presentation to the standing committee on appropriations national health insurance progress report...
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Presentation to the Standing Committee on Appropriations
National Health InsuranceProgress Report
05 March 2014
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
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
NHI Pilot District performance against key indicators
4
Comparison Child under 5 years pneumonia incidence 2010/11 and 2013/14
Comparison Child under 5 years severe malnutrition incidence 2010/11 and 2013/14
Comparison Inpatient death under 1 year rate 2010/11 and 2013/14
Comparison Inpatient death under 5 year rate 2010/11 and 2013/14
Comparison cervical cancer screening rate 2010/11 and 2013/14
Comparison TB (new smear positive) cure rate 2009/10 -2011/12
Comparison Antenatal first visit before 20 week rate 2010/11 and 2013/14
Comparison Infant 1st PCR test positive around 6 weeks rate 2010/11- 2013/14 Q1-Q3
Comparison Delivery in Facility under 18 Years Rate 2010/11 and 2013/14
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
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
Summary of Facility Improvement Team Interventions
16
Summary of FIT Interventions
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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
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
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)
The following pictures represent the changes brought about by the facility improvement teams
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Kareeberg, Pixley Kaseme, NC: ProgressKareeberg, Pixley Kaseme, NC: Progress
Water tanks installed at Vanwyksvlei clinic Water tanks installed at Vanwyksvlei clinic New flooring at Vanwyksvlei clinic New flooring at Vanwyksvlei clinic
Free State - BAINSVLEI CLINICFree State - BAINSVLEI CLINIC
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CEILING BEFORE CEILING AFTER
Examples compliance with National Core Standards Gert Sibande
Store room on initial visit Store room on follow up visitCleanliness at Embalenhle CHS
Dispensary room 1st visit Dispensary room follow up visit
Drug availability at Paulina Morapeli
LuthubeniLuthubeni Clinic OR TamboClinic OR TamboLuthubeniLuthubeni Clinic OR TamboClinic OR TamboBefore
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 Facility24
Maphuzi ORTamboMaphuzi ORTamboMaphuzi ORTamboMaphuzi ORTamboBefore
After
Facility restored to 5 consulting rooms;Has water installed inside the clinic
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Ideal Clinic Prototype Realization
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Ideal Clinic Components and Elements1. Administration2. Clinical Guidelines and Integrated
Clinical Services Management3. Medicines, Supplies and Laboratory
Support4. Staffing and professional Etiquette5. Availability of a doctor6. Infrastructure (physical condition,
ICT Essential Equipment)7. Health Information Management8. Communication9. District Health Support Systems10. Partners and stakeholders
There are currently 185 elements across the 10 components
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Key
In place and functioning well
In process of being put in place/fixed
Not in place/broken/not functioning
Progress with regard to PHC re-engineering priorities
34
District Clinical Specialist Teams
• All Pilot Districts have teams of at least 3/7 members
35
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
DISTRICT NO School Health Teams
Dr Kenneth Kaunda 7
Eden 8
Gert Sibande 5
Oliver Tambo 23
Pixley Kaseme 0
Thabo Mofutsanyana 5
Tswane 15
Umgungundlovu 20
Umzinyathi 6
Vhembe 17
TOTAL 106
Municipal Ward Based Primary Health Care Outreach Teams
37
38
NHI Pilot DistrictWBOT Required based on 1:1500 households
Number of WBOT registered
Amajuba DM 74 10Dr K Kaunda DM 139 49G Sibande DM 182 9O Tambo DM 199 223Pixley ka Seme DM 33 41T Mofutsanyane DM 145 29Tshwane MM 608 19uMgungundlovu DM 182 17Umzinyathi DM 76 20Vhembe DM 229 17Eden 109 0Grand Total 1976 568
39
WBPHCOT members provided with cell phones and trained on collecting and sending patient information by cell phoneAdvantages:
This improves turnaround time for required patient interventionsImproves data quality for monitoring and evaluation of the WBPHCOT programme
Total WPHCBOT m-health trainedTrained 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
Progress on Key Support Interventions
41
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
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 46 52.87Thabo Mofutsanyana 66 33 50.00
Eden 76 Have recently commenced with the programme
Improvement of Data Quality and Information Management
Summary of Achievements• Approved:
– e-health strategy
– Interoperability standards
– District Health Information Management policy
43
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
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
• 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.
Reforms in Hospital Services
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
THANK YOU FOR YOUR ATTENTION!
www.doh.gov.zawww.doh.gov.za
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