Representative of various media
Ladies and gentleman good afternoon
Since my appointment as the MEC for Health and Social Development, I have visited a number of health facilities with a view to assess levels of service delivery. During visits to various health facilities, the MEC interacted with patients, doctors, nurses and other support health professionals with regard to delivery of health care services in Gauteng. Work that is being done by doctors, nurses and support health professionals in spite of significant challenges is greatly appreciated.
In this interaction, the following challenges stood out:
* Patients being turned away from health facilities
* Overcrowding due to high patient volumes and burden of disease
* Poor environmental conditions in facilities for patients and staff
* Interruption in supply of medication at facilities
* Failure to procure adequate medical equipment
* Breakdown in service due to non payment of suppliers and non-governmental organisation (NGO’s).
This operation, “Kuyasheshwa-La,” will deal with the root cause of the above challenges and effectively bring solutions to deliver the best accessible health care to the people of Gauteng. The delivery of an acceptable standard of care, implying quality health service for patients and the community at large, through empowered health personnel is a strategic priority for the GDH and SD. The operation will further deliver the highest quality of service and sustained improvement in the health care services within available resources for the people of Gauteng.
The activities within this operation will be scaled up incrementally until stabilisation has been achieved. The department is committed to setting higher standards of care and changing negative perceptions of health service delivery. Being cognisant of the challenges that lie ahead, the department has examined the past failures and successes in order to institute changes that are real, practical and that will make a difference to the people served.
Task team and its mandate
The managers comprising the team for the planning and implementation of this operation will be led by Dr A Rahman Chief of Operations.
He will be assisted by the following senior managers:
* Dr Ernest Kenoshi
* Dr Patrick Maduna
* Dr Phila Mazamisa
* Mrs Johanna More
* Mrs Thandi Chaane
* Dr Trevor Fisher
* Dr Claude Mondzanga
* Dr Mamorena Mofokeng
* Ms Shoki Tshabalala
Dr Rahman will update the MEC on a daily basis. The operations of GDH and SD will be supported by the human resource, finance and corporate service divisions. Management Support Teams (MST) for all clinics, Community Health Centres (CHCs) and hospitals in Region A, B, C, each MST leader will put together a team, with names to be supplied to Dr Rahman. Each team will be composed of the team leader, medical superintendent, a nursing manager and a medical officer.
The MSTs will visit all institutions within the province, including clinics, Community Health Centres (CHCs), district hospitals, regional hospitals, specialised hospitals, rehabilitation institutions and central hospitals, with special focus on the areas mentioned above, and any other that may become evident.
This team along with subsets of smaller teams will provide the management towards achievement of the goals within the stipulated time frame. It will also ensure that appropriate resources are made available within public service prescripts. The team will submit written weekly reports and will be update Dr Rahman on a daily basis.
Support for the operation by senior management of GDH and SD:
The two Heads of Departments of Health and Social Development and all Senior Managers will support the implementation of this operation and avail resources where appropriate and applicable.
Deliverables
* Appropriate staffing levels
* Improvement of Patient care
* Stabilisation of drug supply
* Improvement of queue management
* Rapid patient registration
* Efficient and secure patient file management
* Prevention of patients from being turned away
* Better linen management
* Excellent customer service
* Improved facility management and maintenance.
To meet the set deliverables the following areas need immediate attention and strengthening:
Strengthening the district health system
Strengthening of the district health system is a national priority
* Each of the three Regions (Johannesburg and West Rand, Tshwane-Metsweding and Ekhurhuleni and Sedibeng) shall have management strengthened with immediate effect. Each of the six districts will have a full time manager. This will ensure efficient management of district hospitals, districts and sub-districts. The regional management functions will ensure that all institutions (including clinics and Community Health Centres (CHC)) are well stocked with medicines and other supplies and ensure improved provision of quality health services.
* The regional management shall work with the district directors and clinic managers on a regular basis to streamline services in each region
* We have introduced family physicians in the district health services to strengthen primary health care. This will remove the need for patients to present at inappropriate levels of care and can be assured of access to doctors at the district level
* The program to increase hours of operation will continue in designated clinics and CHCs
* Services provided by provincial and local government health facilities will be standardised to offer quality health care.
Quality patient care, including waiting times in registration points and dispensaries:
* In order to improve patient care at clinics, queue management shall be implemented in all clinics, CHCs and hospitals and managed by dedicated personnel
* All waiting times will be monitored and recorded, and action plans will be developed with the aim of reducing these waiting times to minimum, from the point of appointments, registration, consultation, surgical procedures and dispensing of medicines
* No patient shall be turned away from a facility without having been stabilised. Patients must not be moved from one institution to another without being helped. Each patient presenting at a health facility will be properly assessed and if necessary, referred in the prescribed manner to an appropriate institution. Emergency treatment must always be given even if the patient is not from the designated patient catchments area in accordance with the departmental referral system
* Customer/client service training of staff shall be a priority to ensure respectful and empathetic communication with patients and other members of the public.
Complaints management:
Management of complaints must be a priority at each institution.
Complaints call centre:
A central complaints management call centre is being established in Charlotte Maxeke Johannesburg Academic Hospital to receive and manage complaints from members of the public. This call centre will be kept operating day and night and will be managed by competent staff. Complaints lodged with this centre will be processed within 48 hours. The call centre will link up with the Managing Medical Officer (MMOs) and Institutional Clinical Managers on duty on a 24/7 basis. The complaints will be categorised and managed appropriately. Drug unavailability and out-of-stock consumables from health facilities will also be reported through this call centre after hours. The telephone numbers are as follows: 011 488 4394, 011 488 4351, 011 488 4366, 011 488 4445
Pharmaceuticals and surgical sundries supply stabilisation:
* Regional pharmacists shall actively support clinics and CHCs to replenish their stocks of essential drugs as a matter of urgency, and ensure stock-level management in these facilities
* Central Hospital CEOs shall identify one or two pharmacy assistants per Central Hospital who will be seconded to regional pharmacies to assist the regional pharmacists.
* Mobile Therapeutic Response Vehicle (MTRV) will be introduced to provide uninterrupted supply of drugs at all facilities after hours.
Stabilisation of the hospital services:
All four central hospitals and specific hospitals will be a priority for this financial year. Closer attention will also be given to other institutions soon thereafter.
Facilities’ state of repair and cleanliness:
Clinics, CHCs and hospitals shall be kept in a good state of repair at all times. CEOs and institutional facility managers are responsible for ensuring that all repairs are done as soon as the need arises and that institutions are kept clean all day and night, even if it means cleaning the high human traffic areas several times a day.
Staff facilities (such as restrooms) will be upgraded in order to provide staff motivation in an improved working environment.
Equipment:
Equipment in hospitals is grouped as:
* “Big ticket items” PET scanner, MRI and CT scanners etc
* Medium items ventilators, ultrasound scanners, specialised vital sign monitors, anaesthetic machines, blood gas analysers etc. These items may be procured simultaneously whenever several institutions require similar items, to achieve gains from economies of scale
* Small items: Defibrillators, ECG machines, Dinamaps, Endoscopes, etc These should be procured by hospitals as soon as they are needed so that patient clinical care is not compromised by lack of such low cost items
* Diagnostic Tools: Baumanometer, otoscope, laryngoscope, stethoscope etc
* Nursing-related items: Bed pans, urinals, thermometers, medicine trolleys etc.
* Hospital furniture: ICU working platforms (ICU beds), ward beds, bedside tables, etc
* Instruments: Instruments used in operating theatres, specialized clinics, etc. Can also be consignment items or loan sets
* Pharmacy related instruments: special fridges, medicine mixers, special scales, etc
* Allied health professionals’ equipment: assistive devices, hearing aids, walking frames, Neurophysiological tests, infrared lamps etc
* Surgical implants: artificial joints, artificial heart valves, plates, screws and nails etc
* Office and household furniture and cleaning equipment
* Garden maintenance.
Budgets for all equipment will be allocated to institutions to manage. There shall be equipment management committees in each institution, as well as at Central Office level. Leasing of equipment is an option which should also be considered.
Linen
Upgrades of laundry equipment will be made to ensure optimal availability of linen. Strict control measures will ensure that linen will be supplied regularly to all clinical areas (such as doctor’s coats, theatre gowns, theatre drapes, bedding etc). Institutions will have designated linen managers to oversee this.
Communication strategy
Internal and external communication shall be strengthened.
Human resources issues
Positions affecting service delivery, such as doctors, nurses, pharmacists, will be prioritised over non-core appointments. Temporary deployments and acting positions shall be filled with fulltime appointed staff within the next six months. This applies especially to senior management positions insofar as they affect service delivery and appointment of health professionals.
Internal stakeholders to be met as soon as possible:
* CEOs forum
* HR forum
* Finance forum
* Nurse managers forum
* Facility management forum
* Health professionals
* Organised labour
Enquiries:
Mandla Sidu
Cell: 083 602 6169
Issued by: Department of Health and Social Development, Gauteng Provincial Government
25 June 2009
