oral presentations and at clinics as well as church groups.
demonstrations on breast self-examination; educationon early signs of breast and cervical cancer; one to one Men’s health
individual talks; pap smears done as part of awarenessactivities; education utilising audio-visual aids (videos); Cancer of the prostate is the commonest cancer in articles on Joburg website; as well as the involvement adult males in South Africa. Knowledge of the early of stakeholder organisations (CANSA, FBOs, traditional signs and symptoms of prostate cancer that can lead to timeous medical assessment can decrease the morbidityand mortality related to the condition. Community The “Saving Mothers Report” by the National workshops on raising awareness on prostate cancer Department of Health reported that 61% (264) of the were conducted in 10 regions. In regions 7 and 11 maternal deaths in Gauteng were due to direct causes.
urologists were involved in clinical assessments on Hypertensive conditions accounted for 20,2%; obstetric identified clients. Urologists did clinical assessments on haemorrhage (Antepartum and postpartum) 15,2%; men and this took place at East Bank Clinic in pregnancy related sepsis 7,9% and abortions 6,5% of Alexandra and CANSA offices in Lenasia. A total of the direct causes of maternal deaths. Fifty seven 146 men were tested. Various other forms of percent (16 deaths) of all deaths due to abortions were awareness activities took place (drama and traditional related to unsafe abortions. Non-pregnancy related dancing, pamphlet distribution, talks etc).
/ Chapter 5
Training
Partnerships
A total of 21 professional nurses and one manager The partnerships are with the Reproductive Health have been trained in the "Integrated Management of Research Unit, for the Health Precinct Development Childhood Illness" (IMCI) programme. The total trained project, and with Vusabantu – for the provision of anti- in the city has now increased from 62 to 84. The retroviral treatment programme. Both partnerships training is now staggered and staff can be released for remain active and well functional. Vusabantu currently two days a week until the training is completed. In has 159 people on the Anti-Retroviral Treatment addition, the City has also seven trained "facilitators" programme, and has a very viable support group for people living with HIV/AIDS. The Health PrecinctDevelopment project is also progressing well, with Essential data set
plans on physical upgrading and training continuing.
Service delivery also continues to be enhanced. The weighing rate of children less than five years at the RHRU is also providing training support with regard to Local Government clinics increased from 88,9% to PMTCT and ARV training for the health professionals.
90,1%. Of the total number of children weighed whowere under five years, the rate of children with severe AIDS Council programmes
malnutrition remained 0,05% (212 children). Theattendances included children with pneumonia Implementation of targeted programmes is seen to be (2 851 children), diarrhoea WITH dehydration more effective in the development of the community in (828 children) and diarrhoea with no dehydration dealing with the HIV and AIDS problem. Numerous sites were identified, around which the saidprogrammes could be clustered for effective In maternal health, there was an increase of 15,4% in implementation to take place. The five identified areas the first antenatal care visit (8 409 in 2004/05 and include two informal settlements (i.e. Ivory Park in 9 708 in 2005/06). The early booking ratio for Region 2, and Mathole’sville in Region 5); two hostels antenatal care services was 23,2%. This showed that (Merafe in Region 6 and Diepkloof in Region 10), as women were beginning to come earlier (before 20 well as the Youth Out of School Programme (which is weeks) during pregnancy for their first antenatal care being continued in Ivory Park, and extended to Devland visits. The teenage (under 18 years) pregnancy rate and Eldorado Park). All five programmes were The cumulative cervical cancer screening coverage for The hostel programme entailed training 100 people the period July 2005 to April 2006 was 5,5%. The from Merafe and Diepkloof Hostels, and was National Health Laboratory Services (NHLS) reports implemented as part of the Moral Regeneration indicated that 24 662 (88%) pap smears were taken at Programme. The trainees were selected through an Local Government PHC facilities during July 2005 to interactive process that involved hostel Indunas, JAC members and the regional HIV and AIDS coordinators.
The chronic consultations at the clinics increased from The programme was aimed at increasing the 8,9% (2004/05) to 9,5% in 2005/06. There were also knowledge of HIV/AIDS amongst hostel dwellers.
13 214 visits for asthma treatment (9,7% comprised Special emphasis was placed on prevention, especially children below 18 years of age). Of the total on how to prevent infection of sexual partners, headcounts, the asthma load was 0,6%. The Referral particularly as most of the hostel dwellers rate to hospital remains at only 1,4%. This is indicative acknowledged having multiple partners, as well as of the value of effective treatment at our clinics (the traditional families in rural areas. They were also given information on how to make use of the availableservices resources to cope in case of infection. All trained people were encouraged to promote dialogueson HIV and AIDS at the hostels and in rural areaswhere they originally came from. The HIV/AIDS pandemic is one of the most seriousdevelopmental challenges facing South Africa today.
The informal settlement programme at Mathole’sville Johannesburg, like the rest of the country, will be and Ivory Park has been continued since 2004, and severely affected by HIV/AIDS. It is for this reason that was intensified in the run up to the World AIDS Day the prevention and management of HIV/AIDS was 2005. As part of the Matholes’ville HIV/AIDS campaign, made one of the six mayoral priorities. Implementation 560 houses were visited, 1 264 people reached, and of targeted programmes is seen to be more effective 850 condoms issued, whilst a total number of people in assisting the community in dealing with the referred for services in relation to identified problems were 45. At Ivory Park, 15 565 people were reached. Chapter 5 /
Youth – Out of School Programme is continued in Ivory The total number of people tested to date is 5 321 and Park, and new peer educators have been trained in 1 991 (37,4%) tested positive. Four French-speaking Region 10 (Devland and Eldorado Park). The volunteers support the Esselen and Joubert Park clinics Mathole’sville peer educators continued with the with translation for health workers. In addition, they education programme as part of the Jozi Ihlomile also provide the necessary information of all services programme. In Region 10, 60 youth peer educators provided at the clinics. An outreach programme were trained during October 2005. The trained youth targeted at commercial sex workers is currently are encouraged to engage in informal information operational at 12 sites and hotels within the Hillbrow giving sessions at all available opportunities with other area. Between March 2006 and June 2006, a total of young people. They also participated in conducting the 530 commercial sex workers were seen, 430 of them door-to-door campaign, as part of World AIDS Day treated for STIs, 59 tested for HIV and 40 (68%) tested The involvement of youth in the implementation of theprogramme is without doubt contributing in Mayoral AIDS fund
capacitating of young people and strengthening of A proposal for the establishment of the Johannesburg Mayoral AIDS Fund (JMAF), with an objective of Rapid on-site testing
generating funds for expanding HIV and AIDSprogrammes implementation, was made at a The establishment of a rapid HIV/AIDS testing service Johannesburg AIDS Council meeting. A document was on site is an important part of the strategies of developed on the processes to be followed in the promoting HIV/AIDS testing in the community, and raising of funds in line with the Council policies. The working towards increasing the number of people JMAF document was accepted and approved by the City’s Mayoral Committee on 15 September 2005.
Fundraising to raise financial resources is quite a big The ease of testing and the quick delivery of results challenge. The Health Department, Finance and Legal encourages people to test. The target set for 2005/06 will evaluate and assess funds challenge. is to establish service in 100% of fixed health facilitiesin order to increase access to this service in all regions.
A total of R303 191,61 has been collected from a Voluntary counselling and testing together with HIV number of sources. An additional R3 million in and AIDS education is provided in all fixed (74) facilities resources was contributed through the Reproductive Health Research Unit and the "Vusabantu" City of ParisProject in Jabavu Clinic. There are lay counsellors who have been trained inpreparation for the establishment of a service in Diflucan Programme
outstanding fixed health facilities. All sites have trainedvolunteers and professionals supporting the The Diflucan Programme entails the use of Fluconazole for treatment of Cryptococcal Meningitis and Provision of HIV testing through the long method of Oesophageal Candidiasis as part of the management drawing blood from a vein and sending that blood to of AIDS opportunistic infections. The service is provided National Health Laboratory Services (NHLS) (Eliza Test) mainly in provincial health service delivery points, for testing continues to be provided in 100% of fixed hospitals and community health centres. At least health facilities. This service is on maintenance mode, 19 clinics are now providing the service. More facilities and is necessary to maintain for confirmations of are being prepared, where additional services which are to be provided can be accessed by all communitiesacross the City. Our assurance and commitment to VCT service
providing the necessary training for the staff was wellreceived by the GHD. The number of staff trained is 62.
The VCT service is provided at all the fixed clinics. This The number of patients who have benefited from this ensures access to free testing to those who so desire service is 456. Health professionals in the regions have it. Approximately 40 014 people were tested across been trained on the implementation of the the City and 12 000 (52%) tested positive. There is, however, still a very strong resistance to testing dueto the stigma attached to this condition. The social(family) and economic (employment) factors ofdisclosure are also a big barrier to testing. But VCTremains one of the many weapons in the arsenal tocombat this pandemic.
/ Chapter 5
Essential data set
Public health
There was a notable decrease (from 2004/05) of 5,6% (56 171) in the treatment of newly diagnosed sexually transmitted infections seen in 2005/06 (53 023). About 22% were male urethritis. There was an increase in the Improving reproductive and women’s health and partner notification rate from the previous year (from reduce maternal mortality from potentially 82,4% to 94,8%). This is evidence of a greater awareness and acceptance for seeking treatment. Strengthening the implementation of TB control Of the 136 309 patients who were pre-test counselled, the VCT uptake rate was 91,6%. This included TB andantenatal care patients. Of the patients tested, 35,3% tested positive for HIV. Of the women who attended Reducing the prevalence complications and impact antenatal care visits, 30,3% tested positive.
HIV and AIDS
Environmental health
Expand Jozi Ihlomile in six new areas and create Environmental health services is engaged in eliminating adverse physical and biological conditions that may lead to disease and ill health. High on the list of Increase the number of areas to cover during the priorities is the provision of the following services: World AIDS Day 2006 awareness campaign with Pollution prevention and reduction programme; the involvement of 3 300 community trainedvolunteers; Environmental risk management programme; and Increase the number of schools to be visited to two per region and improve coordination as well including by-law enforcement and education. as the distribution of promotional material; and Primary health care
Johannesburg Mayoral AIDS Fund project tosupport 2 000 destitute families with food Extension of all satellite clinics (open for 2 – 3 days vouchers as a Christmas gift from the City.
Extend service hours in pilot clinics across the City– subject to budget availability; Set up interim mobile service points at selectedinformal settlements – Sweetwaters,Zevenfonrtein, and Braamfischerville; and Chapter 5 /

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