Limpopo Health Challenges: Select Committee on Social Services Dr Sipho Kabane 26th May 2015

Contents Vision and Mission Key Mandates and Priorities Major Challenges What has improved What still needs to be improved Vision 2030

Strategic Priority 5: Improve the health profile of all South Africans Manifesto, MTSF, Outcomes & Mandated Outputs - The focus – 2010 to 2015 Manifesto MTSF Strategic Priority 5: Improve the health profile of all South Africans Outcomes A Long and Healthy Life for All South Africans Mandated Outputs Output 1: Increasing Life Expectancy Output 2: Decreasing Maternal and Child mortality Output 3: Combating HIV and AIDS and decreasing the burden of disease from Tuberculosis Output 4: Strengthening Health System Effectiveness

What are the Major Challenges?

Major Challenges: Service Delivery Poor quality of health care services Lack of essentials[ food, medicines, security etc] High number of reported and unreported adverse events High litigation costs due to medico-legal claims Poor access and long waiting times Rude, uncaring, unethical and unprofessional staff attitudes High perinatal deaths in many facilities Slow response times by our ambulances

Major Challenges: Workforce Shortage of key clinical and clinical support personnel Shortage of specialist and academic personnel High personnel turnover Ageing personnel Inequitable distribution of personnel Poor staff attitudes, Culture of entitlement, Lack of professionalism and corruption

Major Challenges: Leadership and Governance Key posts occupied by unqualified, incompetent and unskilled officials Ageing, unproductive, uncommitted and obstructive officials in key posts Appointment of Governance structures not in line with National Health Act Role confusion between management, labour and governance structures High leadership turnover and vacancies in key executive posts; numerous acting officers

Major Challenges: Infrastructure, ICT Ageing and poorly maintained infrastructure Unfunded infrastructure backlogs Dysfunctional laundries, generators, autclaves etc Poorly planned and constructed infrastructure High cost, High maintenance and low value add ICT systems Ageing and poorly maintained ICT infrastructure Lack of ICT hardware, connectivity and telecommunications systems on the coalface

Major Challenges: Information Management Key vacancies at provincial and district level Inappropriately skilled personnel in key posts Shortage of data capturers Inability to capture, secure, analyse, report and use data for planning and decision-making Lack of credible information management systems between facilities and levels of care Lack of storage and security for key information used in administration and patient care Repeated exceptions from the AG on organisational performance vs targets

Major challenges: Medicines, Technology and Equipment Sporadic medicine and consumable stock-outs Long lead times between ordering and delivery of key items Backlogs of key clinical and non clinical equipment Lack of basic equipment at PHC facilities Poor planning and maintenance of equipment Obsolete, non-compliant and dysfunctional equipment

Major Challenges: Financial Management Budgetary shortfalls vs Increased demand Three disclaimers in a row previous audits Poor compliance with SCM prescripts Poor revenue collection and management Irregular, Unauthorised, Fruitless and Wasteful expenditure Fraudulent, unethical and corrupt practices Poor asset and records management

What Has Improved?

What has improved? Maternal and under 5 mortality rates have improved Life expectancy for both males and females has increased HIV, AIDS,TB and Malaria disease burden has decreased Complaints management at hospital level has improved Patient Satisfaction rates have also improved

What has improved? Medicine availability improved from 45 to >80% Consumable availability improved to 75% Increased number of clinical and clinical support staff appointed Increased number of key posts filled at hospital level including CEO’s Increased number of completed infrastructure projects Increased number of clinics supplied with computers and connectivity

What has improved? Increased number of clinical equipment procured Improved audit outcome from a series of disclaimers Improved financial management and accountability for assets Improved supply chain processes Response times are improving as a result of the procurement of 50 ambulances

What still needs to be improved?

What still needs to be improved? Accelerated implementation of programmes that will lead to the realisation of Universal Coverage through the NHI Focus on maintenance of infrastructure in the short to medium term Accelerated delivery of health infrastructure in the long term Improve Life Expectancy and reduce burden of disease from HIV, AIDS, TB, Malaria and non-communicable diseases

What still needs to be Improved? Provincial Health Information system to be fully revitalised Implement electronic patient records Implement systems that will improve data collection, security, analysis, usage and storage Maintain high levels of medicine and consumable availability at all facilities including the depot all the time Maintain and improve on the audit outcomes

What still needs to be improved? Increase the number of operational ambulance through significant investments Set up systems for the efficient deployment of EMS vehicles Restructure, capacitate and reopen the Ambulance College New health sector generic structure to be implemented based on an extensive scientific skills audit recommendations

What still needs to be improved? Improve the compliance with the National core quality standards by all our facilities Reduce litigation costs through safer health care systems and effective management of claims Improvement of health outcomes through accelerated reduction of burden of disease Increased focus on non-communicable disease burden Improve leadership and management of all facilities through mentoring and coaching

What still needs to be improved? Accelerate the recruitment, appointment and retention of specialists to sustain tertiary services and the new medical school Accelerate the appointment of key clinical and clinical support personnel in line with resources Equitable redistribution of clinical personnel Streamline bursary awards with the skills requirements and availability of funded posts

National Development Plans The nine health pillars Manifesto, MTSF, Outcomes & Mandated Outputs - The focus – 2010 to 2015 Manifesto National Development Plans The nine health pillars 1. Average male and female life expectancy increased to 70 years; 2. Tuberculosis prevention and cure rates progressively improved; 3. Maternal and child mortality rates reduced; 4. Prevalence of chronic Non-Communicable Diseases reduced by 28%; 5. Injury, accidents and violence reduced by 50% from 2010 levels; 6. Health systems reforms completed. 7. Primary Health Care teams deployed to provide care to families and communities; 8. Universal Health Coverage achieved; 9. Posts filled with skilled, committed and competent individuals.

Vision 2030 Increased Life expectancy Reduction of burden of TB, HIV and AIDS Reduction of burden of non-communicable disease Reduction of maternal and child deaths Accelerated health infrastructure delivery Improved quality of health care services Implementation of quality information systems Universal coverage

The End!! Thank You!!