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Historical Background

National Department of Health Presentation to the Portfolio Committee on Health Health in the Eastern Cape Province 30 October 2013. Historical Background. Significant backlogs were inherited in 1994 Amalgamation of health authorities, including two homelands

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Historical Background

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  1. National Department of Health Presentation to the Portfolio Committee on HealthHealth in the Eastern Cape Province30 October 2013

  2. Historical Background • Significant backlogs were inherited in 1994 • Amalgamation of health authorities, including two homelands • Significant levels of poverty, under-development, large areas with poor soil, under-development of infrastructure, including health infrastructure

  3. BACKGROUND: SELECTED DATA • PHC expenditure per capita (uninsured) was R684 on average nationally with the average for the EC being R646 (compared to Limpopo at R589 and Mpumalanga at R571); OR Tambo spend R595 per capita – the lowest of all districts and with Nelson Mandela Metro spending R928 • Of all district health service expenditure, district hospital spending nationally constitutes 39.1%; for the Eastern Cape district hospital expenditure as a proportion of total district spending was 41.7%; 37% of district spending is on district hospitals in ORT • PHC utilisation rate (visits per person per year) nationally was 2.6; with ORT at 2.79 • Early neonatal mortality rates in districts in the EC range from: 5.1/1000 (Cacadu) to 17.2 in NMM with ORT being at 20.8 (national average is 10.2) • In facility under 1 mortality rate in the EC range from 2.8% in Cacadu to 16% in ORT (national average is 6.8% - calculated as a percent of all separation)

  4. Table: Comparison of iMMR per province from 2008 - 2012 Province 2008 2009 2010 2011 2012 Eastern Cape 180.4 215.2 197.0 158.26 146.44 Free State 267.0 350.9 263.5 240.08 124.54 Gauteng 136.0 160.2 159.2 121.45 142.52 KwaZulu - 186.74 160.33 Natal 183.8 194.2 208.7 Limpopo 176.6 160.4 166.7 195.51 185.80 Mpumalanga 179.8 159.4 218.6 190.13 173.76 North West 161.7 279.5 256.1 153.75 127.76 Northern 191.10 149.33 Cape 274.4 251.8 267.4 Western 64.81 78.64 Cape 61.8 113.1 88.0 South Africa 164.8 188.9 186.2 159.14 146.71

  5. Report from Ministerial team’s visit to Holy Cross Hospital on 13 September 2013 • To investigate the state of affairs in Holy Cross Hospital allegations from a report written by a suspended doctor, Dr DingemanRijken, who was an employee of the hospital • Find facts on allegations on state of health services in the Eastern Cape as stated in an article by TAC, Section 27 and other organisations titled:’ Death and Dying in the Eastern Cape’ ,an investigation into the collapse of a health system • Investigate and make findings whether : • The rights of any patients were violated • Any health professional breached any professional health ethical or other code of conduct • The conduct of management of the hospital contributed in any manner to the state of affairs in the hospital • The oversight role of the district to the hospital was exercised adequately • The provincial support to the hospital was exercised adequately • Support services are functioning optimally • Procurement procedures are in place and compliance adherence thereof • The role supervisors played in bringing to the attention of Eastern Cape Provincial Department of Health , National Department of Health and the Health Professions Council of South Africa, the state of affairs in the hospital

  6. Key Findings at Holy Cross Hospital • Lack of key pieces of equipment • Lack of consistent supply of oxygen • Poor record keeping • Poor staff attitude • Poor quality of care • Irregularities in procurement • Inadequate emergency medical services in the Flagstaff area (ORT)

  7. Recommendations by the team: Holy Cross Hospital • The CEO should be suspended with immediate effect pending a full investigation into her role in respect of serious dereliction of duty, mismanagement and harm to patient care. • The Nursing Services Manager should be suspended with immediate effect pending a full investigation into her role in respect of serious dereliction of duty, mismanagement and harm to patient care. • Progressive disciplinary measures should be instituted against the Hospital Administrator for her role in the poor management of oxygen supply to the hospital. • All of the above have been effected

  8. Strengthening the supply of pharmaceuticals • Historical challenges with the functionality of the Umtata depot • Various attempts made to strengthen the depot over time including a plan to implement direct deliveries for hospitals. • A chronic medicine supply tender to be awarded soon which would decongest public facilities allowing patients to receive their chronic medicines at a point closer to their home/work. • Currently: • link between depot and NDOH to monitor stock levels at the depot. • Intervention were stocks levels are low. • District pharmacists are expected to monitor facility stock levels and report supply problems when detected to the HOPS. • A national toll free stockout line for reporting on stock outs for patients and health professionals.

  9. Strengthening Hospital Management • Provincial management has been workshopped on the key issues to strengthen hospital management in the following areas: • Governance, including clinical governance • Procurement • Financial management • Human resources management

  10. Provision of essential equipment, ORT hospitals • NDOH has arranged for essential equipment to hospitals in the OR Tambo district • Equipment has been delivered to Holy Cross Hospital for example

  11. Strengthening services in OR Tambo District • A Facility Improvement Team from the NDOH has been working in the district for the past 18 months (focusing on strengthening infrastructure, and quality improvement) • The provincial management, District Management Team and the District Clinical Specialist Team have also developed an action plan to strengthen services in the district as a whole

  12. ORT Action Plan

  13. Provincial District Improvement Teams • The ECDOH has appointed a provincial team to work with the DMT and the DCST to support ORT • ECDOH is also in the process of establishing teams for each of the other districts • Team leaders report to the Head of Department and the MEC

  14. Conclusions • Clearly there are many challenges in the EC and in ORT in particular • NDOH with the ECDOH has a robust plan to strengthen health services in the EC and in ORT in particular

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