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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

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

4 NHI Pilot District performance against key indicators

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 2009/10 -2011/12

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 2010/11- 2013/14 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

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

16 Summary of Facility Improvement Team Interventions

17 Summary of FIT Interventions
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
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
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

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

22 Free State - BAINSVLEI CLINIC
CEILING BEFORE CEILING AFTER

23 Examples compliance with National Core Standards Gert Sibande
Cleanliness at Embalenhle CHS Store room on initial visit Store room on follow up visit Drug availability at Paulina Morapeli Dispensary room 1st visit Dispensary room follow up visit Cleaniness at Embalenhle CHC: Areas observed were toilets & bathrooms; floors, walls, windows and curtains; and the surroundings outside the facility and the gardens Drug Availability at Paulina Morapeli CHC: The FIT team observed work in progress at the Pharmacy store room where the pharmacy assistant was busy organizing the room and updating the stock cards. FIT need to develop a quarterly indicators based on the NCS

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

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

26 Ideal Clinic Prototype Realization

27 Ideal Clinic Components and Elements
Administration Clinical Guidelines and Integrated Clinical Services Management Medicines, Supplies and Laboratory Support Staffing and professional Etiquette Availability of a doctor Infrastructure (physical condition, ICT Essential Equipment) Health Information Management Communication District Health Support Systems Partners and stakeholders There are currently 185 elements across the 10 components 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 place p y 2 Internal signage in place 3 The Patients' Rights Charter neatly on display 4 The Batho Pele Principles neatly on display 5 The National Core Standards neatly on display 6 The Core Values and Service Standards of facility neatly on display 7 The Clinic hours and services board displayed

29 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 A. Signage, Branding and Values Displayed 8 The appropriate signage to indicate that the facility is a ‘weapons free zone’ on display p y n 9 A signage board regarding the control of access to public premises on display nn B. Service Organisation 10 Disability access to all clinic areas 11 Reception / Information staff available and on duty 12 Staff who receives, greets, helps and informs patients appropriately 13 The appropriate compliments / complaints box(es) in place

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 women’s health (MCWH) 29 Retrieves patient files before they arrive for their appointments y 30 Pre-dispenses patient medication as per scripts p 31 Implements a patient defaulter tracing system

31 IDEAL CLINIC PROTOTYPE Medicines and Supplies
National Core Standards DASHBOARD January 2014 Clinic Name Component  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 y p n 48 A system to monitor the stock levels and availability of medicines and supplies 49 Stock files and orders medicines according to these stock files 50 A Dispensary Room where the temperature is appropriately controlled 51 A Medicine Store which is kept locked at all times

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 p y 69 An up to date Facility Organogram 70 Up to date Job Descriptions for all positions on the Facility Organogram 71 An adequate number of Doctor/s available n 72 An adequate number of Nurses available 73 An adequate number of Pharmacist(s) or Pharmacy Assistant(s) available 74 An adequate number of Administration Staff available

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 y p n 171 Beneficial relationships with partners and NGOs 172 A beneficial relationship with Local Councillor 173 Members of the Community doing voluntary work in the Clinic 174 Regular Clinic Open Days

34 Progress with regard to PHC re-engineering priorities

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

36 School Health Services
DISTRICT NO School Health Teams Dr Kenneth Kaunda 7 Eden 8 Gert Sibande 5 Oliver Tambo 23 Pixley Kaseme Thabo Mofutsanyana Tswane 15 Umgungundlovu 20 Umzinyathi 6 Vhembe 17 TOTAL 106 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

37 Municipal Ward Based Primary Health Care Outreach Teams

38 WBOT Required based on 1:1500 households Number of WBOT registered
NHI Pilot District WBOT Required based on 1:1500 households Number of WBOT registered Amajuba DM 74 10 Dr K Kaunda DM 139 49 G Sibande DM 182 9 O Tambo DM 199 223 Pixley ka Seme DM 33 41 T Mofutsanyane DM 145 29 Tshwane MM 608 19 uMgungundlovu DM 17 Umzinyathi DM 76 20 Vhembe DM 229 Eden 109 Grand Total 1976 568

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

41 Progress on Key Support Interventions

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  Districts Number of Clinics Doctor coverage % coverage Pixley Ka Seme 39 30 76.92 Vhembe 113 38 33.63 Gert Sibande 37 32 86.49 Kenneth Kaunda 41 31 75.61 OR Tambo 143 Have not yet commenced. Minister Motsoaledi addressed GPs in February 2014  Umzinyathi 34 18 52.94 Umgungundlovu 59 46 77.97 Tshwane 87 52.87 Thabo Mofutsanyana 66 33 50.00 Eden 76 Have recently commenced with the programme Doctor coverage: The PHC clinic has at least one doctor doing sessions (working specified hours) for at least one day per week

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

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 Reforms in Hospital Services
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 CEO’s of hospitals were re-advertised and filled in line with these regulations Delegations to CEO’s 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 CEO’s and hospital managers to develop capacity to execute the new delegations.

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

48 THANK YOU FOR YOUR ATTENTION!


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