NHI Pilot Districts12 months progress report

Presentation to the Portfolio Committee on HealthCommittee Room 514, Marks Building

24 July 2013

Background• August 2011: NHI Green Paper – action plan

• April 2012: NHI pilot districts to prepare for:– Purchasing of services; – Engaging the private sector; – Introducing a district health authority;

• April 2013: Rapid appraisal to:– Assess progress in preparing for NHI– Provide a framework for monitoring

NHI domains appraised

1. NHI management

2. Hospitals

3. Quality

4. Primary Health Care

re-engineering

5. Infrastructure &

Equipment

6. Human Resources

7. Health information

8. District Management

Teams

9. Conditional Grant

10. Referral

11. Contracting Private

Providers

Key  

  Nearly or completely achieved (where numerical data available >75%)

  Partially achieved (where numerical data available 25 - 74%)

  Minimally, or not achieved (where numerical data available <25%)

No data available

Tabular summary per District

NHI management & coordination

Hospital Reform

Quality

PHC facility OSC inspectionsBaseline and 2013 follow-up scores and differences for each districtEight districts showed a fall in scores (five less than 5%)Two districts showed significant improvements (17% and 8%)

District

Number of PHC facilities

inspected

Baseline

Score %

2013 follow-up

Score %

Score difference %

Vhembe 12 53.1% 32.0% - 21.1%

Oliver Tambo 25 63.9% 48.1% - 15.8%

Dr Kenneth Kaunda 10 60.2% 47.2% - 13.0%

City of Tshwane 13 78.4% 69.8% - 8.5%

Amajuba 10 59.8% 55.5% - 4.4%

Umzinyathi 7 66.4% 62.4% - 4.0%

Eden 1 56.9% 54.7% - 2.2%

uMgungundlovu 10 58.6% 58.4% - 0.2%

Thabo Mofutsanyana 11 68.1% 72.7% 4.6%

Pixley ka Seme 6 48.4% 56.8% 8.4%

Gerte Sibande 17 33.9% 51.2% 17.2%

PHC Re-engineering

Infrastructure

Equipment Audit in Primary Health Care Facilities

Summary of facilities assessed in NHI pilot districts

District Total Complete Remaining

OR Tambo 131 43 88

Thabo Mofutsanyana 73 23 50

City of Tshwane 60 60 0

Amajuba, Umzinyathi,

uMgungundlovu91 45 46

Vhembe 112 47 65

Gerte Sibande 55 30 25

Dr Kenneth Kaunda 27 20 7

Pixley ka Seme 29 23 6

Eden 31 10 21

Total 609 301 308

Human Resources for Health

Health Management Information

National Health Information Repository and Data warehouse (NHIRD) Rollout Process

• A 2 day workshop in each district• The team will comprise of the Planning Unit from the National

Department of Health, a software developer and facilitators from HISP The purpose of the visits are to:• Ensure that the NHIRD reporting system is available for use to the District

Management Team• Ensure that the District staff are able to maintain and utilise the NHIRD

system so that data is accessible .During the visits the team are proposing to meet with the following :• The District Management Team to orientate them on the basic use of the

NHIRD reporting system• Senior staff from the DHS, planning/information or M&E units as decided

by the Province

District Preparation for the Roll-out

In preparation for the provincial roll-out of the NHIRD, the following need to be addressed:•Each participant should have access to a computer , with internet access and the latest version of Internet Explorer installed, need to be available in the office of the HOD and the NHIRD support office. •As these computers will be used to access the national server, the latest version of Google Chrome must be installed and computers must have reliable internet access.•The computers should be connected to printers, ideally colour printers so that reports and graphs can be printed from the NHIRD database;•The team will need access to these computers during the rollout visits.

Proposed ScheduleProvince Proposed Dates

Support Team

Northern Cape – Pixley ka Seme 12 and 13 August

Free State – Thabo Mofutsanyana 5 and 6 August

KwaZulu-Natal COMPLETE

Western Cape - Eden 19 and 20 August

Mpumalanga – Gert Sibande 15 and 16 August

Limpopo - Vhembe 22 and 23 August

Gauteng - Tshwane 10 and 11 September

Eastern Cape – OR Tambo 27 and 28 August

North West – Dr K Kaunda 3 and 4 September

District Management

Referral systems

GPs in districts on national contract

Assessment of PHC Clinics in NHI PILOT DISTRICTS

• The facility visits focus on infrastructure, personnel, equipment, access to drugs, and other system processes.

• This information will allow the NDOH to determine which facilities do not meet the minimum requirements and the process to bring them to standard. – In total, there are 764 PHC facilities in the 11 Pilot

Districts. • 669 PHC Clinics• 67 CHCs

Overview of Method of Assessment• The Assessments focus on all NHI pilot districts with a

combination of quantitative data and qualitative observations, as well as conducting interviews with facility staff .

• Facilities were assessed in terms of various aspects relating to their functionality and were scored or assessed in terms of the following areas:– Human Resources:– Relative comparison of workload with Professional Nursing staff– Range of Services rendered against the PHC package– Physical Space– Infrastructure conditions such as broken windows, locks on doors,

cracks on walls, leaking roofs etc.– Can they physically accommodate a doctor in the existing premises?– Pharmacy services– System and process elements– Essential Equipment

Overview of Approach

• Human Resources:– What are the current staffing levels by professional

grouping?– Do they have access to services of a Medical Officer or

General Practitioner on sessional basis?• Relative comparison of workload with Professional

Nursing staff– Patient Data– Clients seen on average in a day, week, month and over

the past 12 months– Range of Services rendered against the PHC package– What services are current offered?

Overview of Approach continued

• Physical Space– Number of consulting rooms– Storage and filing– Access to utilities such as piped water, sanitation, electricity

• Infrastructure conditions such as broken windows, locks on doors, cracks on walls, leaking roofs etc.– Major Infrastructure challenges including requiring major repairs, lack of

adequate space, can the building be extended or requires a temporary (park home) structure.

– Can they physically accommodate a doctor in the existing premises?• Pharmacy services

– Availability of a pharmacy or dispensary– Availability of medicines trolleys in consulting rooms– Access to qualified pharmacist or pharmacy assistant– Drug stock outs– Issues with routine and continuous supply of medicines

Overview of Approach continued • System and process elements

– Access to telephones, fax, internet– Data capturers– Filing systems– Patient scheduling– Availability of key communication and information materials– Availability and understanding of SOPs, guidelines and policies

• Essential Equipment– Availability of essential equipment required for services

rendered– Ordering and accessing missing equipment

Overview of Approach continued

• Each element above is scored on the basis of (i) acceptable, (ii) fair or adequate and (iii) poor condition and categorized as follows:– Staffing– Space– Building Condition– Do they have a pharmacy?– Equipment– If yes to the question above, is there space for the GP?– When can they start contracting a GP?

PROGRESS • As of 1st June 2013, 556 of the facilities in the 10 Pilot Districts

have been prioritized. • Amajuba will be completed after the 10 pilots

Preliminary Analysis

• Criteria– Staffing– Space– Building Condition– Equipment– Would you like a GP to come in part-time?– If yes to the question above, is there space for the GP?

• How many facilities are “READY”?– Of the 556 the facilities were scored as being ready as

follows:• Only 125 facilities scored YES to all the questions;• If you remove staffing, then 164 facilities are classified as ready

SCORING INDICATING CHALLENGESCRITERIA GOOD FAIR POOR TOTAL

Staffing 152 242 162 556

Space 175 184 197 556

Building Condition 172 235 149 556

Equipment 165 233 158 556

CRITERIA YES NO NOT SURE TOTAL

Would you like a GP to come in part-time? 508 12 36 556

Is there space for the GP? 175 248 133 556

Next Steps

• Most facilities do not have a service improvement plan to address areas of weakness arising from the assessments.

• Support from NHI coordinators and District Managers in order to develop, and implement service improvement plans and thereby meets deadlines important.

• NDOH has begun to engage the Province on specific feedback sessions and will develop and monitor progress following these initial facility assessments

• The placement of GPs in facilities should be directly linked to service needs and then informed by the state of facility readiness.

Summary• NHI management and coordination in place and DHMTs realigning their

priorities

• NHI Conditional Grants have contributed to progress

• Quality improvement interventions underway

• Hospital reform being introduced

• Referral mechanisms are in place

• PHC Re-engineering: Three streams (DCSTs, WBOT and School Health) teams not yet complete

• Health staff is insufficient; WHO WISN norms and standards being used to motivate for increased funding

• Private providers – districts ready for private GPs to work alongside nurses in primary health care facilities

• Challenges – these are identified per facility and are being addressed specifically