Rheumatic fever efforts fall short

Two Auckland DHBs among target missers

The Government has admitted it is unlikely to meet its rheumatic fever target and says community clinics to prevent the illness were not up to scratch.

The $65 million programme is part of former prime minister John Key’s Better Public Services targets and two Auckland health boards were the worst performers.

The target is to reduce the annual number of new cases of potentially fatal rheumatic fever since 2012 by two-thirds by this June — to a rate of 1.4 cases per 100,000 people.

But officials now say the target might not be met until next year or even mid-2019.

In papers obtained this year under the Official Information Act, the Ministry of Health’s director of protection, regulation and assurance, Dr Stewart Jessamine, told Health Minister Jonathan Coleman: “Meeting the two- thirds reduction in 2017 will be challenging”. “However, the rates for the last three financial years . . . show an overall decreasing trend. This can also be seen when comparing trends across the last three calendar years . . . These downward trends suggest that [it] is possible that the target may be met in a further 12-24 months.”

The Herald sought the papers in November, after the ministry revealed that of the 11 district health boards involved in the Rheumatic Fever Prevention Programme because of their high rates of the illness, only four — Northland, Tairawhiti, Hawkes Bay and Hutt Valley — had met the interim target at June 2016. Waikato was later said to have met the target after data corrections.

Counties Manukau, Lakes, Bay of Plenty and Capital and Coast partially achieved; and Auckland and Waitemata, whose rates had actually increased, fell outside it.

DHBs have implemented the pro- gramme with variations. It generally involves school clinics in high-risk areas at which children with a sore throat have it swabbed and are given antibiotics if the test is positive for group-A strep.

There are also several hundred free sore-throat clinics for high-needs groups at general practices, pharmacies, after-hours clinics and pathology laboratories.

The ministry papers say, following research interviews with some affec- ted parents, young people and health providers in Counties Manukau, Hutt Valley, Waikato and Tairawhiti, that many aspects of the non-school clinics did not align with the ministry’s intentions.

“They were not rapid, drop-in, convenient or attractive to whanau and youth.”

The Auckland and Waitemata DHBs said their revised plans included greater efforts to raise rheumatic fever awareness in Pacific communities and extending the reach of the Healthy Housing initiative.

Waikato DHB’s executive director of community and clinical support, Mark Spittal, said its rate of rheumatic fever for 2016 was 1.3 per 100,000, putting it on track to meet its target for the 2017 June year of 1.2.

A public health physician at Counties Manukau DHB, Dr Pip Anderson, said it had focused on the school-based programme, leading to a significant reduction in rheumatic fever in the 5 to 12 age group.

Labour’s health spokeswoman, Annette King, said: “The key issues, particularly in South Auckland, are the housing issues and they haven’t been resolved.

“We know one of the greatest contributors is poor housing and overcrowding.”