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Presentation to the Standing Committee on Appropriations National Health Insurance Progress Report 05 March 2014.

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Presentation on theme: "Presentation to the Standing Committee on Appropriations National Health Insurance Progress Report 05 March 2014."— Presentation transcript:

1 Presentation to the Standing Committee on Appropriations National Health Insurance Progress Report 05 March 2014

2 Content Strategic Goals of the National Health Grant – NHI Component NHI Pilot district performance against key indicators Background to the activities reported on Summary of Facility Improvement Team Interventions A Systematic Approach – The Ideal Clinic Project Progress with regard to PHC re-engineering priorities Progress on key support interventions Hospital Reform 2

3 Strategic Goals of the National Health Grant – NHI Component Strengthen aspects of the public healthcare system in preparation for National Health Insurance Strengthen the design of NHI based on innovating and testing of new reforms in pilot sites A public health care system that is better prepared to implement reforms necessary for NHI 3

4 NHI Pilot District performance against key indicators 4

5 Comparison Child under 5 years pneumonia incidence 2010/11 and 2013/14

6 Comparison Child under 5 years severe malnutrition incidence 2010/11 and 2013/14

7 Comparison Inpatient death under 1 year rate 2010/11 and 2013/14

8 Comparison Inpatient death under 5 year rate 2010/11 and 2013/14

9 Comparison cervical cancer screening rate 2010/11 and 2013/14

10 Comparison TB (new smear positive) cure rate 2009/ /12

11 Comparison Antenatal first visit before 20 week rate 2010/11 and 2013/14

12 Comparison Infant 1st PCR test positive around 6 weeks rate 2010/ /14 Q1-Q3

13 Comparison Delivery in Facility under 18 Years Rate 2010/11 and 2013/14

14 Background to the activities reported on To start to prepare the health service environment for the implementation of NHI: – Independent Baseline Health Facility Audit completed in 3880 public sector facilities spanning from 2011 to 2012 – Established Facility Improvement Teams (FIT) to begin catalytic improvements in the NHI pilot districts – Launched a number of required policies and strategies (Integrated School Health Policy, HRH policy, e-health strategy, interoperability standards, District Health Information Management policy – Executive leadership and management programme established 14

15 NHI: Pilot Districts In response to the findings of the Health Facilities Baseline Audit, Health Facility Improvement teams under the leadership of senior management from the National Department of Health was established for the following districts – O.R. Tambo (Eastern Cape); – Mangaung and Thabo Mofutsenyana (Free State) – Tswane (Gauteng) – Amajuba, Umzinyathi and Umgungundlovu (KZN) – Vhembe (Limpopo) – Gert Sibande (Mpumalanga) – Dr. K. Kaunda (North West) – Pixley ka Seme (Northern Cape) – Eden (Western Cape) The Health Facility Improvement Teams supported the development of quality improvement plans for health facilities on these districts Approximately 1000 facilities were directly or indirectly supported through this initiative 15

16 Summary of Facility Improvement Team Interventions 16

17 Summary of FIT Interventions 17 CATALYTIC INTERVENTIONS Established Quality Improvement plans for each of the facilities and implemented these in collaboration with local staff Established sub-district structures supported by all role-players in the district Procurement of equipment and computers Strengthened Re-engineering of PHC priorities Training in Infection control, quality assurance, PHC Supervision and Monitoring and Evaluation Improvement in drug supply management in the facilities

18 Summary of FIT Interventions continued 18 CATALYTIC INTERVENTIONS Commenced the integration of chronic care services with clinics re-organized into 3 streams of acute, chronic and maternal and child services Levels of care were shifted appropriately at for example Nic Bodenstein and Ventersdorp Hospital with strengthening of PHC services and then down referral to PHC services Standard operating procedures for cleaning were introduced and training done Installation of washing machines and appointment of cleaners Started the process of preparing infrastructure budgets early in the year to improve spending

19 Summary of FIT Interventions continued 19 CATALYTIC INTERVENTIONS Some of the worst clinics observed by the FIT team have had face lifts Improvements in security conditions Modular building structures to improve the availability of space in clinics and to make provision for doctors consulting rooms Installed generators for back-up power supply and water tanks for back-up water Strengthening of leadership and promotion of sustainability through the development of a team of mentors (change agents) for the District Facilitated greater involvement of governance structures (Clinic Committees, Hospital Boards)

20 The following pictures represent the changes brought about by the facility improvement teams 20

21 Kareeberg, Pixley Kaseme, NC: Progress Water tanks installed at Vanwyksvlei clinic New flooring at Vanwyksvlei clinic

22 Free State - BAINSVLEI CLINIC 22 CEILING BEFORE CEILING AFTER

23 Examples compliance with National Core Standards Gert Sibande Store room on initial visitStore room on follow up visit Cleanliness at Embalenhle CHS Dispensary room 1 st visit Dispensary room follow up visit Drug availability at Paulina Morapeli

24 LuthubeniClinic OR Tambo Luthubeni Clinic OR Tambo Before After Roof of one of the consulting rooms. The sun shone through onto the examination couch The roof was replaced; Air conditioner installed; Water connected inside the Facility 24

25 Maphuzi ORTambo Before After Facility restored to 5 consulting rooms; Has water installed inside the clinic 25

26 Ideal Clinic Prototype Realization 26

27 Ideal Clinic Components and Elements 1.Administration 2.Clinical Guidelines and Integrated Clinical Services Management 3.Medicines, Supplies and Laboratory Support 4.Staffing and professional Etiquette 5.Availability of a doctor 6.Infrastructure (physical condition, ICT Essential Equipment) 7.Health Information Management 8.Communication 9.District Health Support Systems 10.Partners and stakeholders There are currently 185 elements across the 10 components 27 Key In place and functioning well In process of being put in place/fixed Not in place/broken/not functioning

28 National Core Standards DASHBOARD January 2014 Clinic Name Component Breyten Efaye Garankuwa View Jack Hindon K T Motubatse Ladybrand Element Domain 1: Patient Rights Administration Signage, branding and values Displayed 1 External signage in placepyypyy 2 Internal signage in placeyyppyy 3 The Patients' Rights Charter neatly on display yyyyyy 4 The Batho Pele Principles neatly on displayyyyyyy 5 The National Core Standards neatly on display yyyyyy 6 The Core Values and Service Standards of facility neatly on display yyyyyy 7 The Clinic hours and services board displayed pyypyy

29 National Core Standards DASHBOARD January 2014Clinic Name Component Breyten Efaye Garankuwa View Jack Hindon K T Motubatse Ladybrand Element Domain 1: Patient Rights Administration A. Signage, Branding and Values Displayed 8 The appropriate signage to indicate that the facility is a weapons free zone on display pynnny 9 A signage board regarding the control of access to public premises on display ppnnnny B. Service Organisation 10 Disability access to all clinic areasyyyyyy 11 Reception / Information staff available and on duty yypyyy 12 Staff who receives, greets, helps and informs patients appropriately yyppyy 13 The appropriate compliments / complaints box(es) in place yyyyyy

30 IDEAL CLINIC PROTOTYPE National Core Standards DASHBOARD January 2014 Clinic Name Component Breyten Efaye Garankuwa View Jack Hindon K T Motubatse Ladybrand D. Clinical Service Integration 21 Implements integrated clinical care 22 Jointly plan programmes with DCST, School Health Teams and WBOTs 23 Created 3 streams of services related to acute or minor ailments, chronic conditions and maternal, child and womens health (MCWH) 29 Retrieves patient files before they arrive for their appointments y 30 Pre-dispenses patient medication as per scriptsypp 31 Implements a patient defaulter tracing systemppypp

31 IDEAL CLINIC PROTOTYPE National Core Standards DASHBOARD January 2014 Clinic Name Compone nt F.Medicines and Supplies Breyten Efaye Garankuwa View Jack Hindon K T Motubatse Ladybrand Element 47 A computerised Inventory Management System for medicines and supplies yypnpy 48 A system to monitor the stock levels and availability of medicines and supplies yyynyy 49 Stock files and orders medicines according to these stock files yyyypy 50 A Dispensary Room where the temperature is appropriately controlled yyyyyy 51 A Medicine Store which is kept locked at all times yyyyyy

32 IDEAL CLINIC PROTOTYPE National Core Standards DASHBOARD January 2014 Clinic Name Component H. Staffing Breyten Efaye Garankuwa View Jack Hindon K T Motubatse Ladybrand Element 68 Staff levels determined through a WISN study ppyppp 69 An up to date Facility Organogram ypypyy 70 Up to date Job Descriptions for all positions on the Facility Organogram yyyyyy 71 An adequate number of Doctor/s available yyynyp 72 An adequate number of Nurses available pyppyp 73 An adequate number of Pharmacist(s) or Pharmacy Assistant(s) available ynpnpy 74 An adequate number of Administration Staff available yypyyp

33 IDEAL CLINIC PROTOTYPE National Core Standards DASHBOARD January 2014 Clinic Name Component Y.Community Engagement Breyten Efaye Garankuwa View Jack Hindon K T Motubatse Ladybrand Element 170 A functional Clinic committee yypnny 171 Beneficial relationships with partners and NGOs yyyyyy 172 A beneficial relationship with Local Councillor yyynyy 173 Members of the Community doing voluntary work in the Clinic ynyyyy 174 Regular Clinic Open Days pyyyny

34 Progress with regard to PHC re- engineering priorities 34

35 District Clinical Specialist Teams All Pilot Districts have teams of at least 3/7 members 35

36 School Health Services 30 School Mobile Vehicles in field – Dental Care – Eye Care – PHC Additional to be delivered March 2014 – 17 PHC Panel Van – 10 Dental Vanel Van 36 DISTRICTNO School Health Teams Dr Kenneth Kaunda7 Eden8 Gert Sibande5 Oliver Tambo23 Pixley Kaseme0 Thabo Mofutsanyana5 Tswane15 Umgungundlovu20 Umzinyathi6 Vhembe17 TOTAL106

37 Municipal Ward Based Primary Health Care Outreach Teams 37

38 38 NHI Pilot District WBOT Required based on 1:1500 households Number of WBOT registered Amajuba DM7410 Dr K Kaunda DM13949 G Sibande DM1829 O Tambo DM Pixley ka Seme DM3341 T Mofutsanyane DM14529 Tshwane MM60819 uMgungundlovu DM18217 Umzinyathi DM7620 Vhembe DM22917 Eden1090 Grand Total

39 39 WBPHCOT members provided with cell phones and trained on collecting and sending patient information by cell phone Advantages: This improves turnaround time for required patient interventions Improves data quality for monitoring and evaluation of the WBPHCOT programme

40 Total WPHCBOT m-health trained Trained end Feb 2014 One Province 31 WBPHCOT 166 CHWs To be Trained end March 2014 Six Provinces 65 WBOT 518 CHWs NB: M-health training will be expanded beyond NHI pilot districts over the next 24 months 40

41 Progress on Key Support Interventions 41

42 Current Doctor Coverage with 96 GPs on the National Contract Doctor coverage is obtained through: – Nationally Contracted GPs – Doctors on full- time employment – Doctors doing Outreach from Hospitals – Provincially contracted doctors 42 Doctor coverage: The PHC clinic has at least one doctor doing sessions (working specified hours) for at least one day per week DistrictsNumber of Clinics Doctor coverage% coverage Pixley Ka Seme Vhembe Gert Sibande Kenneth Kaunda OR Tambo143 Have not yet commenced. Minister Motsoaledi addressed GPs in February 2014 Umzinyathi Umgungundlovu Tshwane Thabo Mofutsanyana Eden76 Have recently commenced with the programme

43 Improvement of Data Quality and Information Management Summary of Achievements Approved: – e-health strategy – Interoperability standards – District Health Information Management policy 43

44 Fixed PHC (CHC and Clinics) in 10 NHI Pilot Districts Within next two months: – All fixed PHC clinics in NHI Pilot Districts will receive computer equipment allocated to the reception desk – 251 facilities will receive computers in each consulting rooms as well

45 Benefits of computerization Enable Management access to electronic communication to keep updated with policies, guidelines and good – An example in point is the Pharmaceutical Application on the NDoH website for standard treatment guidelines Enable online DHIS Daily Data Capturing – Improve Data Quality (daily validation reduce human error) – Reducing monthly validation and collation time as well as human error during calculation – Reduce data flow time lines Support online monthly DHIS data capturing for Ward Based Outreach Teams Improve patient health record management Scheduling of patients to reduce waiting times SMS reminders to reduce dropout rates / identification of dropout patients to be followed up by community health workers Capturing of doctors attendance to clinics

46 Improving hospital leadership and management – Re-designated hospitals and appointed appropriately qualified CEOs – The Regulation on the classification and management of hospitals was promulgated in 2012 in line with section 35 (a) & (b) of the National Health Act (NHA) – The posts of CEOs of hospitals were re-advertised and filled in line with these regulations – Delegations to CEOs are in the process of being revised to be consistent with the Accounting Officer System – Treasury has agreed to assist with the training of the CEOs and hospital managers to develop capacity to execute the new delegations. Reforms in Hospital Services

47 Established Structures in Hospitals to Improve Management Efficiency and Effectiveness: 1.Medicines and Therapeutics Committee 2.Equipment Committee 3.Cost Centre Management Committees 4.Cash Flow Committee

48 THANK YOU FOR YOUR ATTENTION!


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