NHI Pilot Districts 12 months progress report

1. NHI Pilot Districts12 months progress report Presentation to the Portfolio Committee on Health Committee Room 514, Marks Building 24 July 2013

2. Background • August 2011: NHI Green Paper – action plan • April 2012: NHI pilot districts to prepare for: • Purchasing of services; • Engaging the private sector; • Introducing a district health authority; • April 2013: Rapid appraisal to: • Assess progress in preparing for NHI • Provide a framework for monitoring

3. NHI domains appraised Human Resources Health information District Management Teams Conditional Grant Referral Contracting Private Providers • NHI management • Hospitals • Quality • Primary Health Care re-engineering • Infrastructure & Equipment

4. Tabular summary per District

5. NHI management & coordination

6. Hospital Reform

7. Quality

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

9. PHC Re-engineering

10. Infrastructure

11. Equipment Audit in Primary Health Care Facilities Summary of facilities assessed in NHI pilot districts

12. Human Resources for Health

13. Health Management Information

14. National Health Information Repository and Data warehouse (NHIRD) Rollout Process • A 2 day workshop in each district • The team will comprise of the Planning Unit from the National Department of Health, a software developer and facilitators from HISP The purpose of the visits are to: • Ensure that the NHIRD reporting system is available for use to the District Management Team • Ensure that the District staff are able to maintain and utilise the NHIRD system so that data is accessible . During the visits the team are proposing to meet with the following : • The District Management Team to orientate them on the basic use of the NHIRD reporting system • Senior staff from the DHS, planning/information or M&E units as decided by the Province

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

16. Proposed Schedule

17. District Management

18. Referral systems

19. GPs in districts on national contract

20. Assessment of PHC Clinics in NHI PILOT DISTRICTS • The facility visits focus on infrastructure, personnel, equipment, access to drugs, and other system processes. • This information will allow the NDOH to determine which facilities do not meet the minimum requirements and the process to bring them to standard.   • In total, there are 764 PHC facilities in the 11 Pilot Districts. • 669 PHC Clinics • 67 CHCs

21. Overview of Method of Assessment • The Assessments focus on all NHI pilot districts with a combination of quantitative data and qualitative observations, as well as conducting interviews with facility staff . • Facilities were assessed in terms of various aspects relating to their functionality and were scored or assessed in terms of the following areas: • Human Resources: • Relative comparison of workload with Professional Nursing staff • Range of Services rendered against the PHC package • Physical Space • Infrastructure conditions such as broken windows, locks on doors, cracks on walls, leaking roofs etc. • Can they physically accommodate a doctor in the existing premises? • Pharmacy services • System and process elements • Essential Equipment

22. Overview of Approach • Human Resources: • What are the current staffing levels by professional grouping? • Do they have access to services of a Medical Officer or General Practitioner on sessional basis? • Relative comparison of workload with Professional Nursing staff • Patient Data • Clients seen on average in a day, week, month and over the past 12 months • Range of Services rendered against the PHC package • What services are current offered?

23. Overview of Approach continued • Physical Space • Number of consulting rooms • Storage and filing • Access to utilities such as piped water, sanitation, electricity • Infrastructure conditions such as broken windows, locks on doors, cracks on walls, leaking roofs etc. • Major Infrastructure challenges including requiring major repairs, lack of adequate space, can the building be extended or requires a temporary (park home) structure. • Can they physically accommodate a doctor in the existing premises? • Pharmacy services • Availability of a pharmacy or dispensary • Availability of medicines trolleys in consulting rooms • Access to qualified pharmacist or pharmacy assistant • Drug stock outs • Issues with routine and continuous supply of medicines

24. Overview of Approach continued • System and process elements • Access to telephones, fax, internet • Data capturers • Filing systems • Patient scheduling • Availability of key communication and information materials • Availability and understanding of SOPs, guidelines and policies • Essential Equipment • Availability of essential equipment required for services rendered • Ordering and accessing missing equipment

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

26. PROGRESS • As of 1st June 2013, 556 of the facilities in the 10 Pilot Districts have been prioritized. • Amajuba will be completed after the 10 pilots

27. Preliminary Analysis • Criteria • Staffing • Space • Building Condition • Equipment • Would you like a GP to come in part-time? • If yes to the question above, is there space for the GP? • How many facilities are “READY”? • Of the 556 the facilities were scored as being ready as follows: • Only 125 facilities scored YES to all the questions; • If you remove staffing, then 164 facilities are classified as ready

28. SCORING INDICATING CHALLENGES

29. Next Steps • Most facilities do not have a service improvement plan to address areas of weakness arising from the assessments. • Support from NHI coordinators and District Managers in order to develop, and implement service improvement plans and thereby meets deadlines important. • NDOH has begun to engage the Province on specific feedback sessions and will develop and monitor progress following these initial facility assessments • The placement of GPs in facilities should be directly linked to service needs and then informed by the state of facility readiness.

30. Summary • NHI management and coordination in placeand DHMTs realigning their priorities • NHI Conditional Grants have contributed to progress • Quality improvementinterventions underway • Hospital reformbeing introduced • Referralmechanisms are in place • PHC Re-engineering: Three streams (DCSTs, WBOT and School Health) teamsnot yet complete • Health staff is insufficient; WHO WISN norms and standardsbeing used to motivate for increased funding • Private providers – districts ready for private GPs to work alongside nurses in primary health care facilities • Challenges – these are identified per facility and are being addressed specifically