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The National Health Care Facilities Baseline Audit National Summary Report

2012

HEALTHSYSTEMST R U S T

National Health Care Facilities

Baseline Audit

National Summary Report

34 Essex Terrace

Westville

3630

South Africa

Tel: +27 (0)31 266 9090

Fax: +27 (0)31 266 9199

Email: [email protected]

http://www.hst.org.za

September 2012Revised February 2013

HEALTHSYSTEMST R U S T

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ACKNOWLEDGEMENTS

An audit of the entire spectrum of the public health sector’s health facilities is a massive undertaking and the Health Systems Trust extends its sincere appreciation to all who contributed to this project.

FuNDEr

National Department of Health

with particular appreciation extended to:

the Director-General of Health, Ms Precious Malebona Matsoso, for her unending support; the National Steering Committee, chaired by Dr Yogan Pillay, and members of the committee; and the Provincial Steering Committees and Provincial Focal Persons for facilitating audit processes within the provinces.

PArTNErS

Project Consortium partners include: Exponant, Health Information Systems Programme, ARUP and the South African Medical Research Council

rEPOrT COMPiLED By:

Ms Ronel Visser, HST (Overall Project Leadership)

Ms Rakshika Bhana, HST

Ms Fiorenza Monticelli, HST

Contributors:

Ms Emmanuelle Daviaud, MRC

Dr Natalie Leon, MRC

Dr Annette Gerritsen, Epi Result

Mr Jaco Venter, HISP

PrOjECT TECHNiCAL SuPPOrT: (iN AlpHABeticAl oRdeR)

Ms Rakshika Bhana, HST

Ms Emmanuelle Daviaud, MRC

Ms Candy Day, HST

Mr Joseph de Klerk, Exponant

Mr Philip de Wet, Exponant

Dr René English, HST

Mr Stefan Ferreria, ARUP

Mr Deena Govender, HST

Ms Jeanette Hunter, HST

Dr Waasila Jassat, HST

Dr Natalie Leon, MRC

Ms Nandy Mothibe, HST

Mr Kevin Steins, ARUP


Ms Ronel Visser, HST

TOOL DESiGN

Office of Standards Compliance, NDoH

FiELDWOrK

Many individuals and teams have contributed both directly and indirectly to the audit processes. We would like to thank the Project Managers, audit team members, validation teams and data capturers.

(See Appendix A for a list of all audit team members.)

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DATA QuALiTy AND VALiDATiON

Ms Ronel Visser, HST


Mrs Margaret Loxton, HST

Mr Robert Morupane, HST

Ms Sunette Markus, HST

DATABASE DEVELOPMENT

Mr Ciaran Burnand, ASG Performance Solutions

Mr Werner Merbold, ASG Performance Solutions

Mr Michael Phillpotts, ASG Performance Solutions

COPy EDiTiNG:

Mr Ross Haynes, HST

Ms Ashnie Padarath, HST

COVEr DESiGN AND LAyOuT:

Ms Catherine Pagett, HST

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ABBrEViATiONS

AIDS Acquired Immune Deficiency Syndrome

CDC Community Day Centre

CHC Community Health Centre

CSSD Central Sterilisation Service Department

DHER District Health Expenditure Review

DHIS District Health Information System

DM District Municipality

EC Eastern Cape Province

FS Free State

FTE Full-time Equivalent

GP Gauteng Province

HCT HIV Counselling and Testing

HISP Health Information Systems Programme

HIV Human Immunodeficiency Virus

HR Human Resources

HST Health Systems Trust

ICU Intensive Care Unit

KZN KwaZulu-Natal Province

LM Local Municipality

LP Limpopo Province

MDG Millennium Development Goal

MOU Maternal Obstetrics Unit

MP Mpumalanga Province

MRC Medical Research Council

NC Northern Cape Province

NCCEMD National Committee for the Confidential Enquiries into Maternal Deaths

NCS National Core Standards

NDoH National Department of Health

NICU Neonatal Intensive Care Unit

NW North West

PEP Post-exposure Prophylaxis

PHC Primary Health Care

PN Professional Nurse

STI Sexually Transmitted Infections

TB Tuberculosis

TOP Termination of Pregnancy

WC Western Cape Province

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Table of ConTenTs

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abbReVIaTIons �� iii

lIsT of fIGURes �� vii

lIsT of Tables �� viii

eXeCUTIVe sUMMaRY �� ix

1� InTRoDUCTIon ��xi

2� baCKGRoUnD: soUTH afRICan HealTH ConTeXT �� 1

3� MeTHoDoloGY �� 3

3�1 aims and objectives ��3

3�2 Data Collection Tools ��3

3�3 Training and Data Collection ��3

3�4 Data Capture ��4

3�5 Data analysis ��4

3.6 Definition of Terms ��5

4� sUMMaRY of fInDInGs �� 7

4�1 facilities: Type and access ��7

4�2 outcome and Compliance ��9

4.2.1 Priority Areas for Quality Service ......................................................................................................................................9

4.2.2 Functional areas ................................................................................................................................................................17

4.3 Provision of Services ��20

4.3.1 Support Services ................................................................................................................................................................20

4.3.2 Clinical Services ................................................................................................................................................................21

4.3.3 Therapeutic Services ..........................................................................................................................................................22

4.3.4 Bulk Supplies .....................................................................................................................................................................23

4�4 Human Resources ��24

4.4.1 Primary Health Care facilities ...........................................................................................................................................24

4.4.2 Hospitals ............................................................................................................................................................................24

4�5 finances ��25

4.6 Infrastructure ��26

4�7 Health Technology ��29

4�8 Medicine supplies and Management ��30

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5� ReCoMMenDaTIons �� 33

5.1 Description of Facilities ��33

5�2 Priority areas: outcome and compliance ��33

5.3 Provision of services ��33

5�4 Human Resources ��33

5.5 Infrastructure ��33

5�6 Health Technology ��34

6� RefeRenCes �� 35

7� aPPenDICes �� 36

7.1 Appendix A: Names of Audit Team Members ��36

7�2 appendix b: national Health Care facilities baseline audit Tools ��37

7.3 Appendix C: Classification of Facilities – Categories of Facilities ��38

7.4 Appendix D: Facilities not Functioning by Classification Status ��40

7�5 appendix e: Vital and essential Measures by Priority area ��43

7�6 appendix f: facilities with no Water and electricity supply ��56

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LiST OF FiGurES

Figure 1: Access to public health facilities, 2011 ��8

Figure 2: Compliance score to the six priority areas on vital measures, 2011��9

Figure 3: Overall compliance score on vital measures in the six priority areas by province, 2011 ��10

Figure 4: Eastern Cape: Compliance score to the six priority areas on vital measures, 2011 ��10

Figure 5: Free State: Compliance score to the six priority areas on vital measures, 2011 ��11

Figure 6: Gauteng: Compliance score to the six priority areas on vital measures, 2011 ��11

Figure 7: KwaZulu-Natal: Compliance score to the six priority areas on vital measures, 2011 ��12

Figure 8: Limpopo: Compliance score to the six priority areas on vital measures, 2011 ��12

Figure 9: Mpumalanga: Compliance score to the six priority areas on vital measures, 2011 ��13

Figure 10: Northern Cape: Compliance score to the six priority areas on vital measures, 2011 ��13

Figure 11: North West: Compliance score to the six priority areas on vital measures, 2011 ��14

Figure 12: Western Cape: Compliance score to the six priority areas on vital measures, 2011 ��14

Figure 13: District ranking on vital measures in the six priority areas, 2011 ��15

Figure 14: Compliance to the six priority areas on vital measures for PHC and hospitals, 2011 ��16

Figure 15:Number of facilities compliant per priority area, 2011 ��16

Figure 16: Compliance in the functional areas on vital measures, 2011 ��17

Figure 17: Compliance to vital measures for clinical services, 2011 ��18

Figure 18: Compliance to vital measures for management, 2011 ��18

Figure 19: Compliance to vital measures for patient care, 2011 ��19

Figure 20: Compliance to vital measures for support services, 2011 ��19

Figure 21: Proportion of support services provision, off-site or on-site, 2011 ��20

Figure 22: Percentage own staff versus contracted staff, 2011 ��20

Figure 23: Average overall infrastructure scores by province, 2011 ��27

Figure 24: District ranking on infrastructure scores, 2011��28

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LIST OF TABLES

Table 1: Number of audited facilities, by facility classification, 2011 ��7

Table 2: Number of facilities not functioning as classified, 2011 ��8

Table 3: Assessment components per functional area, 2011 ��17

Table 4: PHC Clinical Services Audited. Out-patient, 2011 ��21

Table 5: Hospital Clinical Services Audited. In-patient, 2011 ��22

Table 6: Therapeutic services offered by PHC facilities, 2011 ��22

Table 7: Therapeutic services offered by hospitals, 2011 ��23

Table 8: Number of facilities with no bulk supply services at the time of audit, 2011 ��23

Table 9: Number of hospitals: Acute vs Specialised, 2011 ��24

Table 10: Percentage failure on measures for financial management - hospitals, 2011 ��25

Table 11: Average score per infrastructure assessment area – all facilities, 2011 ��26

Table 12: Average score per infrastructure assessment area – PHC, 2011 ��26

Table 13: Average score per infrastructure assessment area – hospitals, 2011 ��26

Table 14: Number of facilities with asbestos used as a building material, 2011 ��27

Table 15: Number of facilities with asbestos in between one and four of the building’s different structural components, 2011��27

Table 16: Percentage failure on vital measures for health technology – all facilities, 2011 ��29

Table 17: Percentage failure on vital measures for health technology – PHC facilities, 2011 ��29

Table 18: Percentage failure on vital measures for health technology – hospitals, 2011 ��30

Table 19: Percentage failure on vital measures for the availability of medicines and supplies – audited clinics, 2011 ��31

Table 20: Percentage failure on vital measures for the availability of medicines and supplies – audited CHCs, 2011 ��31

Table 21: Percentage failure on vital measures for the availability of medicines and supplies - hospitals, 2011��32

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EXECuTiVE SuMMAry

As in other countries, South Africa’s healthcare system comprises a network of health facilities providing primary health care, supported by several higher levels of care. Information on individual facilities allows analysis and reflec-tion on how the country’s health services inputs meet the population’s needs in terms of the type, quantity and qual-ity of the services. This information is essential to identify health system strengths and gaps, to assess current and future needs and for planning investments and future services such as the National Health Insurance.

From May 2011 to May 2012, with funding from the national Department of Health, an audit of every health facility in the public health sector was conducted by a consortium of partnersi. The audit assessed infrastructure, classifica-tion of facilities, compliance to priority areas of quality and function, human resources, access and range of services offered, and geographic positioning (GPS) for location of facilities and photographs. The overall objective of the audit was to collect baseline data from all public health facilities in the country using standardised and existing measure-ment tools provided by the national Department of Health. The data collected were captured into the National Core Standards database established by the national Department of Health.

Data collected from each of the facilities were aggregated to sub-district, district and national averages that are pre-sented by theme in a variety of dashboards and can be accessed centrally from the web-based reporting database. This national summary report provides a succinct and high level interpretation of the results and summary of the findings as at 29 August 2012. The full extent of results of the status of health facilities will only be seen when examining the data at lower levels such as at facility type, individual facility, sub-district and district level, or when individual priority and functional areas are unpacked at lower levels of aggregation. The baseline audit findings are presented according to the key audit outcome areas as determined by the national Department of Health’s National Core Standards. These findings can inform evidence-based objectives and plans towards scaling up national qual-ity improvement strategies. Cleaning and validation of the baseline data will continue for a time to ensure data of the highest quality and accuracy. Updating of the baseline data is essential to ensure that quality improvements are tracked and monitored over time.

KEy FiNDiNGS

Facility classification

The facility classification status of 80 health facilities (ranging across facility types and provinces) were found to be functioning differently from their classification status. Consistency between facility classifications and their actual functioning is necessary to allow health authorities to correctly monitor that the range and level of public health services provided meet the needs of the population. Useful documents in this classification process include the Government Gazette No. 35101 of 2 March 2012, Regulations Relating to Categories of Hospitalsii and the national Department of Health’s Facility Definitions, 2006.

Quality of services

Public health facilities in South Africa collectively scored less than 50% compliance with vital measures in two out of the six priority areas. These measures included: Patient safety and security (34%) and Positive and caring attitudes (30%). The priority area Waiting times scored the highest compliance to vital measures at 68%. Primary care facili-ties on average scored lower than hospitals in all priority areas. Overall, the facilities in Gauteng province obtained the highest compliance score on quality (69%) while the Northern Cape reflected the lowest (40%).

Functionality of services

In terms of performance in the five functional areas (Clinical Services, Infrastructure, Management, Patient Care, Support Services and Clinical Care), the compliance score obtained by the country’s facilities is the lowest for Clini-cal Services (38%). Within Clinical Services, the area of Health Technology recorded the lowest compliance for both PHC and hospital facilities followed by Pharmacy. This, and the low number of pharmacists working in public health facilities, needs urgent attention.

Range of services

Attention should be given to ensuring that all facilities provide a comprehensive range of services in the light of current and forthcoming priorities in PHC re-engineering. Dental services are lacking across the board at PHC level, an issue that needs to be addressed, as it is extremely costly for the patients to access these services through the private sector.

i Health Systems Trust, HISP, Exponant, MRC ARUP, National Department of Healthii Available from: http://www.doh.gov.za/docs/regulations/2012/regr185.pdf

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PHC facilities should offer more therapeutic services such as audiology, speech therapy and psychology as the major-ity of patients accessing these services are referred to a higher level of care. Of note, however, is that the provision of these services is also limited in hospitals.

The public health service provides a range of beds per clinical service to the population and whilst the audit has provided the numbers of beds available in each clinical area, further research is needed to analyse whether these numbers are appropriate with respect to the growing population and future needs. The national Department of Health should provide national norms to guide this analysis.

Certain services, including two which are highly crucial health support services - Emergency Medical Rescue Services and Laboratories, are inadequately covered in the audit tool provided by the national Department of Health and can therefore not be reported on regarding either scope of services or quality.

Human Resources

Human resources norms per type of facility are required from the national Department of Health to assist provinces, districts and facilities to assess recruitment priorities and to guide intra-facility deployment, thus moving closer to an optimal skills mix and equity in allocation of human resources.

The human resources audit tool and the method of information collection should be revisited in the light of lessons learnt during this facility audit. Separate tools should be developed for PHC facilities and hospitals. The practice of a self-completed questionnaire, filled in by the facility staff, should be reviewed to enhance data reliability. This is also relevant to other services assessed by means of a self-assessment questionnaire.

Physical infrastructure

Generally, management of the facility infrastructure requires attention, especially at PHC level. The quality of physi-cal infrastructure has a major impact on the functioning of services and clients’ satisfaction with services. Of the three infrastructures assessment areas, Facility Infrastructure Management needs the most improvement, especially at PHC level.

Prioritised attention should be given to those facilities without provision for water and electricity at the time of the audit. Many of these facilities are subject to intermittent interruption of these services, or seasonal interruptions where the water supply is dependent on rainfall.

Health technology

The availability of functional and essential medical technology equipment in maternity wards needs priority attention, especially considering the high maternal mortality rates in the country, the imperative of Millennium Development Goal #5 to improve maternal health and the findings of the recent National Committee for the Confidential Enquiries into Maternal Deaths report.1

Medicines and supplies management

Hospitals and PHC facilities throughout the country show a high percentage failure in compliance to the vital measure dealing with the availability of medicines as per the Essential Drug List. Drug supply chain management needs priority attention in the majority of facilities to improve the situation.

District performance

The facilities in JT Gaetsewe District Municipality, Northern Cape, obtained the lowest overall score in quality (31%) and infrastructure (52%) among all districts in the country. Facilities in this district need to be prioritised for improve-ment in order to ensure that the population receives appropriate and high quality healthcare services delivered in buildings with sound infrastructure. Tshwane Metropolitan Municipality obtained the highest overall score in quality (74%) and with respect to infrastructure the following districts where ranked as having the highest score of 74%: Ugu and Umzinyathi District Municipalities (KwaZulu-Natal), Tshwane Metropolitan Municipality (Gauteng) and Dr Ruth Segomotsi Mompati District Municipality (North West).

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1� iNTrODuCTiONThe South African national Department of Health (NDoH) has reaffirmed, through various recent policy and legisla-tive mandates, its commitment to improving the quality of health care in the country. The Department’s vision, as stated in the National Strategic Plan for 2010/11–2012/13, is to ensure “an accessible, caring and high quality health system”2 aligned to the objectives of the 10-Point Plan and the strategic outputs of the Negotiated Service Delivery Agreement; with emphasis on strengthening health system effectiveness through improved health care and patient satisfaction and the accreditation of health establishments. As South Africa embarks on the implementation of pri-mary health care (PHC) re-engineering and National Health Insurance the continuous monitoring of quality of care and health service delivery will be integral to informing health system strengthening strategies.

To align to the NDoH’s legislative and policy mandates, the Office of Health Standards Compliance developed the National Core Standards (NCS) for Health Establishments in South Africa that provide a benchmark of quality of care against which the delivery of health services can be monitored. Through the implementation of the NCS, which is based on a risk matrix, an assessment of a health facility’s compliance to service standards can be measured. These internationally recognised standards are used as a means of establishing expected minimum safety standards required across a health system, as well as assessing desired best practice.

In February 2011 Health Systems Trust was awarded a tender by the NDoH to conduct an audit of every public health facility in South Africa using the NCS quality framework. The project was implemented by a Consortium comprising Health Systems Trust (HST) (lead partner), Exponant, ARUP, Health Information Systems Programme (HISP) and the South African Medical Research Council (MRC). The overall objective of the audit was to collect baseline data from all public health facilities in the country using standardised and existing measurement tools and capturing the data into the National Core Standards database established by the NDoH. Data collection commenced in the Northern Cape in May 2011 and by July 2011 all provinces had commenced with the data collection. The Eastern Cape was the last province to complete the audit in May 2012. Data was collected from each facility to provide baseline information on (i) the condition assessment of a facility and (ii) health service provision in relation to the six quality priority areas for patient-centred care.

In this national summary report the findings of the baseline audit are presented in accordance with the key audit outcome areas covered in the NCS tools. These findings can be used to inform evidence-based objectives and plans towards scaling up national quality improvement strategies.

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2� BACKGrOuND: SOuTH AFriCAN HEALTH CONTEXTSouth Africa had an estimated population of 50.3 million people in 2011, of which slightly less than one million were under one year of age. The population density and the age-gender structure of the population vary dramatically across districts in the country. The aging index (ratio of the number of people 65+ to the number under 15 years) gives an indication of how far districts are in the demographic transition and, thus, where the greatest burden on health ser-vices is likely to fall in the future. Districts in the Northern and Western Cape have the highest aging index, whereas most districts in KwaZulu-Natal have much younger populations. The dependency ratio (ratio of the child and aged population (0-14 and 65+)) to the working age population (15-64) gives an indication of areas likely to have greater need of social and financial support. This ratio tends to be low in urban metro areas, notably in Gauteng, and higher in rural and deprived areas. Most of the population, 82.4% (41 million), were dependent on the public health sector and only 17.6% of people belonged to a medical scheme in 2010.3

South Africa has nine provinces, each with its own legislature, premier and executive council and with its distinctive landscape, population, economy and climate.

Eastern Cape province, located on the south-eastern seaboard of South Africa, is the second larg-est province after the Northern Cape. The province’s 169 580 sq. km in area accounts for 13.9% of the total land area of the country. Eastern Cape province has six district municipalities with the total population of 6 654 844 (2011)3 in 1 590 936 households, and three principal languages – IsiXhosa 83.4%, Afrikaans 9.3% and English 3.6%.4

Free State province is South Africa’s third largest province (129 480 sq. km), although it has the second smallest population of only 2 930 351 (2011)3 in 806 702 households. It lies in the centre of the country between the Vaal River in the north and the Orange River in the south, with the Kingdom of Lesotho to the south-east. There are four district municipalities within the Free State. The principal languages are Sesotho 64.4%, Afrikaans 11.9% and IsiXhosa 9.1%.4

Gauteng province is the economic powerhouse of South Africa, providing 33.89% of the coun-try’s total Gross Domestic Product, and it is an economic force on the African continent itself accounting for 10% of Africa’s Gross Domestic Product, as well as being the financial services capital of Africa. Three of South Africa’s eight metropolitan municipalities are situated in Gauteng, while province also has two district municipalities. Geographically Gauteng province is the small-est South African province 17 010 sq. km (1.4% of the country’s surface area). Gauteng has the largest population 10 929 377 (2011)3 and 3 468 615 households. The principal languages are IsiZulu 21.5%, Afrikaans 14.4%, Sesotho 13.1% and English 12.5%.4

KwaZulu-Natal province, 92 100 sq. km in size, is one of South Africa’s most popular holiday destinations. KwaZulu-Natal has one metropolitan municipality, ten district municipalities (each with its own local municipalities) with a total population of 10 819 130 (2011)3 and 2 367 737 households. The principal languages are IsiZulu 80.9%, English 13.6% and Afrikaans 1.5%.4

Limpopo province, covering an area 123 910 sq. km., is the northern-most province of South Af-rica and is the gateway to the rest of Africa. Limpopo consists of five district municipalities with the population of 5 261 994 (2011)3 in 1 305 075 households. The principal languages are (Seso-tho sa Leboa) Northern Sotho 52.1%, Xitsonga 22.4% and Tshivenda 15.9%.4

Mpumalanga province is 79 490 sq. km in area. There are three district municipalities, with a total population of 3 661 849 (2011)3 and 948 876 households. The principal languages are siSwati 26.4%, IsiZulu 26.4% and isiNdebele 12.1%.4

Northern Cape province, the largest province in South Africa with the area size of 361 830 sq. km, consists of five district municipalities, each with its own local municipalities. The Northern Cape province has the population of 1 158 088 (2011)3 and 272 502 households. The principal lan-guages are Afrikaans 68% and Setswana 20.8%.4

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North West province consists of four district municipalities with a population of 3 497 833 (2011)3, and 889 981 households. The principal languages are Setswana 65.4%, Afrikaans 7.5% and IsiXhosa 5.8%.4

Western Cape province is situated at the southern tip of Africa with a geographical area of 129 370 sq. km. The province is South Africa’s most cosmopolitan with a demographic profile quite different to the rest of the country. There is one metropolitan municipality in the Western Cape, five district municipalities (each with their own local municipalities) with a population of 5 553 957 (2011)3 and 1 420 893 households. The principal languages are Afrikaans 55.3%, IsiXhosa 23.7% and English 19.3%.4

Over the past five years, public sector health funding has increased by an average of 8.5% per annum in real (infla-tion-adjusted) terms. In particular, spending on HIV, health infrastructure, PHC services, personnel, medicines, labo-ratories and capital expenditure has grown. The proportion of total expenditure on human resources has increased to around 59% of expenditure, while pharmaceuticals comprise the next largest proportion at 12.3% and blood sup-plies, clinical supplies and laboratory costs comprise 7.1%.

Total PHC expenditure per capita has almost doubled from R666 in 2005/06 to R1 100 in 2010/11 in real terms. The average PHC utilisation rate in SA in 2010/11 was 2.3 visits per person per year. The proportion of district health services expenditure on district hospitals was 39.8% for 2010/11, down from 41.8% in 2008/09. The average ex-penditure per patient day equivalent for all district hospitals in South Africa in 2010/11 was R1 543.

Data from the District Health Information System (DHIS) show that the proportion of pregnant women whose first antenatal HIV tests were positive was 22% in 2010/11. This is considerably lower than the 29.4% prevalence found in the 2009 antenatal seroprevalence survey. The survey prevalence has remained stable at 29% since 2006. The HIV positivity rate reported in the DHIS has changed slightly from 24% in 2006/07 to 22% in 2010/11, probably due to more women knowing that they are already HIV-positive when booking at antenatal clinics.

South Africa has one of the highest incidence rates of tuberculosis (TB) in the world. In 2010 the reported number of cases for all types of TB was 805 per 100 000 population. The incidence rates vary from 1 142 per 100 000 in KwaZulu-Natal to 422 per 100 000 in Limpopo. Overall, the cure rate for smear-positive TB patients in South Africa continues to improve and in the last five years has increased by over 20 percentage points from 50.8% (2004) to 71.1% (2009). The provinces reporting the least improvement in cure rates were the Free State and North West.

The stillbirth rate decreased from 27.8 per 1 000 births in 2003/04 to 23.0 per 1 000 in 2007/08. Since then the rate has been stable between 22.2 and 23 per 1 000, the latter being the 2010/11 rate. The 2010/11 provincial still-birth rate ranged from 19.9 in the Western Cape to 30.9 in the Free State.

South Africa is one of 12 countries in which mortality rates for children have increased since the Millennium Develop-ment Goal (MDG) baseline in 1990. Long-term trends from DHIS data do, however, suggest a gradual decline in the perinatal mortality rate in facilities from 38.6 in 2003/04 to 31.0 in 2008/09.

In the past year non-communicable diseases have increasingly attracted global attention. In 2010/11 the average diabetes detection rate was 0.11% with a range of 0.03-0.27%. The average hypertension detection rate in 2010/11 was 0.32%, nearly three times higher than the diabetes detection rate.

The facility crude death rate is an impact indicator that refers to the proportion of all inpatient separations that are deaths. The average facility crude death rate in district hospitals declined from 6.4% in 2008/09 to 5.7% in 2010/11. The four leading single causes of years of life lost in South Africa in 2008 were TB, pneumonia, diarrhoea and HIV-related.

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3� METHODOLOGy

3�1 Aims and Objectives

The aim of the audit was to utilise the National Core Standards quality assessment framework to collect baseline data from all public health facilitiesi in the country. The focus of the audit was on a sub-set of the seven domains of the NCS which included the six priority areas for fast-tracking quality improvement in patient-centred care.

The two key objectives of the audit were:

✜ To conduct an audit of facility infrastructure, including the condition of land and buildings, access to water and electricity, condition of medical equipment, condition of surrounding roads and access to transport routes

✜ To conduct an audit of services, including operational times, work load, allocation and availability of personnel and compliance to quality standards in the six priority areas

3�2 Data Collection Tools

The NCS toolsii (version 2011) developed by the NDoH were used for the collection of baseline data. The Facility Profile questionnaire was amended to include Part A and B as detailed below. The tool-set that was used in the baseline audit is included in Appendix B.

The final NCS tool-set that was administered at each facility comprised the following:

✜ Facility profile questionnaire:

» Part A: a self-assessment questionnaire to be completed by the Facility Manager prior to the audit teams arrival at the facility

» Part B: completed by the audit team on arrival at the facility

✜ Facility questionnaire: a separate questionnaire was available for each facility type, i.e. clinic, community health centre (CHC) and hospital.

A district office questionnaire was administered at district level to members of the district health management team prior to the commencement of the audit. Baseline audit data were collected on-site and the allocation of days for the collection of data was determined by facility type as follows:

✜ Clinic – half day

✜ CHC – one day

✜ District hospital – three days

✜ Regional/tertiary and specialised hospitals – four days

3�3 Training and Data Collection

Data was collected from facilities in all provinces by teams comprising designated staff from the district as well as mem-bers of the project Consortium. Twenty data collection teams were mobilised during the one-year data collection period from May 2011 to May 2012. Each data collection team consisted of 10 members, three from the Consortium and seven from the district/province.iii Prior to the data collection commencing, a three-day training session was conducted for the Consortium-appointed team members. The training included:

✜ Orientation to the health system, its policies and guidelines including the National Health Act, National Core Standards and Fast Track to Quality Improvement

✜ National Core Standards toolkit

✜ Data collection methodology

i Included fixed facilities: clinics and community health centres, maternity obstetric units, district, regional, specialised and tertiary hospitals.ii These tools were specified for use as per the project tender requirements.iii Each data collection team consisted of 10 members: 1 Team Coordinator, 1 Infrastructure Assessor, 1 Data Capturer and 7 provincial / district

staff who were trained on the national core standards assessment process.

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✜ Orientation on the data collection tools, including facility role-plays

✜ Capturing of data

✜ Roles and responsibilities of team members

✜ Data quality and validation checks

✜ Fieldwork logistics and management procedures

The training of provincial and district-designated staff was conducted by representatives from the Office of Health Stand-ards Compliance. The appointed Team Co-ordinator of each team was responsible for ensuring the ongoing orientation of team members with respect to data collection methodology, quality checks and secure storage of questionnaires.

3�4 Data Capture

As stipulated in the formal tender requirements, the DHIS software was used for the capturing and storage of data. Data were captured into the National Core Standards for Health Establishments module by a trained Data Capturer.

At hospitals, data were captured on-site into the DHIS NCS database and feedback on the preliminary compliance outcome scores was provided to the hospital management team on the last day of the audit. An electronic copy of the outcome report and a data export file was also provided to the management team. For PHC facilities, data were captured off-site and feedback on the compliance outcomes for each facility was provided to the district health management team at the end of the audit. Data captured by the Data Capturer was exported on a daily basis to the Database Manager for import into a central DHIS data repository.

3�5 Data Analysis

Data from the central DHIS data repository was validated and exported into a web-based reporting system. Several dash-boards/interfaces in the web-based reporting databaseiv were developed. These formed the basis for the analysis of the data presented in Section 4 of this report.

Additional methodologies were used, specifically in relation to the HR and infrastructure data. STATA statistical software was used as the key data analysis tool for the HR data. Human resources data collected on the number of full-time, part-time and visiting staff in each staff category were converted to full-time equivalents (FTEs) to allow for staff comparisons across categories, facilities and levels of care. The following formulae were used for the FTE calculations:

✜ Full time = 1.0 FTE

✜ Part-time = 0.5 FTE

✜ Visiting = 0.25 FTE

The staff numbers and FTEs for selected staff categories were extracted to present data for PHC and hospitals. The data presented in the HR section of this report differ from that in the DHER in that the audit data were self-completed by each facility without the level of guidance and support given in the DHER workshops. This has implications for the reliability of some of the data. The baseline audit covered a wider range of personnel categories and assessed information per facility in contrast to the DHER for which information was aggregated by sub-districts for clinics and CHCs. In the case of hospitals, the audit tool reflects all hospital types whereas the DHER only covers district and TB hospitals.

The HR audit data should be interpreted with caution as there are indications that the accuracy and reliability of the data may be low and this is attributed to the HR questions which were asked in the self-assessment questionnaire.

Infrastructure audit data for a facility were converted into a weighted score with the maximum score for each facility be-ing 100%. The analysis template for facility infrastructure data was developed in conjunction with the NDoH. An overall infrastructure profile for each facility was obtained by grouping the infrastructure audit questions under the following three categories:

✜ Physical Condition of the Buildings, as well as Site Infrastructure and Services

✜ Facilities Infrastructure Management

✜ Space Standards.

iv The web-based reporting database was developed by ASG Performance Solutions.

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Weighting the questions according to level of importance in each of the three areas resulted in the identification of problem areas as well as the identification of red flags for urgent remedial action. The weighting system was configured to disre-gard services not offered by a facility so as to not affect the overall percentage outcome of the facility.

3�6 Definition of Terms

Context of quality In the NDoH’s document, ‘Policy on Quality in Health Care for South Africa of 2007’,5 quality is defined as the attainment of the best results given available resources. This definition gives contextual adaptability to the term quality and in this discussion document and the development of indicators, it is crucial to give context to the work that is being done.

Developmental measures

Developmental measures are those elements of quality of care to which health management should aspire in order to achieve optimal care. While non-compliance to these standards does not necessarily constitute a risk to patients, they form an integral part of a comprehensive healthcare system.

Essential measures Essential measures are those measures considered fundamental to the provision of safe, decent, quality care and are designed to provide an in-depth view of what is expected within available resources.

Full-time Personnel working an average of 40 hours per week.

Full-time equivalent (FTE)

A unit to reflect different length of time worked where 1 Full-time = 1 FTE, 1 Part-time (20 hours/week) = 0.5 FTE and visiting staff (10 hours a week) = 0.25 FTE.

Health audit A methodologically unbiased examination of health establishments by comparing what is done with agreed best practice and identifying and resolving problems in healthcare service delivery.

Health care Health care is defined as the combined functioning of public health and personal medical services.

Public health facility A health facility is the whole or part of a facility, building or place managed and owned by the public health sector, that is operated or designed to provide healthcare services.

Health technology Medical equipment for safe and efficient patient care.

Hospital beds (usable)

Beds which are regularly maintained and staffed in a hospital and which are immediately available for the care of admitted patients.

Measures To enable objective and comparable assessment of compliance, each criterion is broken down into measures that have been adapted to be context specific. Measures are the means or evidence for determining whether or not the criterion has been met.

Non-hospital PHC expenditure

This is the amount of money, per capita, and excluding expenditure on hospitals, that a district spends on primary health care annually and that is not covered by medical insurance (it does not include HIV, coroner and nutrition expenditure, but includes local government expenditure).

Non-hospital PHC expenditure per patient visit

This is the average amount of money spent on a patient visit to a PHC facility. It includes the cost to the health service of a patient visiting a CHC, CDC, clinic, satellite clinic or mobile clinic, excluding district hospitals but including the cost of managing the district (it does not include HIV, coroner and nutrition expenditure, but includes local government expenditure).

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Part-time Personnel employed in a part-time position and/or working less than an average of 40 hours a week. In this report Part-time staff are assumed to work an average of 20 hours a week in the relevant facility.

Visiting Personnel employed elsewhere and providing a service at the facility for an average of 10 hours per week.

Vital measures Vital measures are those measures that ensure that the safety of patients and staff are safeguarded so as to not result in unnecessary harm or death.

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4� SuMMAry OF FiNDiNGS

4�1 Facilities: Type and Access

At the start of the audit the NDoH estimated that the country had a total of 4 300 public health facilities. On completion of the audit in May 2012, the total number of public health facilities covered amounted to 3 880. Reasons for the discrepancy between the NDoH estimate of 4 300 and the number of facilities for which audit data are available is as follows:

✜ Prior to the audit the figure of 4 300 facilities from the DHIS, which was provided by the NDoH, was found to include private facilities, services listed as facilities, facilities which had closed down, and duplications.

✜ During the auditing process, the list of public health facilities was corrected to include new facilities and facilities not on the DHIS. It excluded closed facilities and those outside the definition of the public health facility.6

✜ Twenty-one PHC facilities in the City of Cape Town were excluded from the audit at the request of the City of Cape Town Metropolitan Municipality.

Table 1 presents the number of public health facilities audited in South Africa.

Table 1: Number of audited facilities, by facility classification, 2011

Facility classification Number of facilities

Satellite Clinic 125

Clinic 3 074

Specialised Clinic 4

Maternal Obstetrics Unit (MOU) 1

Community Day Centre (CDC) 44

Community Health Centre (CHC) 238

District Hospital 253

Regional Hospital 55

Tertiary Hospital 10

National Central Hospital 6

Rehabilitation Hospital 3

Children's Hospital 1

Chronic Hospital 4

Orthopaedic Hospital 1

Psychiatric Hospital 23

TB Hospital 35

TB and Psychiatric Hospital 2

Private Hospital 1

Total 3 880

The facilities in Table 2 are listed by classification statusv and not by their functional classification. A total of 80 facilities were found to be functioning differently from their classification (Table 2). The names of these 80 facilities are listed in Appendix D by province.

v Facility definitions are listed in Appendix C.

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Table 2: Number of facilities not functioning as classified, 2011

Classified As Functioning As No. of facilities

Clinic Satellite Clinic 9

Satellite Clinic Clinic 14

Clinic Specialised Clinic 1

Clinic CHC 2

CDC Clinic 6

CDC CHC 1

CHC Clinic 29

CHC CDC 1

District Hospital Clinic 1

District Hospital CHC 2

District Hospital Regional Hospital 3

Regional Hospital Specialised TB and Psychiatric Hospital 1

Tertiary Hospital Regional Hospital 5

Central Hospital Regional Hospital 1

Central Hospital Tertiary Hospital 3

Specialised TB Hospital Specialised TB and Psychiatric Hospital 1

Total facilities 80

Almost all facilities in the country are accessible by road (96%), while access via taxi is also high (87%) (Figure1). However, access to facilities by public transport is more limited, 58% facilities are accessible by bus and 9% by train. The audit did not assess how many people are within walking distance from their nearest health facility. For the indigent and rural communities, transport costs significantly affect out-of-pocket expenses when accessing healthcare services.

Figure 1: Access to public health facilities, 2011

96%

58%

9%

87%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Road Bus Route Train Route Taxi Route

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4�2 Outcome and Compliance

The outcome and compliance findings reflect the average scores according to the NCS measures. The results show the average percentage compliance to vital measures, as explained in more detail below.

Based on an NCS risk rating framework, measures are classified into three risk levels that form an integral part of a comprehensive quality healthcare system7, namely:

✜ Vital measures are those that ensure that the safety of patients and staff are safeguarded so as not to result in unnecessary harm or death

✜ Essential measures are those considered fundamental to the provision of safe, decent quality care and are designed to provide an in-depth view of what is expected within available resources

✜ Developmentalvi measures are those elements of quality of care to which health management should aspire to in order to achieve optimal care.

Achieving 100% compliance to vital measures in each of the priority areas is what distinguishes a high ranking facility (ideal facility) from a weak ranking facility. These NCS vital measures that were assessed in the audit in each of the six priority areas are listed in Appendix E.

4.2.1 Priority Areas for Quality ServiceFacilities’ compliance scores on vital measures in the six priority areas for patient-centred care are presented in this section. The six priority areas are (1) Positive and caring attitudes, (2) Waiting times, (3) Cleanliness, (4) Patient safety, (5) Infection prevention and control, and (6) Availability of medicines and supplies. The NDoH flagged these six as areas that are fundamental to the provision of quality health care in all establishments. Collectively, the audited facilities in the country obtained average scores per priority area as illustrated in Figure 2.

Positive and caring attitudes (30%) had the overall weakest compliance score on vital measures among the six prior-ity areas, followed by Improved patient safety (34%). Expressed differently and using Cleanliness as an example, this means that across the whole country the audited facilities together scored an average of 50% on cleanliness (and not that 50% of facilities complied with cleanliness).

Waiting times had the highest average percentage compliance score (68%) on vital measures across all facilities in the country (Figure 2).

Figure 2: Compliance score to the six priority areas on vital measures, 2011

30%

34%

50% 50% 54%

68%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Positive and caring attitudes

Improve patient safety and Security

Infection Prevention and Control

Cleanliness Availability of medicines and supplies

Waiting times

vi The baseline audit excluded the assessment of developmental measures.

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The overall audit outcome scores on quality measures are presented in Figure 3. The national average score is 53%. By province, Gauteng scored the highest (69%), followed by KwaZulu-Natal (58%) and Free State (57%). Northern Cape thus has the lowest score (40%) in terms of overall compliance in the country.vii

Figure 3: Overall compliance score on vital measures in the six priority areas by province, 2011

69%

58% 57% 57%

51% 48% 47% 46%

40%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Gauteng KwaZulu-Natal Free State Western Cape Eastern Cape North West Mpumalanga Limpopo Northern Cape

Figures 4 to 12 show the compliance scores per province in the six priority areas for vital measures.

Figure 4: Eastern Cape: Compliance score to the six priority areas on vital measures, 2011

22%

34%

47%

53% 54%

75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Cleanliness Infection prevention and control

Availability of medicines and supplies

Waiting times

vii The scoring works the same way as an average mark that a class of students obtains in an exam. For instance, Gauteng province students obtained a class average of 70% for their maths test, whilst the average class mark for Northern Cape students was 41%.

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Figure 5: Free State: Compliance score to the six priority areas on vital measures, 2011

37%

44% 47%

54% 56% 57%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%




Infection prevention and control

Waiting times

Figure 6: Gauteng: Compliance score to the six priority areas on vital measures, 2011

50%

58% 61%

65% 68%

79%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





Waiting times

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Figure 7: KwaZulu-Natal: Compliance score to the six priority areas on vital measures, 2011

37% 38%

56% 56%

63%

76%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





Cleanliness Waiting times

Figure 8: Limpopo: Compliance score to the six priority areas on vital measures, 2011

25%

31%

38%

42% 43%

74%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





Waiting times

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Figure 9: Mpumalanga: Compliance score to the six priority areas on vital measures, 2011

23% 27%

43% 45% 46%

62%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





Waiting times

Figure 10: Northern Cape: Compliance score to the six priority areas on vital measures, 2011

17%

23%

37%

42% 42% 42%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





Waiting times

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Figure 11: North West: Compliance score to the six priority areas on vital measures, 2011

21%

30%

45% 47%

50% 51%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Waiting times Infection prevention and control


Figure 12: Western Cape: Compliance score to the six priority areas on vital measures, 2011

37% 39%

50% 50%

60%

69%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Cleanliness Infection prevention and control


Waiting times

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At district level, the lowest and highest ranked districts on quality (vital) measures are shown in Figure 13. Of all the districts in the country, JT Gaetsewe District Municipality (Northern Cape) has the lowest overall quality score of 31%, while Tshwane Metropolitan Municipality (Gauteng) has the highest score of 74%. Of note, is that four of the six Gauteng districts have the highest scores in quality across all districts in the country.

Figure 13: District ranking on vital measures in the six priority areas, 2011

39%

46%

53%

53% 54%

54%

59%

53%

54%

56%

56%

66%

61%

64%

67% 68%

72% 74%

48% 49%

56% 56%

57%

58% 58%

59% 60%

61%

65%

34%

45% 45%

50%

57%

36%

52% 52%

31%

35%

39%

43%

50%

40% 41%

60%

65%

51% 52%

54%

57%

57%

64%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

J T Gaetsewe

Namakwa

A Nzo

Bojanala

Siyanda

Gr Sekhukhune

Uthukela

Pixley Ka Seme

West Coast

Ehlanzeni

C Hani

Joe Gqabi

Overberg

Cacadu

Sisonke

Lejweleputswa

Amajuba

Vhembe

Umkhanyakude

Ugu

Ruth Segomotsi Mompati

eThekwini MM

Sedibeng

Dr K Kaunda

Ekurhuleni MM

Johannesburg MM

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The percentage quality score on vital measures for PHC facilities and hospitals is illustrated in Figure 14. The average score that PHC facilities obtained for positive and caring attitudes was 25%, whilst hospitals scored 47%. The PHC facilities’ scored was on average lower in all six priority areas.

Figure 14: Compliance to the six priority areas on vital measures for PHC and hospitals, 2011

25%

30%

47% 48% 47%

66%

47%

52%

64% 62%

68%

84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





Waiting times

PHC Compliance - Vitals % Hospital Compliance - Vitals %

Figure 15 reflects the actual number of facilities that are fully compliant per priority area (vital measures). Two of the six priority areas – Improve patient safety and Infection prevention and control – reflect very low numbers. The two fully compliant facilities in terms of the priority area Improve patient safety were PHC facilities (one clinic and one satellite clinic). No hospitals were fully compliant in this area, nor in the Infection prevention and control priority area.

Figure 15:Number of facilities compliant per priority areaviii, 2011

395

161 2 32

666

2573

0

400

800

1200

1600

2000

2400

2800

3200

3600

Availability of medicines and

supplies

Cleanliness Improve patient safety



Waiting times

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viii Figures exclude all those which did not respond or for which there is no data.

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The quality scores previously discussed (Figure 2) represent the average score that all facilities achieved in a priority area (denominator = number of vital measures). Figure 15, on the other hand, shows the number of facilities that are fully complaint in each priority area (denominator = total number of facilities).

4.2.2 Functional areasSection 4.2.1 looked at compliance in the six priority areas – this section looks at outcomes with respect to the functional areas within the NCS. Facilities that were audited were analysed with respect to five functional areas. Table 3 lists the components that were assessed within each functional area.

Table 3: Assessment components per functional area, 2011

Functional Area Components

Clinical services Blood services, Laboratory, Health Technology, Pharmacy, Radiology

Infrastructure Integrated audit infrastructure, Integrated audit health technology

Management CEO/ hospital manager, Communications, Facility infrastructure, Financial management, HR management, Infection control, Procurement, Occupation health and safety, Clinical management group, Case management, Legal/insurance division

Patient care Accident and emergency unit, Outpatient department, Maternity ward incl. Maternity theatres, Medical ward, Surgical ward, Paediatric ward, Generic ward, Therapeutic support services, Speciality ward/ICU/HCU/Burn, Operating theatre, Psychiatric ward

Support services CSSD, Cleaning services, Food services, Laundry services, Maintenance services incl. garden, Record/archive department, Waste management, Transport services incl. Ambulance/patient transport, Security services, Entrance/reception/help desk, Patient administration, Mortuary services, Public areas

Compliance and non-compliance to vital measures relating to the above five functional areas is shown in Figure 16. The compliance is lowest for Clinical Services (38%), followed by Management (43%). The functional area where the compliance is highest is Patient Care (53%).

Figure 16: Compliance in the functional areas on vital measures, 2011

53%

45%

40% 43%

38%

47% 55% 60% 57% 62%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Patient Care Support Services Infrastructure Management Clinical services

Non-compliant

Compliant

Figures 17 to 20 below display the percentage of vital measures passed for each functional area. The Infrastructure functional area is reported in section 4.6 below. In the area of Clinical Services (Figure 17), Health technology has the lowest compliance (46%) to vital measures and Laboratory the highest (70%). In the area of Management (Figure

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18), Infection control and Clinical management has the lowest percentage of vital measures passed (54%), while Financial Management had a pass rate of 79%. With respect to Patient care (Figure 19), the Outpatient Department and the Psychiatric Ward scored 45% and 47% respectively, while the Medical Ward scored highest with 65%. Finally, in Support Services (Figure 20), Maintenance Services has the lowest score (33%), while Laundry services have the highest (86%).

Figure 17: Compliance to vital measures for clinical services, 2011

46%

52%

66%

70%

54%

48%

34%

30%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Health technology

Pharmacy

Blood services

Laboratory

% vitals passed

% vitals failed

Figure 18: Compliance to vital measures for management, 2011

54%

54%

58%

61%

64%

69%

76%

77%

79%

46%

46%

42%

39%

36%

31%

24%

23%

21%

0% 20% 40% 60% 80% 100%

Infection control

Clinical management group

HR management

Facility Infrastructure

Communications

Procurement

Occupational health & safety

CEO/Hospital manager

Financial management

% vitals passed

% vitals failed

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Figure 19: Compliance to vital measures for patient care, 2011

45%

47%

50%

50%

51%

53%

54%

60%

63%

65%

55%

53%

50%

50%

49%

47%

46%

40%

37%

35%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Outpatient Department

Psychiatric Ward

Maternity Ward incl Maternity theatres

Surgical Ward

Generic Ward

Operating Theatre (incl Cath Labs)

Accident & Emergency Unit

Speciality Ward/ICU/HCU/Burn

Paediatric Ward

Medical Ward

% vitals passed

% vitals failed

Figure 20: Compliance to vital measures for support services, 2011

33%

39%

53%

58%

62%

81%

86%

67%

61%

47%

42%

38%

19%

14%

0% 20% 40% 60% 80% 100%

Maintenance services

Food services

CSSD

Security services

Cleaning services

Waste management

Laundry services

% vitals passed

% vitals failed

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4.3 Provision of Services

4.3.1 Support ServicesThe provision of support services includes cleaning, catering, security, maintenance and health technology. The term ‘off-site’ means that the service is provided away from the facility, while ‘on-site’ means that the service is provided on the premises of the facility. ‘Own staff’ means that staff are employed and managed by the facility and ‘contracted out’ denotes staff that belong to an external organisation and are contracted to work at the facility for a specific purpose and period as determined by a service contract. Cleaning and security services, due to the nature of the service, can only be supplied on-site. Figure 21 shows that catering services are mostly supplied on-site (94%), but technology and maintenance services are mainly provided off-site (95% and 88% respectively).

Figure 21: Proportion of support services provision, off-site or on-site, 2011

5%

12%

94%

100%

100%

95%

88%

6%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Technology services

Maintenance

Catering

Cleaning

Security

% on-site

% off-site

Figure 22 provides an overview of staff involved in the provision of different services — facility employed staff versus contracted/outsourced staff. The highest number of contracted staff is in security (81%), followed by technology services (75%), while cleaning services has the highest number of facility-employed staff (87%).

Figure 22: Percentage own staff versus contracted staff, 2011

19%

25%

36%

72%

87%

81%

75%

64%

28%

13%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Security

Technology services

Maintenance

Catering

Cleaning

% own

% contracted

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The support services assessed include Central sterilisation services, Cleaning services, Food services, Laundry ser-vices, Maintenance services incl. gardens, Record/archive department, Waste management, Transport services incl. Ambulance/patient transport, Security services, Entrance/reception/help desk, Patient administration, Mortuary ser-vices and Public areas. Overall, support services’ compliance to vital measures is 45% (Figure 16). When looking at a selection of support services as detailed in Figure 20, Maintenance services has the lowest compliance score of 33% while Laundry services has the highest at 86%. Maintenance services are mostly provided off-site (88%) and 64% of the maintenance services staff is contracted out.

4.3.2 Clinical Services

PriMAry HEALTH CArE FACiLiTiES

All PHC facilities do not provide the full spectrum of PHC services. The likely reason for this is that around one third of PHC facilities are owned by local government and many of these do not provide the same spectrum of services expected of provincially owned and managed facilities. In addition, the four specialised clinics offer a narrow and focused range of services. Table 4 illustrates the key PHC services and the percentage of facilities found to provide these services nationally. Dental services (31%) are offered by the lowest proportion of PHC facilities. No data were collected on optometric services offered by the audited facilities.ix

Table 4: PHC Clinical Services Audited. Out-patient, 2011

Primary Health Care services % of facilities

Immunisation 93%

TB treatment 93%

HIV counselling and testing (HCT) 95%

Antiretroviral therapy 75%

Contraceptive 95%

TOP counselling 76%

Post-exposure prophylaxis (PEP) 80%

Cervical screening 92%

Syndromic management STIs 94%

Dental 31%

Mental Health 80%

HOSPiTALS

Table 5 illustrates the number of beds available in a number of crucial in-patient hospital services. For Accident and emergency and Maternity/Obstetric services beds in the PHC facilities are also included. Considering the high infant and maternal mortality rates in the country and the requirements of MDG 5, the number of neonatal intensive care unit (NICU) beds and maternal/obstetric beds available need to be carefully evaluated. Developed countries such as Australia, New Zealand, United Kingdom, United States of America and Canada recommend one NICU bed per 1 000 live births. The Royal College of Physicians recommends 1.5 beds per 1 000 live births. The audit reveals 647 NICU beds in the public health sector in South Africa. Taking into account the 1 294 694x live births in 2010, the ratio is around 0.5 NICU beds per 1 000 live births.

The public sector has 11 218 maternal/obstetric beds serving approximately 12 322 500xi women between the ages of 15 and 45, providing a ratio of maternal beds to the child bearing population of around 0.9 beds per 1 000. Hos-pital management and programme managers need to analyse the number of beds available with respect to national and international norms and national needs in order to ensure the appropriate number of beds are provided for babies and pregnant women requiring specialised care.

ix The NCS audit tools did not include the assessment of optometric services.x Recorded Live Births 2010. Statistics South Africa, Pretoria; August 2011. xi 2011 population estimate from DHIS 2010 population file: Za_PopEst_2001_2016_With_PopPyramids _Feb2010

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Table 5: Hospital Clinical Services Audited. In-patient, 2011

Clinical service category Number of beds

Accident and Emergency* 1 506

High care unit 924

Neonatal ICU 647

Intensive Care Unit (ICU) 799

Isolation 707

Total Maternity / Obstetric beds** 11 218

Gynaecology 1 864

Cardiology 299

Neurology 464

TB 7 467

Mental health 11 545

Oncology / nuclear medicine 712

Paediatrics and Paediatric surgery 9 932

Transplant unit 49

HIV and AIDS management 676

*This includes 277 beds in CHCs

**This includes 1 481 beds in clinics, CHCs, MOU and CDCs

4.3.3 Therapeutic Services

Audiology, Dietetics, Occupational therapy, Physiotherapy, Psychology, Social Work and Speech therapy are offered as an out-patient, PHC level service as well as by hospitals. Table 6 illustrates the therapeutic services offered by PHC facilities. Each of these services is offered by less than a quarter of PHC facilities, with some considerably lower, which means that most patients are referred for more specialised care. There is also a paucity of dedicated space and required equipment for these services. Audiology services are worst-off, being offered at only 6% of facilities nation-wide, with only 2% of facilities having dedicated space for the service and 3% having the required equip-ment. Considering the increasing prevalence of diabetes, obesity and hypertension in the country, the percentage of facilities offering Dietetics (16%) is very low. No facilities indicate dedicated space or equipment for Dietetics. The percentage of PHC facilities offering Psychology and Speech therapy services is also low, each being offered at only 10% of facilities.

Table 6: Therapeutic services offered by PHC facilities, 2011

Service On-site Dedicated space Have required equipment

% of Facilities % of Facilities % of Facilities

Audiology 6% 2% 3%

Dietetics 16% 0% 0%

Occupational therapy 20% 6% 7%

Physiotherapy 19% 7% 7%

Psychology 10% 5% 4%

Social work 21% 15% 11%

Speech therapy 10% 3% 3%

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Table 7 reflects the therapeutic services offered in hospitals and shows that, in particular, the Audiology, Psychology and Speech therapy services are limited. Given that the percentage of PHC facilities offering these services is also low, it is possible that many patients have no access to these services within the public health sector.

Table 7: Therapeutic services offered by hospitals, 2011

Service On-site Dedicated space Have required equipment

% of Facilities % of Facilities % of Facilities

Audiology 32% 31% 29%

Dietetics 65% 0% 0%

Occupational therapy 69% 61% 55%

Physiotherapy 77% 70% 65%

Psychology 39% 37% 30%

Social work 72% 68% 60%

Speech therapy 37% 33% 32%

4.3.4 Bulk SuppliesBulk supplies assessed include the provision of water, electricity, domestic waste removal, medical waste removal, hazardous waste removal and ash removal. Domestic waste removal is the bulk supply service for which a large num-ber of clinics (449), CHCs and CDCs combined (29) and hospitals (26) have no municipal service. The data reflect a lack of ash removal in CHCs, CDCs and hospitals (Table 8). Facilities with no water and no electricity at the time of the audit are listed in Appendix F. Of note is that the majority of these facilities are located in the Eastern Cape province.

Table 8: Number of facilities with no bulk supply services at the time of audit, 2011

Supplies Clinics CHC+CDC Hospitals Total

No water 56 1.7% 0 0.0% 0 0.0% 56 1.4%

No electricity 35 1.1% 1 0.4% 0 0.0% 36 0.9%

No domestic waste removal 449 14.0% 29 10.2% 26 6.6% 504 13.0%

No medical waste removal 113 3.5% 16 5.6% 7 1.8% 136 3.5%

No hazardous waste removal 139 4.3% 19 6.7% 16 4.1% 174 4.5%

No ash removal 4 0.1% 30 10.6% 33 8.4% 67 1.7%

Some facilities reported experiencing interruptions of bulk supply services. Reasons provided for these interruptions include:

✜ PHC facilities with rainwater tanks as the only source of water run out of water during rainless periods.

✜ PHC facilities with pre-paid electricity connections experience interruptions when the District Office does not purchase electricity vouchers.

✜ Interruption of medical waste removal results from expired service level agreements due to inadequate monitoring or non-renewal of service level agreements.

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4�4 Human resources

This section reports on the audit findings concerning human resources for primary health care facilities and hospitals, per facility type. The report presents a national level picture with a focus on gaps in selected categories of staffing considered crucial to ensure high quality, efficiently delivered services meeting the expected scope per type of facil-ity. Gaps in the availability of staff are presented as a percentage of facilities that have NO INPUT (i.e. visits) for a particular category of staff, neither Full-time, Part-time nor Visiting.

4.4.1 Primary Health Care facilitiesA total of 3 487 primary health care facilities (namely 238 CHCs, 44 CDCs, 3 074 clinics, 125 Satellite clinics, four Spe-cialised clinics and two Health Posts) reported on their HR situation. Results for clinics and for CHCs and CDCs combined are presented below.

CLiNiCS

Although the majority of clinics have Facility Managers, a significant 21% do not. Nearly half of the clinics (47%) report no visit from Doctors. All clinics would have Professional Nurses (PN) if the facility manager is assumed to be a PN, although without this assumption 3% would not have any PN input. A high 84% of clinics have no input from a Pharmacist or Pharmacy Assistant Post-Basic, while 5% have only Pharmacy Assistants Basic who are not supervised by a Pharmacist. Eleven per cent of clinics report not having any Lay Counsellors. A high percentage of clinics (57%) have no Administration support and 79% have no Information Management staff, both of which increase the nursing staff’s workload.

CHCs/CDCs

While most CHCs and CDCs have Facility Managers, 19% report that they do not. A high 20% do not have any Doctor visits and 48% have no Advanced Midwives. Lay Counsellors are not available in 17% of facilities. Over 40% have no Pharmacists nor Pharmacy assistant Post-Basic and 12% have unsupervised Pharmacy Assistant Basic. Over half of CHCs/CDCs (52%) cannot offer proper dental services in the absence of Dental practitioners or dental therapists. Three quarters (76%) of facilities have no Radiographer input and most facilities (89%) have no optometrist/optician input. Rehabilitation services are not available in the majority of facilities: 72% have no Physiotherapists, 74% no Occupational Therapists, 82% no Psychologists and 89% no Speech Therapists. Nearly 70% of facilities have no Social Worker input. Administra-tive support is not available in 13% of facilities and 43% report having no Information Management staff. Nearly half (44%) report having no Security guards, although outsourced services may not have been systematically reported.

The staffing gaps identified for PHC facilities raise concerns about quality of services provided (absence of medical staff and of Advanced Midwives for CHC/CDC services), efficiency (absence of lay counsellors and administrative support, especially in clinics) and limitations in the scope of services rendered (in particular dental, optical, rehabilitation and social work services in CHCs/CDCs).

4.4.2 HospitalsStaffing information was provided by 391 hospitals: six Central hospitals, 10 Tertiary, 55 Regional, 254 District and 66 Specialised hospitals (Table 9).

Table 9: Number of hospitals: Acute vs Specialised, 2011

Acute Hospitals Specialised Hospitals

Central Tertiary Regional District Chronic Orthopaedic Psychiatric Rehabilitation TB

6 10 55 254 4 1 23 3 35

All hospitals indicated the availability of facility management staff, although many management teams were missing finan-cial managers and/or HR managers. The data reflect the absence of financial managers in 6% of Central/Tertiary hospitals, 33% of Regional hospitals and nearly half of District hospitals and Specialised hospitals, although this may be a function of the small size of some hospitals. An absence of HR managers was reported in 18% of Central/Tertiary hospitals, 33% of Regional hospitals and over 40% of District hospitals and Specialised hospitals.

Specialists were available in all Central/Tertiary hospitals and Regional hospitals, but 9% of Regional hospitals reported fewer than 5 specialist FTEs. For both District and Specialised hospitals, 22% did not have any specialist input. In Central/Tertiary hospitals there was 1 registrar per specialist, with 1 per 2 specialists in Regional hospitals. Two per cent of District hospitals and 1% of Specialised hospitals did not have any doctor input. A quarter of acute hospitals had no Advanced Midwives, with a similar proportion for each category of hospitals.

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The ratio of Professional and Specialised Nurses to Doctors ranged from 2.2 Nurses per doctor in Central/Tertiary hospitals to 3.5 per doctor in Regional hospitals, 5.4 in District hospitals and 7.7 in Specialised hospitals.

No pharmacists were available in 12% of both District and Specialised hospitals, while 16% of district hospitals reported no radiographers input. Availability of dental services was measured by assessing input from Dental Specialists or Dental Practitioners and their absence was noted in 59% of Central/Tertiary hospitals, 50% of Regional hospitals and 42% of District hospitals.

The availability of Physiotherapists was used as an indicator for Rehabilitation services. There was no input from Physi-otherapists in 12% of Central/Tertiary hospitals, 6% of Regional hospitals, 28% of District hospitals and 59% of Special-ised hospitals.

Engineering technicians and technologists were often not available, impacting negatively on maintenance operations. The absence of inputs from Civil and Electrical/Electronic Engineering Technicians was noted in 41% of Central/Tertiary hospi-tals, 59% of Regional hospitals, 65% of District hospitals and 69% of Specialised hospitals. Clinical Engineering Technician inputs were absent in 29% of Central/Tertiary hospitals, 63% of Regional hospitals, 77% of District hospitals and 94% of Specialised hospitals.

In the absence of staffing norms, it is not possible to assess the adequacy of the staff profile and skills mix for the ex-pected scope of services.

4�5 Finances

The audit covered the assessment of financial management within the management functional area (sub-domain opera-tional management) but did not give detailed coverage of the assessment of facility budgets and expenditure reports, such as those covered in the DHER.xii The financial management priority questionnaire was administered at all hospitals and the questions assessed the following:

✜ Procedures in place to ensure that expenditure meets defined service needs

✜ Variance analysis of actual expenditure to budget to ensure the continuity of service provision.

Table 10 shows the percentage failure for hospitals on measures assessed under financial management.

Table 10: Percentage failure on measures for financial management - hospitals, 2011

Question Number

Question Number of Facilities

% Failure

6.3.1.3.2 There is evidence that exception reports are compiled where expenditure on high risk / priority areas deviates from budget by more than 5%

363 28%

6.3.1.2.2 Financial projections show evidence that the health establishment will deliver defined service needs within the annual allocated budget

375 24%

6.3.1.2.1 Monthly reports are presented to the management team which monitor budget expenditure against budgeted costs with variance analysis

375 12%

xii Tools administered were those that were developed and prescribed by the NDoH as per the terms of reference of the project.

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4�6 Infrastructure

There were three main areas that were assessed in the infrastructure audit. These include:

✜ Building and site infrastructure, which includes general site location (geological land information, geographical topography, geographical zoning, perimeter fencing, internal roads and paving materials, fire hydrants and fire booster pumps) and building materials (internal and external walls, roof, ceiling, floor material).

✜ Facilities infrastructure management, which includes security, maintenance of access roads, electrical and water supply, waste management, sanitation, linen and laundry, and food services.

✜ Space standards, which includes the assessment of space to meet service and patient needs, and waiting areas.

The average overall infrastructure score for facilities in all three assessment areas was 65%. The average individual scores by assessment area are detailed in Table 11. Facilities infrastructure management is the area with the lowest score with respect to the status of infrastructure.

Table 11: Average score per infrastructure assessment area – all facilities, 2011

Assessment Area Average score (out of 100)

Building and site infrastructure 73.6%

Facilities infrastructure management 66.9%

Space standards 78.4%

The average overall score for PHC facilities where scores were obtained on all three assessment areas was 64% and the score for hospitals was 70%. As illustrated in Tables 12 and 13, PHC and hospital facilities have similar scores on Building and site infrastructure; however hospitals scored higher on Space standards and on Facilities infrastructure management.

Table 12: Average score per infrastructure assessment area – PHC, 2011





Table 13: Average score per infrastructure assessment area – hospitals, 2011





Table 14 provides the number of facilities where asbestos was used as a building material in different structural compo-nents (roof, ceiling, internal and external walls). As facilities often have asbestos in more than one structural component, Table 14 gives a breakdown of the number of facilities with asbestos in between one and four of the four different compo-nents. From the data it is clear that asbestos is most frequently used in roof and ceiling materials. Given that asbestos pos-es a health hazard, action should be taken to replace the asbestos currently in use as a building material and to eliminate future use of it. Two thousand seven hundred and thirty seven (70.5%) facilities did not have any asbestos components.

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Table 14: Number of facilities with asbestos used as a building material, 2011

Building materials with asbestos No. of facilities

Roof 592 (15.2%)

Ceiling 565 (14.6%)

Internal walls 126 (3.2%)

External walls 80 (2.1%)

Table 15: Number of facilities with asbestos in between one and four of the building’s different structural components, 2011

Structural components (roof, ceiling, internal and external walls) with asbestos

No. of facilities

1 out of 4 958 (24.7%)

2 out of 4 160 (4.1%)

3 out of 4 23 (0.6%)

All 4 4 (0.1%)

The average overall infrastructure scores by province are shown in Figure 23. Gauteng and KwaZulu-Natal provinces have the highest score (70%), followed by Free State (67%), with Northern Cape having the lowest score (56%).

Figure 23: Average overall infrastructure scores by province, 2011

70% 70% 67% 65% 64% 62% 61%

58% 56%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Gauteng KwaZulu-Natal Free State North West Western Cape

Limpopo Eastern Cape

Mpumalanga Northern Cape

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The infrastructure scores by district, ranked from highest to lowest score are detailed in Figure 24. The scores are not as widely dispersed as those obtained on the quality component and range from 74% in Ugu (KwaZulu-Natal) and Tshwane (Gauteng) to a low of 52% in JT Gaetsewe (Northern Cape). Gauteng and KwaZulu-Natal have the most districts within the top 10 scores, whilst Northern Cape has the most districts falling into the lowest 10 scores.

Figure 24: District ranking on infrastructure scores, 2011

54% 55%

61% 62% 62%

69%

69%

65%

65%

68%

69%

70%

65%

68%

69%

71%

72%

74%

65%

67%

67%

69%

69%

69%

71% 71%

72%

74%

74%

59% 59%

60%

64%

71%

55%

58%

60%

52%

55% 55%

58%

63%

60%

64%

65%

74%

55%

63% 63%

64%

64%

67%

0% 20% 40% 60% 80% 100%

J T Gaetsewe A Nzo

O R Tambo Central Karoo

G Sibande Siyanda

Namakwa Nkangala

Pixley Ka Seme Vhembe

Capricorn Ngaka Modiri Molema

Waterberg Ehlanzeni

Joe Gqabi Amathole

C Hani Eden

Cape Town MM Frances Baard

Overberg Bojanala Mopani

West Coast Dr K Kaunda

Thabo Mofutsanyane Metsweding

uMgungundlovu Motheo

Uthungulu Cape Winelands

iLembe Johannesburg MM

Fezile Dabi Uthukela Xhariep

Umkhanyakude N Mandela MM

West Rand Cacadu

Zululand Lejweleputswa eThekwini MM

Sisonke Gr Sekhukhune Ekurhuleni MM

Amajuba Sedibeng

Dr Ruth Segomotsi Mompati Umzinyathi

Tshwane MM Ugu

WC NW NC MP LP KZN GP FS EC

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4�7 Health Technology

The NCS integrated health technology measures assessed whether equipment available in the facilities meets the minimum requirements for the appropriate levels of care, if staff are able to use the equipment correctly and whether the equipment is in working order.

Table 16 shows that the highest failure rate (93%) was on the availability of functional and essential equipment in maternity wards and in theatre. Given the high maternal mortality rates in the country, the imperative of MDG #5 and the findings in the recent National Committee for the Confidential Enquiries into Maternal Deaths (NCCEMD) report, this area needs priority attention.

Table 16: Percentage failure on vital measures for health technology – all facilities, 2011

Question number


% Failure

3.4.1.1.4 CHECKLIST - Functional essential equipment as listed in the checklist is available in the Maternity ward/section

2460 93%

3.4.1.1.5 CHECKLIST - Functional essential equipment as listed in the checklist is available in the Theatre

285 93%

3.4.1.1.3 CHECKLIST - Functional essential equipment as listed in the checklist is available in the general wards

3208 83%

3.4.3.1.3 An up-to-date report the last 12 months shows that adverse events involving medical equipment are reported and actions taken to prevent recurrence have been implemented

3061 80%

3.4.1.1.1 CHECKLIST - Functional essential medical equipment as listed in the checklist is available in the Trauma/Accident and Emergency Department

318 77%

3.4.3.1.1 CHECKLIST – Up-to-date records the last 6 months show that the equipment listed has been maintained according to a planned schedule

577 67%

3.4.3.1.2 There is a system in place to monitor that items requiring replacement or ordering are received within 3 months and action is taken if this is not done

3684 58%

Table 17: Percentage failure on vital measures for health technology – PHC facilities, 2011

Question number


% Failure


47 100%

3.4.1.1.4 CHECKLIST - Functional essential equipment as listed in the checklist is available in the Maternity section

2161 94%

3.4.1.1.3 CHECKLIST - Functional essential equipment as listed in the checklist is available in the general section

2894 84%


2761 83%

3.4.3.1.1 CHECKLIST – Up-to-date records the last 6 months show that the equipment listed has been maintained according to a planned schedule

2345 79%


3336 60%

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In hospitals (Table 18) the availability of equipment in theatres, maternity wards, general wards and Trauma/accident and Emergency department requires considerable improvement.

Table 18: Percentage failure on vital measures for health technology – hospitals, 2011

Question Number


% Failure

3.4.1.1.5 CHECKLIST - Functional essential equipment as listed in the checklist is available in the Theatre

284 93%

3.4.1.1.4 CHECKLIST - Functional essential equipment as listed in the checklist is available in the Maternity ward

299 87%

3.4.1.1.3 CHECKLIST - Functional essential equipment as listed in the checklist is available in the general wards

314 77%


271 73%

3.4.3.1.1 CHECKLIST - Up-to-date records the last 6 months show that the equipment listed has been maintained according to a planned schedule

342 61%


300 51%


348 45%

4.8 Medicine Supplies and Management

Access to essential medical products, vaccines and technologies forms part of the six building blocks of a health sys-tem. Within the NCS the Availability of medicines and supplies is one of the six priority areas and assesses whether:

✜ Prescribed medicines and medical supplies are available as needed

✜ Procurement, payment and delivery processes are reliable and on time

✜ Stock levels of medicines and medical supplies are managed to prevent stock shortages and stock loss and they are properly stored and controlled

✜ Contingency plans are in place to maintain the cold chain for medicines and vaccines.

Section 4.2, which deals with the compliance to the six priority areas, reflects a national compliance of 54% by facilities to the ‘Availability of medicines and supplies’ priority area (Figure 2). The tables below show the percentage failure of vital measures within this priority area for PHC facilities (Table 19) and hospitals (Table 20).

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Table 19: Percentage failure on vital measures for the availability of medicines and supplies – audited clinics, 2011

Question number

Question Number of facilities

% Failure

3.1.2.1.1 CHECKLIST - Tracer medicines as per applicable Essential Drugs List or formulary are available in the pharmacy/medicine room

3154 77%

3.1.3.3.1 A standard operating procedure is available which indicates how schedule 5 and 6 medicines are stored / controlled / distributed in accordance with the Medicines and Related Substances Act 101 of 1965

2945 51%

1.5.1.3.1 CHECKLIST - 10 random selected scripts in pharmacy are correlated with medication dispensed to ensure that all medication was received as prescribed

2929 34%

6.4.4.1.2 There is evidence that turnaround times for critical stock are set and monitored regularly

246 11%

There is a high percentage failure (77%) in clinics for the vital measure ‘Tracer medicines as per applicable Essential Drugs List or formulary are available in the pharmacy/medicine room’ (Table 19). A similar situation exists for the majority of CHCs (237, 99%) where a 70% failure was recorded for the same vital measure (Table 20).

Table 20: Percentage failure on vital measures for the availability of medicines and supplies – audited CHCs, 2011

Question number


% Failure


237 70%

3.1.3.3.1 A standard operating procedure is available which indicates how schedule 5 and 6 medicines are stored / controlled / distributed in accordance with the Medicines and Related Substances Act 101 of 1965

233 44%

1.5.1.3.1 CHECKLIST - 10 random selected scripts in pharmacy are correlated with medication dispensed to ensure that all medication was received as prescribed

230 37%


24 17%

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Among hospitals (Table 21) this measure had the highest percentage failure to compliance (66%). Improved availabil-ity of medicines as per the Essential Drug List is necessary at all levels of facilities. Drug supply chain management requires urgent attention in PHC and hospitals, especially considering the size and needs of the country’s massive HIV and TB programmes. Linking these results to section 4.4, which covers Human Resources, highlights the paucity of pharmacists and pharmacist assistants, especially among clinics and CHC/CDCs. The lack of resources appears to be a contributing factor to the low compliance in the ‘Availability of medicines and supplies’ priority area.

Table 21: Percentage failure on vital measures for the availability of medicines and supplies - hospitals, 2011

Question number


% Failure


385 66%

3.3.1.1.2 All adverse blood reactions are documented and reported to the committee dealing with adverse events on a monthly basis

311 57%

3.3.1.1.3 At least 2 units of O-negative blood are available in a designated fridge for emergencies

325 37%

2.4.1.2.4 There is evidence that health establishment monitor morbidity and mortality statistics regularly and the outcomes are used to develop improvement plans

374 35%

3.3.1.1.1 CHECKLIST - Two staff members interviewed are able to explain how the cold chain is ensured for all blood products including ordering / storage / issuing

339 32%


369 31%

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5� rECOMMENDATiONS

5�1 Description of Facilities

✜ The facility audit’s census and classification activities revealed that 80 health facilities, ranging across all types and provinces, were functioning differently to their classified status. The reasons for these devia-tions must be investigated and addressed, particularly at hospital level. This will promote standardisation and ensure accurate records for purposes for monitoring and financing, as well as ensuring that the ap-propriate range and level of services are provided to the population

5�2 Priority areas: Outcome and compliance

✜ Two out of the six priority areas scored less than 50% compliance to vital measures and should there-fore be addressed in all facilities, especially PHC facilities as they on average scored lower on quality than hospitals. Positive and caring attitudes requires special attention as it had the lowest overall compliance score (at 30%) of the six priority areas, with an even lower score of 25% for PHC facilities.

✜ At district level JT Gaetsewe District (Northern Cape), which has 39 PHC facilities and two District hospitals, has the lowest overall quality (31%) and infrastructure (52%) scores among all districts in the country. Improvements to this district’s facilities should be prioritised to ensure that the population receives appropriate and high quality healthcare services delivered in acceptable buildings with sound infrastructure.

5�3 Provision of services

✜ Priority attention is necessary to ensure that all facilities provide a comprehensive range of services, especially in the light of current and forthcoming priorities in PHC re-engineering.

✜ Dental services are lacking across the board at PHC level. This needs to be rectified as it is extremely costly for clients to have to use private sector services.

✜ More therapeutic services, such as audiology, speech therapy and psychology, should be offered at PHC facilities as the majority of patients accessing these services are referred. Of note, however, is that the provision of these services is also limited in hospitals.

✜ Hospital management and programme managers need to analyse the number of beds available per service with respect to the growing population and national and international norms.

5�4 Human resources

✜ Human Resources norms per type of facilities should be provided by the NDoH to assist provinces, dis-tricts and facilities to assess priority recruitment needs and intra-facility deployment so as to move closer to an optimal skills mix and equity in allocation of human resources.

✜ The HR audit tool and the method of information collection should be revisited in the light of lessons learnt during this facility audit. Different tools should be developed for PHC and hospitals. Self-comple-tion of the questionnaire by facility staff should be reviewed to enhance data reliability.

5�5 Infrastructure

✜ The quality of physical infrastructure has a major impact on the functioning of services and clients’ satisfaction with the services. Of the three infrastructure assessment areas, Facility infrastructure man-agement needs to be improved, especially at PHC level.

✜ Prioritised attention should be given to those facilities without provision of water and electricity at the time of the audit. Many of these facilities are subject to intermittent interruption of these services, or seasonal interruptions where the water supply is dependent on rainfall.

✜ Considering that asbestos poses a health hazard, measures should be taken to replace this building ma-terial in those facilities that have asbestos in the roof, ceilings or internal walls.

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5�6 Health Technology

✜ Given the high maternal mortality rates in the country, the requirements of MDG #5 and the findings in the recent NCCEMD report, the availability of functional and essential medical technology equipment in maternity wards needs priority attention.

RefeRenc

es


6� rEFErENCES1 National Committee for the Confidential Enquiries into Maternal Deaths. Saving Mothers 2008 - 2010: The

Fifth Report on Confidential Enquiries into Maternal Deaths in South Africa. Pretoria: Government Printer, 2012

2 National Department of Health. National Strategic Plan 2010/11-2012/13. Pretoria: National Department of Health; 2010.

3 Day C, Barron P, Massyn N, Padarath A, English R, editors. District Health Barometer 2010/11. Durban: Health Systems Trust; January 2012.

4 Gaffney’s Local Government in South Africa – Official Yearbook: 2011-2013. Sandton: The Gaffney Group; November 2011.

5 Department of Health. Policy on Quality in Health Care for South Africa. Government Printer: National Department of Health; April 2007.

6 Department of Health. Health Facility Definitions. Government Printer, Pretoria: National Department of Health; November 2006.

7 National Core Standards for Health Establishments in South Africa. National Department of Health; Government printer: Pretoria; 2011.

8 Department of Health. R655 National Health Act (61/2003): Regulations Relating to Categories of Hospitals. Government Gazette No. 9570; Government Printer, Pretoria: National Department of Health; August 2011

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7. APPENDICES

7.1 Appendix A: Names of Audit Team Members

Aldon Mark TaylorAndile M LeseleAndre Du BuissonAnele BokleniAnna Van KratenburgAnnemien GibsonBarry MashigoBlake FrancisBrandwin FerrisBrian MphahleleBuzwe M MzanaCarel OosthuizenCoenraad BooyensDaisy PillayDenvor FieliesDirk FourieDirk HaywardDylan StevensonElethu GqoliElsie P TsubaneFezile T NgubaneGranny MatjekeGugulethu SokhelaHannie KohlmeyerHendrik ZwiegelaarHlanganani MabundaImeraan Cassiem Innocent D MzukeJacque van den HeeverJacques FarrellJulius MahlatsiKehliwe P ThokameloKeith PurseyKhethukuthula MthembuKirsten HowardKrynauw KrugerLandiwe KhuzwayoLiesel RavellsLindiwe SikakaneLwandlekazi SeptemberMahlatse Robert MorupaneMandi HaydenMannini Makoa

Margaret LoxtonMarieta LiebenbergMark KleinMbalenhle C NgemaMbali D ShabalalaMeriam MoeketsiMichael MoroneyMlondolozi MhlanaMogamat FaikierMohamed SheerazMotlatsi RangoananaMukadekezi XaverineNaledi L MakurubeNandy MothibeNceba GxagisaNelisiwe NdlovuNobathini KomaniNtombomhlaba NyangaNwabisa XwayiOtto DavisOumiki KhumisiPalisa MavasaPhalaza Z LunikaPieter Le GrangeReuben KekanaRochester MdakaneRussell van Wyk Sam RangataBrent MathysenSandy DoveSello MoremiShaheeda FredericksShariefa PotgieterSibangane M TshabalalaSibongile MinisiSiyabonga NzimandeSunette MarkusThembisile MafuTheodorus RenckenTheodorus VoslooTimbela V DamaneWerner Jobse

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7�2 Appendix B: National Health Care Facilities Baseline Audit Tools

The tools used in the audit are available on the Health Systems Trust website at:

http://www.hst.org.za/sites/default/files/AppendixB_NHFA_Baseline_Audit_Tools.zip

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7�3 Appendix C: Classification of Facilities – Categories of Facilities8

1. FACiLiTiES PRoViDiNG PREDoMiNANTLy AMBuLAToRy CARE

1.1 Health Post

A health post is a room in a house or other structure in a community from which a range of elementary PHC services are provided.

1.2 Mobile Clinic

A mobile clinic is a temporary service from which a range of PHC services are provided and where a mobile unit/bus/car provides the resources for the service. This service is provided on fixed routes and at a number of points which are visited on a regular basis. Some visiting points may involve the use of a room in a building, but the resources (equip-ment, stock) are provided from the mobile when the service is available and are not maintained at the visiting point.

1.3 Satellite Clinic

A satellite clinic is a facility that is a fixed building, where one or more rooms are permanently equipped and from which a range of PHC services are provided. It is open for up to 8 hours per day and less than 4 days per week.

1.4 Clinic

A clinic is an appropriately permanently equipped facility at which a range of Primary Health Care services are pro-vided. It is open at least 8 hours a day at least 4 days a week.

1.5 Community Day Centre

A Community Day Centre (CDC) is a facility which is not open 24 hours a day, 7 days a week, but at which a broad range of Primary Health Care services are provided. It also offers accident & emergency but not midwifery services or surgery under general anaesthesia.

1.6 Community Health Centre

A CHC is a facility which is open 24 hours a day, 7 days a week, at which a broad range of Primary Health Care services are provided. It also offers accident & emergency and midwifery services, but not surgery under general anaesthesia.

1.7 Specialised Health Centre

A Specialised Health Centre is a facility that provides specialised care to particular groups of patients, usually for less than 24 hours at a time. There are many possibilities for such units, but the most common are Maternal Obstetric Units (open 24 hours and providing midwifery services) and Renal Dialysis Units.

2. FACiLiTiES PRoViDiNG iNPATiENT SERViCES

2.1 District Hospital (Level 1 Hospital)

A District Hospital is a facility at which a range of outpatient and inpatient services are offered, mostly within the scope of general medical practitioners. It has a functional operating theatre in which operations are performed regu-larly under general anaesthesia.

2.2 Regional Hospital (Level 2 Hospital)

A Regional Hospital is a facility that provides care requiring the intervention of specialists as well as general medi-cal practitioner services. A hospital providing a single specialist service would be classified as a specialised level 2 hospital. A general level 2 hospital should provide and be staffed permanently in the following six basic specialties of surgery, medicine, orthopaedics, paediatrics, obstetrics and gynaecology and psychiatry, plus diagnostic radiology and anaesthetics.

2.3 Tertiary Hospital ii(Level 3 Hospital)

A Tertiary Hospital is a health facility that provides specialist and sub-specialist care which is provided by Regional Hospitals. The facility also provides intensive care services under supervision of a specialist and receives referrals from Regional Hospitals not limited to provincial boundaries. The hospital generally has in the region of 400 – 600 beds.

i Also known as Provincial Tertiary Hospital/ Tertiary 1 Hospital

Appen

dIc

es


2.4 National Central Hospital iiii(Level 3 Hospital)

National Central hospitals provide tertiary hospital services and central referral services and may provide national referral services. Central referral services are provided in highly specialised units and require unique, scarce and spe-cialised personnel. National referral services represent extremely specialised and expensive services such as heart and lung transplants, bone marrow transplant, liver transplants and cochlear implants.

National central hospitals provide training of health care providers, conduct research and receive patients referred from more than one province. The hospital is attached to a medical school as the main teaching platform.

2.5 Specialised Hospitals

There are wide a range of possible specialties that could be focused in a hospital, the two most common being TB and Psychiatry but also includes Orthopaedic hospitals, Children’s hospitals, maternity, infectious diseases and so on. These units may also provide either acute, sub-acute or chronic care or all of those levels of care.

3. FACiLiTiES PRoViDiNG SuB- ACuTE (ALSo CALLED STEP DoWN) SERViCES

These provide in-patient care for patients who no longer require acute intervention and can be cared for mostly by professional nurses or allied professions (i.e. they are clinically stable, have a final diagnosis, treatment plan and pre-scribed medication). They will not generally have been discharged from hospital except where their care can be better managed in a specialist unit as described below.

3.1 Rehabilitation Hospital

These cater for patients who require physical or psychiatric rehabilitation or respite care. They will be staffed either by professions allied to medicine (physical rehab) or specialist nurses (psychiatric rehab). Patients may be discharged from hospital into off-site units.

ii Also known as Tertiary 2 (National Referral) or Tertiary 3 (Central Referral) hospitals depending on the range of specialities provided.

App

end

Ices


7�4

App

endix D: Facilities not Fun

ctioning by Classificatio

n Status

Cla

ssifie

d A

sFu

nction

ing

As

Prov

ince

Dis

tric

tSub

-dis

tric

tFa

cilit

y N

ame

DIS

TRIC

T H

OSPI

TAL

REG

ION

AL

HO

SPI

TAL

East

ern

Cap

eC

Han

i DM

Lukh

anji

SD

Fron

tier

Hos

p

CLI

NIC

CH

CEa

ster

n C

ape

C H

ani D

MN

gcob

o SD

Ngc

obo

CH

C

CH

CC

DC

East

ern

Cap

eC

acad

u D

MC

amde

boo

SD

Gra

aff-

Rei

n D

ay H

osp

SATEL

LITE

CLI

NIC

CLI

NIC

East

ern

Cap

eC

acad

u D

MKo

uga

SD

Add

o C

linic

SATEL

LITE

CLI

NIC

CLI

NIC

East

ern

Cap

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e G

qabi

DM

Mal

etsw

ai S

DThe

mbi

sa S

at

CH

CC

LIN

ICEa

ster

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ape

N M

ande

la M

MN

Man

dela

A S

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hele

CH

C

CH

CC

LIN

ICEa

ster

n C

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N M

ande

la M

MN

Man

dela

B S

DRos

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ICEa

ster

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ande

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dela

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DC

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al C

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ande

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ande

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right

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ic

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Gau

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ille

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C

Appen

dIc

es


Cla

ssifie

d A

sFu

nction

ing

As

Prov

ince

Dis

tric

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-dis

tric

tFa

cilit

y N

ame

DIS

TRIC

T H

OSPI

TAL

REG

ION

AL

HO

SPI

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teng

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ane

MM

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ane

East

ern

SD

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p

SATEL

LITE

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NIC

CLI

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teng

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ane

MM

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ane

Nor

th E

ast

SD

Doo

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ort

Sat

CH

CC

LIN

ICG

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e M

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orth

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t SD

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ison

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HC

CH

CC

LIN

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u-N

atal

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Sub

Cat

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anor

CH

C

CEN

TRA

L H

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TAL

REG

ION

AL

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atal

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Kin

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war

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III H

osp

REG

ION

AL

HO

SPI

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SPE

CIA

LISED

TB A

ND

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u-N

atal

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Kin

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p

PSY

CH

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TE

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NIC

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atal

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ic

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ater

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ham

App

end

Ices


Cla

ssifie

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nction

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As

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ince

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tric

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cilit

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ame

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er

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tern

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n M

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orth

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ic

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est

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st D

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erus

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Appen

dIc

es


7�5

App

endi

x E:

Vita

l and

Ess

entia

l Mea

sure

s by

Pri

ority

Are

a

Vita

l Mea

sure

ts

Ava

ilabi

lity

of m

edic

ines

and

sup

plie

s

2.4

.1.2

.4. The

re is

evi

denc

e th

at h

ealth

esta

blis

hmen

t m

onito

r m

orbi

dity

and

mor

talit

y st

atis

tics

reg

ular

ly a

nd t

he o

utco

mes

are

use

d to

dev

elop

impr

ovem

ent

plan

s

3.1

.2.1

.1. C

HEC

KLI

ST -

Tra

cer

med

icin

es a

s pe

r ap

plic

able

Ess

ential

Dru

gs L

ist

or f

orm

ular

y ar

e av

aila

ble

in t

he p

harm

acy/

med

icin

e ro

om

3.3

.1.1

.1. C

HEC

KLI

ST -

Tw

o st

aff

mem

bers

inte

rvie

wed

are

abl

e to

exp

lain

how

the

col

d ch

ain

is e

nsur

ed f

or a

ll bl

ood

prod

ucts

incl

udin

g or

derin

g / st

orag

e / is

suin

g

3.3

.1.1

.2. A

ll ad

vers

e bl

ood

reac

tion

s ar

e do

cum

ente

d an

d re

port

ed t

o th

e co

mm

itte

e de

alin

g w

ith

adve

rse

even

ts o

n a

mon

thly

bas

is

3.3

.1.1

.3. A

t le

ast

2 u

nits

of

O-

nega

tive

blo

od a

re a

vaila

ble

in a

des

igna

ted

frid

ge f

or e

mer

genc

ies

6.4

.4.1

.2. The

re is

evi

denc

e th

at t

urna

roun

d tim

es f

or c

ritic

al s

tock

are

set

and

mon

itore

d re

gula

rly

Cle

anlin

ess

1.1

.3.1

.2. C

HEC

KLI

ST -

5 c

hose

n ar

eas

are

chec

ked

for

the

stat

e of

cle

anlin

ess

7.4

.1.1

.1. Rec

ords

sho

w t

hat

daily

insp

ection

s of

cle

anlin

ess

are

carr

ied

out

7.4

.1.1

.2. Sam

ple

of 5

war

d to

ilets

and

bat

hroo

ms

are

clea

n bo

th o

n th

e floo

r an

d ab

ove

the

floo

r/do

or h

andl

es/c

oute

rtop

s/to

ilets

7.4

.1.2

.1. C

lean

ing

mat

eria

ls c

loth

s /

dust

ers

/ sc

oure

rs a

nd c

hem

ical

s an

d eq

uipm

ent

are

avai

labl

e an

d st

ored

in a

n ap

prop

riate

saf

e lo

ckab

le a

rea

/ w

ith

clea

r la

bels

for

eq

uipm

ent

used

inte

rnal

ly a

nd e

xter

nally

7.4

.1.2

.4. C

lean

ing

staf

f w

ear

prot

ective

clo

thin

g w

hile

car

ryin

g ou

t th

eir

duties

7.4

.1.2

.5. The

re a

re rec

ords

of

the

man

dato

ry p

re-e

mpl

oym

ent

test

s fo

r cl

eani

ng s

taff

7.4

.1.3

.1. Rec

ords

sho

w t

hat

Pest

Con

trol

is d

one

mon

thly

in a

ll ar

eas

7.5

.4.1

.1. The

out

side

bin

/was

te c

onta

iner

sec

tion

is w

ell m

aint

aine

d an

d po

ses

no h

ealth

risk

Impr

ove

patien

t sa

fety

1.2

.1.2

.2. C

HEC

KLI

ST -

For

ms

used

for

info

rmed

con

sent

are

com

plet

ed c

orre

ctly

by

the

heal

th p

rofe

ssio

nals

1.2

.1.2

.3. C

HEC

KLI

ST -

10 p

atie

nt rec

ords

sho

w t

hat

the

heal

th e

stab

lishm

ent

conf

irmed

with

the

patien

t w

heth

er c

onse

nt f

or p

roce

dure

had

bee

n ta

ken

1.6

.1.1

.1. C

HEC

KLI

ST -

Pat

ient

rec

ords

dem

onst

rate

tha

t th

e co

rrec

t ha

ndov

er p

roce

dure

was

fol

low

ed

1.6

.1.2

.1. C

HEC

KLI

ST -

5 p

atie

nts

reco

rds

or f

iles

indi

cate

tha

t th

e gu

idel

ines

reg

ardi

ng e

xam

inat

ion

and

stab

ilisa

tion

hav

e be

en a

dher

ed t

o

1.6

.1.2

.2. C

HEC

KLI

ST -

Pat

ient

s re

quiri

ng t

rans

fer

out

of t

he f

acili

ty a

re s

tabi

lised

acc

ordi

ng t

o ap

prop

riate

gui

delin

es b

efor

e th

ey c

an b

e sa

fely

tra

nsfe

rred

out

/ d

oes

not

mea

n th

eir

cond

itio

n is

sta

ble

1.6

.1.4

.1. M

orta

lity

rate

s w

ithi

n th

e em

erge

ncy

unit o

f th

e he

alth

est

ablis

hmen

t ar

e w

ithi

n ac

cept

able

ben

chm

arks

App

end

Ices


2.1

.1.2

.1. The

re is

evi

denc

e th

at t

he h

ealth

esta

blis

hmen

t co

nduc

ts m

onth

ly m

ater

nal a

nd p

erin

atal

mor

bidi

ty a

nd m

orta

lity

mee

ting

s

2.2

.1.2

.1. C

HEC

KLI

ST -

The

est

ablis

hmen

t co

nduc

ts c

linic

al a

udits

of

each

prio

rity

prog

ram

me/

heal

th in

itia

tive

Rev

iew

the

clin

ical

aud

it rep

orts

- c

heck

list

prov

ided

If N

o cl

inic

al a

udits

con

duct

ed rev

iew

5 P

atie

nt f

iles

per

prio

rity

prog

ram

2.2

.1.3

.2. The

hea

lth

initia

tive

s ou

tcom

e re

port

sho

ws

that

qua

lity

impr

ovem

ent

plan

has

bee

n im

plem

ente

d to

add

ress

sho

rtco

min

gs a

nd im

prov

e ou

tcom

es

2.3

.1.2

.1. H

ealthc

are

prof

essi

onal

s sp

ecific

ally

doc

tors

and

nur

ses

indi

cate

tha

t th

ey h

ave

acce

ss t

o ad

equa

te s

uper

visi

on (ex

cl d

octo

rs f

or p

rivat

e se

ctor

)

2.4

.1.2

.3. The

rec

ent

min

utes

withi

n th

e la

st 6

mon

ths

of t

he c

omm

itte

e re

view

ing

clin

ical

ris

ks in

dica

te t

hat

clin

ical

ris

ks a

re reg

ular

ly d

iscu

ssed

/ a

naly

sed

and

action

s ha

ve

been

tak

en t

o re

duce

sig

nifica

nt r

isks

2.4

.2.1

.3. The

est

ablis

hmen

t ha

s a

proc

edur

e fo

r th

e co

nduc

ting

of

risk

asse

ssm

ents

of

frai

l and

age

d pa

tien

ts

2.4

.2.1

.4. The

est

ablis

hmen

t ha

s a

proc

edur

e fo

r th

e co

nduc

ting

of

risk

asse

ssm

ent

of p

atie

nts

with

redu

ced

mob

ility

2.4

.2.2

.1. C

HEC

KLI

ST -

With

resp

ect

to 7

2 h

our

obse

rvat

ion

of p

atie

nts

/ th

e re

quire

d cr

iter

ia a

re m

et

2.4

.2.2

.2. C

HEC

KLI

ST -

The

Est

ablis

hmen

t ha

s a

prot

ocol

for

the

man

agem

ent

of p

atie

nts

requ

iring

72 h

ours

obs

erva

tion

as

per

the

Men

tal H

ealth

Car

e A

ct

2.4

.2.3

.1. C

HEC

KLI

ST -

The

file

s of

2 f

rail

or a

ged

patien

t in

dica

te t

hat

a ris

k as

sess

men

t w

as c

ondu

cted

of

the

risk

of d

evel

opin

g pr

essu

re s

ores

/ W

ater

low

sca

le a

nd r

isk

of

falli

ng e

g M

orse

fal

l sca

le

2.4

.2.3

.2. C

HEC

KLI

ST -

The

file

s of

5 f

rail

or a

ged

patien

t in

dica

te t

hat

a ris

k as

sess

men

t w

as c

ondu

cted

on

patien

ts a

t ris

k of

fal

ling

eg M

orse

Fal

l Sca

le

2.4

.2.4

.1. C

HEC

KLI

ST -

Ini

tial

ass

essm

ents

of

high

ris

k pa

tien

ts r

efle

cts

the

iden

tifica

tion

of

spec

ific

ris

k fa

ctor

s

2.4

.2.5

.1. C

HEC

KLI

ST -

The

initia

l ass

essm

ent

of h

igh

risk

mat

erni

ty p

atie

nts

reflec

ts t

he id

entifica

tion

and

impl

emen

tation

of

spec

ific

pla

ns t

o en

sure

the

ir sa

fety

2.4

.2.6

.1. Sec

urity

mea

sure

s ar

e ad

equa

te t

o sa

fegu

ard

new

born

s an

d un

acco

mpa

nied

chi

ldre

n in

clud

ing

rest

ricte

d ac

cess

and

exi

t m

onito

ring

in w

ards

/ id

entifica

tion

of

new

born

s/ c

hild

ren

and

thei

r pa

rent

s

2.4

.3.1

.1. C

HEC

KLI

ST -

The

rev

iew

of

5 f

iles

of p

atie

nts

who

hav

e be

en t

rans

ferr

ed f

rom

one

dep

artm

ent

to a

noth

er o

r fr

om a

noth

er in

stitut

ion

dem

onst

rate

tha

t pa

tien

t sa

fety

che

cks

have

bee

n ap

plie

d

2.4

.3.2

.1. C

HEC

KLI

ST -

Pat

ient

s` p

eri-o

pera

tive

doc

umen

ts d

emon

stra

te t

hat

safe

ty c

heck

s ha

ve b

een

cond

ucte

d du

ring

and

afte

r su

rger

y

2.4

.3.3

.1. C

HEC

KLI

ST -

The

est

ablis

hmen

t ha

s a

form

al p

olic

y fo

r ha

ndlin

g em

erge

ncy

resu

scita

tion

s

2.4

.3.3

.3. The

rec

ent

min

utes

withi

n 6 m

onth

s of

the

com

mitte

e re

view

ing

resu

scita

tion

s in

dica

tes

that

res

usci

tation

s ar

e re

gula

rly d

iscu

ssed

/ a

naly

sed

and

action

s ha

ve

been

tak

en t

o re

duce

sig

nifica

nt r

isks

2.4

.3.3

.4. C

HEC

KLI

ST E

SSEN

TIA

L -

Emer

genc

y tr

olle

ys a

re s

tand

ardi

sed

as f

ar a

s pr

actica

l app

ropr

iate

ly s

tock

ed a

nd reg

ular

ly c

heck

ed

2.4

.3.3

.5. C

HEC

KLI

ST V

ITA

LS -

Em

erge

ncy

trol

leys

are

sta

ndar

dise

d as

far

as

prac

tica

l app

ropr

iate

ly s

tock

ed a

nd reg

ular

ly c

heck

ed

2.4

.3.4

.1. A

pro

toco

l reg

ardi

ng t

he s

afe

adm

inis

trat

ion

of m

edic

ines

to

patien

ts is

ava

ilabl

e in

clud

ing

a pr

otoc

ol f

or t

he s

afe

adm

inis

trat

ion

of m

edic

ines

to

child

ren

2.4

.3.4

.2. C

HEC

KLI

ST -

Obs

erva

tion

of

patien

t re

ceiv

ing

med

icat

ion

conf

irms

that

pat

ient

s` s

afet

y is

ass

ured

2.4

.3.5

.1. C

HEC

KLI

ST -

Pat

ient

file

s de

mon

stra

te t

hat

the

prot

ocol

on

adm

inis

trat

ion

of b

lood

has

bee

n ad

here

d to

2.4

.3.5

.2. Em

erge

ncy

bloo

d is

ava

ilabl

e on

-site

or w

ithi

n 30 m

inut

es

Appen

dIc

es


2.5

.1.1

.2. C

HEC

KLI

ST -

3 a

dver

se e

vent

rep

orts

ref

lect

tha

t Im

med

iate

act

ions

are

tak

en a

t th

e tim

e of

inci

dent

to

addr

ess

harm

and

adv

erse

eve

nts

are

anal

ysed

to

iden

tify

un

derly

ing

caus

es a

nd c

ontr

ibut

ory

fact

ors

ie a

roo

t ca

use

anal

ysis

2.5

.2.2

.1. Rec

ent

min

utes

withi

n la

st 6

mon

ths

of t

he c

omm

itte

e re

view

ing

adve

rse

even

ts in

dica

tes

that

adv

erse

eve

nts

are

regu

larly

dis

cuss

ed / a

naly

sed

and

action

s to

re

duce

sig

nifica

nt r

isks

hav

e be

en im

plem

ente

d

3.1

.4.2

.3. C

HEC

KLI

ST -

Dis

pens

ing

is d

one

in a

ccor

danc

e w

ith

appl

icab

le p

olic

ies

and

legi

slat

ion

incl

udin

g la

belli

ng

3.1

.4.2

.4. C

HEC

KLI

ST -

The

labe

ls o

f m

edic

ines

dis

pens

ed f

or p

atie

nts

com

ply

with

legi

slat

ive

requ

irem

ents

as

per

Che

cklis

t 31

423

3.1

.4.3

.1. C

HEC

KLI

ST -

A ran

dom

sel

ection

of

10 p

atie

nts

rece

ivin

g m

edic

ine

indi

cate

tha

t th

ey h

ave

a cl

ear

unde

rsta

ndin

g of

how

and

whe

n to

tak

e th

eir

med

icat

ion

and

any

othe

r re

leva

nt in

form

atio

n -

Gen

eric

out

patien

t ch

eckl

ist

3.1

.4.4

.1. C

HEC

KLI

ST -

A ran

dom

sel

ection

of

10 p

resc

ription

s au

dite

d sh

ows

that

pre

scrib

ing

is d

one

to f

acili

tate

rat

iona

l use

of

med

icin

e an

d in

acc

orda

nce

with

pres

crib

ing

guid

elin

es a

nd p

olic

ies

3.1

.5.1

.2. The

min

utes

of

the

com

mitte

e w

hich

dea

ls w

ith

adve

rse

drug

rea

ctio

ns d

emon

stra

tes

that

act

ions

hav

e be

en t

aken

to

repo

rt / a

naly

se a

nd t

ake

appr

opria

te a

ctio

n re

gard

ing

adve

rse

drug

rea

ctio

ns

3.2

.1.1

.2. C

HEC

KLI

ST -

Lab

orat

ory

resu

lts a

re c

ompl

eted

withi

n th

e ag

reed

upo

n tu

rnar

ound

tim

es

3.2

.2.1

.5. C

HEC

KLI

ST -

Rad

iolo

gy res

ults

are

com

plet

ed w

ithi

n th

e ag

reed

upo

n tu

rnar

ound

tim

es

3.2

.2.1

.6. C

HEC

KLI

ST -

Rad

iolo

gy res

ults

req

uest

ed a

re a

vaila

ble

in t

he p

atie

nt`s

file

or

nurs

ing

unit

3.4

.1.1

.1. C

HEC

KLI

ST -

Fun

ctio

nal e

ssen

tial

med

ical

equ

ipm

ent

as li

sted

in t

he c

heck

list

is a

vaila

ble

in t

he T

raum

a/A

ccid

ent

and

Emer

genc

y D

epar

tmen

t

3.4

.1.1

.3. C

HEC

KLI

ST -

Fun

ctio

nal e

ssen

tial

equ

ipm

ent

as li

sted

in t

he c

heck

list

is a

vaila

ble

in t

he g

ener

al w

ards

3.4

.1.1

.4. C

HEC

KLI

ST -

Fun

ctio

nal e

ssen

tial

equ

ipm

ent

as li

sted

in t

he c

heck

list

is a

vaila

ble

in t

he M

ater

nity

war

d

3.4

.1.1

.5. C

HEC

KLI

ST -

Fun

ctio

nal e

ssen

tial

equ

ipm

ent

as li

sted

in t

he c

heck

list

is a

vaila

ble

in t

he T

heat

re

3.4

.3.1

.1. C

HEC

KLI

ST -

Up

to d

ate

reco

rds

the

last

6 m

onth

s sh

ow t

hat

the

equi

pmen

t lis

ted

has

been

mai

ntai

ned

acco

rdin

g to

a p

lann

ed s

ched

ule

3.4

.3.1

.2. The

re is

a s

yste

m in

pla

ce t

o m

onito

r th

at it

ems

requ

iring

rep

lace

men

t or

ord

erin

g ar

e re

ceiv

ed w

ithi

n 3 m

onth

s an

d ac

tion

is t

aken

if t

his

is n

ot d

one

3.4

.3.1

.3. A

n up

to

date

rep

ort

the

last

12 m

onth

s sh

ows

that

adv

erse

eve

nts

invo

lvin

g m

edic

al e

quip

men

t ar

e re

port

ed a

nd a

ctio

ns t

aken

to

prev

ent

recu

rren

ce h

ave

been

im

plem

ente

d

5.1

.1.1

.1. The

hea

lth

esta

blis

hmen

t /

dist

rict

has

rece

ived

a c

opy

of a

n un

qual

ifie

d or

em

phas

is o

f m

atte

r au

dit

resu

lt f

rom

the

Aud

itor

Gen

eral

(qu

alifie

d or

dis

clai

mer

aud

its

cons

titu

te a

0 s

core

)

5.1

.3.2

.1. The

min

utes

of

the

gove

rnan

ce s

truc

ture

withi

n th

e la

st 6

mon

ths

indi

cate

tha

t qu

ality

of c

are

in t

he h

ealth

esta

blis

hmen

t is

reg

ular

ly d

iscu

ssed

and

mon

itore

d an

d re

med

ial a

ctio

ns a

re im

plem

ente

d

5.2

.1.2

.2. D

oc e

vide

nce

that

hea

lth

est

man

ager

com

pl w

ith

law

in rel

atio

n to

clin

ical

pra

ctic

e su

ch a

s cu

stod

ians

hip

of m

inor

s / m

enta

l hea

lth

act

for

adm

issi

on / c

onse

nt in

em

erge

ncy

surg

ery

whe

n a

patien

t is

una

ble

to o

r no

nex

t of

kin

5.2

.4.1

.1. The

hea

lth

esta

blis

hmen

t ca

n pr

ovid

e ev

iden

ce t

hat

oper

atio

nal p

lans

are

mon

itore

d qu

arte

rly a

gain

st t

arge

ts a

nd in

dica

tors

and

rem

edia

l act

ions

are

in p

lace

to

addr

ess

gaps

App

end

Ices


5.3

.2.1

.1. The

re is

evi

denc

e th

at t

he in

sura

nce

cove

rage

is c

urre

nt a

nd a

ppro

pria

te f

or t

he le

vel o

f th

e es

tabl

ishm

ent

5.6

.2.3

.4. The

hea

lth

esta

blis

hmen

t re

spon

ded

withi

n a

reas

onab

le t

ime

with

com

mun

icat

ion

to t

he p

ublic

dur

ing

a re

cent

hea

lth

rela

ted

issu

e su

ch a

s an

out

brea

k or

pub

lic

heal

th c

once

rn

6.1

.1.2

.1. Sta

ff p

atie

nt rat

ios

in k

ey a

reas

are

in a

ccor

danc

e w

ith

the

staf

fing

pla

n fo

r em

erge

ncy

unit /

out

patien

ts / m

edic

al/ su

rgic

al / p

aedi

atric

s / IC

U w

ards

as

appl

icab

le

6.1

.1.4

.1. A

reg

iste

r is

ava

ilabl

e w

ith

up t

o da

te a

nnua

l pro

fess

iona

l bod

y re

gist

ration

num

bers

for

eac

h ca

tego

ry o

f st

aff

6.1

.1.5

.1. The

re is

evi

denc

e th

at d

emon

stra

tes

that

sta

ff v

acan

cy/

turn

over

and

abs

ente

eism

rat

es a

re m

onito

red

and

action

s im

plem

ente

d to

add

ress

sig

nifica

nt is

sues

6.1

.2.2

.1. C

HEC

KLI

ST -

The

file

s of

5 m

embe

rs o

f st

aff

reflec

t th

at c

ompr

ehen

sive

per

form

ance

rev

iew

s ar

e do

ne b

ased

on

thei

r pe

rfor

man

ce p

lans

and

in a

ccor

danc

e w

ith

the

hum

an res

ourc

e m

anag

emen

t po

licy

6.3

.1.2

.1. M

onth

ly rep

orts

are

pre

sent

ed t

o th

e m

anag

emen

t te

am w

hich

mon

itor

budg

et e

xpen

ditu

re a

gain

st b

udge

ted

cost

s w

ith

varia

nce

anal

ysis

6.3

.1.2

.2. Fi

nanc

ial p

roje

ctio

ns s

how

evi

denc

e th

at t

he h

ealth

esta

blis

hmen

t w

ill d

eliv

er d

efin

ed s

ervi

ce n

eeds

withi

n th

e an

nual

allo

cate

d bu

dget

6.3

.1.3

.2. The

re is

evi

denc

e th

at e

xcep

tion

rep

orts

are

com

pile

d w

here

exp

endi

ture

on

high

ris

k /

prio

rity

area

s de

viat

es f

rom

bud

get

by m

ore

than

5%

7.1

.4.1

.1. M

aint

enan

ce rec

ords

sho

w t

hat

reco

mm

enda

tion

s of

ann

ual m

anag

emen

t in

spec

tion

rep

orts

on

safe

ty h

azar

ds a

nd m

aint

enan

ce n

eeds

are

impl

emen

ted

7.1

.4.1

.2. N

o ob

viou

s sa

fety

haz

ards

are

obs

erve

d du

ring

the

visi

t su

ch a

s lo

ose

elec

tric

al w

iring

/ c

olla

psin

g ce

iling

s / un

stab

le w

alls

/ le

akin

g w

ater

7.2

.1.2

.2. The

re is

a s

yste

m t

o pr

ovid

e em

erge

ncy

pow

er f

or a

ll st

rate

gic

area

s su

ch a

s O

pera

ting

The

atre

s /

ICU

s/ c

linic

al c

are

and

emer

genc

y lig

htin

g of

gro

unds

/ p

assa

ges

/ cl

inic

al c

are

area

s

7.2

.1.3

.1. M

aint

enan

ce rec

ord

reflec

ts t

hat

emer

genc

y ge

nera

tor

is f

unct

iona

l and

mai

ntai

ned

and

that

the

gen

erat

or is

sta

rted

and

run

for

5 m

inut

es w

eekl

y

7.2

.1.4

.1. M

aint

enan

ce rec

ords

sho

w t

hat

wat

er s

uppl

ies

are

chec

ked

daily

for

ade

quac

y an

d av

aila

bilit

y fr

om t

he m

ain

reticu

lation

sys

tem

7.3

.1.2

.1. Sec

urity

syst

ems

are

posi

tion

ed a

t vu

lner

able

pat

ient

are

as s

uch

as m

ater

nity

/ p

aedi

atric

and

psy

chia

tric

uni

ts

Infe

ctio

n Pr

even

tion

and

Con

trol

2.6

.1.2

.1. The

re is

a q

ualif

ied

and

or e

xper

ienc

ed h

ealthc

are

prof

essi

onal

with

desi

gnat

ed res

pons

ibili

ties

for

infe

ctio

n co

ntro

l in

the

heal

th e

stab

lishm

ent

2.6

.1.3

.1. The

hea

lth

esta

blis

hmen

t ha

s a

form

al s

urve

illan

ce a

nd rep

orting

sys

tem

for

hea

lthc

are

asso

ciat

ed in

fect

ions

2.6

.1.4

.2. The

rec

ent

min

utes

withi

n 6 m

onth

s of

the

com

mitte

e re

view

ing

infe

ctio

n co

ntro

l ind

icat

e th

at in

fect

ion

cont

rol s

urve

illan

ce d

ata

and

cont

rol m

easu

res

are

regu

larly

dis

cuss

ed /

ana

lyse

d an

d ac

tion

s ta

ken

to r

educ

e in

fect

ions

2.6

.1.4

.3. Sta

tist

ics

on c

omm

on h

ealth

care

ass

ocia

ted

infe

ctio

ns d

emon

stra

te t

hat

they

are

in li

ne w

ith

acce

ptab

le b

ench

mar

ks

2.6

.1.4

.4. The

min

utes

/doc

umen

tation

of

the

com

mitte

e re

view

ing

infe

ctio

n pr

even

tion

and

con

trol

dem

onst

rate

tha

t re

com

men

dation

s on

ant

ibio

tic

usag

e fo

r th

e es

tabl

ishm

ent

base

d on

the

org

anis

ms

sens

itiv

ity

prof

iles

are

mad

e an

d ad

here

d to

2.6

.2.1

.2. The

hea

lth

esta

blis

hmen

t pr

ovid

es a

ppro

pria

te t

ypes

of

mas

ks a

nd F

DA

app

rove

d re

spira

tors

whi

ch a

re f

it t

este

d fo

r al

l sta

ff w

ho a

re a

t ris

k of

con

trac

ting

TB o

r fo

r al

l sta

ff e

xpos

ed t

o se

rious

con

tagi

ous

resp

irato

ry in

fect

ions

2.6

.3.1

.2. The

est

ablis

hmen

t ha

s a

repo

rtin

g sy

stem

for

nee

dle

stic

k in

jurie

s or

oth

er in

cide

nts

rela

ted

to f

ailu

re o

f st

anda

rd p

reca

utio

ns

Appen

dIc

es


2.6

.3.2

.1. C

HEC

KLI

ST -

A ran

dom

sel

ection

of

5 c

linic

al a

reas

sho

w t

hat

shar

ps a

re s

afel

y m

anag

ed a

nd d

ispo

sed

of

2.6

.3.4

.2. C

HEC

KLI

ST -

App

ropr

iate

isol

atio

n ac

com

mod

atio

n ex

ists

for

pat

ient

s w

ith

com

mun

icab

le d

isea

ses

- as

a m

inim

um f

or h

azar

dous

dia

rrhe

al d

isea

ses

2.6

.3.4

.3. C

HEC

KLI

ST -

App

ropr

iate

isol

atio

n ac

com

mod

atio

n ex

ists

for

pat

ient

s w

ith

com

mun

icab

le d

isea

ses

- as

a m

inim

um f

or v

iral h

aem

orrh

agic

dis

ease

3.5

.1.1

.2. C

HEC

KLI

ST -

Sta

ff a

re a

ble

to e

xpla

in t

he p

roce

dure

by

whi

ch d

irty

inst

rum

ents

are

ste

rilis

ed f

rom

sta

rt t

o fini

sh

3.5

.1.3

.3. Rec

ords

sho

w t

hat

the

ster

ilisa

tion

man

ager

mon

itors

the

Ser

vice

Lev

el A

gree

men

ts f

or d

econ

tam

inat

ion

serv

ices

3.5

.1.4

.2. A

ll st

erili

sation

equ

ipm

ent

is v

alid

ated

/ li

cens

ed a

nd m

aint

aine

d ac

cord

ing

to a

pla

nned

sch

edul

e

3.5

.1.5

.1. The

re is

a s

yste

m in

pla

ce t

o m

onito

r al

l inc

iden

ts o

f st

erili

sation

fai

lure

whe

reby

fai

lure

s ar

e do

cum

ente

d w

ith

a de

taile

d ac

tion

pla

n an

d ou

tcom

es o

f th

ose

action

s ta

ken

are

reco

rded

6.2

.2.4

.1. Rec

ords

sho

w t

hat

heal

thca

re w

orke

rs h

ave

been

giv

en p

roph

ylac

tic

imm

unis

atio

ns f

or h

igh

risk

infe

ctio

ns s

uch

as h

epat

itis

B / M

MR / in

flue

nza

6.2

.2.4

.2. Rec

ords

of

need

le s

tick

inju

ries

show

tha

t th

ose

staf

f ha

ve r

ecei

ved

post

exp

osur

e pr

ophy

laxi

s an

d ha

ve b

een

re-t

este

d

7.5

.2.1

.1. The

Hea

lth

Car

e ris

k w

aste

man

agem

ent

HC

RW r

epor

t un

dert

aken

in t

he p

revi

ous

two

year

s sh

ow m

anag

emen

t`s

plan

and

mea

sure

s un

dert

aken

to

addr

ess

iden

tified

ris

ks

7.5

.2.3

.2. Rec

ords

sho

w t

hat

the

was

te m

anag

er m

onito

rs a

nd m

anag

es t

he s

ervi

ce le

vel a

gree

men

ts f

or w

aste

rem

oval

and

dis

posa

l

7.5

.2.4

.1. The

re a

re a

dequ

ate

cont

aine

rs f

or d

ispo

sal o

f H

CRW

sto

red

in a

n ea

sily

acc

essi

ble

/ w

ell m

aint

aine

d ce

ntra

l dis

posa

l are

a

7.6

.1.2

.2. A

reas

for

rec

eivi

ng s

oile

d lin

en a

re s

epar

ated

fro

m a

reas

of

clea

n lin

en

7.7

.1.8

.4. D

ocum

ents

sho

w t

hat

prob

lem

s in

dent

ifie

d du

ring

heal

th in

spec

tion

s ha

ve b

een

rect

ifie

d

Posi

tive

and

car

ing

attitu

des

1.1

.1.1

.3. Rec

ent

reco

rds

show

wha

t ac

tion

s ha

ve b

een

take

n in

the

eve

nt o

f an

inci

dent

of

staf

f ab

use

on a

pat

ient

2.1

.1.1

.1. C

HEC

KLI

ST -

The

file

s of

5 p

atie

nts

rece

ntly

dis

char

ged

show

tha

t a

com

preh

ensi

ve c

linic

al a

sses

smen

t an

d di

agno

sis

has

been

don

e

6.2

.1.1

.1. Rec

ent

reco

rds

show

wha

t ac

tion

s ha

ve b

een

take

n in

the

eve

nt o

f an

inci

dent

on

a st

aff

mem

ber

6.2

.2.2

.2. The

rec

ent

min

utes

of

the

occu

pation

al h

ealth

and

safe

ty c

omm

itte

e w

ithi

n th

e la

st 6

mon

ths

indi

cate

tha

t oc

cupa

tion

al r

isks

are

reg

ular

ly d

iscu

ssed

/ a

naly

sed

and

action

s im

plem

ente

d to

red

uce

sign

ific

ant

risks

Wai

ting

tim

es

1.5

.1.3

.1. C

HEC

KLI

ST -

10 ran

dom

sel

ecte

d sc

ripts

in p

harm

acy

are

corr

elat

ed w

ith

med

icat

ion

disp

ense

d to

ens

ure

that

all

med

icat

ion

was

rec

eive

d as

pre

scrib

ed

1.5

.1.4

.1. The

re is

a h

ealth

care

pro

fess

iona

l res

pons

ible

for

rev

iew

ing

or a

sses

sing

and

cha

nnel

ling

patien

ts o

r cl

ient

s

1.5

.1.4

.2. The

hea

lth

care

pro

fess

iona

l res

pons

ible

for

pat

ient

sor

ting

can

exp

lain

cle

arly

how

she

/he

asse

sses

and

sor

ts p

atie

nts

App

end

Ices


Esse

ntia

l Mea

sure

s

Ava

ilabi

lity

of m

edic

ines

and

sup

plie

s

3.1

.2.2

.1. C

HEC

KLI

ST -

Tra

cer

med

ical

sup

plie

s ar

e av

aila

ble

in t

he a

rea

whe

re m

edic

al s

uppl

ies

are

stor

ed

3.1

.2.3

.1. A

doc

umen

t ou

tlin

ing

the

term

s of

agr

eem

ent

for

the

supp

ly o

f m

edic

ine

is a

vaila

ble

and

ther

e is

evi

denc

e th

at C

ompl

ianc

e w

ith

the

agre

emen

t is

bei

ng m

onito

red

and

appr

opria

te a

ctio

n ta

ken

as n

eces

sary

als

o lo

ok f

or m

edic

ine

stoc

k

3.1

.2.3

.2. A

doc

umen

t ou

tlin

ing

the

deliv

ery

sche

dule

for

med

icin

e is

ava

ilabl

e

3.1

.2.4

.1. A

doc

umen

t ou

tlin

ing

the

term

s of

agr

eem

ent

for

the

supp

ly o

f m

edic

al s

uppl

ies

is a

vaila

ble

and

ther

e is

evi

denc

e th

at C

ompl

ianc

e w

ith

the

agre

emen

t is

bei

ng

mon

itore

d an

d ap

prop

riate

act

ion

take

n as

nec

essa

ry (

chec

k st

ock-

outs

)

3.1

.2.4

.2. A

doc

umen

t ou

tlin

ing

the

deliv

ery

sche

dule

for

med

ical

sup

plie

s is

ava

ilabl

e

3.1

.2.5

.1. D

uty

rost

ers

indi

cate

tha

t at

leas

t on

e ph

arm

acis

t in

pha

rmac

ies

or p

harm

acis

t`s

assi

stan

t or

pro

fess

iona

l nur

se in

clin

ics

is o

n du

ty a

nd a

vaila

ble

to d

ispe

nse

med

icin

e as

req

uire

d du

ring

open

ing

hour

s

3.1

.2.6

.1. A

sta

ndar

d op

erat

ing

proc

edur

e is

ava

ilabl

e w

hich

indi

cate

s ho

w h

ealth

care

pro

fess

iona

ls c

an a

cces

s m

edic

ines

whe

n th

e ph

arm

acy

is c

lose

d

3.1

.2.6

.2. The

nam

e an

d co

ntac

t de

tails

of

the

phar

mac

ist

on d

uty

for

the

prov

isio

n of

ser

vice

s af

ter

hour

s is

ava

ilabl

e

3.1

.2.6

.3. The

re is

a lo

cked

em

erge

ncy

cupb

oard

for

the

sup

ply

of m

edic

ines

nee

ded

afte

r ho

urs

3.1

.3.1

.1. C

HEC

KLI

ST -

Med

icin

e is

sto

red

corr

ectly

as p

er G

ood

Phar

mac

y Pr

actice

3.1

.3.1

.2. C

HEC

KLI

ST -

Pro

cedu

res

rela

ting

to

the

man

agem

ent

of m

edic

ine

as req

uire

d by

Goo

d Ph

arm

acy

Prac

tice

are

fol

low

ed in

the

pha

rmac

y

3.1

.3.1

.3. C

HEC

KLI

ST -

Med

icin

es in

the

war

ds o

r co

nsul

tation

roo

ms

are

appr

opria

tely

sto

red

and

man

aged

3.1

.3.2

.1. The

sto

ck c

ontr

ol s

yste

m s

tock

car

ds o

r co

mpu

teris

ed s

yste

m s

how

s m

inim

um a

nd m

axim

um o

r re

-ord

er le

vels

for

med

icin

es

3.1

.3.2

.2. C

HEC

KLI

ST -

Phy

sica

l sto

ck c

orre

spon

ds t

o st

ock

on t

he in

vent

ory

man

agem

ent

syst

em a

s pe

r ch

eckl

ist

3121

1

3.1

.3.2

.3. The

re is

evi

denc

e th

at a

sto

ck t

ake

was

don

e in

the

last

12 m

onth

s fo

r m

edic

ines

3.1

.3.3

.1. A

sta

ndar

d op

erat

ing

proc

edur

e is

ava

ilabl

e w

hich

indi

cate

s ho

w s

ched

ule

5 a

nd 6

med

icin

es a

re s

tore

d / co

ntro

lled

/ di

strib

uted

in a

ccor

danc

e w

ith

the

Med

icin

es

and

Rel

ated

Sub

stan

ces

Act

101

of

1965

3.1

.3.3

.2. The

ent

ries

in t

he s

ched

ule

5 a

nd/o

r 6 d

rug

regi

ster

are

com

plet

e an

d co

rrec

t (C

heck

one

ent

ry -

mus

t sh

ow a

t le

ast

date

/ n

ame

of p

atie

nt / d

ose

of m

edic

ine

/ ro

ute

/ si

gnat

ure

of p

erso

n w

ho a

dmin

iste

red

it p

lus

bala

nce

in s

tock

)

3.1

.3.3

.3. The

ent

ries

in t

he s

ched

ule

6 d

rug

regi

ster

are

com

plet

e an

d co

rrec

t C

heck

tha

t ph

ysic

al s

tock

of

one

S6 m

edic

ine

corr

espo

nds

to t

he q

uant

ity

in t

he reg

iste

r

3.1

.3.4

.1. The

re is

a p

roce

dure

rel

atin

g to

the

man

agem

ent

of m

edic

al s

uppl

ies

3.1

.3.4

.2. C

HEC

KLI

ST -

Med

ical

sup

plie

s ar

e st

ored

cor

rect

ly

3.1

.3.5

.1. The

sto

ck c

ontr

ol s

yste

m s

tock

car

ds o

r co

mpu

teris

ed s

yste

m s

how

s m

inim

um a

nd m

axim

um o

r re

-ord

er le

vels

for

med

ical

sup

plie

s

3.1

.3.5

.2. C

HEC

KLI

ST -

Phy

sica

l sto

ck c

orre

spon

ds t

o st

ock

on t

he in

vent

ory

man

agem

ent

syst

em a

s pe

r C

heck

list

31221

3.1

.3.5

.3. The

re is

evi

denc

e th

at a

sto

ck t

ake

was

don

e in

at

leas

t th

e la

st 1

2 m

onth

s

Appen

dIc

es


3.1

.4.1

.2. The

min

utes

of

the

Pha

rmac

y an

d The

rape

utic

s co

mm

itte

e de

mon

stra

te t

hat

action

s ha

ve b

een

take

n to

opt

imis

e th

e qu

ality

use

of m

edic

ine

6.4

.4.2

.2. Ph

ysic

al s

tock

cor

resp

onds

to

stoc

k on

the

inve

ntor

y m

anag

emen

t sy

stem

6.4

.4.2

.3. The

re is

evi

denc

e th

at a

sto

ck t

ake

was

don

e in

the

last

12 m

onth

s fo

r su

pplie

s

Cle

anlin

ess

1.1

.3.1

.1. Pa

tien

t sa

tisf

action

sur

vey

resu

lts s

how

tha

t pa

tien

ts a

re s

atis

fied

with

clea

nlin

ess

of h

ealth

esta

blis

hmen

t

1.1

.3.2

.1. Pa

tien

t sa

tisf

action

sur

vey

resu

lts s

how

tha

t pa

tien

ts a

re s

atis

fied

with

linen

ser

vice

s of

the

hea

lth

esta

blis

hmen

t

1.1

.3.3

.1. Pa

tien

t sa

tisf

action

sur

vey

resu

lts s

how

tha

t pa

tien

ts a

re s

atis

fied

with

food

ser

vice

s of

the

hea

lth

esta

blis

hmen

t

1.1

.3.4

.1. The

re is

cle

an w

ater

and

dis

posa

ble

cup

for

patien

ts in

wai

ting

are

as

7.4

.1.4

.3. Sm

okin

g ar

eas

are

prov

ided

and

iden

tified

for

sta

ff /

vis

itors

and

pat

ient

s

7.7

.1.8

.5. The

re a

re n

o si

gns

of v

isib

le d

irt in

the

kitc

hens

or

food

sto

rage

are

as

Impr

ove

patien

t sa

fety

1.2

.1.2

.1. The

re a

re w

ritte

n po

licie

s or

gui

delin

es rel

atin

g to

info

rmed

con

sent

1.6

.1.3

.1. A

writ

ten

polic

y is

ava

ilabl

e re

gard

ing

heal

th e

stab

lishm

ent

clos

ures

and

am

bula

nce

dive

rsio

ns

1.6

.1.4

.2. The

res

pons

e tim

e of

em

erge

ncy

serv

ices

are

withi

n ac

cept

able

ben

chm

arks

1.7

.1.1

.1. C

HEC

KLI

ST -

The

def

ined

pac

kage

of

serv

ice

is a

vaila

ble

for

the

type

of

heal

th e

stab

lishm

ent

or le

vel o

f ca

re

1.7

.1.1

.2. The

lice

nsin

g sp

ecific

atio

ns in

ter

ms

of s

ervi

ces

prov

ided

are

adh

ered

to

by t

he h

ealth

esta

blis

hmen

t

1.8

.2.2

.1. C

ompl

aint

s w

hich

are

ser

ious

adv

erse

eve

nts

are

mar

ked

as s

uch

in t

he c

ompl

aint

s re

gist

er

1.8

.2.2

.2. C

opie

s of

com

plai

nts

whi

ch a

re id

entified

as

serio

us a

dver

se e

vent

s ar

e re

ferr

ed t

o th

e co

mm

itte

e re

view

ing

adve

rse

even

ts f

or a

naly

sis

and

mon

itorin

g

2.2

.1.1

.1. C

HEC

KLI

ST -

The

mos

t up

to

date

gui

delin

es o

n th

e na

tion

al s

trat

egic

prio

rity

prog

ram

mes

or

heal

th in

itia

tive

s ar

e av

aila

ble

2.2

.1.3

.1. C

HEC

KLI

ST -

Evi

denc

e is

ava

ilabl

e th

at h

ealth

outc

omes

of

the

prio

rity

prog

ram

mes

or

heal

th in

itia

tive

s ar

e m

onito

red

agai

nst

the

rele

vant

tar

gets

2.3

.1.2

.2. H

ealthc

are

prof

essi

onal

s sp

ecific

ally

pha

rmac

ists

and

rad

iogr

aphe

rs in

dica

te t

hat

they

hav

e ac

cess

to

adeq

uate

sup

ervi

sion

2.3

.1.2

.3. H

ealthc

are

prof

essi

onal

s sp

ecific

ally

the

rape

utic

clin

ical

ser

vice

s pr

ofes

sion

als

indi

cate

tha

t th

ey h

ave

acce

ss t

o ad

equa

te s

uper

visi

on

2.3

.1.3

.1. M

inut

es o

f re

leva

nt q

ualit

y co

mm

itte

e fr

om t

he la

st 6

mon

ths

reflec

t th

at h

ealthc

are

prof

essi

onal

s pa

rtic

ipat

e as

act

ive

mem

bers

and

/or

chai

r th

e co

mm

itte

e

2.3

.1.4

.1. A

rec

ent

qual

ity

impr

ovem

ent

plan

/pro

gram

mes

withi

n th

e la

st 6

mon

ths

show

s th

at h

ealthc

are

prof

essi

onal

s ar

e re

spon

sibl

e fo

r im

plem

enting

rel

evan

t im

prov

emen

ts t

o pa

tien

t ca

re

2.4

.1.1

.1. The

re is

an

up t

o da

te c

linic

al r

isk

polic

y an

d pr

otoc

ol w

hich

hig

hlig

hts

the

esta

blis

hmen

ts a

ppro

ach

to t

he m

anag

emen

t of

clin

ical

ris

k

2.4

.1.2

.1. Te

rms

of ref

eren

ce o

f a

com

mitte

e re

view

ing

clin

ical

ris

k is

ava

ilabl

e w

hich

det

ails

the

inte

rdis

cipl

inar

y m

embe

rshi

p / re

spon

sibi

litie

s / ac

coun

tabi

lity

/ st

rate

gy t

o m

anag

e cl

inic

al r

isks

2.4

.1.2

.2. C

linic

al r

isk

asse

ssm

ents

are

con

duct

ed in

eac

h se

rvic

e/de

part

men

t of

the

est

ablis

hmen

t on

a reg

ular

bas

is a

nd w

hen

requ

ired

App

end

Ices


2.4

.2.1

.1. The

est

ablis

hmen

t ha

s a

proc

edur

e fo

r th

e ca

re o

f th

e te

rmin

ally

ill w

hich

add

ress

es t

he n

eeds

of

the

patien

ts a

nd t

heir

fam

ily

2.4

.2.1

.2. The

est

ablis

hmen

t ha

s a

proc

edur

e fo

r th

e m

anag

emen

t of

pat

ient

s de

tain

ed f

or 7

2 h

our

obse

rvat

ions

2.4

.2.6

.2. In

uni

ts w

here

chi

ldre

n ar

e ca

red

for

spec

ific

saf

ety

prec

aution

s ar

e in

pla

ce t

o pr

even

t ha

rm c

over

s on

pow

er p

oint

s/ba

rrie

rs/c

otsi

des/

child

res

ista

nt c

upbo

ards

/saf

e w

ater

tem

pera

ture

/doo

rs w

ith

high

han

dles

/win

dow

s sa

fety

cat

ch

2.4

.3.2

.2. C

linic

al rec

ords

sho

w t

hat

patien

ts v

ital s

igns

and

leve

l of

cons

ciou

snes

s ar

e m

onito

red

in rec

over

y ro

om u

ntil

patien

t is

for

mal

ly d

isch

arge

d to

the

war

d or

ICU

2.4

.3.2

.4. The

re is

doc

umen

tary

evi

denc

e th

at d

octo

rs f

ollo

w le

gal p

roce

ss w

hen

perf

orm

ing

proc

edur

es o

n pa

tien

ts w

itho

ut t

heir

cons

ent

such

as

emer

genc

y su

rger

y or

w

hen

next

of

kin

is u

nava

ilabl

e

2.4

.3.3

.2. A

n ap

prop

riate

com

mitte

e w

hich

rev

iew

s re

susc

itation

s eg

res

usci

tation

com

mitte

e is

for

mal

ly c

onst

itut

ed w

ith

a te

rms

of ref

eren

ce a

nd a

ppro

pria

te

mul

tidi

scip

linar

y m

embe

rshi

p

2.4

.3.6

.1. The

re a

re d

ocum

ente

d ad

mis

sion

and

dis

char

ge c

riter

ia t

o IC

U w

hich

are

spe

cific

to t

he e

stab

lishm

ent

2.4

.3.6

.2. The

hea

lth

esta

blis

hmen

t ha

s pr

oced

ures

in p

lace

to

redu

ce t

he r

isk

of h

ospi

tal a

ssoc

iate

d in

fect

ions

in in

tens

ive

care

pat

ient

s su

ch a

s Bes

t C

are

Alw

ays

cam

paig

n/ba

rrie

r nu

rsin

g an

d is

olat

ion

2.5

.1.1

.1. The

re is

an

up t

o da

te a

dver

se e

vent

s po

licy

avai

labl

e w

hich

det

ails

the

est

ablis

hmen

ts a

ppro

ach

to t

he m

anag

emen

t of

clin

ical

ris

k in

clud

ing

risk

iden

tifica

tion

m

etho

ds

2.5

.1.2

.1. C

HEC

KLI

ST -

5 s

taff

mem

bers

inte

rvie

wed

con

firm

the

est

ablis

hmen

t en

cour

ages

the

rep

orting

of

adve

rse

even

ts

2.5

.1.2

.2. The

re is

a p

roce

dure

in p

lace

to

supp

ort

staf

f af

fect

ed b

y ad

vers

e ev

ents

2.5

.2.1

.1. Es

tabl

ishm

ent

has

a re

port

ing

syst

em f

or a

dver

se e

vent

s in

dica

ting

sev

erity

/ ca

tego

risat

ion

and

action

s ta

ken

2.5

.2.1

.2. The

com

mitte

e re

view

ing

adve

rse

even

ts h

as c

lear

ter

ms

of r

efer

ence

whi

ch d

etai

ls t

he in

terd

isci

plin

ary

mem

bers

hip

/ re

spon

sibi

litie

s / lin

es o

f ac

coun

tabi

lity

and

stra

tegy

to

man

age

clin

ical

ris

ks

2.5

.2.4

.1. The

re is

evi

denc

e th

at a

dver

se e

vent

s fo

r th

e he

alth

est

ablis

hmen

t ar

e m

onito

red

agai

nst

rele

vant

tar

gets

incl

udin

g fa

lls / p

ress

ure

sore

s / m

edic

atio

n er

rors

3.1

.4.2

.1. A

sta

ndar

d op

erat

ing

proc

edur

e is

ava

ilabl

e w

hich

out

lines

the

dis

pens

ing

of m

edic

ines

acc

ordi

ng t

o th

e Ph

arm

acy

Act

53 o

f 1974 a

nd M

edic

ines

and

Rel

ated

Sub

stan

ces

Act

101

of

1974

3.1

.4.2

.2. A

sta

ndar

d op

erat

ing

proc

edur

e is

ava

ilabl

e fo

r th

e co

mpo

undi

ng o

f m

edic

ines

incl

udin

g ex

tem

pora

neou

s co

mpo

unds

/ c

ytot

oxic

s an

d TPN

as

appl

icab

le

3.1

.5.1

.1. The

re a

re s

tand

ard

oper

atin

g pr

oced

ures

for

the

mon

itorin

g of

adv

erse

dru

g re

action

s

3.2

.1.1

.3. C

HEC

KLI

ST -

Lab

orat

ory

resu

lts req

uest

ed a

re a

vaila

ble

in t

he p

atie

nts

file

3.2

.1.2

.1. A

cop

y of

the

qua

lity

cont

rol a

udit d

one

by t

he la

bora

tory

in t

he la

st 6

mon

ths

is a

vaila

ble

and

show

s th

at a

ccur

ate

/ re

liabl

e re

sults

are

bei

ng p

rovi

ded

3.2

.2.1

.7. The

rad

iolo

gy d

epar

tmen

t is

SA

NA

S o

r eq

uiva

lent

acc

redi

tation

bod

y ac

cred

ited

3.3

.2.1

.1. C

HEC

KLI

ST -

Ass

ess

5 f

iles

of p

atie

nts

that

hav

e be

en ref

erre

d to

the

rape

utic

sup

port

ser

vice

s fo

r a

mul

tidi

scip

linar

y ap

proa

ch

3.3

.2.1

.2. M

ultidi

scip

linar

y m

eeting

s oc

cur

on a

reg

ular

bas

is in

the

uni

t an

d ar

e at

tend

ed b

y th

e fu

ll ra

nge

of c

linic

al s

uppo

rt s

ervi

ces

staf

f O

ccup

atio

nal t

hera

pist

/ ph

ysio

ther

apis

ts /

die

tici

an /

soc

ial w

orke

r /

psyc

holo

gist

etc

3.3

.2.2

.1. C

HEC

KLI

ST -

Ass

ess

5 f

iles

of p

atie

nts

requ

iring

reh

abili

tation

and

see

if t

hey

have

bee

n as

sess

ed a

nd t

reat

ed a

ccor

ding

to

prot

ocol

Appen

dIc

es


3.3

.2.3

.1. A

n up

to

date

rev

ised

withi

n th

e la

st 2

4 m

onth

s lis

t of

ref

erra

l ser

vice

s is

ava

ilabl

e in

the

uni

t fo

r pa

tien

ts req

uirin

g ad

dition

al t

reat

men

t at

a m

ore

appr

opria

te

heal

th e

stab

lishm

ent

clos

er t

o th

eir

hom

e

3.4

.1.1

.2. C

HEC

KLI

ST -

Fun

ctio

nal e

ssen

tial

equ

ipm

ent

as li

sted

in t

he c

heck

list

is a

vaila

ble

in t

he R

adio

logy

Dep

artm

ent

3.4

.1.1

.6. C

HEC

KLI

ST -

Fun

ctio

nal e

ssen

tial

equ

ipm

ent

as li

sted

in t

he c

heck

list

is a

vaila

ble

in t

he O

utpa

tien

t de

part

men

t an

d co

nsul

ting

roo

ms

3.4

.1.1

.7. C

HEC

KLI

ST -

Fun

ctio

nal e

ssen

tial

equ

ipm

ent

as li

sted

in t

he c

heck

list

is a

vaila

ble

in t

he IC

U

3.4

.1.1

.8. C

HEC

KLI

ST -

Fun

ctio

nal e

ssen

tial

equ

ipm

ent

as li

sted

in t

he c

heck

list

is a

vaila

ble

in t

he IC

U n

eona

tal o

r pa

edia

tric

s

3.4

.2.1

.1. The

orie

ntat

ion

prog

ram

me

of t

he e

stab

lishm

ent

indi

cate

s th

at t

ime

has

been

allo

cate

d fo

r th

e tr

aini

ng o

f st

aff

in t

he u

se o

f m

edic

al e

quip

men

t

3.4

.2.1

.2. The

sta

ff d

evel

opm

ent

and

in-

serv

ice

trai

ning

pro

gram

me

mak

es p

rovi

sion

to

asse

ss a

nd u

p da

te s

taff

on

the

corr

ect

use

of m

edic

al e

quip

men

t

3.7

.1.1

.5. The

re is

evi

denc

e to

sho

w t

hat

qual

ity

impr

ovem

ent

plan

s ha

ve b

een

impl

emen

ted

to a

ddre

ss s

hort

com

ings

in le

ngth

of

stay

and

leve

l of

care

4.3

.1.1

.1. A

n up

date

d w

ithi

n th

e la

st 1

2 m

onth

s in

ters

ecto

ral p

lan

for

man

agem

ent

of p

ossi

ble

heal

th e

mer

genc

ies

and

dise

ase

outb

reak

s is

ava

ilabl

e

4.3

.1.2

.1. 5 ran

dom

ly s

elec

ted

staf

f m

embe

rs in

man

agem

ent

are

awar

e of

the

dis

ease

out

brea

k pl

ans

and

of t

heir

role

s in

thi

s pl

an (eg

for

a c

hole

ra / d

iarr

heal

/ in

flue

nza

outb

reak

)

4.3

.1.2

.2. The

re is

evi

denc

e th

at in

-ser

vice

tra

inin

g w

as d

one

on d

isea

se o

utbr

eaks

as

they

pre

sent

4.3

.1.3

.1. A

n an

nual

ly u

pdat

ed d

isas

ter

man

agem

ent

plan

is a

vaila

ble

and

disp

laye

d at

str

ateg

ic p

oint

s

4.3

.1.3

.2. The

hea

lth

esta

blis

hmen

t co

nduc

ts a

t le

ast

year

ly d

rills

to

test

the

pre

pare

dnes

s of

the

ir di

sast

er p

lan

incl

udin

g em

erge

ncy

/ di

seas

e ou

tbre

ak / f

ire / n

atur

al

disa

ster

4.3

.1.3

.3. C

HEC

KLI

ST -

5 ran

dom

ly s

elec

ted

staf

f m

embe

rs a

re in

terv

iew

ed t

o ev

alua

te t

heir

awar

enes

s of

the

dis

aste

r m

anag

emen

t pl

an in

clud

ing

heal

th e

mer

genc

ies

and

thei

r ro

le in

the

pla

n

5.2

.3.1

.1. The

hea

lth

esta

blis

hmen

t ha

s an

up-

to-d

ate

stra

tegi

c pl

an f

or t

he c

urre

nt 3

yea

r pe

riod

whi

ch h

as b

een

agre

ed u

pon

by t

he g

over

nanc

e st

ruct

ures

6.1

.1.5

.2. Tr

ends

in v

acan

cy /

tur

nove

r /

abse

ntee

ism

rat

es s

how

impr

ovem

ent

over

tim

e

6.1

.1.5

.4. Sta

ff w

orki

ng h

ours

are

mon

itore

d to

ens

ure

that

the

y co

mpl

y w

ith

the

Bas

ic C

ondi

tion

s of

Em

ploy

men

t A

ct in

ter

ms

of h

ours

per

wee

k

6.1

.1.5

.5. The

est

ablis

hmen

t ha

s an

agr

eem

ent

in p

lace

with

the

pref

erre

d ag

ency

for

con

trac

t la

bour

tha

t en

sure

s th

at t

he a

genc

y is

res

pons

ible

for

mon

itorin

g th

e ho

urs

wor

ked

by c

ontr

act

staf

f

6.1

.4.1

.1. The

hea

lth

esta

blis

hmen

t pr

ovid

es in

duct

ion/

orie

ntat

ion

for

all n

ew m

embe

rs o

f st

aff

whi

ch f

ocus

es o

n po

licie

s / pr

oced

ures

/ h

ealth

and

safe

ty / c

linic

al q

ualit

y ca

re

6.1

.4.1

.2. The

re is

a rec

ent

trai

ning

rec

ord

withi

n th

e la

st 6

mon

ths

avai

labl

e fo

r th

e In

duct

ion/

Orie

ntat

ion

Prog

ram

me

whi

ch s

how

s th

at a

ll ne

w s

taff

hav

e un

derg

one

trai

ning

6.1

.4.2

.2. The

re is

evi

denc

e av

aila

ble

that

sta

ff h

ave

unde

rgon

e tr

aini

ng a

gain

st t

he W

orkp

lace

Ski

lls P

lan

for

the

mos

t re

cent

pla

n

7.1

.1.1

.1. The

hea

lth

esta

blis

hmen

t ha

ve b

een

licen

sed

annu

ally

aga

inst

the

R158 o

r R187 reg

ulat

ions

7.1

.1.1

.2. The

hea

lth

esta

blis

hmen

t ha

ve a

n au

thor

isat

ion

notice

in li

ne w

ith

R42 a

nd t

he M

enta

l Hea

lth

Act

reg

ulat

ions

App

end

Ices


7.1

.1.1

.3. C

HEC

KLI

ST -

The

hea

lth

esta

blis

hmen

t m

eet

the

requ

irem

ents

of

R158 b

y m

ore

than

80%

7.1

.2.1

.1. In

spec

tion

rec

ords

sho

w t

hat

a re

cent

eva

luat

ion

withi

n th

e la

st 2

4 m

onth

s ha

s be

en c

arrie

d ou

t to

det

erm

ine

whe

ther

ava

ilabl

e fa

cilit

ies

are

used

as

inte

nded

in

the

build

ing

plan

s

7.1

.4.2

.1. The

re is

an

upda

ted

plan

ned

mai

nten

ance

pro

gram

me

avai

labl

e in

the

hea

lth

esta

blis

hmen

t w

hich

is m

onito

red

and

reflec

ts t

hat

mai

nten

ance

is c

arrie

d ou

t ac

cord

ing

to s

ched

ule

7.1

.4.2

.2. Rep

air

requ

isitio

ns a

re rev

iew

ed m

onth

ly a

nd o

utst

andi

ng it

ems

rais

ed w

ith

the

resp

onsi

ble

pers

on/s

ervi

ce p

rovi

der

7.1

.6.2

.1. A

ll ac

cess

rou

tes

are

clea

rly m

arke

d an

d sa

fe

7.1

.6.3

.1. Em

erge

ncy

vehi

cle

acce

ss roa

ds a

re c

lear

ly m

arke

d an

d th

ere

are

no p

hysi

cal o

bsta

cles

7.2

.1.4

.2. M

aint

enan

ce rec

ords

sho

w t

he res

ults

of

mon

thly

wat

er s

uppl

y qu

ality

chec

ks b

acte

riolo

gica

l / c

hem

ical

and

res

idua

l chl

orin

e ar

e w

ithi

n ac

cept

able

lim

its

7.2

.3.1

.2. C

lear

ly le

gibl

e an

d up

to

date

em

erge

ncy

num

bers

are

dis

play

ed a

t th

e sw

itchb

oard

/rec

eption

are

a

7.2

.4.2

.1. C

HEC

KLI

ST -

5 s

taff

mem

bers

kno

w h

ow t

o re

act

to a

n em

erge

ncy

war

ning

7.3

.1.1

.1. The

re is

a s

ecur

ity

syst

em in

pla

ce in

the

est

ablis

hmen

t co

verin

g bu

ildin

gs a

nd p

rem

ises

as

docu

men

ted

in t

he S

ecur

ity

Polic

y

7.3

.1.3

.1. Rec

ords

sho

w n

ight

ly in

spec

tion

s ar

e do

ne o

f th

e pr

emis

es t

o en

sure

ligh

ting

is f

unct

iona

l and

all

area

s ar

e lit

up

7.3

.1.4

.1. Rec

ords

or

min

utes

of

mee

ting

s sh

ow w

hat

action

s ha

ve b

een

take

n to

add

ress

sec

urity

inci

dent

s re

port

ed

7.3

.1.6

.1. The

Fire

Cer

tifica

te f

or t

he h

ealth

esta

blis

hmen

t is

ava

ilabl

e

7.3

.1.7

.1. The

re a

re q

uart

erly

em

erge

ncy

drill

s

Infe

ctio

n Pr

even

tion

and

Con

trol

2.4

.3.2

.3. In

fect

ion

cont

rol m

easu

res

of p

articl

e co

unts

and

bac

teria

l gro

wth

are

per

form

ed in

eac

h th

eatr

e ev

ery

6 m

onth

s

2.6

.1.1

.1. C

HEC

KLI

ST -

A p

olic

y re

gard

ing

infe

ctio

n co

ntro

l in

the

heal

th e

stab

lishm

ent

cove

rs a

ll as

pect

s of

infe

ctio

n pr

even

tion

and

con

trol

2.6

.1.4

.1. Te

rms

of ref

eren

ce o

f th

e co

mm

itte

e re

view

ing

infe

ctio

n pr

even

tion

and

con

trol

is a

vaila

ble

whi

ch d

etai

ls t

he in

terd

isci

plin

ary

mem

bers

hip

/ ro

les

/ re

spon

sibi

litie

s an

d st

rate

gy t

o m

anag

e he

alth

care

ass

ocia

ted

infe

ctio

ns

2.6

.1.5

.2. The

re is

evi

denc

e th

at t

he e

stab

lishm

ent

reco

rds

all n

otifia

ble

dise

ase

and

repo

rts

them

to

the

appr

opria

te p

ublic

hea

lth

agen

cy

2.6

.1.6

.1. The

pro

port

ion

of t

rain

ed h

ealthc

are

wor

kers

in a

t le

ast

4 c

ompo

nent

s of

sta

ndar

d pr

ecau

tion

s to

unt

rain

ed h

ealthc

are

wor

kers

is g

reat

er t

han

one

2.6

.1.6

.2. The

ann

ual i

n-se

rvic

e ed

ucat

ion

and

trai

ning

pla

n in

clud

es in

fect

ion

cont

rol e

duca

tion

/ p

reve

ntio

n of

res

pira

tory

infe

ctio

ns e

spec

ially

TB a

nd u

nive

rsal

pre

caut

ions

2.6

.1.6

.3. The

re is

edu

cation

al m

ater

ial a

vaila

ble

for

staf

f on

uni

vers

al p

reca

utio

ns in

clud

ing

hand

was

hing

/ res

pira

tor

use

/ th

e sa

fe u

se a

nd d

ispo

sal o

f sh

arps

/ u

se o

f pe

rson

al p

rote

ctiv

e eq

uipm

ent

/ co

ugh

etiq

uett

e

2.6

.1.6

.4. The

re is

edu

cation

al m

ater

ial a

vaila

ble

for

the

publ

ic /

pat

ient

s on

spe

cific

heal

thca

re a

ssoc

iate

d in

fect

ions

tha

t re

quire

add

itio

nal p

reca

utio

ns s

uch

as s

win

e flu

/ M

RSA

/ c

hole

ra

2.6

.2.1

.1. The

re is

edu

cation

al m

ater

ial a

vaila

ble

to p

atie

nts

on p

reve

ntio

n of

the

spr

ead

of T

B a

s w

ell a

s ot

her

infe

ctio

n co

ntro

l pre

caut

ions

2.6

.2.2

.1. The

hea

lth

esta

blis

hmen

t`s

room

s to

be

used

for

con

firm

ed in

fect

ious

TB p

atie

nts

are

loca

ted

away

fro

m n

on-T

B p

atie

nts

Appen

dIc

es


2.6

.2.2

.2. The

hea

lth

esta

blis

hmen

t`s

room

s us

ed f

or t

he a

ccom

mod

atio

n of

pat

ient

s w

ith

resp

irato

ry in

fect

ions

hav

e na

tura

l or

mec

hani

cal v

entila

tion

2.6

.2.3

.1. C

HEC

KLI

ST -

Sta

ff res

pons

ible

for

tra

nspo

rtat

ion

of p

atie

nts

follo

w t

he p

roto

col f

or t

he s

afe

tran

spor

t of

infe

cted

pat

ient

s in

ter

ms

of red

ucin

g th

e ris

k of

tr

ansm

issi

on

2.6

.3.1

.1. C

HEC

KLI

ST -

A c

ompr

ehen

sive

Sta

ndar

d pr

ecau

tion

s po

licy

and

proc

edur

e is

ava

ilabl

e

2.6

.3.3

.1. A

pro

gram

me

indi

cate

s th

at a

han

d w

ashi

ng d

rive

or c

ampa

ign

is h

eld

at le

ast

annu

ally

in t

he e

stab

lishm

ent

2.6

.3.3

.2. The

res

ults

of

hand

was

hing

aud

its s

how

Com

plia

nce

withi

n th

e he

alth

est

ablis

hmen

t of

at

leas

t 80%

2.6

.3.4

.1. A

pol

icy

and

proc

edur

e is

ava

ilabl

e th

at d

etai

ls t

he m

echa

nism

s in

whi

ch in

fect

ious

pat

ient

s ar

e is

olat

ed / w

hich

isol

atio

n fa

cilit

ies

are

used

and

the

man

ner

in

whi

ch t

hese

fac

ilities

and

equ

ipm

ent

are

disi

nfec

ted

2.6

.3.5

.1. Sta

ff a

re a

ble

to e

xpla

in h

ow t

hey

term

inal

ly c

lean

or

disi

nfec

t th

e ro

om a

nd e

quip

men

t us

ed b

y in

fect

ed p

atie

nts

2.6

.4.1

.1. The

re is

a f

unct

iona

l fee

d pr

epar

atio

n ar

ea a

vaila

ble

withi

n th

e he

alth

est

ablis

hmen

t if t

hey

adm

it in

fant

s

2.6

.4.1

.2. Pe

rson

nel w

orki

ng in

the

fee

d pr

epar

atio

n ar

ea w

ear

prot

ective

clo

thin

g su

ch a

s gl

oves

mas

ks a

nd a

pron

s

2.6

.4.1

.3. A

ppro

pria

te h

and

was

hing

fac

ilities

are

ava

ilabl

e in

the

fee

d pr

epar

atio

n ar

ea w

ith

appr

opria

te d

isin

fect

ant

solu

tion

s

2.6

.4.1

.4. A

ppro

pria

te f

acili

ties

and

equ

ipm

ent

to c

lean

and

dis

infe

ct u

tens

ils in

the

fee

d pr

epar

atio

n ar

ea a

re a

vaila

ble

and

func

tion

al

2.6

.4.1

.5. In

form

atio

n ab

out

disi

nfec

tant

sol

utio

ns a

nd f

requ

ency

of

repl

acem

ent

in t

he f

eed

prep

arat

ion

area

is d

ispl

ayed

on

the

wal

ls

2.6

.4.1

.6. The

re is

a c

lear

sig

nage

of

no u

naut

horis

ed e

ntry

on

the

door

to

the

feed

pre

para

tion

are

a to

lim

it p

eopl

e tr

affic

2.6

.4.1

.7. The

sto

rage

cup

boar

d fo

r ba

bies

for

mul

a is

cle

arly

mar

ked

and

lock

ed

3.5

.1.1

.1. C

HEC

KLI

ST -

An

up t

o da

te d

econ

tam

inat

ion

polic

y is

ava

ilabl

e

3.5

.1.2

.1. The

ste

rilis

atio

n m

anag

er is

app

ropr

iate

ly q

ualif

ied

in s

teril

e se

rvic

es in

clud

ing

expe

rienc

e an

d tr

aini

ng

3.5

.1.2

.2. Tr

aini

ng rec

ords

sho

w t

hat

staf

f w

orki

ng in

the

ste

rilis

atio

n se

rvic

es rec

eive

tra

inin

g in

the

tec

hnic

al a

spec

ts o

f st

erili

sation

and

on

use

of t

he e

quip

men

t

3.5

.1.3

.1. A

pro

cedu

re d

etai

ling

clea

r re

spon

sibi

litie

s fo

r th

e va

rious

asp

ects

in t

he d

econ

tam

inat

ion

cycl

e fo

r th

e st

erili

sation

ser

vice

s is

ava

ilabl

e

3.5

.1.3

.2. The

re is

a c

ontr

act

and

Ser

vice

Lev

el A

gree

men

t in

pla

ce w

ith

an a

ppro

ved

and

lega

lly c

ompl

iant

was

te s

teril

isat

ion

serv

ice

prov

ider

3.5

.1.4

.1. The

dep

artm

ent

is d

esig

ned

to a

llow

the

seg

rega

tion

of

clea

n an

d di

rty

area

s

3.5

.1.4

.3. A

log

book

is k

ept

for

each

mac

hine

det

ailin

g th

e st

erili

sation

his

tory

of

that

mac

hine

7.5

.1.1

.1. The

est

ablis

hmen

t ha

s an

up

to d

ate

was

te m

anag

emen

t pl

an rev

iew

ed a

nd u

pdat

ed w

ithi

n th

e pr

evio

us t

wo

year

s an

d co

mpl

ies

with

the

lega

l req

uire

men

ts a

nd

nation

al g

uide

lines

7.5

.1.2

.1. The

re is

a d

esig

nate

d or

app

oint

ed w

aste

man

ager

7.5

.2.2

.1. C

HEC

KLI

ST -

Pol

icy

for

HC

RW

man

agem

ent

cont

ain

the

proc

edur

e on

col

lect

ion

/ ha

ndlin

g /

segr

egat

ion

/ st

orag

e / di

spos

al / t

rain

ing

of s

taff

7.5

.2.3

.1. The

re is

a v

alid

con

trac

t an

d Ser

vice

Lev

el A

gree

men

t fo

r w

aste

rem

oval

whi

ch is

reg

ular

ly m

onito

red

App

end

Ices


7.5

.2.4

.2. The

re is

a p

roce

dure

in p

lace

for

obt

aini

ng a

dditio

nal H

CRW

con

tain

ers

shou

ld t

here

be

a ne

ed

7.5

.2.5

.1. The

re is

a u

p to

dat

e re

gist

er f

or a

ll an

atom

ical

was

te in

dica

ting

the

dat

e of

pla

cem

ent

and

date

of

rem

oval

for

dis

posa

l

7.6

.1.2

.1. The

pol

icy

indi

cate

s pr

oced

ures

for

han

dlin

g of

cle

an a

nd d

irty/

soile

d/in

fect

ious

line

n

7.7

.1.1

.1. Pr

oced

ures

for

pro

cure

men

t/ s

tora

ge a

nd p

repa

ration

of

food

ser

vice

s ar

e av

aila

ble

and

revi

ewed

ann

ually

7.7

.1.5

.1. H

and

was

hing

bas

ins

are

prov

ided

with

a so

ap d

ispe

nser

with

liqui

d so

ap /

nai

lbru

shes

/ p

aper

tow

els

7.7

.1.5

.2. A

ppro

pria

te h

and

was

hing

fac

ilities

are

ava

ilabl

e

7.7

.1.5

.3. H

ot w

ater

is a

vaila

ble

for

was

hing

of

dish

es

7.7

.1.5

.4. The

tem

pera

ture

s on

the

frid

ges

are

cont

rolle

d da

ily a

nd rec

orde

d

7.7

.1.6

.2. The

re a

re d

esig

nate

d se

para

te a

reas

for

foo

d pr

epar

atio

n of

raw

mea

t /

fish

and

veg

etab

les

7.7

.1.7

.2. The

re a

re rec

ords

of

the

man

dato

ry p

re-e

mpl

oym

ent

test

s fo

r fo

od-h

andl

ers

7.7

.1.7

.3. A

ll st

aff

use

Pers

onal

Pro

tect

ion

Equi

pmen

t as

nec

essa

ry in

clud

ing

for

exam

ple

mac

hine

ope

ration

and

fre

ezer

wor

k

7.7

.1.8

.3. The

re a

re rec

ords

of

heal

th in

spec

tion

s ca

rrie

d ou

t in

the

last

6 m

onth

s w

hich

sho

w t

hat

the

heal

th e

stab

lishm

ent

mee

ts t

he h

ygie

ne req

uire

men

ts

Posi

tive

and

car

ing

attitu

des

1.1

.1.1

.1. C

HEC

KLI

ST -

5 p

atie

nts

are

inte

rvie

wed

to

asse

ss w

heth

er t

hey

feel

tha

t th

ey h

ave

been

tre

ated

in a

res

pect

ful a

nd c

arin

g m

anne

r

1.1

.1.1

.2. C

HEC

KLI

ST -

5 ran

dom

sta

ff m

embe

rs o

bser

ved

by t

he a

sses

sor

dem

onst

rate

cou

rtes

y /

patien

ce / e

mpa

thy

/ to

lera

nce

1.1

.1.2

.1. Pa

tien

t ca

n be

con

sulted

in a

roo

m o

r re

ceiv

e tr

eatm

ent

in a

war

d in

a m

anne

r w

hich

allo

ws

for

priv

acy

eith

er t

hrou

gh c

lose

d do

ors

or s

cree

ns a

nd c

urta

ins

1.1

.1.2

.2. C

ouns

ellin

g ta

kes

plac

e in

a p

rivat

e ph

ysic

al s

pace

whe

re t

he c

ouns

ellin

g se

ssio

n ca

nnot

be

hear

d by

oth

ers

1.1

.1.3

.1. C

HEC

KLI

ST -

Men

tal i

ll pa

tien

ts a

re t

reat

ed in

suc

h a

way

tha

t th

eir

self res

pect

and

dig

nity

is p

rese

rved

1.1

.1.4

.1. The

hea

lth

esta

blis

hmen

t ha

s po

licie

s or

gui

delin

es w

here

by p

rovi

sion

is m

ade

for

pare

nts

or g

uard

ians

to

stay

ove

rnig

ht w

hen

child

ren

are

rece

ivin

g in

-pat

ient

tr

eatm

ent

1.1

.1.4

.2. The

hea

lth

esta

blis

hmen

t ha

s re

clin

ers/

chai

rs o

r be

ds a

vaila

ble

for

pare

nts

stay

ing

with

thei

r ch

ildre

n

1.2

.1.1

.2. C

HEC

KLI

ST -

Pat

ient

inte

rvie

w p

atie

nts

know

of

thei

r rig

hts

and

resp

onsi

bilit

ies

1.8

.1.1

.1. C

HEC

KLI

ST -

The

hea

lth

esta

blis

hmen

t ha

s an

up

to d

ate

proc

edur

e fo

r th

e m

anag

emen

t of

com

plai

nts

whi

ch in

clud

es a

ckno

wle

dgem

ent

/ in

vest

igat

ion/

res

pons

e an

d tim

elin

es a

nd m

itig

atio

n st

rate

gy

1.8

.1.1

.2. The

re is

evi

denc

e th

at c

ompl

aint

s re

late

d to

doc

tors

are

for

mal

ly t

able

d w

ith

the

doct

or o

r do

ctor

s pe

er rev

iew

bod

y

1.8

.1.2

.1. In

form

atio

n on

the

pro

cedu

re f

or c

ompl

aint

s is

cle

arly

dis

play

ed t

o pa

tien

ts

1.8

.1.2

.2. The

pos

ter

or p

amph

let

on c

ompl

aint

s is

sim

ple

to r

ead

and

avai

labl

e in

the

loca

l lan

guag

es

1.8

.2.1

.1. The

com

plai

nts

regi

ster

indi

cate

s th

at a

ll co

mpl

aint

s ar

e lo

gged

incl

udin

g w

hat

tim

efra

mes

wer

e m

et t

o re

solv

e th

em

1.8

.2.1

.2. C

ompl

aint

s ar

e cl

assi

fied

by

orde

r of

sev

erity

Appen

dIc

es


1.8

.2.4

.2. The

rec

ent

min

utes

of

the

com

mitte

e re

view

ing

com

plai

nts

withi

n th

e la

st 6

mon

ths

indi

cate

s th

at c

ompl

aint

s st

atis

tics

are

reg

ular

ly d

iscu

ssed

/ a

naly

sed

and

action

s im

plem

ente

d to

add

ress

con

cern

s

1.8

.2.5

.1. Ev

iden

ce s

how

s th

at a

ctio

n is

tak

en w

ithi

n 10

wor

king

day

s of

rec

eivi

ng o

f a

com

plai

nt

6.2

.1.2

.1. A

rec

ent

repo

rt w

ithi

n th

e la

st 6

mon

ths

dem

onst

rate

s th

at s

taff

utilis

e th

e Em

ploy

ee A

ssis

tanc

e Pr

ogra

mm

e

6.2

.1.2

.2. Sta

ff s

atis

fact

ion

surv

ey res

ults

sho

w t

hat

maj

ority

of s

taff

are

sat

isfied

with

thei

r w

orki

ng c

ondi

tion

s

6.2

.1.2

.3. The

re is

a rec

ent

repo

rt w

ithi

n th

e la

st 6

mon

ths

whi

ch d

emon

stra

tes

that

act

ions

hav

e be

en t

aken

to

impr

ove

on a

reas

iden

tified

in s

taff

sat

isfa

ctio

n su

rvey

6.7

.1.2

.1. Pa

tien

t re

cord

s in

the

ser

vice

are

as w

ards

/ c

onsu

ltation

roo

ms

/ re

cord

roo

ms

are

kept

in a

sui

tabl

e pl

ace

that

mai

ntai

ns t

he p

atie

nt`s

conf

iden

tial

ity

6.7

.2.2

.2. The

med

ical

rec

ords

roo

m is

sec

ure

and

only

acc

essi

ble

to a

utho

rised

sta

ff

Wai

ting

tim

es

1.5

.1.1

.1. A

que

ue m

anag

er o

r m

arsh

al o

r tr

iage

off

icer

is a

vaila

ble

to a

ssis

t pa

tien

ts in

the

que

ue w

here

to

sit

1.5

.1.1

.2. A

que

ue m

arsh

al in

form

s th

e pa

tien

t ap

prox

imat

ely

how

long

he

or s

he w

ill w

ait

OR t

he c

urre

nt w

aiting

tim

e is

dis

play

ed o

n a

boar

d

1.5

.1.2

.2. The

re is

a rec

ent

repo

rt w

ithi

n th

e la

st 6

mon

ths

on m

easu

red

wai

ting

tim

es t

hat

dem

onst

rate

s th

at w

aiting

tim

es h

ave

been

ana

lyse

d an

d im

prov

ed o

ver

tim

e

1.5

.1.4

.3. O

bser

ve w

heth

er s

peci

al q

ueue

s ar

e de

sign

ated

for

spe

cific

grou

ps o

f pa

tien

ts

1.5

.1.5

.1. Tr

ends

in w

aiting

tim

es f

or f

iles

show

an

impr

ovem

ent

over

tim

e

1.5

.2.1

.1. A

rep

ort

show

s th

at w

aiting

tim

es f

or e

lect

ive

proc

edur

es a

re m

onito

red

on a

reg

ular

bas

is a

nd h

ave

impr

oved

ove

r tim

e

7.1

.2.2

.1. The

layo

ut o

f th

e he

alth

est

ablis

hmen

t al

low

s fo

r ef

fici

ent

and

logi

cal f

low

of

patien

ts

7.1

.3.1

.1. The

wai

ting

are

a ha

s ad

equa

te s

pace

/ h

eating

/ n

umbe

r of

cha

irs t

o ac

com

mod

ate

all p

atie

nts

in t

he a

rea

7.1

.3.1

.2. W

aiting

are

as a

re lo

cate

d in

the

are

as w

here

the

ser

vice

tak

es p

lace

App

end

Ices


7�6

App

endi

x F:

Fac

ilitie

s w

ith N

o W

ater

and

Ele

ctri

city

Sup

ply

Faci

litie

s w

ith

no w

ater

and

ele

ctric

ity

at t

he t

ime

of t

he a

udit.

No

Wat

er S

uppl

y

Prov

ince

Dis

tric

tFa

cilit

yRea

sons

doc

umen

ted

East

ern

Cap

eA

Nzo

DM

ec L

ugan

geni

Clin

icM

unic

ipal

wat

er s

uppl

y on

ly a

vaila

ble

3 d

ays

per

mon

th. Rai

n w

ater

tan

k sy

stem

, w

ater

onl

y av

aila

ble

in rai

ny s

easo

ns

East

ern

Cap

eA

Nzo

DM

ec M

ntw

ana

Clin

icRai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eA

Nzo

DM

ec M

veny

ane

Clin

icRai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eA

mat

hole

DM

ec T

hoza

mile

Mad

akan

a C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eA

mat

hole

DM

ec N

daba

kazi

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eA

mat

hole

DM

ec B

ulem

bu C

linic

No

runn

ing

wat

er s

ince

2000, w

ater

obt

aine

d in

buc

kets

fro

m c

omm

unity

tap.

The

w

ater

tan

ks a

re o

ld a

nd r

usty

East

ern

Cap

eA

mat

hole

DM

ec S

prin

gs C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eA

mat

hole

DM

ec G

rain

valle

y C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eA

mat

hole

DM

ec N

qaba

ra C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eA

mat

hole

DM

ec M

send

o C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eA

mat

hole

DM

ec N

cize

le C

linic

Rai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eA

mat

hole

DM

ec N

gqus

i Clin

icRai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eA

mat

hole

DM

ec G

qunq

e C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eA

mat

hole

DM

ec M

tyho

lo C

linic

Rai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n. W

ater

sup

ply

from

mob

ile t

anke

r is

un

relia

ble

East

ern

Cap

eA

mat

hole

DM

ec D

r C

L Bik

itsha

Clin

icRai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eA

mat

hole

DM

ec N

qabe

ni C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eC

Han

i DM

ec P

rices

dale

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eC

Han

i DM

ec R

wan

tsan

a C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eC

Han

i DM

ec T

ora

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eC

Han

i DM

ec M

ahlu

bini

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eJo

e G

qabi

DM

ec E

silin

dini

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eJo

e G

qabi

DM

ec P

elan

daba

Clin

icN

o re

ason

pro

vide

d

Appen

dIc

es


No

Wat

er S

uppl

y

Prov

ince

Dis

tric

tFa

cilit

yRea

sons

doc

umen

ted

East

ern

Cap

eJo

e G

qabi

DM

ec H

lank

omo

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eJo

e G

qabi

DM

ec M

acac

uma

Sat

ellit

e C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eJo

e G

qabi

DM

ec H

lang

alan

e C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eJo

e G

qabi

DM

ec M

ango

loan

eng

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eO

Tam

bo D

Mec

Qan

qu C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eO

Tam

bo D

Mec

Man

tlan

eni C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eO

Tam

bo D

Mec

Gur

a C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eO

Tam

bo D

Mec

Nts

hent

she

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eO

Tam

bo D

Mec

Mta

katy

e C

linic

Rai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eO

Tam

bo D

Mec

Nol

ita C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eO

Tam

bo D

Mec

Qan

du C

linic

Rai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eO

Tam

bo D

Mec

Mak

wan

tini

Clin

icRai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eO

Tam

bo D

Mec

Mej

e C

linic

Rai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eO

Tam

bo D

Mec

Lw

andi

le C

linic

Rai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n. M

obile

tan

kers

are

ava

ilabl

e fo

r fill

l tan

ks

East

ern

Cap

eO

Tam

bo D

Mec

Pha

kam

ile C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eO

Tam

bo D

Mec

Lut

uben

i Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eO

Tam

bo D

Mec

Wilo

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eO

Tam

bo D

Mec

Zw

eleb

hung

a C

linic

Rai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eO

Tam

bo D

Mec

Tab

ase

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eO

Tam

bo D

Mec

Mpu

nzan

a C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eO

Tam

bo D

Mec

San

goni

Clin

icN

o re

ason

pro

vide

d

East

ern

Cap

eO

Tam

bo D

Mec

Qas

a C

linic

Rai

nwat

er t

ank

syst

em - r

uns

dry

whe

n no

rai

n

East

ern

Cap

eO

Tam

bo D

Mec

Upp

er X

ongo

ra C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eO

Tam

bo D

Mec

Xhw

ili C

linic

No

reas

on p

rovi

ded

East

ern

Cap

eO

Tam

bo D

Mec

Pal

mer

ton

Clin

icN

o re

ason

pro

vide

d

App

end

Ices


No

Wat

er S

uppl

y

Prov

ince

Dis

tric

tFa

cilit

yRea

sons

doc

umen

ted

East

ern

Cap

eO

Tam

bo D

Mec

Mpo

za C

linic

(Lu

siki

siki

)N

o re

ason

pro

vide

d

Kw

aZul

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Date post:	01-Mar-2020
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The National Health Care Facilities Baseline Audit Publications/NHFA... · 2017-06-28 ·...

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