RMCH School Health Project

Strengthening school health services (Output 2A)

29th January 2015 NDoH Steer Committee MeetingSue Jones: School Health AdvisorThoko Ndaba: Project ManagerMaredi Modiba: Field Team Co-ordinator

Outline of presentation• Model of RMCH School Health TA• 2 legacies• 4 high level recommendations• DFID recommendations reviewed• Outstanding work to be done• Final document dissemination

Model of technical assistance

• National policy advocacy– Health system strengthening: co-ordination structures,

referral system – Clinical: Health promotion and ISHP family planning in

schools,

• Capacity building– Strengthen integration, partnerships, planning, reporting, co-

ordination, M&E and increasing demand for ISHP

• Monitoring and evaluation– District Reporting Tool adapted for the ISHP

• Knowledge management– Documentation of lessons learnt and best practice

Legacies

Clinical: 1. The ISHP (Policy) to change to “opt-out” for family planning services

within schools. Already planned to incorporate in the revised DBE HIV and STI policy soon to be gazetted.

– provide greater access for adolescents to SRH services– provide greater awareness to parents and school community that this is

necessary– ultimately to reduce high risk sexual behaviour and reduce teenage pregnancy

(proxy outcome measurements)

HSS interventions 2. District ISHP task team and ToR existing in 20 districts

– Integration of 3 key departments DoH, DoE and DSD and external partners supporting ISHP is the key to ISHP success

– Co-ordination structures strengthen implementation and effectiveness of ISHP

3. The RMCH District Reporting Tool (DRT) can provide a structured method for monthly monitoring of ISHP implementation, assessment of the enabling environment and a tool for future planning and accurate, regular reporting.

Status of District Task Teams

Dr K Kaunda DMBojanala Platinum DM

Frances Baard DMSiyanda DM

uMgungundlovu DMG Sibande DMCapricorn DM

J T Gaetsewe DMO Tambo DM

A Nzo DMMangaung MM

Ugu DMFezile Dabi DMeThekwini MMAmathole DMUthukela DM

Ekurhuleni MMUthungulu DM

Ngaka Modiri Molema DMWaterberg DM

T Mofutsanyane DMXhariep DM

Pixley ka Seme DMLewjeleputswa DM

0 1 2 3 4 5 6 7

Northern Cape North WestMpumalangaLimpopoKwaZulu-NatalGautengFree StateEastern Cape

Presently there are 20 DTT that have been formed: 14 are institutionalised 3 are integrated into routine practice 3 are in the process of implementation

4 are pre-implementation

High level recommendation 1 (DFID 1)

The National ISHP Task Team will need to deliberate and motivate for effective use of existing resources to ensure that District ISHP Task Team are established and sustained in all districts to provide a sustainable District Lead integrated structure to implement, plan, monitor and report in respect to the ISHP. District ISHP task teams are clearly stipulated in the Integrated School Health Policy to enable ISHP implementation.

• The Provincial Task Team is the key mechanism to continue the sustainability of the District Task Teams.

• Critical success factors for sustainable action between departments: strong leadership, accountability, commitment to action and better defined roles and responsibilities. Dedicated ISHP co-ordinators for each department

• If this recommendation is adopted and taken to scale co-ordination structures will be institutionalised, ISHP will be a consistent part of the district health plan

High level recommendation 2 (DFID 2)

To urgently revise the Integrated School Health Policy to an “opt out” basis for SRH services and provide clear guidelines for the consultation of SGB and parents.

• Strengthen advocacy for the ISHP and Family Planning services to the School Governing Bodies and Parents. The National DBE document “Guidelines for School Governing Bodies to consult parents on the ISHP” has now been approved by the Council of Education Ministers enabling its cascading to the Provinces, Districts and SGBs this year.

• This will facilitate standardised consultations between SGB and parents in respect to increasing the awareness of the need for SRH services in the school community (and so the parental community can “opt out” if agreed)

• The implications are full roll out of SRH services in schools, greater access for adolescents, reduction in teenage pregnancy.

High level recommendation 3To improve the quality of care through the ISHP by strengthening the referral system through the ISHP to PHC

• Standardise a tracking system from schools to PHC/other sources. The 3 streams of PHC re-engineering can be linked effectively to support learner referrals and follow up (SHT, WBOT and DCST), and the link should also be strengthened to the SBST.– Incorporate the 3 streams into the extended SBST network

• Implications if adopted: improved outcome of ISHP interventions, barriers to learning treated/rectified, SRH service accessed longer term better educational outcomes.

High level recommendation 4

Improve the quality of data capturing and recording at local level and ensure districts gain access to DHIS and utilise data for planning and reporting • Capacity building for districts where data capturing is poor

quality• Ensure all districts have access to the National ISHP

recording and reporting system, and standardise data collection tools

• The District Task Teams adopt District Reporting Tool• The implication is that the quality of ISHP implementation,

M&E, planning and reporting will be improved and greater coverage will be reached.

DFID review October 2014 recommendation 1

Recommendation 1 2014 Status Response

Task teams have been established as part of a strategy to implement the ISHP nationally. These teams are jointly staffed by DoH and DoE. At present responsibility for leading and coordinating these teams is unclear. This creates a risk to the sustainability of the school health work. RMND to work with relevant government departments to clarify responsibility for leadership of these teams.

Pending To provide recommendation to the final SteerCom on 29th January 2015 for the Provincial ISHP Task Teams to continue strengthening the District ISHP Task Teams and motivate for clearly defined roles for the respective department ISHP co-ordinators from DoH, DoE and DSD.

DFID review October 2014 recommendation 2

Recommendation 2 2014 Status Response

RMND to work with NDoH and DBE to galvanise support for an opt-out approach (instead of opt-in) to providing sexual and reproductive health services in schools.

Achieved National DBE has approved this change which will be effected through the revised DBE HIV and STI policy. RMCH has advocated for the Integrated School Health Policy to be updated to specify the school SRH services will be “opt-out” only and clearly define the process for consultation for SGB and parents to opt out.

DFID review October 2014 recommendation 3

Recommendation 3 2014 Status Response

In the final year of the programme the focus of school health and WBOT work should move from achieving coverage to measuring quality and impact. Measures of quality, performance and impact should be developed with NDoH and put into use before the end of the programme. These measures are not primarily to assess the performance of the RMND programme but to aid the future development of the national strategy. Indicators could be added to the RMND log-frame for the extension period related to this recommendation.

Pending To be recommended to the final SteerCom on 29th January 2015.

Analysis of the status 50 HPS has been conducted and available in the PCR and Provincial Profiles

Outstanding work to be doneWhat?• WC did not receive RMCH

School Health TA• Priority for Provincial ISHP

task team support to NW, NC and GP

• ISHP DRT capacity building and full launch across districts. DRT champions are needed at all levels government

Why?• WC PDoH requested RMCH to

work in another district• Challenges to access district and

implementation ended Nov 2014. Ideal would be 1 RMCH school health facilitator for each Province

• ISHP DRT is now being finalised and presented to NDoH M&E

• In hindsight need all systems in place at the end of the inception phase (eg DBE approval, DRT)

• All systems are now developed now ready to use

Product dissemination February 2015

Documents for National, Provincial and District task teams:• School Health Baseline summary and

recommendations• RMCH School Health Manual

– Accompanying CD with all presentations and documents produced by RMCH

• Case studies• Policy brief (for National only)• Provincial ISHP profiles (for Provinces)

THANK YOU