INVITATION FOR BID

YOU ARE HEREBY INVITED TO SUBMIT INFORMATION FOR THE REQUIREMENTS OF NATIONAL HEALTH LABORATORY SERVICE

BID NUMBER: RFI 001/15-16

CLOSING DATE: 22 April 2016

CLOSING TIME: 11:00AM

DESCRIPTION: REQUEST FOR INFORMATION: APPLYING THE ITSDM MODEL TO SMALL DISTRICT HOSPITALS TO ADDRESS REQUESTS FOR A LABORATORY SERVICE BY THE GAUTENG DEPARTMENT OF HEALTH

RFI MUST BE MARKED WITH THE FOLLOWING: OR DEPOSITED IN THE BID BOX SITUATED AT:

Procurement Controller: MS A Shusha

RFI 001/15-16

Bidders Name: ______________________

RFB: Enclosed-Regret (delete N/A)

Closing Date: _______________________

NHLS MAIN RECEPTION

1 Modderfontein Road, Sandringham, Johannesburg.

Respondents should ensure that responses are delivered in time to the correct address. If the response is

late, it will not be accepted for consideration. The bid box is generally accessible 24 hours a day, 7 days a

week.

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THE FOLLOWING PARTICULARS MUST BE FURNISHED:

NAME OF RESPONDENT

CONTACT PERSON

TELEPHONE NUMBER

FAX NUMBER

POSTAL ADDRESS

PHYSICAL ADDRESS

SIGNATURE OF RESPONDENT: ………………………………………………………………

DATE: ……………………………………………………………

CAPACITY UNDER WHICH THIS RFI IS SIGNED: ………………………………………

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CONTENTS

GENERAL TERMS AND CONDITIONS

1 Introduction 42 Definitions 43 Acronyms, abbreviations and technical definitions 54 Confidentiality 65 Preferential Procurement Reform 76 News and Press Releases 77 Precedence of documents 78 Language 89 Gender 8

10 Headings 811 The manner for submission of the RFI 812 Instructions for the submission of the RFI 913 Oral presentations and briefing session 1014 Information required 1015 Evaluation criteria 10

11

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GENERAL TERMS AND CONDITIONS

1. Definitions

2.1 “RFI” - means a Request for information, which is a written official enquiry document encompassing all

the terms and conditions of the information in a prescribed or stipulated form.

2.2 “RFI response” - means a written response in a prescribed form in response to an RFI.

2.3 “Acceptable RFI” - means any RFI, which, in all respects, complies with the specifications and

conditions of the Request for RFI as set out in this document.

2.4 “Vendors” - means any enterprise, consortium or person, partnership, company, close

corporation, firm or any other form of enterprise or person, legal or natural, which has been invited by

NHLS to submit a bid in response to this RFI.

2.5 “Client” - means Government departments, provincial and local administrations that participate in NHLS

procurement processes.

2.6 “Comparative Price” - means the price after deduction or addition of non-firm price factors,

unconditional discounts, etc.

2.7 “Consortium” - means several entities joining forces under an umbrella to gain a strategic collaborative

advantage by combining their expertise, capital, efforts, skills and knowledge for the purpose of executing

a tender.

2.8 “Goods” – means any work, equipment, machinery, tools, materials or anything of whatever nature to be

rendered to NHLS or Government in terms of a bid.

2.9 “Hosting Partners” - means companies who entered into an agreement with NHLS in the areas of

application management; application hosting, application service provision, and marketplace hosting are

incorporated in this category.

2.10 “Internal Collaboration” - means collaborative arrangements within a group of companies or within

various strategic business units/subsidiaries/operating divisions in order to gain a strategic position whilst

sharing resources, profits and losses as well as risks.

2.11 “Management” - in relation to an enterprise or business, means an activity inclusive of control, and

performed on a daily basis, by any person who is a principal executive officer of the company, by

whatever name that person may be designated, and whether or not that person is a director.

2.12 “Organ of State” - means a constitutional institution defined in the Public Finance Management Act,

Act 1 of 1999.

2.13 “Person (s)” - refers to a natural and/or juristic person (s).

2.14 “Rand Value” - means the total estimated value of a contract in Rand denomination, which is

calculated at the time of information invitations and includes all applicable taxes and excise duties.

2.15 “Respondent” – means any person (natural or juristic) who forwards an acceptable RFI in response

to this RFI with the intention of being the main contractor should the RFI be awarded to him.

3. Acronyms, abbreviations and technical definitions

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The following acronyms and abbreviations are used in this information and must be similarly

used in the information submitted in response and shall have the meaning ascribed thereto

below.

Term Definition

BEE Black Economic Empowerment as defined by Act 5 of 2000.

CPI Consumer Price Index

GITOC Government IT Officers Council

HDI Historically Disadvantaged Individuals

ICT Information and Communication Technology

IMS Information Management System

IS Information Systems

ISO International Standards Organization

IT Information Technology

LAN Local Area Network

OEM Original Equipment Manufacturer (see Brand owner, Legal entity)

PPPFA Preferential Procurement Policy Framework Act

RSA Republic of South Africa

NHLS National Health Laboratory Services

4. Confidentiality

4.1.The information contained in this document is of a confidential nature, and must only be used for

purposes of responding to this RFI. This confidentiality clause extends to all respondent or

associates whom you may decide to involve in preparing a response to this RFI.

4.2.For purposes of this process, the term “Confidential Information” shall include all technical and

business information, including, without limiting the generality of the foregoing, all secret knowledge

and information (including any and all financial, commercial, market, technical, functional and

scientific information, and information relating to a party’s strategic objectives and planning and its

past, present and future research and development), technical, functional and scientific requirements

and specifications, data concerning business relationships, demonstrations, processes, machinery,

know-how, architectural information, information contained in a party’s software and associated

material and documentation, plans, designs and drawings and all material of whatever description,

whether subject to or protected by copyright, patent or trademark, registered or un-registered, or

otherwise disclosed or communicated before or after the date of this process.

4.3.The receiving party shall not, during the period of validity of this process, or at any time thereafter,

use or disclose, directly or indirectly, the confidential information of NHLS (even if received before

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the date of this process) to any person whether in the employment of the receiving party or not, who

does not take part in the performance of this process.

4.4.The receiving party shall take all such steps as may be reasonably necessary to prevent NHLS’s

confidential information coming into the possession of unauthorised third parties. In protecting the

receiving party’s confidential information, NHLS shall use the same degree of care, but no less than

a reasonable degree of care, to prevent the unauthorised use or disclosure of the confidential

information as the receiving party uses to protect its own confidential information.

4.5.Any documentation, software or records relating to confidential information of NHLS, which comes

into the possession of the receiving party during the period of validity of this process or at any time

thereafter or which has so come into its possession before the period of validity of this process:

Shall be deemed to form part of the confidential information of NHLS,

Shall be deemed to be the property of NHLS;

Shall not be copied, reproduced, published or circulated by the receiving party unless

and to the extent that such copying is necessary for the performance of this process and

all other processes as contemplated in; and

Shall be surrendered to NHLS on demand, and in any event on the termination of the

investigations and negotiations, and the receiving party shall not retain any extracts.

5. Preferential Procurement Reform

5.1 NHLS supports Black Economic Empowerment as an essential ingredient of its business. In

accordance with government policy, NHLS insists that the private sector demonstrates its

commitment and track record to Black Economic Empowerment in the areas of ownership

(shareholding), skills transfer, employment equity and procurement practices, (SMME Development)

etc.

5.2 No preference certificate shall be completed for this RFI.

6. News and Press Releases

6.1 Vendors or their agents shall not make any news releases concerning this RFI or the awarding of the

same or any resulting agreement(s) without the consent of, and then only in co-ordination with NHLS.

7. Precedence of documents

7.1 This RFI consists of a number of sections (see list). Where there is a contradiction in terms between the

clauses, phrases, words, stipulations or terms and herein referred to generally as stipulations in this RFI

and the stipulations in any other document attached hereto, or the RFI submitted hereto, the relevant

stipulations in this RFI shall take precedence.

7.2 Where this RFI is silent on any matter, the relevant stipulations addressing such matter and which

appears in the NHLS Procurement Policy and Procedures (which are NHLS’s general conditions for

Procurement) shall take precedence. RFI shall refrain from incorporating any additional stipulations in its

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RFI submitted in terms hereof other than in the form of a clearly marked recommendation that NHLS may

in its sole discretion elect to import or to ignore. Any such inclusion shall not be used for any purpose of

interpretation unless it has been so imported or acknowledged by NHLS

7.3 It is acknowledged that all stipulations in the NHLS Procurement Policy and Procedures are not equally

applicable to all matters addressed in this RFI. It however remains the exclusive domain and election of

NHLS as to which of these stipulations are applicable and to what extent. The vendors are hereby

acknowledging that the decision of NHLS in this regard is final and binding. The onus to enquire and

obtain clarity in this regard rests with the vendors. The vendors shall take care to restrict its enquiries in

this regard to the most reasonable interpretations required to ensure the necessary consensus.

8. Language

Responses shall be submitted in English.

9. Gender

Any word implying any gender shall be interpreted to imply all other genders.

10. Headings

Headings are incorporated into this RFI and submitted in response thereto, for ease of reference only

and shall not form part thereof for any purpose of interpretation or for any other purpose.

11. The manner for submission of the RFI

11.1 Vendors shall submit RFI response in accordance with the prescribed manner of submissions as

specified below.

11.2 Vendors shall submit one (1) original copy, 1 (one) hard copy and 1(one) electronic copy (on a single

CD/DVD) in DOC or PDF format.

11.3 The original copy must be signed IN INK by an authorised employee, agent or representative of the

respondent and initialised on each and every page of the information.

11.4 Respondents are requested to complete their responses in electronic format, in the spaces provided

for answers within this document.

11.5 The CD / DVD must be marked with the responding organisation’s name and RFI number. The CD /

DVD must be enclosed in a cover that is also marked with the responding organisation’s name and

RFI number.

11.6 The CD / DVD and cover must be enclosed and sealed in a padded envelope that is marked with the

responding organisation’s name and RFI number.

11.7 All additions to the information documents i.e. appendices, supporting documentation, photographs,

technical specifications and other support documentation covering suggested solutions etc. shall be

neatly bound as part of the schedule concerned. No product information or company profiles will be

considered.

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12. Instructions for submission of the RFI 12.1 RFI responses must be submitted in a prescribed format herewith reflected as Response Format, and

be sealed in an envelope addressed as follows:

RFI number: RFI001/15-16

RFI Description: REQUEST FOR INFORMATION: APPLYING THE ITSDM MODEL TO SMALL DISTRICT HOSPITALS TO ADDRESS REQUESTS FOR A LABORATORY SERVICE BY THE GAUTENG DEPARTMENT OF HEALTH

Addressed to: The Head: ProcurementNHLS Head Office 1 Modderfontein RoadSandringhamJohannesburg2131

12.2 Vendors shall submit information responses in accordance with the prescribed manner of

submissions as specified above.

12.3 RFI Responses must be deposited into NHLS’s Tender box on or before 22 April 2016 not later

than 11h00 South African Time. The Tender Box is situated at the Main Reception area of

NHLS Head Office in Sandringham.

12.4 The physical size of the envelope must be limited to 750mm x 300mm x 90mm as the Tender Box

aperture cannot accommodate larger sizes. Alternative arrangements for the submission of the

information shall be made with the Tender Office at telephone number: (011) 386 6165.

12.5 All responses in this regard shall only be accepted if they have been placed in the tender box before

or on the closing date and stipulated time.

12.6 RFI responses sent by post or courier must reach this office at least 36 hours before the closing date

to be deposited into the information box. Failure to comply with this requirement will result in your

information being treated as “late response” and will not be entertained. Such responses will be

returned to the respective vendors.

12.7 No information shall be accepted by NHLS if submitted in any manner other than as prescribed

above.

12.8 NHLS will not disqualify any vendor for purposes of this Request for Information. Apart from the RFI

document in its original format, no mandatory documents are required in the RFI response. The R500

fee payable for receipt of bids is not applicable for this RFI.

12.9 There will be NO PUBLIC OPENING of the RFI responses received and; however, the list of bids

received may be published on the NHLS website. Any subsequent discussions shall be at the

discretion of NHLS.

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12.10 Unless specifically provided for in the information document, responses submitted by means of

telegram, telex, facsimile or similar means will not be considered.

12.11 No response from any vendor with offices within the RSA will be accepted if sent via the Internet or e-

mail. However responses from international vendors with no office or representation in the RSA will

be accepted if received via the Internet or E-mail before the closing date and time.

12.12 NHLS will not be liable for any costs incurred by the respondents in the preparation of response to

this RFI. The preparation of responses will be made without obligation to accept any of the

suggestions included in any response, or to discuss the reasons why such suggestions were

accepted or rejected.

12.13 Responses are non-binding on both NHLS and the respondent.

12.14 Respondents may respond only to selected parts of the document, should they choose to do so.

12.15 All questions in respect of this RFI must be forwarded to andy.shusha@nhls.ac.za

13. Oral presentations and briefing sessions 13.1 Vendors who respond to this RFI may be required to give an oral presentation.

13.2 No briefing session will be held for this RFI.

14. Information requested

14.1 The objective of this Request for Information (RFI) is to obtain information from Industry regarding the

applying the ITSDM model to small district hospitals to address requests for a laboratory service by

the Gauteng Department of Health.

15. Evaluation criteria 15.1 No awards will be done in terms of this RFI

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ANNEX A: RFI DETAILS

1. Background

The NHLS laboratory service provides a wide range of pathology testing to NDOH clinics and state

hospitals across South Africa. The latter include district, regional and tertiary hospitals as per

classification by NDOH. District hospitals are further classified by the number of beds into small

(50-150), medium (150-300) and large (300-500) facilities and typically these facilities provide

emergency, trauma, paediatric and obstetric care. However, geographical location and distance to

the nearest testing facility (laboratory) may also impact the total basket of tests offered at this

hospital level.

2. . Statement of NeedThis notice is issued by the NHLS, as a Request for Information (RFI) to solicit responses from

interested parties.

This notice, which is for information and planning purposes only, allows industry the opportunity to

provide feedback on their ideas for the provision of services noted above. This document will also

verify reasonableness and feasibility of future program requirements and promote competition.

NHLS intends to set up and implement these new innovative technologies as soon as feasible and

is looking for a service provider that provides solutions and support for the issues listed below.

This RFI is not to be construed as a commitment by NHLS, nor will NHLS pay for the information

submitted in response. This RFI is being used to obtain information for planning purposes only.

Please note that, responses to this notice are not considered offers and cannot be accepted by the

NHLS to form a binding contract. NHLS does not intend to pay for information furnished in

response hereto.

The National Health Laboratory Service (NHLS) National Priority Programme (NPP) Unit has

developed an Integrated Tiered Service Delivery Model (ITSDM) to ensure universal access to CD4

testing across South Africa using a full coverage approach (1). This model, utilizes daily testing

volumes to guide the placement of appropriate equipment, with the requisite capacity, to match

service requirements (1). It incorporates 5 testing tiers and a sixth tier, as a coordinating/overseeing

tier (1)(refer to figure below).

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Figure 1: ITSDM (left) indicating the proposed tiers of service delivery, indicated on a map to show

coverage.

According to the World Health Organisation classification, a district hospital should provide

diagnostic, treatment, care, counselling and rehabilitation services(2). It should cover the following

clinical disciplines at a generalist level(2):

Table 1 : WHO recommendation for clinical disciplines to be provided at district hospitals

Family

Medicine

Rehabilitation Medicine

Surgery Obstetrics Paediatrics

Psychiatry Eye care Geriatrics

Primary

health care

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The table below links the ITSDM developed for CD4 testing for the District Health System facility classification as well as the level of testing stipulated in the Maputo declaration:

Table 2 : Linking the ITSDM tier to facility classification and tests to be performed according to the Maputo declaration

ITSDM Tier NDOH DHSServices Provided

Tests to be performed (Maputo

Declaration)

Tier 1Decentralised POC

Primary Health

Care (PHC)

Based on the

PHC

Package of

Services and

facility

classification

Level ITier 2POC Hub

Community

Health Centre

(CHC)

Tier 3Community Labs

Small-Medium

District Hospitals

(<150 Beds) Generalist

Level ILevel II

Tier 4District Labs

Large District

Hospitals (<600

Beds)

Tier 5Metro Labs

Regional

Hospitals

(200-800 Beds)

Tertiary Hospitals

(400-800 Beds)

Super

Specialist

Level III and

IV

The norms and standards defined in the district hospital package for South Africa stipulate the

requirement for emergency laboratory facilities to conduct the laboratory tests listed in the table

below (2):-

Table 3 : Laboratory testing requirements set out the norms and standards for the district hospital package

Chemical Pathology Haematology MicrobiologyUrine/blood pregnancy

testing

Full blood count (FBC) Microscopy of

CSF/stool/urineBilirubin Erythrocyte

Sedimentation Rate

(ESR)

AFB microscopy

Liver function test (LFT) Malaria screen Syphilis screen and

quantitative tests Cardiac enzymes Partial thromboplastin

time

Gram stain

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Urea, creatinine &

electrolytes (U&E)Prothrombin Preparation of culture

specimens

Calcium, phosphate Fibrinogen Typhoid serology

Amylase Preparation of bone

marrow specimensEmergency HIV testing

Lipids

Glucose

Uric acid

Not all of the tests listed above need to be provided at the district hospital, the clinical service

requires access to the tests above through the laboratory network, i.e. more specialised tests are

referred within the laboratory network. This is well described in the Maputo declaration that

recommends also tiered laboratory network which consists of an integrated network of laboratories

organized in alignment with the public health delivery network in the country (3).

In the Maputo declaration, four levels of laboratories are described (3):-

Level I: Primary Health Care laboratories that primarily serve outpatients.

Level II: District laboratories with intermediate referral facilities (e.g., district hospitals).

Level III: Regional/Provincial laboratories in a regional/provincial referral hospital that may

be part of a regional or provincial health bureau.

Level IV: National/Multi-country reference laboratory for one or more countries.

The tiered levels of a laboratory system and the testing performed at each level may vary

depending on the population served (e.g., infants, adults), level of service available, physical

infrastructure, electricity, water, road conditions, and the availability of trained technical personnel

in-country (3).

In annexure D of the Maputo declaration, the tests to be performed at each of the laboratory tiers

described above is listed (3). The level II recommended laboratory tests are listed in the table

below, along with example of kits and reagents proposed in 2008 (3).

Table 4 : NHLS test baskets by laboratory tier (from Annexure D: Maputo Declaration) (3)

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The aim of this business case is to apply the ITSDM model to small district hospitals in the Gauteng

province to assess the feasibility of providing a laboratory service. The district hospitals in the

Gauteng provide are listed in the table below:-

Table 5 : District hospitals in Gauteng by district and sub-district with hospital beds

Source: http://www.hst.org.za/sites/default/files/District%20Hopsital%20Performance

%20Assessment%20Report_Gauteng%20Province.pdf

.

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Methodology

The following steps were followed:-

An on-site visit to the Pretoria West and Bronkhorspruit district hospitals was undertaken on the

2nd of February 2016 to assess laboratory service requirements.

Secondary Corporate Data Warehouse (CDW) TrakCare test volumes were extracted between

August and October 2015 for each health facility in the Gauteng province for the defined list of

tests listed in the table below.

Individual test names were then categorized in to test groups, e.g. .sodium, chloride, etc. into

the Urea and Electrolytes test group/panel.

The Gauteng province district hospitals listed in table above were categorized using Microsoft

Access to obtain test volumes for the specified district hospital locations. This data did not

include laboratory test volumes which would include primary health care (PHC) tests referred to

the local laboratory, i.e. only local district hospital test volumes were analysed.

For the U&E and LFT test group, the maximum test volume per test method was assumed for

the test group.

For the remaining test groups, the total test volume across all test methods was assessed. This

was based on local knowledge of how these tests are coded in the TrakCare laboratory

information system (LIS). It was also an attempt to reconcile test volume back to test orders on

the laboratory request form.

For the daily volumes, the average across the three month period was assessed (assumed 3

months and 21.73 days per month).

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The table below lists the logic used to group test names to a logical test group:-

Table 6 : TrakCare test groupand test method names for which test volumes were extracted

TEST_GROUP TEST_METHOD_NAME TEST_GROUP TEST_METHOD_NAME

AMYLASE AMYLASE LFT

 

 

 

 

 

ALANINE TRANSAMINASE (ALT)

CK CREATINE KINASE (CK) ALBUMIN

CRP C-REACTIVE PROTEIN ALKALINE PHOSPHATASE (ALP)

D-DIMER D-DIMER ASPARTATE TRANSAMINASE (AST)

FBC

 

 

 

 

FBC AND DIFF CONJUGATED BILIRUBIN

FULL BLOOD COUNT LACTATE DEHYDROGENASE (LD)

HAEMATOCRIT TOTAL BILIRUBIN

HAEMOGLOBIN TOTAL PROTEIN

PLATELET COUNT

MALARIA

MALARIA

RED CELL COUNT MALARIA RAPID SCREEN

WHITE CELL COUNT PI&PTT INT NORMALISED RATIO (INR)

GLUC

 

 

GLUCOSE (120 MIN)

U&E

 

 

 

BICARBONATE

GLUCOSE (60 MIN) CHLORIDE

GLUCOSE (FASTING) CREATININE (PLUS MDRD)

GLUCOSE (RANDOM) POTASSIUM

HEPATITIS

 

 

 

HEPATITIS A IGM SODIUM

HEPATITIS B CORE IGM UREA

HEPATITIS B CORE TOTAL AB

HEPATITIS B E AB

HEPATITIS B E AG

HEPATITIS C ANTIBODY

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The table below list all the hospitals included in the data analysis. From this list, only the district

hospitals in the Gauteng province were analysed.

Figure 2 : List of district hospitals included in the data analysis (highlighted)

FACILITY_NAMEBertha Gxowa Hospital ODI Community Hospital

Bronkhorstspruit Phc Clinic Pholosong Hospital

Carletonville Hospital Pretoria West Hospital

Charlotte Maxeke Hospital Rahima Moosa Mother And Child

HospitalChris Hani Baragwanath Hosp Sebokeng Hospital

Dr George Mukhari Hospital Sizwe Tropical Diseases Hosp

Dr Yusuf Dadoo Hospital South Rand Hospital

Edenvale Hospital St John's Eye Hospital

Far East Rand Hospital Sterkfontein Hospital

Heidelberg Hospital Steve Biko Academic Hospital

Helen Joseph Hospital Tambo Memorial Hospital

Jubilee Hospital Tara H Moross Hospital

Kalafong Hospital Tembisa Hospital

Kopanong Hospital Thelle Mogoerane Regional Hospital

Leratong Hospital Tshwane District Hospital

Mamelodi Hospital Weskoppies Hospital

Milpark Hospital Wits Oral And Dental Hospital

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Results

The results will be reported as follows:-

Findings from the on-site visits

Analysis of Gauteng district hospitals: bed size and mean daily FBC and U&E

Proposed ITSDM Model for small/medium district hospitals in Gauteng

Analysis of mean daily test volumes for 4 small-medium hospitals that request 25-50

FBC/U&E per day

5.1 Findings from the on-site visits

Significant challenges with the current laboratory service were highlighted, the key aspects

discussed at the meeting are summarised below:-

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Table 7 : Summary findings from the on-site visits

Pretoria West District Hospital Bronkhorspruit District Hospital

Currently operating as a depot, with an on-site data capturerExpanding service package to include theatre and neonatal servicesCurrently have 4 courier collections per day as well as the SkyNet after hours urgent serviceHave network points for TrakCare webview. Unfortunately, the GDOH was unable to procure computers.The previous laboratories repertoire primarily consisted on FBC, U&E, LFT and GlucoseMultiple wards are making use of POCT in the absence of a laboratory (no POCT data available).Require an on-site laboratoryComplaint report compiled by Dr Boswell highlighting impact on patient outcome Major issue: access to bilirubin for neonatesNeed a Yes/No decision from the NHLSAdditional new district hospitals include Daveyton, Soshanguve and Lillian NgoyiKey issue is patient care and not test volumes

Patients are being own-referred from

Kalafong - +- 5 babies per day

Small district hospital offering emergency,

accident and MOU services, planned

expansion of services to include high-care.

Patients that cannot be managed due to the

absence of a laboratory service are referred to

the Mamelodi hospital

Tests required: FBC, U&E, CRP, Malaria,

Cardiac enzymes, D-Dimer, LFT and INR

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5.2 Analysis of Gauteng district hospitals: bed size and mean daily FBC and U&E

There are multiple small-medium district hospitals that request between 25 and 50 tests per day

that would benefit from smaller testing platforms (figure only includes data for the hospitals listed in

table four). There seems to be a correlation between bed size and daily testing volumes.

0

50

100

150

200

250

300

350

400

450

- 10 20 30 40 50 60 70 80 90 100 110

Bed

Size

Mean FBC, U&E and LFT specimens

Small District Hospitals

Medium District Hospitals

Large District Hospitals

Figure 3 : Scatter plot of hospital bed size and mean daily Full Blood Count (FBC) and Urea & Electrolytes (U&E)

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5.2 Proposed ITSDM Model for small/medium district hospitals in Gauteng

The following ITSDM model is proposed for small and medium hospitals. Hospitals requesting less

than 25 U&E and LFT specimens per day could cope with improved logistics. The new tier involved

small hospitals that request between 25 and 50 tests per day. For these laboratories, a limited

repertoire of tests is proposed. Additionally, with the low daily volumes POC testing or low capacity

analysers are proposed. Additionally, the impact of clinic volumes must also be considered. Finally,

where a hospital offers clinical services that require short turn-around-time, e.g. high care, a district

laboratory service has to be provided.

Assess Clinical Services Offered

High-Care, etc. services offered that require testing

with a short TAT (6hrs District Package)

High-Care services not offered

Provide district laboratory

service

FBC/U&E 51-450 p/dRoutine District Lab

FBC/U&E 26-50 p/dSmall STAT District Lab

FBC/U&E <= 25 p/d Improve logistics

Tiered-Laboratory Service

StatFBCINR & PTTLFTProcalcitonin rapidTroponin TUrea, elecs, creat, glu

Assess impact of

Clinic volumes

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Applying this methodology four district hospitals in Gauteng were identified as potential small STAT

district laboratories, i.e. Heidelberg, Pretoria West, Yusuf Dadoo and Carletonville hospitals. These

are specifically based on test

5.3 Analysis of mean daily test volumes for 4 small-medium hospitals that request 25-50 FBC/U&E

per day

Daily mean testing volumes were analysed for the Heidelberg, Pretoria West, Yusuf Dadoo and

Carletonville hospitals. The range of daily volumes is provided in the table below:-

Figure 4 : Mean daily test volumes for four small-median district hospitals in Gauteng

Test BasketMin Daily Vols

Max Daily Volumes

AMYLASE/AMYLASE 1 1 CK/CREATINE KINASE (CK) 0 2 CRP/C-REACTIVE PROTEIN 7 24 D-DIMER/D-DIMER 0 2 FBC 27 50 GLUC 0 3 HEP 2 5 LFT 14 21 MALARIA 0 2 PI&PTT 1 5 PROCALCITONIN - - TROP-T - 2 U&E 35 43 Hospitals in Sample: Carletonville, Yusuf Dadoo, Heidelberg and Pretoria West

These hospitals would perform between 27 and 50 FBC tests per day using a haematology

analyser. Similar, the chemistry analyser would perform between 35 and 43 for the U&E test and 14

and 21 LFT tests per day. Overall, for these tests no hospital requested more than 50 tests per day.

For the remaining tests, daily volumes were very low, mostly <=5 per day.

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Proposed way forward

Submit a request for information for platforms that meet the following daily testing thresholds:-

Daily Testing Volume

Test Basket

Full Blood Count (FBC)Urea & Electrolytes (U&E) with CreatinineLiver Function Tests (LFT)Amylase/LipasCreatinine Kinase (CK)C-Reactive Protein (CRP)D-DimerGlucoseHepatitis RapidMalaria RapidProthrombin Index (PI)/INRProcalcitonic RapidTrop-R Rapid

25-50

<=5

In the supplier responses we also require information about the following aspects:-

Batch size

Reagent stability (expiry dates, shelf life and storage conditions)

Number of controls to be run daily

Daily/Weekly maintenance required

Reagent pack size

Cost per test

Capital costs for outright purchase

Equipment rental cost

Any preventative service required

Ability to scale up to cater for higher daily test volumes

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