Kwazulu-Natal HPH Committee Dept. of Health & School of Public Health .

1. DEVELOPING HPH STANDARDS IN PUBLIC HOSPITALS IN SOUTH AFRICARAMDASS PD, JINABHAI CC, CASSIMJEE MH, GEDDES R Kwazulu-Natal HPH Committee Dept. of Health & School of Public Health.

3. BACKGROUND • The WHO Health Promoting Hospitals (HPH) project aims to incorporate health promotion into the culture and management of hospitals to improve patient and staff health. • The Department of Health, Kwazulu-Natal, piloted the WHO self-assessment tool, in six public hospitals, as part of the international collaboration.

4. 70% of global total SAHARA SUB – SAHARAN AFRICA SOUTH AFRICAN DEVELOPMENT COMMUNITY(SADC) KWAZULU -NATAL SOUTH AFRICA

6. The hospitals are distributed over an area of about 93 000 km² but access is difficult due to poor roads. Although the KZN Province inherited a number of disadvantaged hospitals from the previous apartheid government, it is working at improving them.

8. Objectives of Pilot Project in S A Adapt & contextualise the Self-Assessment Tool (SAT)performancestandards &indicators Assess existing Hospital Information Systems Develop quality improvement plans based on Indicator assessment & compliance with standards Integrate the HPH data sets into the local Hospital Information Systems Recommend the implementation of HPH in all Public Hospitals in South Africa & Africa

9. METHODS • Permission & authorization from policy makers to undertake pilot in 6 hospitals • Consultations with Hospital staff • Establishment of KZN HPH committees • Mobilsation & allocation of resources • Integrate indicators into Hospital Information Systems • Submission of Reports to policy makers / WHO

10. The process in KwaZulu Natal The implementation of the pilot phase involved the following processes : • Infrastructure Development • Hospital enrolment and information sharing • Data collection, collation & analysis • Presentation of Draft Report to policy makers • Formulation of Recommendations for full implementation

11. InfrastructureDevelopment • Senior General Manager - Dr S.M. Zungu • Principal Specialist Health Service- Dr P Ramdas • Chief Specialist - Prof M. H. Cassimjee • Analytical, technical support Prof Jinabhai / Dr R Geddes School of Public Health University of KwaZulu-Natal • Provincial PATH (Performance Assessment Tool-WHO) Coordinator for the Hospitals Dr. S. Sirkar • Office space at Northdale Hospital • Employment of a data Capturer– Mr S. Rungasami • Allocation of IT equipment for the Project

12. Pilot implementation of Self-Assessment Tool Timelines • Phase 1:Preparation – March 2004 • Phase 2:Assessment of standards • compliance– April and May 2004 • Phase 3:Data collection for -indicators– • June to Dec 2004 • Phase 4: Development of quality • improvement plans– Sept to Dec • 2004 • Phase 5:Reporting results– 2005

13. Pilot project process • Phase 1: Preparatory - March 2004 • Provincial coordinating team established: • Department of Health including Sub-Directorates • Nelson R Mandela School of Medicine • Participating Hospitals / Institutions selected: • Inkosi Albert Luthuli Central Hospital • Greys, • Edendale, • Northdale Hospitals, • Ngwelezana • Lower Umfolozi • Provincial coordinator: Dr P.D. Ramdass • Institutional coordinators: Quality Improvement team coordinators

15. Phase 2: Assessment of standards compliance (April-May2004). • Consult with Quality Improvement (QIP)teams at institutions (applicability and areas of clarification). • Indicator development (identification and data collection)

16. Pilot project process (cont.) • Phase 3:QIP plan development (June -December 2004) • Based on the gaps after the assessment of compliance to standards Phase 4:Reporting to World Health Organsiation (Sept-Dec 2004) • Meta-analysis form (results to be computed by WHO and feedback given) • Finalisation of tools by WHO

17. Benefits:FOR KZN DOH, South Africa Monitoring & Evaluation Unit has a WHO Standard HPH tool & strategy Able to monitor trends in change / improvements in HPH over time Has potentail to offer leadership for Public Health sector in S A

18. Benefits: FOR KZN DOH, South Africa • Participation in the International arena of Quality Improvement, HPH & Performance Measurement • Participation in the global HPH network • Decentralisation of data capturing to institutions • Empowering hospitals to use their own data • Methods to expand existing QIP projects

19. Benefits: FOR KZN DOH, South Africa • A self monitoring tool to identify areas of need • Adaptable to all levels of care • Encourages participation by all categories of staff + management • A data base for different areas eg Human resources, Employee Assisstance Programmes, Occupational Health,PATH Tool from WHO.

20. Conclusion • Hospitals were encouraged to use the adapted self-assessment tool to • improve health promotion activities, • accelerate continuous quality improvement for improved quality of care; and • expand the scope for participatory research.

21. Acknowledgement Dr S. Sirkar – Path Technical Co-ordinator Dr C. Bhagwandeen – Human Resource Support Unit Ms V. Moodley – Health Promotion Unit Mrs A. Khathi – Quality Assurance & Accreditation Unit Ms J. Maher – Quality Assurance & Accreditation Unit Mr C. Shawe – Quality Assurance & Accreditation Unit Dr V. Maistry – Edendale Hospital Ms H. Findlay – Greys Hospital Ms. V. Bawany – Lower Umfolozi War Memorial Hospital Ms R. Jele – Ngwelezana Hospital Ms U. Sooruth – Northdale Hospital Ms N. Mbambo – Inkosi Albert Luthuli Central Hospital

22. THE ENDHEALTH PROMOTING HOSPITALS SOUTH AFRICA