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

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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

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NHI Pilot District performance against key indicators

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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

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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

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Summary of Facility Improvement Team Interventions

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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

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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

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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

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District Clinical Specialist Teams

• All Pilot Districts have teams of at least 3/7 members

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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

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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

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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

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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

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Progress on Key Support Interventions

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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

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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!

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