1. DEVELOPING HPH STANDARDS IN PUBLIC HOSPITALS IN SOUTH AFRICA DEVELOPING HPH STANDARDS IN PUBLIC HOSPITALS IN SOUTH AFRICA RAMDASS PD, JINABHAI CC, CASSIMJEE MH, GEDDES R Kwazulu-Natal HPH Committee Dept. of Health & School of Public Health.

3. BACKGROUND The WHO Health Promoting Hospitals (HPH) project aims to incorporate health promotion into the culture and management of hospitals to improve patient and staff health. The Department of Health, Kwazulu-Natal, piloted the WHO self-assessment tool, in six public hospitals, as part of the international collaboration.

4. 70% of global total SOUTH AFRICAN DEVELOPMENT COMMUNITY (SADC) KWAZULU -NATAL SOUTH AFRICA SUB – SAHARAN AFRICA SAHARA

6. The hospitals are distributed over an area of about 93 000 km² but access is difficult due to poor roads. Although the KZN Province inherited a number of disadvantaged hospitals from the previous apartheid government, it is working at improving them.

8. Objectives of Pilot Project in S A Adapt & contextualise the Self-Assessment Tool (SAT) performance standards & indicators Assess existing Hospital Information Systems Develop quality improvement plans based on Indicator assessment & compliance with standards Integrate the HPH data sets into the local Hospital Information Systems Recommend the implementation of HPH in all Public Hospitals in South Africa & Africa

9. METHODS Permission & authorization from policy makers to undertake pilot in 6 hospitals Consultations with Hospital staff Establishment of KZN HPH committees Mobilsation & allocation of resources Integrate indicators into Hospital Information Systems Submission of Reports to policy makers / WHO

10. The process in KwaZulu Natal The implementation of the pilot phase involved the following processes : 1.Infrastructure Development 2.Hospital enrolment and information sharing 3.Data collection, collation & analysis 4.Presentation of Draft Report to policy makers 5.Formulation of Recommendations for full implementation

11. InfrastructureDevelopment Senior General Manager - Dr S.M. Zungu Principal Specialist Health Service - Dr P Ramdas Chief Specialist - Prof M. H. Cassimjee Analytical, technical support Prof Jinabhai / Dr R Geddes School of Public Health University of KwaZulu-Natal Provincial PATH (Performance Assessment Tool-WHO) Coordinator for the Hospitals Dr. S. Sirkar Office space at Northdale Hospital Employment of a data Capturer – Mr S. Rungasami Allocation of IT equipment for the Project

12. Pilot implementation of Self- Assessment Tool Timelines Phase 1: Phase 1: Preparation – March 2004 Phase 2: Phase 2: Assessment of standards compliance – April and May 2004 Phase 3: Phase 3: Data collection for -indicators – June to Dec 2004 Phase 4 Phase 4 : Development of quality improvement plans – Septto Dec 2004 Phase 5: Phase 5: Reporting results – 2005

13. Pilot project process March 2004 Phase 1: Preparatory - March 2004  Provincial coordinating team established: Department of Health including Sub-Directorates Nelson R Mandela School of Medicine  Participating Hospitals / Institutions selected: Inkosi Albert Luthuli Central Hospital Greys, Edendale, Northdale Hospitals, Ngwelezana Lower Umfolozi  Provincial coordinator: Dr P.D. Ramdass  Institutional coordinators: Quality Improvement team coordinators

15. Phase 2: Assessment of standards compliance (April-May2004).  Consult with Quality Improvement (QIP)teams at institutions (applicability and areas of clarification).  Indicator development (identification and data collection)

16. Pilot project process (cont.) Phase 3: QIP plan development (June - December 2004)  Based on the gaps after the assessment of compliance to standards Phase 4: Reporting to World Health Organsiation (Sept-Dec 2004)  Meta-analysis form (results to be computed by WHO and feedback given)  Finalisation of tools by WHO

17. Benefits: FOR KZN DOH, South Africa 1.Monitoring & Evaluation Unit has a WHO Standard HPH tool & strategy 2.Able to monitor trends in change / improvements in HPH over time 3.Has potentail to offer leadership for Public Health sector in S A

18. Benefits: FOR KZN DOH, South Africa 4.Participation in the International arena of Quality Improvement, HPH & Performance Measurement 5.Participation in the global HPH network 6.Decentralisation of data capturing to institutions 7.Empowering hospitals to use their own data 8.Methods to expand existing QIP projects

19. Benefits: FOR KZN DOH, South Africa 9.A self monitoring tool to identify areas of need 10.Adaptable to all levels of care 11.Encourages participation by all categories of staff + management 12.A data base for different areas eg Human resources, Employee Assisstance Programmes, Occupational Health,PATH Tool from WHO.

20. Conclusion Hospitals were encouraged to use the adapted self-assessment tool to  improve health promotion activities,  accelerate continuous quality improvement for improved quality of care; and  expand the scope for participatory research.

21. Acknowledgement Dr S. Sirkar– Path Technical Co-ordinator Dr C. Bhagwandeen– Human Resource Support Unit Ms V. Moodley– Health Promotion Unit Mrs A. Khathi– Quality Assurance & Accreditation Unit Ms J. Maher – Quality Assurance & Accreditation Unit Mr C. Shawe – Quality Assurance & Accreditation Unit Dr V. Maistry – Edendale Hospital Ms H. Findlay – Greys Hospital Ms. V. Bawany– Lower Umfolozi War Memorial Hospital Ms R. Jele – Ngwelezana Hospital Ms U. Sooruth – Northdale Hospital Ms N. Mbambo – Inkosi Albert Luthuli Central Hospital

22. THE END HEALTH PROMOTING HOSPITALS SOUTH AFRICA