STRATEGY 2010 - 2015 Presentation to the Health Portfolio Committee Sagie Pillay CEO May 5, 2010.

STRATEGY 2010 - 2015STRATEGY 2010 - 2015

Presentation to the Health Portfolio Committee

Sagie Pillay CEO

May 5, 2010

STRATEGY 2010-2015:STRATEGY 2010-2015:

1.1. Mission & PurposeMission & Purpose

2.2. Guiding Principles:Guiding Principles: “NHLS Credo”“NHLS Credo”

3.3. Strategic DialogueStrategic Dialogue

4.4. Key Strategic IssuesKey Strategic Issues

5.5. Strategic Dilemmas:Strategic Dilemmas: “Themes”“Themes”

6.6. Strategic Dream: Strategic Dream: “Vision”“Vision”

7.7. Strategic Drivers: Strategic Drivers: “10-point Plan”“10-point Plan”

8.8. Strategic Deliverables: “Strategic Objectives” 5 Strategic Deliverables: “Strategic Objectives” 5 yryr

9.9. Strategic Deliverables: “Balanced Score-card” Strategic Deliverables: “Balanced Score-card” 1 yr1 yr

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OUR PURPOSE & MISSION OUR PURPOSE & MISSION

To provide quality, affordable and sustainable health laboratoryhealth laboratory and related public health servicesservices, ,

To train for health science educationhealth science education, , and To promote and undertake health researchhealth research

In support of National & Provincial Departments of Health

In their delivery of health care to the nation

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THE NHLS CREDO: THE NHLS CREDO: “OUR GUIDING PRINCIPLES”“OUR GUIDING PRINCIPLES”

Our first responsibility is to our customerscustomers whom we desire to serve with passion and commitment, and strive to provide with an effortless quality yet affordable experience

We are accountable to our employeesemployees, respect their dignity and recognise their value.

We value a disciplined organisation cultureculture that promotes loyalty, trust, accountability and collaborative effort to mutual benefit, with employees who seek to contribute to the pursuit of NHLS’s purpose

We endeavour to maintain exceptional standards and improve our offering through continuous learning continuous learning and innovation appropriate to our environment

We strive to contribute to and make a difference make a difference to the Communities in which we live and work, ultimately influencing the improvement in our Nation’s health

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For the first time in NHLS history, Key Stakeholders were invited to engage in a national Strategic discussion to provide insight and guide the strategic thrust of the next 5 year period.

The following documents were used to inform the strategic discussion: The Maputo Declaration on the Strengthening of Laboratory Systems, WHO, 2008 Government’s Programme of Action 2009 – Human Development Cluster: Health NDOH 10 point plan NHLS Strategy 2007-2010 (February 2009 Review) NHLS Annual Report 2008/2009

Invitees included*: Key Customers on Service Delivery: DDG: Strategic Health Programmes, CD:

Communicable Disease, CD: Non-Communicable Diseases (from National Department of Health), all 9 Provincial Heads of Health,

Key Stakeholders in Research and Teaching: Department Science and Technology, all 9 Deans of University Faculties of Health Sciences, all 9 Heads of Schools of Pathology (or equivalent), Key representatives from Universities of Technology

Internal Stakeholders: Chairpersons of NHLS Board and its Subcommittees, in addition to the NHLS Executive Management Team

STAKEHOLDER INPUTSTAKEHOLDER INPUT

STRATEGIC DIALOGUESTRATEGIC DIALOGUE

*Full list of Attendees, and their Strategic Input (in the form of Powerpoint presentations) are attached as Appendices 5

Where we’ve come from......Where we’re going to

DIRECTION OF TRAVEL....DIRECTION OF TRAVEL....


Phase 1: Phase 1: 2001 – 20052001 – 2005

AmalgamationAmalgamation& Formation& Formation

Phase 2: Phase 2: 2005 – 20102005 – 2010Financial & Financial & Operational Operational

StabilityStability

Phase 3: Phase 3: 2010 – 20152010 – 2015

Customer Focus & Customer Focus & AffordabilityAffordability

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Strategic Issues related to SERVICE DELIVERY:SERVICE DELIVERY:

The NHLS and the DOH need to weigh up the affordability of the current fee-for-service model, which results in invoices that exceed DOH’s budget, against the cost of accessibility of NHLS services, particularly in relation to the expectation by the DOH that laboratories be available at the most local level.

The NHLS must seek clarity on who is/should be responsible for containing DOH costs through “gate-keeping” the volumes & types of tests requested in relation to the established guidelines.

The NHLS must establish a costing model and correlate this to its key cost drivers, namely: Human Resources, Technology and Physical Infrastructure (whilst maintaining Quality Assurance).

The NHLS must establish a funding model that will generate a meaningful tariff. The options to weigh up are the current fee-for-service model, Lump Sum estimates, Conditional Grant, or combination.

Given the recent Strategic Alignment of NHLS with Government’s Programme of Action, especially the Accelerated Programme for Development, the NHLS must ensure its capacity in terms of Human Resources, Technology and Infrastructure, to respond to help address the emerging Burden of Disease.

The NHLS realises that it is under-utilising its vast potential to provide Information to DOH which should assist with decision-making that informs policy and practice. The potential is currently diminished by the lack of a unique patient identifier, as well as a common IT platform within DOH , & between DOH & NHLS.

The lack of an over-arching framework – such as a National Policy for Laboratory Services – to inform Guidelines (e.g. Point Of Care Testing), Quality Assurance, Training, Monitoring & Evaluation is not ideal and must be addressed.

KEY STRATEGIC ISSUES IDENTIFIED KEY STRATEGIC ISSUES IDENTIFIED


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Strategic Issues related to OPERATIONAL PROCESSESOPERATIONAL PROCESSES:

Skills shortages and the inequitable geographic distribution of talent is a major challenge. In fact the NHLS has an absolute shortage in four key professional groupings which demand long lead times to fill. The NHLS should consider the option of training mid-level laboratory workers to fill the gap.

The NHLS must investigate the cost-benefit of in-sourcing key Auxillary Services which have a massive impact on service delivery - e.g. Transport & Logistics, and Health Care Waste Removal – against the current option of outsourcing alone.

The NHLS must drive Standardisation of Technology to reduce cost and wastage, and improve quality.

Customer-related concerns such as the following must be addressed:1. Turn Around Time (TAT) issues such as the inability to measure & account for Total TAT, as well as key priorities e.g. TB Culture2. The DOH’s need to eliminate duplicate test requests3. Interpretation Issues w.r.t. Billing, Programme Data and Customer Satisfaction Survey results : confusion with regards to non-coterminous boundaries between NHLS Branches and Provinces, and between Business Units and Districts3. Training required on Thusano and wwwDisa4. Training required on clinical specimen collection (e.g. dry spot collection) and request form completion)5. Poor Communication between Stakeholders contributes to unmet expectations.6. Space requirements of NHLS that are not met by DOH compromise the ability to get the job done, and to meet expectations. 7. The NHLS should consider Task-shifting, such as Phlebotomists at high volume hospital

The NHLS has major Cash Flow challenges due to significant outstanding debtors. The users’ poor awareness of NHLS, lack of single identity and poor customer perceptions

does not bode well for the organisation. Poor Staff morale and entropic organisational culture compromise stability and skills

retention.

KEY STRATEGIC ISSUES IDENTIFIED KEY STRATEGIC ISSUES IDENTIFIED


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Strategic Issues related to RESEARCH & DEVELOPMENTRESEARCH & DEVELOPMENT:

This was a previously under-emphasised mandate within NHLS, whereas it is a Cabinet imperative, which has resulted in a missed opportunity for synergy around a National perspective vs. individual University perspectives alone. This must be rectified.

Under-collaboration with the Department of Science and Technology has been a missed potential opportunity.

The Funding Model for research, which currently entails cross-subsidisation from Service Income and externally-funded Grants, must be interrogated. NHLS needs to even consider shifting to a Conditional Grant model or investigate other alternatives. Currently research is an “unfunded mandate” with the resultant impact being poor retention ability of talented & skilled researchers.

The challenge between alignment with National Research Priorities against funder interests & expectations, and even against individual researcher interests, may limit opportunity for “leap-frog” innovation if the NHLS introduces a complete limitation on “blue-sky” research.

Research should be translational i.e. lead to and/or impact changes to policy and practice.

The footprints of the National Institutes for Communicable Diseases and Occupational Health (NICD & NIOH) are too localised, and the NHLS must aim towards extending these nationally.

KEY ISSUES IDENTIFIEDKEY ISSUES IDENTIFIED


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Strategic Issues related to TEACHING & HUMAN RESOURCE PIPELINETEACHING & HUMAN RESOURCE PIPELINE:

Unlike the DOH, the NHLS does not have a 10-year Human Resource Plan for its Core Professionals of Pathologists, Scientists, Medical Technologists and Technicians.

The NHLS is not fully leveraging its relationships with Universities & the Universities of Technology to ensure the sustainability of laboratory services.

The NHLS must recognise that the role of academic institutions is far greater than merely teaching & research; it includes Academic Leadership to optimise technology.

Recruitment for the four core professionals is very difficult. The failure rates of Medical Technologists is concerning; especially with reduced capacity in

NHLS to supervise students. With the reduction in applications into Clinical Pathology as a discipline, academic

institutions are questioning the profitability of providing this specialisation. The NHLS must consider the potential implications should universities decide to cease teaching Clinical Pathology.

The NHLS should consider playing a greater role in undergraduate teaching, thereby also improving current diluted exposure & education in pathology. In addition, the NHLS needs to clarify its teaching role at the Universities of Technology.

There are opportunities for partnering with academic institutions to extend teaching into Africa.

There is a challenge with finding the balance for professional workforce between service : teaching : research

Opportunities for New Professionals exist, e.g. BTech; but experience with conversion courses is problematic.

The current Funding model – which entails Cross-subsidisation from Service Income – needs to be interrogated and perhaps even consider shifting to a Conditional Grant or other alternatives.

KEY ISSUES IDENTIFIEDKEY ISSUES IDENTIFIED


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CONVERT TO STRATEGIC THEMES TO SHAPE STRATEGY CONVERT TO STRATEGIC THEMES TO SHAPE STRATEGY 2010-20152010-2015

STRATEGIC DILEMMASSTRATEGIC DILEMMAS

•↓Costs to Customer (but maintain QA)

•FFS vs. Fixed Fee vs. Conditional Grant ?

•Other Revenue opportunities?

•Cost Drivers - HR, Technology, Infrastructure

•↓Cost-Subsidisation – Teaching & Research

•Provider of Choice vs. Mandatory Provider

•Alone vs. Joint-Venture with Private Sector

•Cross-Subsidisation vs. Conditional Grant vs. other Revenue Generation opportunities

•On-site Lab access vs. On-site Test access?

•Capacity & capability to respond to massive increases in Programmes?

•Out-sourcing vs. In-sourcing?

Strategic DilemmasStrategic Dilemmas

1.Service Delivery Model

2.Service Funding Model

4.Teaching & Research Role& Funding Model

3.Positioning NHLS for NHI

5. Using & Managing Information

8.Technology& Innovation

6.Advocacy & Policy Input7.Stakeholder Collaboration& Partnerships

•Access to data – who owns the data?

•Adding value: Routine vs. Ad hoc reporting vs. Analytical capability - translating data into information

•National resources: Biorepository, Archives

•Translating information into knowledge

•Advocating change in policy &/or practice

•Actively manage vs. reactive

•Partnerships & Collaboration at organisation vs. individual level

•Advanced vs. Appropriate?

•Capacity & capability to respond to massive increases in Programmes?

•Smaller numbers, high volume analysers vs. higher numbers, smaller volumes?

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Current Service Delivery Model: Extended “footprint” of numerous physical laboratories country-wide close to

peripheryHowever, challenges are:

Potentially inefficient test repertoires Costly to run Difficult to staff with Skills shortage Difficult to upscale capacity rapidly

Potential options for the service delivery model Large capacity laboratories with less diverse “footprint”, equipped with bulk

analysers and ramped-up logistics to ensure acceptable TAT standards Hybrid model as a combination of smaller “footprint” and Point-of-Care-Testing

(POCT)However: Is a hybrid model that involves POCT sites which are not managed by a nurse, but by a travelling lab technologist in areas where there is no high throughput possible and financially feasible?

Should the role of the NHLS, NICD particularly, be expanded beyond surveillance alone to that of support to all DOH services?

1. SERVICE DELIVERY MODEL 1. SERVICE DELIVERY MODEL

STRATEGIC DILEMMAS FOR THE NHLSSTRATEGIC DILEMMAS FOR THE NHLS

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Current Service Funding Model:

Fee-for-Service with Cross-subsidisation of Teaching & Research Mandates

However, challenges are:

Unaffordable for Provinces

Does not encourage Efficiency and Waste reduction (for customer or NHLS)

NHLS should investigate and pursue alternative Funding model options

such as:

Conditional grant funding for Research & Teaching + FFS without cross-

subsidisation

Fixed Costs, trading volume for margin

Increasing surveillance grants

Other revenue generation opportunities

Key Cost Drivers are Human Resources, Technology, Infrastructure

Explore the modification of Service grant reporting to reflect Income vs. Outputs

The NHLS must convince the DOH about the additional value that it provides for the

cost of “lab services”

2. SERVICE FUNDING MODEL 2. SERVICE FUNDING MODEL


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The NHLS must maintain competitiveness in an NHI environment Price will be an issue – particularly in a climate where new entrants

could partner with Indian companies. Thus NHLS should:

Explore Optimising partnerships for logistics to bring down costs Explore Partnering with new entrants through a JV system Leverage on current standing - as service provider (with extended test

repertoire), training next generation and conducting research. Improve billing, systems, etc, as this will be even more pertinent than currently. Improve & upscale skills and technical capacity Remain alert to the potential risks (losing public sector work) vs. potential return

(gaining additional private sector work)

Worst case scenario: The NHLS will have to BID to be the preferred provider – the NHLS Act is unlikely to be “protective”.

The NHLS must get involved on technical committee to be set up by the Minister to understand and influence policy formulation.

3. POSITIONING FOR NHI3. POSITIONING FOR NHI


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Current Teaching & Research Funding Model: Cross-subsidisation of Teaching & Research Mandates from Fee-for-Service Tariffs

NHLS should investigate and pursue alternative Funding model options for its Teaching Mandate Note: NHLS not registered as a higher education institution.

NHLS must gain understanding of the implications of a Conditional Grant vs. Fee-for-service on:

budgeting the NHLS’ ability to deliver on the mandates of training and research sustainably ability to attract and retain cutting edge talent

Risk with Conditional Grant: NHLS could eventually viewed as merely “a laboratory service” from which to cherry-pick, and lose the ability to attract core professionals, such as Pathologists and Medical technologists to be the best in the world. Important to keep the currently structured NHLS intact – such as the HPA model.

The NHLS should:

Explore internal mechanism to create teaching platform budgeting mechanism. In reporting, reflect ‘service’ provided by NICD & NIOH against grant by NDoH. Explore additional grant / bridging finance for research to ensure continuity of research/

innovation and fulltime employment of scientists beyond the lifespan of funded Grant. Leverage convening power of NHLS to engage with other agencies/departments.

4. MODEL FOR TEACHING AND RESEARCH4. MODEL FOR TEACHING AND RESEARCH

STRATEGIC DILEMMAS FOR THE NHLS STRATEGIC DILEMMAS FOR THE NHLS

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The NHLS must provide Enabling Health Information

The NHLS must develop and expand the immense value of the extensive Health data (for which its acts as Custodian) into useful Information, through: Developing Stakeholder Accessibility to NHLS Information

Systems Thereby enabling improved Monitoring & Evaluation of

passive surveillance programs & NCR Improving Stakeholder Information Accessibility to Active

Surveillance Programs Improving Stakeholder Information Accessibility to

utilisation trends to enable effective management

5. USING & MANAGING INFORMATION5. USING & MANAGING INFORMATION


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6. ADVOCACY & POLICY FORMULATION6. ADVOCACY & POLICY FORMULATION


Key value-add of NHLS: Translating information into knowledge

(adding expert analysis and interpretation)

NHLS needs to take this step further: Advocating change in policy &/or practice

Key Policy initiatives to engage in and drive:1. National Laboratory Policy

• NHLS to take lead in driving this crucial process2. Point Of Care (POC) Testing

• Requires extensive discussion and investigation• Clarity required as to interpretation of POCT (5000 clinics or 265 labs?).• NHLS should conduct internal analysis to determine feasibility and value-

add to health delivery of POCT; however, POC is not an alternative to a centralised service.

• Also important to investigate consequences of POCT on teaching and research

• NHLS must take the lead in informing policy around the issue of POCT.• NHLS must deal with misperceptions around POC. • Current reality: International agencies are pushing POCT and the

Department of Science and Technology (DST) is informing NDOH that it can work. Should NHLS disagree , must be able to show empirical evidence that POCT not viable option.

3. Gate-keeping / monitoring use of tests Should the NHLS be the “gate-keeper” for the DoH in terms of declining

test requests to limit over-utilisation or over-servicing? Or should NHLS rather provide protocols and formularies, as well as

provide management information to empower hospitals to deal with “guilty doctors” who over-utilise.

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Given that there are many more stakeholders in health than NDOH, the NHLS should endevour to ensure synergy of efforts and elimination of duplication & overlap in funding and service & research efforts

NHLS therefore needs to engage the following stakeholders: Public Sector: DST, DTI, DOE, DOL, DPSA, Dept Public

Enterprises, Treasury Private Sector: other Pathology providers, suppliers, logistics &

supply chain management International: WHO, ILO, etc

The NHLS must actively manage vs. reactively respond to these stakeholder relationships, given that NHLS has significant convening power.

NHLS must ensure that partnerships and collaboration occurs at an organisational vs. individual level, so as to live beyond the individual.

Every overseas visit should be seen as networking and exploratory collaborative opportunity

7. STAKEHOLDER MANAGEMENT & PARTNERSHIPS7. STAKEHOLDER MANAGEMENT & PARTNERSHIPS


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NHLS must ensure Technology is appropriate yet innovative

The NHLS must find the balance between acquiring and utilising highly Advanced “cutting-edge” technology” vs. technology appropriate to resource-limited settings NHLS must balance the needs and the consequences of affordability vs.

future opportunity and possible “leap-frog” innovation created through “cutting-edge” research and retention of committed skilled professionals

The NHLS must ensure technological capacity & capability to respond to massive and rapid upscaling in Priority Health Programmes, as well as consequent large and rapid downscaling with policy changes

NHLS must ensure technology is appropriate to the Service Delivery Framework, Platform and Model, such as: Smaller numbers of high volume analysers for extended “footprint” of

testsvs. larger numbers of small volume analysers for extended “footprint” of labs

NHLS must explore other Innovative ways to deliver Laboratory services in resource-limited settings, and in in remote settings.

8. TECHNOLOGY & INNOVATION8. TECHNOLOGY & INNOVATION


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The NHLS will be:The NHLS will be: ““Household” name in health – with a SINGLE identityHousehold” name in health – with a SINGLE identity Laboratory services provider of choiceLaboratory services provider of choice

Provider of Quality and cost-efficient services through Lab standardisation

African leader in laboratory servicesAfrican leader in laboratory services The provider of WHO African surveillance Primary reference point for promoting worker health sub-Saharan

Africa SA health information powerhouseSA health information powerhouse A key player in Health Policy formulationA key player in Health Policy formulation Top employer of real talent – Laboratory services “employer of Top employer of real talent – Laboratory services “employer of

choice”choice” Protector of our environmentProtector of our environment through Resource and Energy efficiency

THE DESTINATION…2015THE DESTINATION…2015

5-YEAR STRATEGIC DREAM5-YEAR STRATEGIC DREAM

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JOURNEY TO THE DESTINATION…JOURNEY TO THE DESTINATION…

5-YEAR STRATEGIC DREAM5-YEAR STRATEGIC DREAM

20112011

20122012

20132013

20142014

20152015

2014:•Informing Policy & Advocating Change in Practice•Fully automated central labs per NHLS region•NHLS full accountability to pre- and post-analytical processes•Quality affordable service

2013:•Footprint in SADC•Knowledge management institutionalised

•2012: POC policy / approach implemented•Alignment of technology with current/future needs•National network of surveillance labs•Streamlined Supply Chain Management

2011:•Finalised Funding & Costing models•Streamlined business disciplines to appropriate sites•Engage strategic partners•10 yr HR plan operational•Gear up for NHI•Universal Health Information Access to Provinces•Universal Web access to lab results by Clinicians

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1. Deliver affordable service to Public Sectora) Find alternative Funding models for Research & Teaching b) Determine Transparent pricing modelc) Ensure guaranteed Funding for Surveillance Services – NICD + NIOHd) Explore other Revenue-generating opportunities

2. Determine “best-fit” Service Delivery Modela) Ensure Capability & Capacity to rapidly upscale for Health Priority programmes – HIV/AIDS, STI’s, TBb) Choose and implement On-site Laboratory Access (with tiered laboratory model) vs. on-site Test Access

(with tiered test repertoire supported by massive logistics platform)c) Determine Point-of-Care Testing Policy and Implementationd) Determine most appropriate standardised technology – automated, centralised vs. decentralisede) Fulfill Statutory Functions – NIOH, NICD, NCR, expanded to include Forensic Toxicology

3. Deliver Quality, Customer-focused Servicea) Improve Customer perceptions of service delivery to the bench-mark score of 75%b) Ensure retention of international quality standards to ISO 15189

Accredit ALL reference, academic and regional labs with SANAS Develop and maintain internal accreditation system for peripheral labs in line with ISO 15189 Expand accredited EQA programmes throughout Africa

4. Align Resources, Support Services & Infrastructural Development for Service Deliverya) Implement the 10-year Human Resource Pipeline Plan

Partner with Academic Institutions to align teaching and training of core professionals for fulfilment of planned pipeline

Investigate mid-level workersb) Implement the 10-year Infrastructural Planc) Enhance Supply Chain Managementd) Align ICT systems to optimise service delivery

Rollout LIS country-widee) Develop and utilise Health Technology Assessment Unit

5. Become Laboratory Services “Employer of Choice” vs. “Employer of last resort”a) Recruit & retain key talent – both in core professional groups, as well as support servicesb) Strengthen leadership & management capacity – implement NHLS Leadership Academyc) Drive disciplined, accountable, collaborative, purpose-filled Organisational Culture

10-POINT PLAN10-POINT PLAN

5-YEAR STRATEGIC DRIVERS5-YEAR STRATEGIC DRIVERS

NDOH Point 2.3 NDOH Point 2.3 Improving Quality of Improving Quality of Health ServicesHealth Services

NDOH Point 2.5 NDOH Point 2.5 Improved HR Improved HR Planning, Devt and Planning, Devt and ManagementManagementNDOH Point 2.4 NDOH Point 2.4 Overhauling Health Overhauling Health Care System & Care System & Improve its Improve its ManagementManagement

NDOH Point 2.6 NDOH Point 2.6 Revitalisation of Revitalisation of InfrastructureInfrastructure

NDOH Point 2.7 NDOH Point 2.7 Accelerate Accelerate implementation of implementation of HIV/AIDS & STI’s, & HIV/AIDS & STI’s, & increase focus on TBincrease focus on TB

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6. Position NHLS as the Provider of Choice for NHIa) Investigate Joint-Ventures with other providers / suppliersb) Deliver Quality, Customer-focused Service to build credibility and Trust in NHLS

7. Prioritise Innovation & Researcha) Develop new diagnostic tools applicable to resource-limited settingsb) Encourage research into solutions (applicable to resource-limited settings) for priority

diseasesc) Innovate in systems and processes to improve laboratory and health service delivery

8. Become the Health Information Powerhousea) Safeguard national assets

Establish Biorepository – specimens for teaching & research Build Institutional Archives – recording pioneering ventures & historical “firsts”, retaining

knowledge capital for posterityb) Expand monitoring & evaluation of programme & health outcomes beyond Surveillancec) Avail Health System Information to decision-makers (using coterminous health

boundaries)d) Provide information to manage the organisation & promote Accountability culturee) Convert information to knowledge to advocate Policy and change Practice9. Drive Stakeholder Collaborationa) Ensure integrated and unified plans of action amongst cross-sector stakeholders

To manage priority diseases To improve worker health To strengthen Health system delivery

10. Protect our Community & Environment a) Become energy & resource efficientb) Dispose waste and assets in environmentally-friendly mannerc) Strive for paperless organisation

10-POINT PLAN10-POINT PLAN

5-YEAR STRATEGIC DRIVERS5-YEAR STRATEGIC DRIVERS

NDOH Point 2.3 Improving Quality of NDOH Point 2.3 Improving Quality of Health ServicesHealth Services

NDOH Point 2.2 Implementation of NHINDOH Point 2.2 Implementation of NHI

NDOH Point 2.10 Strengthen Research & NDOH Point 2.10 Strengthen Research & DevelopmentDevelopment

NDOH Point 2.1 NDOH Point 2.1 Creation of Social Creation of Social Compact for better Compact for better health outcomeshealth outcomes

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STRATEGIC STRATEGIC DRIVERDRIVER(KEY FOCUS AREA)(KEY FOCUS AREA)

MEASURABLEMEASURABLE(KEY PERFORMANCE INDICATOR)(KEY PERFORMANCE INDICATOR)

TARGETTARGET TIME TIME PERIODPERIOD

Affordable Laboratory Services

1. % Price per test reduction

2. Reduce Debtors days to ensure Cash Flow

3. Costing model for Service, Teaching & Research + Options Appraisal for Alternative Funding finalised

1. 1% per annum

2. 45 days

3. Costing Model established, Options Appraisal finalised, Agreed with NDOH

1. 2011-2013

2. 2011-2015

3. 2010-2011

Reformed modernized“Best-Fit” Service Delivery model

1. Accelerate expansion of TB & HIV/AIDS Lab support services

2. Point of Care Testing Policy finalised

3. Standardised Laboratory Technology framework + Plan + platform finalised

4. Tiered Laboratory Service delivery model agreed with NDOH & implementation plan finalised

1. Line Probe/TB Microscopy Sites/CD4/Viral Load Lab plan implemented

2. Policy finalised & agreed with NDOH

3. Plan finalised & implementation

4. Model Agreed & Implementation plan finalised

1. 2010-2013

2. 2010-2011

3. 2010-2011

4. 2010-2011

Deliver Quality, Timely Accessible and Customer -focused services

1. TAT ( Focus on priority programs for Analytical stages – CD4/VL/PCR/TB Microscopy)

2. Improved Customer Satisfaction Index from 2009 Baseline of 54%

3. Academic and Regional laboratories Accredited

1. CD4 (72hrs), VL (4 days), PCR (5days), TB (48hrs)

2. 10% improvement yr-on-yr until 80% target reached, then maintain 80%

3. All academic & regional labs

1. 2010-2012

2. 2010-2015

3. 2015

STRATEGIC OBJECTIVESSTRATEGIC OBJECTIVES

5-YEAR STRATEGIC DELIVERABLES5-YEAR STRATEGIC DELIVERABLES

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Align resources with strategic service delivery priorities

1. 10 Year Master HR Plan implemented (including teaching and training of Core Professionals)

2. 10 year Infrastructure Plan implemented

3. Efficient Inventory, Logistics & Supply Chain management plan

4. Improve efficiencies and access to lab results to optimize service delivery by rolling out centralized LIS to remaining Regions

1. Plan implemented

2. Plan implemented

3. Plan implemented

4. All regions covered

1. 2010- 2011

2. 2010- 2011

3. 2012-2013

4. 2011-2013

Become “Employer of Choice”

1. Recruitment & Retention strategy

2. Management and leadership development programs developed & implemented

3. Continuing Professional Development Strategy

4. Succession plan developed & implemented

5. Improved staff morale – Employee Satisfaction Index

6. Improved productivity – Workload model to be determined and improvement demonstrated

1. Strategy implemented

2. Programs implemented

3. Strategy implemented

4. Plan implemented

5. Index improved 5% from baseline

6. Tests/HC improvement to Norm

1. 2010-2011

2. 2010-2013

3. 2010-2012

4. 2010-2011

5. 2010-2011

6. 2011-2015

Position NHLS as Provider of Choice for NHI

1. Develop Position Document for NHI

2. Enable integration with NDOH e-Health Strategy, Electronic Health Record (EHR) and NHI

1. Position Doc developed

2. Integration enabled

1. 2010-2011

2. 2015



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Promote Innovation, Research

1. National Research Committee/Agenda commissioned

2. Research studies & Peer reviewed publications aligned with National Research Priorities

3. Enhanced Research grants funding

1. Committee established & Agenda finalised

2. 90% alignment

3. Additional NHLS “bridging” Funding of R10M

1. 2010-2011

2. 2010-2013

3. 2010-2012

Provide Enabling Health Information & Develop Policy

1. Develop stakeholder accessibility to NHLS Information Systems to enable monitoring and evaluation with regards to passive surveillance, Priority Programs and National Cancer Registry

2. Improve stakeholder information accessibility to active surveillance programmes

3. Using Information , develop policies, protocols and guidelines

1. Information Management Unit commissioned & functioning

2. As above

3. As above

1. 2010-2011

2. 2010-2011

3. 2010-2015

Drive Stakeholder Collaboration

1. Develop and implement Structure for Intersectoral Collaboration, including framework for alignment of Priorities

1. Structure & Framework developed and implemented

1. 2010-2011

Protect and ensure sustainability of our Community and Environment

1. Environmentally-sustainable disposal of Biomedical, electronic & laboratory equipment Waste

2. Implement recycling of materials, including paper, plastic and glass at every NHLS site

3. Implement Energy and Utility Savings in the operations of current and design of new facilities & services

1. Plan Developed & Implemented



1. 2010-2012

2. 2010-2012

3. 2010-2013



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BSCBSCPERSPECTIPERSPECTIVEVE

STRATEGIC STRATEGIC DRIVERDRIVER(KEY FOCUS (KEY FOCUS AREA)AREA)

MEASURABLEMEASURABLE(KEY PERFORMANCE (KEY PERFORMANCE INDICATOR)INDICATOR)

TARGETTARGETSTRETCHSTRETCHTARGETTARGET

Customer Value (Service Delivery)


Reduce Price per test for HIV/AIDS & TB 5% reduction 10% reduction

"Best Fit" Service Delivery Model

Finalise Laboratory Service Delivery Framework & Platform

Framework & Platform finalised

Implementation Plan finalised

Finalise Point-of-Care Testing Policy Policy finalised Implementation Plan finalised

Deliver Quality, Timely Accessible & Customer-

focused Services

Decrease TAT TB Microscopy (clinic-to-clinic) 85% within 48 hours 85% within 46 hours

Decrease TAT CD4 (clinic-to-clinic) 95% within 72 hours 95% within 48 hours

Decrease TAT Viral Load (clinic-to-clinic) 80% within 4 days 85% within 4 days

Decrease TAT HIV PCR (clinic-to-clinic) 80% within 5 days 85% within 5 days

Decrease TAT Cervical Smears 80% within 2 weeks 80% within 2 weeks

Improve Customer Satisfaction Index from 2009 baseline of 54%

Improve CSI score by 7.5% from baseline

Improve CSI score by 10% from baseline

Drive Stakeholder Collaboration

Develop Structure for intersectoral collaboration, including framework for aligning priorites

Structure & Framework developed

Structure & Framework implemented –

first meeting held

BALANCED SCORE-CARDBALANCED SCORE-CARD


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Customer Value (Service Delivery)

Promote Innovation & Research

Commission National Research Committee & Agenda

Committee established & Research Agenda

finalised

Research Agenda established with Action

Plan

Provide Enabling Health Information & Develop Policy

Develop Stakeholder accessibility to information through Information Management Unit (IMU)

Develop list and reporting framework (routine & ad hoc) for

Management Information to Stakeholders

Develop list and reporting framework (routine & ad hoc) for

Management Information to Stakeholders

30%

Operational Efficiency (Internal

Operations)

Align Resources with Strategic Service Delivery Priorities

Determine & Implement Standardised Laboratory Technology Framework, Plan and Platform

Framework developed by June 2010 & Plan

implemented

Framework developed by June 2010 & Plan

implemented

Determine & Implement 10 year Infrastructure Plan

Situation Analysis complete and

Infrastructure Plan developed (aligned with

DOH)

Situation Analysis complete and

Infrastructure Plan developed (aligned with

DOH)Review TrakCare Lab LIS Rollout Implementation Plan (aligned to Service Delivery Framework & Platform) & Implement Current Year

Reviewed Plan finalised & Implement for Current

Year Plan

Reviewed Plan finalised & Implement for Current

Year Plan

Deliver Quality, Timely Accessible & Customer-

focused Services

Increase % of Academic & Regional Labs accredited

100% of scheduled1 more lab than

scheduled

25%



27





People Value (Learning and

Growth)

Become "Employer of Choice"

Implement 10 year Human Resources Plan -including teaching & training of Core Professionals (aligned to Service Delivery Framework & Platform)

Situation Analysis complete and HR Plan developed (aligned to

Service Delivery Framework & Platform)

Situation Analysis complete and HR Plan developed (aligned to

Service Delivery Framework & Platform)

Finalise & Implement Recruitment & Retention Strategy

Turnover rate of Health Professionals decreased by 0.5%

Turnover rate of Health Professionals decreased by 0.5%

Develop & Implement Management & Leadership Development Programmes

Yr 1 Plan Implemented Yr 1 Plan Implemented

Develop Succession Plan (aligned with Structure)

Plan developed & approved by Board

Plan developed & approved by Board

Improve Staff MoraleImprove ESS by 5% from baseline

Improve ESS by 7.5% from baseline

30%

Financial Efficiency & Sustainability


Ensure Cash Cover of 4 months of Operational Expenditure

Cash on hand/Average budgeted monthly Expenditure=1.9

Cash on hand/Average budgeted monthly Expenditure=2.4

Reduce Debtors Days to ensure Cash Flow

90

85

15%

100%



28

2010-11 BUDGET HIGHLIGHTS2010-11 BUDGET HIGHLIGHTS

www.nhls.ac.za

Slide 35

Financial Objectives:1. Reduce HIV and TB tests by an average of 10%2. Generate adequate cashflow R30m - R50m

Cost and Volume assumptionsRefer to following slide.

Critical dependency in achieving financial objectivesIn order to achieve the financial objectives set out above, it is imperative that KZN moves from a cost recovery billing model to a Fee for Service model from 1 April 2010.

RecommendationASSUMING that KZN Fee for Service commences 1 April 2010,the following price changes are recommended to achieve a 1.2% overall effectiveprice reduction over all tests.1. HIV + TB --> 10% price reduction2. Other tests --> 1% price increase

This would generate the following:- Accounting Surplus --> R114m- Cash --> R30m

2010-11 BUDGET ASSUMPTIONS2010-11 BUDGET ASSUMPTIONSwww.nhls.ac.za

Slide 36

BUDGET COST + VOLUME ASSUMPTIONSInflation - Materials 7%Inflation - Labour & Overheads 9% Volume Increase - CD4 -25%Volume Increase - Viral Load -15%Volume Increase - Other Priority Tests 10%Volume Increase - Other Tests 6%Volume Increase - Overall 4.1% Capital Expenditure R 365m PRICING ASSUMPTIONS Suggested Average Price Change - HIV + TB -10.0%Suggested Price Change - Other 1.0%Suggested Overall Effective Price Change -1.2%

BUDGET 2010 - 2011BUDGET 2010 - 2011www.nhls.ac.za

Slide 37

INCOME STATEMENT + CASHFLOW 2009-2010 2010-2011

FORECAST BUDGET VARIANCE

R'000 R'000 R'000 %

Revenue 3,035 3,496 461 15%

Cost Sales (2,157) (2,329) (172) 8%

Gross Surplus 878 1,167 289 33%

Other Income 259 106 (153) -59%

Operating Expenses (924) (1,159) (235) 25%

SURPLUS for the year 213 114 (99) -46%

Non cash items 136 90 55 40%

Working Capital Decrease(Increase) (45) 191 (320) 711%

Capital Expenditure (184) (365) (181) 98%

NET CASH SURPLUS for the year 120 30 (90) -75%

CONCLUSIONCONCLUSION

Our appreciation to the honourable Chair and members for this opportunity.

Questions

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STRATEGY 2010 - 2015 Presentation to the Health Portfolio Committee Sagie Pillay CEO May 5, 2010.

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