IM MOLOI 16 AUGUST 2015

1. PPTICRM ORIENTATIONCOMPONENT 9DISTRICT HEALTH SYSTEM SUPPORTLEADERSHIP & CORPORATE GOVERNANCENORTH WEST EXPERIENCES IM MOLOI 16 AUGUST 2015

2. You've failed many times, although you don't remember. You fell down the first time you tried to walk. • You almost drowned the first time you tried to swim. . . Don't worry about failure. . . • Worry about the chances you miss when you don't even try. Sherman Finesilver US District Court Judge

3. There is a health facility operational plan in line with district health plan • The District Health Plan is developed with all stakeholders and availed to the Sub Districts before the beginning of the financial year. • The Annual Performance Plan is also developed and distributed to Districts and Sub Districts. • The District Operational Plan is developed and distributed before the beginning of the financial year around January • Sub District Operational Plans are developed with all stakeholders • Cluster/LHA plans are developed with all stakeholders. • Facilities develop and complete the operational plans before end of March • Annual Performance Plan and Operational plans are reviewed monthly and quarterly.

4. PPTICRM visits ideal clinic twice a year for ICR and correct weaknesses • The appointed Sub District PPTICRM led by the Sub District Manager visits the identified facilities quarterly. • Most of the challenges are resolved immediately since the team is complete. • CQIP’s are developed after each visitand progress discussed at the next monthly reviews meeting.

5. There is a pre-determined ambulance response time to the facility • Rural-40 minutes • Urban-15 minutes • Satellite stations are established at health centres, improve response times from 5-30 minutes. • Satellite stations support the catchments areas and facilities.

6. Ambulances respond in line with the pre-determined response time • Satellite stations at CHC’s greatly reduce response time within 5-10 minutes in a CHC • Catchments areas usually meet the predetermined times from the CHC’s • Challenges are always around resources, ambulances and staff.

7. There is effective planned patient transport to and from the referral hospitals • All hospitals are having reliable PPT’s, inter hospitals transfers are effective. • Additional PPT’s are recently procured for the EMS stations to cover the PHC’s. • The plan still at infancy to report achievements, however since 60% of all calls are P3’s, this is expected to work. • The plan implemented at one Sub District has already yielded good spin offs, and is cost effective.

8. The National Referral Policy is available • The national policy is not available yet • North West referral policy also available and is used by all the facilities.

9. The facility’s standard operating procedure for referrals is available • District referral pathways available which include DCST, OTL & CHW and referrals to Social Cluster • Facilities standard operating procedure developed in line with the above. • Each facility has a copy of the SOP developed at Sub District level.

10. Referral pathways are clearly determined • Pathways are determined in line with the provincial referral policies. • Each facility and the EMS have a copy of pathways and they know exactly where to refer what. • Most PHC facilities refer to District hospitals. • The pathways make room for direct referral up to tertiary level in cases of need.

11. There is a referral register that records referred clients • All referred patients are recorded accordingly with all details kept at the facility. • The emergency services unit also keeps a record of all clients referred. • A report on referred clients forms part of the monthly and quarterly reviews presentation by EMS.

12. Referral records indicate feedback from destination facilities • Feedback from the destinations remains a big challenge. • Institutions fail to give feedback. • Only reengineering referrals have complete feedback. • The is a need to continuously meet with referral institutions and table this matter always. • Plans are in place through bi monthly meetings to discuss the matter with referring and receiving institutions

13. There is a standard National Referral form that is used by all for referring clients • The national referral form is not available hence not used. • The form is still on a draft stage. • The only standard form is for reengineering programme. • Districts and Sub Districts to acquire the form and use it appropriately.

14. Analysis of referral data is conducted to identify service delivery gaps • Information from emergency services analysed at monthly and quarterly reviews. • There are still challenges of analysing the information from the hospitals as the meetings are infrequent. • Plans are in place to address these at the bi monthly meetings among hospitals.

15. RE A LEBOGA.