State of Health Services in the Eastern Cape: A Comprehensive Overview
The presentation outlines the current state of health services in the Eastern Cape Province, highlighting the service delivery environment, health care access, clinical services, and key challenges. With a focus on demographic and socio-economic profiles, the report also addresses important aspects such as referral systems, EMS, pharmaceuticals, TB, psychiatric services, medical waste management, finances, HR, and infrastructure. Recommendations for improvements are included to enhance healthcare delivery in the region.
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STATE OF HEALTH SERVICES IN THE EC PORTFOLIO COMMITTEE ON HEALTH 12 JUNE 2017 2024/07/22 1
PRESENTATION OUTLINE Service delivery environment Health care access Referral system EMS Pharmaceuticals Forensic pathology TB Psychiatric services Medical waste Finances HR Infrastructure Recommendations 2024/07/22 2
SERVICE DELIVERY ENVIRONMENT (1) Demographic profile of the province The Eastern Cape Province ( ECP) is spread over 168 966 km with an estimated population of 6.9 million people which constitutes 12.6% of the S.A population. 2/3 of the population is 30 years & below and 12.6 % is under 5 years The province has 8 health districts (6 municipal districts & 2 Metros) The majority of the population resides in: O.R Tambo District (20.8%) Nelson Mandela Metro (17.6%) Lowest percentage of population is in: Joe Ggabi (5.3%) Sarah Baartman (6.9%) 2024/07/22 3
SERVICE DELIVERY ENVIRONMENT (2) Socio economic profile Predominantly rural community with high poverty and high unemployment rates Low socio-economic status with high poverty rate at 57.2% Most affected districts are Alfred Nzo, Amathole, Chris Hani and O.R. Tambo Burden of disease Quadruple burden which includes TB, HIV, non-communicable diseases and unnatural causes like injuries Communicable diseases like TB (11.4%) and HIV diseases (5.4%) are leading causes of mortality Non-communicable diseases like heart diseases (4,7%),cerebrovascular diseases (4.6%) & Diabetes Mellitus( 4.3%) are also common causes of mortality Maternal and Child Mortality Rates remain high with: MMR at 128/100 000 live births 2024/07/22 4
CLINICAL SERVICES 2024/07/22 5
HEALTH CARE ACCESS (1) For the 2017/18 year, a total of 16. 4 mil visits took place in EC Health facilities The department has 772 fixed PHC facilities, of which 41 of CHCs offering 24 hours There are 66 district hospitals offering 24 hrs services Patients registered on CCMMDD 2024/07/22 6
HEALTH CARE ACCESS (2) For the 2017/18 year, a total of 16. 4 mil visits took place in EC Health facilities The department has 772 fixed PHC facilities, of which 41 of CHCs offering 24 hours There are 66 district hospitals offering 24 hrs services Patients registered on CCMMDD 2024/07/22 7
HEALTH CARE ACCESS (3) Access to school health services Learners Screened Grade 1 Grade 8 Totals Target Achieved 46 710 26 646 73 356 Target 39 766 20 502 60 268 Ideal Clinic Status 2024/07/22 8
HEALTH CARE REFFERAL SYSTEM Community (WBOTs) / ISHP Clinic CHC District Hospital Regional hospital Tertiary hospital Central hospital Back to Community 2024/07/22 9
EMS EMS RESPONSE TIMES 2017/18 P1 urban calls in 15 min [target = 70%] P1 Rural Calls in 45 min [target = 70%] Inter-facility Transfer 70.0% 62.0% 58.0% 60.0% 53.0% 51.2% 50.0% 43.0% 40.0% 34.3% 32.3% 31.1% 30.3% 29.8% 29.8% 30.0% 26.0% 20.0% 10.0% 0.0% Q1 Q2 Q3 Q4 2017/18 2024/07/22 10
EMS AMBULANCE FLEET DISTRIBUTION 2024/07/22 11
EMS PTV FLEET 2024/07/22 12
EMS STAFF DISTRICT BAA AEA ALS/ECT Totals AMATHOLE 250 31 2 283 ALFRED NZO 150 25 13 273 BUFFALO CITY METRO 180 128 11 319 CHRIS HANI 316 48 8 372 NELSON MANDELA BAY 141 111 14 274 JOE GQABI 178 33 4 235 OR TAMBO 217 21 12 250 SARAH BAARTMAN 184 95 13 292 TOTAL 1616 492 77 2185 2024/07/22 13
EMS CHALLENGES & PLANNED RESPONSE CHALLENGES RESPONSES TO CHALLENGES Replacement ambulances being are 4X4 Geographical coverage and terrain Uneven salary scales when people moved from local municipality to Province A task team has been appointed to look into salary disparities and related matters Poor infrastructure for EMS Department is working on a plan to move EMS bases to hospitals and CHC as current properties are either DRPW or privately owned Scarcity of skilled EMS personnel The dept is working with University of Fort Hare to establish a training programme for EMS practitioners.
EMS ACTION PLANS Recruitment of 100 additional AEA by 31 March 2019 Training and upgrade of 96 BAA - identify additional training providers since EC has one college with capacity to train 124 per annual Implementation of the EMS Regulations appointment of task team to advise on the regulations Electronic call taking and dispatch - to be piloted in Chris Hani, Alfred Nzo, ORT Dedicated Employee Wellness Programme engage a service provider to provide the services for EMS & FPS personnel
EMS STAFF DISTRICT BAA AEA ALS/ECT Totals AMATHOLE 250 31 2 283 ALFRED NZO 150 25 13 273 BUFFALO CITY METRO 180 128 11 319 CHRIS HANI 316 48 8 372 NELSON MANDELA BAY 141 111 14 274 JOE GQABI 178 33 4 235 OR TAMBO 217 21 12 250 SARAH BAARTMAN 184 95 13 292 TOTAL 1616 492 77 2185 2024/07/22 16
PHAMARCEUTICALS & MEDICINE AVAILABILITY (1) Dept has strengthened use of electronic inventory management systems Rx Solution installed in 12/48 CHCs (25%) and 58/89 hospitals (65%) Internal capacity building of departmental IT staff taking place on 11-14 June 2018 (OR Tambo & Alfred Nzo; Amathole, BCM, Nelson Mandela & Sarah Baartman) Stock Visibility System used in 768 primary health care facilities (728 clinics and 40 CHCs) Challenge: Improve reporting rate (wich is currently at 64%) to ensure generalisation of results Action: Strengthen governance to ensure effective monitoring and evaluation Improved access to medicine achieved through CCMDD 51.6% growth in number of patients registered between 2016/17 (155 011) and 2017/18 (235 065) Expenditure on non-contracted medicines and surgicals by end Q1 was R101 million of which 51% are medicine and 49% surgicals To ensure provincial contracts for items recommended in EML and National Core Standards/Ideal Clinic requirements 2024/07/22 17
PHAMARCEUTICALS & MEDICINE AVAILABILITY (2) Planned interventions Expand the use of Stock Visibility System & Rx Solution Introduce a new warehouse management system for the pharmaceutical depots Training of nurses on good stock management 2024/07/22 18
PHAMARCEUTICALS & MEDICINE AVAILABILITY (3) Q1 2017/18 Q2 2017/18 Q3 2017/18 Q4 2017/18 Availability ARV 93% 93% 94% 92% TB Medicines 89% 88% 90% 86% Vaccines 92% 92% 92% 89% The average availability of tracer drugs for 2017/18 was as follows: o 93% for ARV o 88% for ARV o 91% for vaccines 2024/07/22 19
FORENSIC PATHOLOGY SERVICES (1) The province is divided into four regions with FP centres at Mthatha, East London, Queenstown and Port Elizabeth. The facilities are graded as per forensic pathology guidelines (M6 M1), this mainly talks to dissecting and holding facilities. o There are 14 dissecting and 10 holding facilities. The Coroner Services sub-programme renders forensic pathology services in order to establish the circumstances and causes surrounding unnatural deaths. The programme performed satisfactorily, having achieved 94% of post mortems conducted within 72 hours. 11 Forensic Pathology Converted Vehicles procured Refurbishment of Aliwal North Mortuary completed. 2024/07/22 20
FORENSIC PATHOLOGY SERVICES (2) CHALLENGES STRATEGIES TO ADDRESS CHALLENGES Shortage of Forensic Pathology Officers (FPOs), resulting in the overuse of overtime exceeding 30% of basic salary cut-off as per DPSA, this is due mainly to service demand. 30 appointment across the centres province by 30 September 2018 forensic pathologists are planned for Increase in the number of unknown bodies which requires paupers burial. The unit is continuously engaging with affected districts municipality and progress is being made except for challenging with municipalities in OR Tambo Shortage of dissecting mortuaries in the province results in the use of holding facilities as dissecting centres. Plans for the upgrading of Uitenhage holding facility to a dissecting facility are underway. The next ones for planning will be Bhisho Non availability of X-Ray facilities for pre-autopsy examination for gunshot and decomposed bodies. 2 Lodox machines have been budgeted for procurement by end of third quarter for Mthatha and Port Elizabeth centres Shortage of Forensic Pathology Specialists to cover the full spectrum of the service. 2 forensic pathology specialists for 2018/19 to be placed in Mthatha and EL 2024/07/22 21
TB MANAGEMENT (1) 90-90-90 strategy on the management of TB & HIV Implementation of prevention initiatives working collaboratively with all sectors, and coordinated by the Eastern Cape AIDS Council (ECAC). Target is the high risk population, youth & young women to prevent both TB and HIV new infections Implementation of case finding initiatives including intense TB screening (Find Actively, Separate Temporarily and Treat Effectively (FAST), Lateral Flow Lipoarabinomannan (LF-LAM) From the interventions, the TB incidence has been decreasing in the EC Pulmonary TB new smear positive incidence rate was 493 per 100 000 in 2009 and has gradually decreased to 206 per 100 000 in 2016. Nelson Mandela Metro remains with the highest incidence (340.2 per 100,000) with the lowest incidence (73.4 per 100,000) reported by Alfred Nzo district in 2016. Department is strengthening ints interventions in districts like NMM and Sarah Baartman 2024/07/22 22
TB MANAGEMENT (2) 90-90-90 strategy on the management of TB & HIV TB treatment success rate for smear positive TB has increased from 83% in 2014 to 86% in 2016 Treatment success rate for all TB has also increased from 82% in 2014 to 84% in 2016, an improvement of more than the National average 2024/07/22 23
TB LOST-TO-FOLLOW-UP PER DISTRICT 2014 2015 2016 Districts Data % Data % Data % A Nzo DM Amathole DM BCM C Hani DM J Gqabi DM NMBM OR Tambo DM S. Baartman DM EC Province 100 100 247 170 72 464 125 70 1348 5,7 5,1 8,9 5,4 6,8 9,4 3,4 10,8 6,7 44 74 188 153 34 488 91 54 1126 3,8 4,4 7,5 6,6 4,4 10,4 3,0 7,7 6,7 38 75 139 100 28 493 43 57 973 5,4 5,3 6 5,3 5,0 11,5 2,0 8,4 6,9
TB MANAGEMENT(3) Strategies to improve patients lost to follow up Use of NHLS lab track to trace TB patients moving from one facility to the other For Sarah Baartman, the dept and URC (NGO) introduced workplace programme for the farming community The dept is currently focusing on the following facilities in NMM: Gqeberha, Chetty , Walmer 14, Booysen Park , Kwa Zakhele, New Brighton & Kwa Dwesi clinics Operational managers are being capacitated on National TB control guidelines All newly diagnosed TB patients are being allocated a Treatment supporter Monthly reviews will be conducted to strengthen data management . 2024/07/22 25
TB MANAGEMENT(4) Strategies to improve patients lost to follow up URC in partnership with the dept has started implementing TB connect, in order to strengthen linkage to care The dept in partnership with the House of Traditional Leaders, Imbumba Yama Khosikazi Akomkhulu (IYA), Councillors, ECAC & other partners continuously embark on awareness campaigns in the fight against TB/HIV. 2024/07/22 26
PYSCHIATRIC SERVICES (1) The province has 4 psychiatric hospitals & 3 mental health units. The psychiatric programme is in the process of alignment with the National Mental Health Policy Framework and Strategic Plan. General challenges There are few mental health specialists to cover the entire province Funding gap for infrastructure requirements to develop psychiatric services, both at designated & listed facilities to comply with the Mental Health Infrastructure Norms and Standards. 2024/07/22 27
PYSCHIATRIC SERVICES PLANS 18/19 Establish community based services for integration and rehabilitation of users in the community. Increase the number of psychiatric acute bed and medium to long term beds Improve capacity to accommodate State Patients in order to reduce waiting times and waiting list Establish additional acute beds to improve access to mental health services in the province. Increase human resource capacity in Mental Health Institutions (ARP, fill replacement posts for clinicians in Mental Institutions: EDH x 1 specialist, Tower x 1 clinical psychologist, Dora Nginza MHU x 2 specialist, EL MHU x 2 specialist. Mthatha MHU x 1 clinical psychologist. Provide psychological services in Designated CHC and PHC clinics by appointing mental health specialist nurses, registered counsellors. Establish District Specialist Teams to support DHS & PHC clinics. Provide mental health training for medical officers and PHC nurses. Improve infrastructural capacity for Mental Health Services. Extend substance abuse programme for mental health users to other Mental Health Institutions. Induction and continuous training of personnel and external stakeholders in mental health institutions 2024/07/22 28
UPDATE ON THE TOWER HOSPITAL INVESTIGATION (1) Department has conducted internal investigations & a Technical Task Team was appointed by the HOD in consultation with the MEC & NDOH A report on the findings has been submitted to the Minister s Office on 06/04/18. Recommendations of the task team have been accepted for implementation by the province. Status quo on implementation of recommendations: CEO has been placed on special leave and has submitted her retirement letter Dept has instituted disciplinary proceedings on implicated staff, including reporting 1 member to HPCSA Dept is following mental health users that were subjected to rapid de- institutionalisation by the former specialist The medical officer who is alleged to have altered medical notes has been reported to the HPCSA 2024/07/22 29
UPDATE ON THE TOWER HOSPITAL INVESTIGATION (2) Department is attending to Leadership and management of the institution by means of secondment of a an Acting CEO including support from the Provincial Office. Appointment of a Psychiatric Specialist has also been effected. Department is attending to the identified maintenance issues and the appointed contractor is already on sight for Kitchen, and isolation wards. Training of staff has commenced on Basic Life Support and Quality Improvement. Strengthening of the Institutional Transformation Units (ITU) and Management interface wherein training session have commenced including provincial support. The Department is planning to conduct assessment of other Mental Health Facilities to improve their effectiveness and function. The Department is in process of addressing the use of private patients funds, by means of condonation. Province is in process of reviewing the policy on utilisation of private patient assets and funds. 2024/07/22 30
MANAGEMENT OF MEDICAL WASTE (1) Sub-programme Other Community Services is responsible for: Managing the devolution of municipal health service from the dept to the district municipalities and metros, (health care waste management and other hazardous substances control), Implements a port health strategy to control the spread of communicable diseases through ports of entry into the province. Programme priorities Development of provincial waste management plan. Establishment of health care waste committees in all facilities. Training of pharmacists on management of pharmaceutical waste. Training of waste generators. Facilitate of the appointment waste collectors. Monitor the segregation and containerisation of waste.
MANAGEMENT OF MEDICAL WASTE (2) CHALLENGES Inadequate segregation of waste , by waste generators especially in PHC Facilities STRATEGIES TO ADDRESS CHALLENGES Training of pharmacists by the service provider (Compass pharmaceutical waste management Training of waste generators (doctors and nurses) and labelling of containers to identify poor segregating units within a hospital Appointment of waste officers to manage health care risk waste in hospitals Waste) on Not all facilities have dedicated personnel to manage waste Inadequate storage facilities for medical waste especially at PHC facilities Manifest registers will be procured end of 2nd quarter of 2018/19 and distributed to all facilities
WASTE MANAGEMENT ACTION PLAN Tasks Deliverables RESPONSIBLE PERSON Cost Development of a provincial waste management plan Training of waste generators Improved waste management GMs: HIV/AIDS, TB and Health Programmes, DD: Environmental Health GMs: HIV/AIDS, TB and Health Programmes, DD: Environmental Health GMs: HIV/AIDS, TB and Health Programmes, DD: Environmental Health GM: HIV/AIDS, TB and Health Programmes, District Hospitals, Tertiary Hospitals DD: Environmental Health GM: HIV/AIDS, TB and Health Programmes DD: Environmental Health R50 000 Improved waste management R100 000 Establishment of Health care waste management committee Facilitate the appointment of waste officers Appointed District health care waste management committee Appointed and responsible officials for waste management R10 000 Included in the ARP Monitor the segregation and containerization of waste Proper segregation of waste and reduction of waste generated Compliance with SANS 10248 in the management of pharmaceutical waste N/A Training of pharmacist management of pharmaceutical waste GM: HIV/AIDS, TB and Health Programmes DD: Environmental Health R60 000
FINANCIAL PERFORMANCE 2024/07/22 34
FINANCIAL PERFORMANCE 31/03/2018 (1) 2017/18 2016/17 (Over) / Under Expendi- ture (Over) / Under Expendi- ture Final Appropri -ation Actual Expendi- ture Final Appropri -ation Actual Expendi- ture Voted funds and Direct charges R'000 R'000 R'000 R'000 R'000 R'000 Programme 1. 597,049 587,480 9,569 713,452 705,035 8,417 Administration 2. 11,355,492 1,279,087 12,996 10,433,717 10,420,604 13,113 District Health Services Emergency Medical Services Provincial Hospital Services Central Hospital Services Health Sciences and Training Health Care Support Services Health Facilities Management 3. 1,280,033 1,279,087 946 1,095 488 1,067,653 27,835 4. 3,501,505 3,488,361 13,144 3,250,469 3,250,197 272 5. 3,476,127 3,471,073 5,054 2,926,360 2,913,621 12,739 6. 747,259 727,692 19,567 755,756 749,372 6,384 7. 100,381 99,998 383 102,512 101,861 651 8. 1,276,757 1,274,514 2,243 1,368,613 1,295,934 72,679 Programme sub total 22,334,603 22,270,701 63,902 20,646,367 20,646,367 142,090 Statutory Appropriation 1,978 1,978 1,902 1,902 TOTAL 22,336,581 22,272,679 63,902 20,648,269 20,506,179 142,090 2024/07/22 35
FINANCIAL PERFORMANCE 31/03/2018 (2) Overall, the department spent 99.7% of its adjusted appropriation & underspent by R63.902 mil (0.3%) On Conditional grants, the department spent R3.804 bil (99.2%) out of the final conditional grant appropriation of R3.834 bil All programmes shows under expenditure after the final shifts & virements At economic classification level, Goods and Services overspent with R 23.881 mil due to the impact of the increased demand of health services as well as the payment of medico legal claims Payments for capital expenditure under spent by R72.482 mil and the main reasons for the under expenditure are: Late delivery of invoices for equipment received close to the end of the financial year Non compliance by CBOs who receive transfers from the department Roll overs requested from Treasury include: ES roll overs Conditional grants roll overs For the 2016/17 year, the department retained the unqualified audit opinion 2024/07/22 36
SOFT SERVICES (1) Commodity Group Project Description Start Date End Date Notes Extension Expiry Date Laundry Services Provision of laundry & related services at Mthatha Hospital Coplex for 36 months 01-Jan-14 31-Dec-16 Extension 30-Sep-18 Provision of laundry services at Nkqubela TB Hospital for a period of 12 months Collection of Waste from Clinics and Community Health Centre Centres to Central points for each Health District in The ECDOH for a period of 36 Months SUPPLY OF MEDICAL WASTE, CONTAINERS , STORAGE,COLLECTION, TRANSPORTAION , TREATMENT AND DISPOSAL OF HEALTH RISK WASTE OR MEDICAL WASTE FOR THE ECDOH FOR PERIOD OF 36 MONTHS Laundry Services Medical Waste 26-Jul-17 01-Dec-15 25-Jul-18 30-Nov-18 Price per item Medical Waste 01-Dec-15 30-Nov-18 Medical Waste Collection of Waste from Clinics and Community Health Centre Centresto Central points for each Health District in The ECDOH for a period of 36 Months Provision of Security Services at Amathole District for 36 months 01-Nov-16 31-Dec-18 Security Services 01-Feb-14 31-Jan-17 Extension 31-Jul-18 Security Services Provision of Security Services at OR Tambo District for 36 months 01-Apr-13 01-Apr-16 Extension 31-Oct-18 Security Services Provision of Security Services in the Alfred Nzo District for 36 months 01-Feb-14 31-Jan-17 Extension 30-Jun-18 Security Services Provision of Security Services in the Joe Gqabi District for 36 months 01-Aug-13 31-Jan-17 Extension 31-Jul-18 Provision of Security Service for at Fort England Hospital for a period of 12 months Provision of Security Service for at St Elizabeth Hospital for a period of 18 months Security Services 01-May-17 30-Apr-18 Extension 31-Jul-18 Security Services 01-May-17 31-Oct-18 Provision of security services at Livingstone Hospital for a period of 18 months Provision of Cleaning and Related Services at the Eastern Cape Department of Health - Mthatha Regional Hospital for a period of 18 months Security Services Cleaning services 01-Sep-17 28-Feb-19 01-Dec-17 31-May-19 Cleaning services Provision of Cleaning and Related Services at the Eastern Cape Department of Health Nelson Mandela Academic Hospital for a period of 18 months 01-Dec-17 31-May-19 2024/07/22 37
SOFT SERVICES (2) Commodity Group Project Description Start Date End Date Notes Extension Expiry Date Provision of Security Services at Dorah Nginza the Eastern Cape Department of Health for a period of 18 months Sercurity Services 01-Dec-17 31-May-20 Security Services Provision of Security Services at Frontier Hospital for a period of 18 months Provision of Catering Catering Services at Nelson Mandela Academic Hospital for a period of 12 months Provision of Security Services at Mthatha Regional Hospital, Sir Henry Hospital and Lilitha College for a period of 18 months Provision of Security Services at Nelson Mandela Bay Health District for a period of 18 months [Cluster 2 & 5] Provision of Security Services at Nelson Mandela Bay Health District for a period of 18 months [Cluster 1 & 4] Provision of Security Services at Nelson Mandela Bay Health District for a period of 18 months [Cluster 3] Provision of Security Services at Chris Hani Health District for a period of 18 months [Cluster ] Provision of Security Services at Chris Hani Health District for a period of 18 months [Cluster ] 01-Jan-18 30-Jun-20 Catering services Security Services 01-Apr-18 31-Mar-19 01-Jun-18 30-Nov-19 Security Services 01-Apr-18 30-Sep-19 Security Services 01-Apr-18 30-Sep-19 Security Services 01-Apr-18 30-Sep-19 Security Services 13-Apr-18 30-Sep-19 Security Services 12-Apr-18 30-Sep-19 Provision of security services at Nelson Mandela Academic Hospital in the Eastern Cape Department of Health for a period of 18 months Provision of security services at the Port Elizabeth Pharmaceutical Depot for a period of 18 months Provision of security services at the Mthatha Pharmaceutical Depot for a period of 18 months Security Services 01-Jun-18 30-Sep-19 Security Services 06-Apr-18 30-Oct-19 Security Services 01-Jun-18 30-Nov-19 Cleaning services Provision of cleaning services at Frontier Hospital for a period of 18 months 05-Apr-18 30-Oct-19 Security Services Provision of security services at Frere Hospital for a period of 18 months Provision of gardening and related services at the Nelson Mandela Academic Hospital for a period of eighteen (18) months 01-Oct-17 31-Mar-18 Gardening Services 01-Jun-18 30-Nov-19 With the exception of security which is completely outsourced, the only institutions that have outsourced certain soft services are Nelson Mandela Academic, Mthatha Regional, Frontier & Nkqubela Hospitals. Medical waste collection and disposal is outsourced. 2024/07/22 38
MEDICO LEGAL CLAIMS To date, the dept has cumulatively paid R 1.1 billion of medico legal claims & R 433.526 mil on Legal fees For 2017/18, the department paid R423.396 mil and R44.452 mil to the State Attorney The department is implementing a multi-pronged medico legal strategy focusing on administrative, legal, clinical & mediation interventions The department is also making progress in the defence of medico legal claims as well as interventions to root out corrupt elements 2024/07/22 39
HUMAN RESOURCES 2024/07/22 40
HUMAN RESOURCES Organisation realignment The department s macro structure has been approved by the MEC in March 2018 after concurrence by the OTP & MPSA & has been rolled out since April 2018 The focus of the organogram is : Delayering and de-centralisation of services to Districts with emphasis on the Reengineering of Primary Health Care (Outreach) and implementation of National Health Insurance. Emphasis on managing patients as close to home as possible and entering into a social compact with the community Lean Head Office that focuses on strategy, policy formulation, monitoring & evaluation and that promotes integration Alignment of health services in line with the National Gazette on classification and management of hospitals. Reduction on cost of employment by ensuring cost effective structures with optimal staff compliment The organisational reform based on the new organogram has made provision for strong district and hospital management team led by high ranking leaders who are empowered to exercise management decision to manage resources and deliver quality services. 2024/07/22 41
RECRUITMENT STATS 31/3/18 NO OF ARP APPROVED POSTS NO OF FILLED POSTS CATERGORY Non-Clinical posts Clincal posts Grant posts TOTAL NO OF ARP POSTS VARIANCE 394 114 205 394 114 113 0 0 92 713 621 92 TURNOVER RATE AS AT 31 MARCH 2018 VACANCY RATE AS AT 31 MARCH 2017 9.5% 2024/07/22 42
RECRUITMENT UPDATE The dept appointed 5 senior Managers (4) of which are women Dept has now exceeded the Employment Equity target of 50:50 at SMS level. An additional allocation of R317m was allocated to the dept for filling of 1 888 (1596 clinical and 292 non-clinical) posts in 26 targeted hospitals. At 31 March 2018 the department filled 1 495 posts and the remainder have been prioritised for the following financial year. Status of appointments in 2017/18 2024/07/22 43
GOVERNANCE & LEADERSHIP The Executive Management Team (SG & DDGs for the Clinical, Finance & HR clusters) have been appointed 84% of SMS posts (108 out of 128) are filled 6 out of 8 District Management posts have been filled. 5 out 8 regional & tertiary hospitals have permanent CEOs Overall vacancy rate in the department is at 9.5%, Hospital boards and clinic committees provide oversight on hospital and PHC services. Of the total 772 PHC facilities in the EC, 582 (75%) had approved clinic committees. Of the 8 health districts, 7 have functional District Health Councils 98% of the SMS contracted for 2017/18 year 2024/07/22 44
INFRASTRUCTURE 2024/07/22 45
INFRASTRUCTURE PERFORMANCE 31/03/2018 Infrastructure projects completed in 2017/18 Project Start Date Practical Completion Date S/N Name of Project Scope of Works Total Project cost 1 Centuli Clinc New clinic, staff accommodation and associated external works and services completion contract 19-Feb-15 29-Nov-17 10 981 109 2 Luthubeni Clinic Replacement of Clinic, new staff accommodation, and other associated external works and services. 16-Feb-15 06-Feb-18 23 047 001 3 Lotana Clinic Replacement of Clinic, new staff accommodation, and other associated external works and services. 12-Feb-15 08-Feb-18 23 191 067 4 Nolitha Clinic New clinic, staff accommodation and associated external works and services 12-Feb-15 22-Nov-17 22 896 873 5 Lusikisiki Clinic Replacement of Clinic, new staff accommodation, and other associated external works and services. 28-Jul-15 23-Jan-18 57 662 825 Upgrading of Cecelia Makiwane Hospital Construction of a Regional Hospital with 530 beds. 01-Jun-15 31-Aug-17 988 283 422 6 2024/07/22 46
INFRASTRUCTURE PERFORMANCE 31/03/2018 Equipment procurement for targeted 26 facilities ANNEXURE B: IMAGING AND LIFE SUPPORT EQUIPMENT DELIVERED DURING 2017/18 FINANCIAL YEAR Total Quantity NO Equipment Category Health Facility/Services Total Cost Radiology Services in Dora Nginza x2, Uitenhage x1, Butterworth x1, Dimbaza CHC x1, Williowvale CHC x1 Digital X-Rays Medical imaging 6 R 28 620 000.00 1 SPEC-CT Gamma Camera Medical imaging 1 Livingstone Hospital s Nuclear Medicine R 18 000 000.00 2 Mobile C-Arm Diagnostic 1 Taylor Bequest Hospital Matatiele R 1 225 825.31 3 Adult Ventilators Life-support 4 Amathole District Hospitals R 1 300 000.00 4 Life-support and Infection Control Suction Units All beds Livingstone Tertiary Hopsital & PE Provincial R 9 131 978.07 5 Nelson Mandela Central, Zithulele, and Cradock hospitals Ultrasound Units Medical imaging 3 R 2 545 848.96 6 Neonatal High Frequency Ventilators Life-support 2 Frontier Hospital R 964 294.08 7 Diagnostic Sets and Laryngoscopoes Diagnostic 100 Sara Baartman Clinics R 1 277 190.48 8 ICU Infant Cribs Therapeutic 11 Nelson Mandela Central Neonatal ICU R 3 048 676.15 9 Automated External Defibrillators (AEDs) Life-support 54 Amathole& OR Tambo Ideal Clinics R 2 210 428.15 10 2024/07/22 47
INFRASTRUCTURE PERFORMANCE 31/03/2018 Equipment procurement for targeted 26 facilities ANNEXURE B: IMAGING AND LIFE SUPPORT EQUIPMENT DELIVERED DURING 2017/18 FINANCIAL YEAR Total Quantity NO Equipment Category Health Facility/Services Total Cost Pulse Oximeters and ECGs Diagnostic 75 Amathole and BCM District Hospitals R 1 860 251.90 11 Defibrillators Life-support 85 District hospitals R 4 829 125.84 12 Vital Signs Monitors Diagnostic 86 Joe Gqabi and Chris Hani District Hospitals R 1 115 793.24 13 Theatre Operating Tables Surgical 4 Amathole District Hospitals R 2 218 226.27 14 Electrosurgical Units Surgical 7 Joe Gqabi and Chris Hani District Hospitals R 1 272 027.00 15 Theatre Operating Tables Surgical 10 Joe Gqabi and Chris Hani District Hospitals R 6 664 641.44 16 Automated External Defibrillators (AEDs) Life-support 36 Chris Hani Ideal Clinics R 1 473 618.77 17 Automated External Defibrillators (AEDs) Life-support 30 Nelson Mandela Ideal Clinics R 1 228 015.64 18 Automated External Defibrillators (AEDs) Life-support 20 Sarah Baartman Ideal Clinics R 818 677.09 19 Ultrasound Units Medical imaging 4 OR Tambo and Alfred Nzo District Hospitals R 1 904 307.30 20 CR Printers Medical imaging 2 Mthatha Regional and Butterworth Hospitals R 925 021.08 21 CR Printers Medical imaging 2 Hewu Hospital and Ngqamakwe CHC R 980 520.84 22 Patient Monitors Monitoring 19 Frontier Hospital R 1 773 321.52 23 TOTAL 550 R 95 387 789.13 2024/07/22 48
DECENTRALISATION OF MAINTENANCE During the 2017/18 adjustment estimates, the dept resolved to decentralise day to day maintenance work to facilities. A budgetary allocation amounting to R142 million was made available to facilities for this purposes. In the 2018/19 financial year, an allocation of R150 million has been set aside and devolved to facilities for their day to day maintenance services. Over the 2018 MTEF period, the department will allocate in excess of R500 million. Over the MTEF, the dept will continue to build the required technical capacities within hospitals and regions in order to fully implement Facilities Maintenance Management 2024/07/22 49
MODEL IMPLEMENTATION FOR CRITICAL AND LIFE SUPPORT PLANT, EQUIPMENT AND MACHINERY Effective functioning of health facilities rely on the safety and running of the critical plant, equipment and machinery listed below: Boilers and Associated Equipment breakdowns Generator breakdowns and installations Electrical Low Voltage and High Voltage, including Uninterrupted Power Supply, Electrical Hospital Communication systems Autoclaves and Sterilization Equipment Theatre Air Conditioners and Central Air Conditioners Vacuum pumps and Compressors Mortuary and Forensic Equipment Kitchen Equipment Laundry Equipment Lifts Fire Detection and fire Equipment General Air-Conditioner 2024/07/22 50
