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Progress Report on National Health Insurance Implementation

This presentation provides an update on the progress made in implementing the National Health Insurance (NHI) program, including the strategic goals, pilot district performance, facility improvement team interventions, and progress on key support interventions.

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Progress Report on National Health Insurance Implementation

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  1. Presentation to the Standing Committee on AppropriationsNational Health InsuranceProgress Report05 March 2014

  2. Content • Strategic Goals of the National Health Grant – NHI Component • NHI Pilot district performance against key indicators • Background to the activities reported on • Summary of Facility Improvement Team Interventions • A Systematic Approach – The Ideal Clinic Project • Progress with regard to PHC re-engineering priorities • Progress on key support interventions • Hospital Reform

  3. Strategic Goals of the National Health Grant – NHI Component • Strengthen aspects of the public healthcare system in preparation for National Health Insurance • Strengthen the design of NHI based on innovating and testing of new reforms in pilot sites • A public health care system that is better prepared to implement reforms necessary for NHI

  4. NHI Pilot District performance against key indicators

  5. Comparison Child under 5 years pneumonia incidence 2010/11 and 2013/14

  6. Comparison Child under 5 years severe malnutrition incidence 2010/11 and 2013/14

  7. Comparison Inpatient death under 1 year rate 2010/11 and 2013/14

  8. Comparison Inpatient death under 5 year rate 2010/11 and 2013/14

  9. Comparison cervical cancer screening rate 2010/11 and 2013/14

  10. Comparison TB (new smear positive) cure rate 2009/10 -2011/12

  11. Comparison Antenatal first visit before 20 week rate 2010/11 and 2013/14

  12. Comparison Infant 1st PCR test positive around 6 weeks rate 2010/11- 2013/14 Q1-Q3

  13. Comparison Delivery in Facility under 18 Years Rate 2010/11 and 2013/14

  14. Background to the activities reported on • To start to prepare the health service environment for the implementation of NHI: • Independent Baseline Health Facility Audit completed in 3880 public sector facilities spanning from 2011 to 2012 • Established Facility Improvement Teams (FIT) to begin catalytic improvements in the NHI pilot districts • Launched a number of required policies and strategies (Integrated School Health Policy, HRH policy, e-health strategy, interoperability standards, District Health Information Management policy • Executive leadership and management programme established

  15. NHI: Pilot Districts • In response to the findings of the Health Facilities Baseline Audit, Health Facility Improvement teams under the leadership of senior management from the National Department of Health was established for the following districts • O.R. Tambo (Eastern Cape); • Mangaung and Thabo Mofutsenyana (Free State) • Tswane (Gauteng) • Amajuba, Umzinyathi and Umgungundlovu (KZN) • Vhembe (Limpopo) • GertSibande (Mpumalanga) • Dr. K. Kaunda (North West) • Pixley ka Seme (Northern Cape) • Eden (Western Cape) • The Health Facility Improvement Teams supported the development of quality improvement plans for health facilities on these districts • Approximately 1000 facilities were directly or indirectly supported through this initiative

  16. Summary of Facility Improvement Team Interventions

  17. Summary of FIT Interventions

  18. Summary of FIT Interventions continued

  19. Summary of FIT Interventions continued

  20. The following pictures represent the changes brought about by the facility improvement teams

  21. Kareeberg, PixleyKaseme, NC: Progress Water tanks installed at Vanwyksvlei clinic New flooring at Vanwyksvlei clinic

  22. Free State - BAINSVLEI CLINIC CEILING BEFORE CEILING AFTER

  23. Examples compliance with National Core Standards GertSibande Cleanliness at Embalenhle CHS Store room on initial visit Store room on follow up visit Drug availability at Paulina Morapeli Dispensary room 1st visit Dispensary room follow up visit

  24. LuthubeniClinic OR Tambo Before Roof of one of the consulting rooms. The sun shone through onto the examination couch After The roof was replaced; Air conditioner installed; Water connected inside the Facility

  25. MaphuziORTambo Before After Facility restored to 5 consulting rooms; Has water installed inside the clinic

  26. Ideal Clinic Prototype Realization

  27. Ideal Clinic Components and Elements • Administration • Clinical Guidelines and Integrated Clinical Services Management • Medicines, Supplies and Laboratory Support • Staffing and professional Etiquette • Availability of a doctor • Infrastructure (physical condition, ICT Essential Equipment) • Health Information Management • Communication • District Health Support Systems • Partners and stakeholders There are currently 185 elements across the 10 components

  28. Progress with regard to PHC re-engineering priorities

  29. District Clinical Specialist Teams • All Pilot Districts have teams of at least 3/7 members

  30. School Health Services • 30 School Mobile Vehicles in field • Dental Care • Eye Care • PHC • Additional to be delivered March 2014 • 17 PHC Panel Van • 10 Dental Vanel Van

  31. Municipal Ward Based Primary Health Care Outreach Teams

  32. WBPHCOT members provided with cell phones and trained on collecting and sending patient information by cell phone • Advantages: • This improves turnaround time for required patient interventions • Improves data quality for monitoring and evaluation of the WBPHCOT programme

  33. Total WPHCBOT m-health trained Trained end Feb 2014 • One Province • 31WBPHCOT • 166CHWs To be Trained end March 2014 • Six Provinces • 65WBOT • 518CHWs NB: M-health training will be expanded beyond NHI pilot districts over the next 24 months

  34. Progress on Key Support Interventions

  35. Current Doctor Coverage with 96 GPs on the National Contract • Doctor coverage is obtained through: • Nationally Contracted GPs • Doctors on full-time employment • Doctors doing Outreach from Hospitals • Provincially contracted doctors Doctor coverage: The PHC clinic has at least one doctor doing sessions (working specified hours) for at least one day per week

  36. Improvement of Data Quality and Information Management Summary of Achievements • Approved: • e-health strategy • Interoperability standards • District Health Information Management policy

  37. Fixed PHC (CHC and Clinics) in 10 NHI Pilot Districts • Within next two months: • All fixed PHC clinics in NHI Pilot Districts will receive computer equipment allocated to the reception desk • 251 facilities will receive computers in each consulting rooms as well

  38. Benefits of computerization • Enable Management access to electronic communication to keep updated with policies, guidelines and good • An example in point is the Pharmaceutical Application on the NDoH website for standard treatment guidelines • Enable online DHIS Daily Data Capturing • Improve Data Quality (daily validation reduce human error) • Reducing monthly validation and collation time as well as human error during calculation • Reduce data flow time lines • Support online monthly DHIS data capturing for Ward Based Outreach Teams • Improve patient health record management • Scheduling of patients to reduce waiting times • SMS reminders to reduce dropout rates / identification of dropout patients to be followed up by community health workers • Capturing of doctors attendance to clinics

  39. Reforms in Hospital Services • Improving hospital leadership and management • Re-designated hospitals and appointed appropriately qualified CEOs • The Regulation on the classification and management of hospitals was promulgated in 2012 in line with section 35 (a) & (b) of the National Health Act (NHA) • The posts of CEO’s of hospitals were re-advertised and filled in line with these regulations • Delegations to CEO’s are in the process of being revised to be consistent with the Accounting Officer System • Treasury has agreed to assist with the training of the CEO’s and hospital managers to develop capacity to execute the new delegations.

  40. Established Structures in Hospitals to Improve Management Efficiency and Effectiveness: • Medicines and Therapeutics Committee • Equipment Committee • Cost Centre Management Committees • Cash Flow Committee

  41. THANK YOU FOR YOUR ATTENTION! www.doh.gov.za

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