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Report on a Service Delivery Inspection of District

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Report on a Service Delivery Inspection of District REPORT ON A SERVICE DELIVERY INSPECTION OF DISTRICT HOSPITALS AND CLINICS REGARDING AVAILABILITY OF MEDICINES AND MEDICAL EQUIPMENT AND THE ROLE OF DISTRICT HEALTH OFFICES DEPARTMENT OF HEALTH: WESTERN CAPE PROVINCE APRIL 2014 TABLE OF CONTENTS FOREWORD ........................................................................................................................................ iv LIST OF ACRONYMS ......................................................................................................................... v 1. INTRODUCTION ........................................................................................................................... 1 2. OBJECTIVES OF THE INSPECTIONS ............................................................................................... 2 3. SCOPE AND METHODOLOGY ....................................................................................................... 3 3.1 Scope ........................................................................................................................................... 3 3.2 Methodology ............................................................................................................................... 3 4. LIMITATIONS OF THE STUDY ....................................................................................................... 4 5. KEY FINDINGS ON ANNOUNCED INSPECTIONS ........................................................................... 4 5.1 Contextual background ............................................................................................................... 4 5.2 Management of medications…….………………………………………………………………………………………….5 5.2.1 Product selection………………………………………………………………………………………………………………….6 5.2.2 Procurement…………………………………………………………………………………………………………………………6 5.2.3 Distribution and storage……………………………………………………………………………………………………….7 5.2.4 Rational use, monitoring and evaluation…………………………………………………………………………….10 5.2.5 Management support…………………………………………………………………………………………………………11 5.5 Challenges…………………………………………………………………………………………………………………………17 6. KEY FINDINGS ON UNANNOUNCED INSPECTION ...................................................................... 17 6.1 Observing facilities………………………………………………………………………………………………………………17 6.2 Observing access to information…………………………………………………………………………………………20 6.3 Talking to citizens………………………………………………………………………………………………………………..21 7. IMPLEMENTATION OF PSC RECOMMENDATIONS .................................................................... 23 8. READINESS OF THE INSPECTED FACILITIES FOR THE ROLL OUT OF THE NATIONAL HEALTH INSURANCE (NHI) ....................................................................................................................... 23 9. RECOMMENDATIONS ................................................................................................................ 24 9.1 Announced Inspections ............................................................................................................. 24 9.2 Unannounced Inspections ......................................................................................................... 25 10. CONCLUSION ............................................................................................................................. 25 11. ACKNOWLEDGEMENT ............................................................................................................... 25 Report on Service Delivery Inspection of Hospitals and Clinics: DoH: Western Cape Province ii 12. LIST OF TABLES, FIGURES, PICTURES AND ANNEXURES TABLES Table 1: Objectives of inspections………………………………………………..…………………………………..……2 Table 2: Sites and dates of inspections……………………………………...………..…………………………..………3 FIGURES Figure 1: The JAC Pharmacy System’s end-to-end management process………………………...………….….…..5 Figure 2: Medicine management cycle…………………………………………………………….…………...………….6 Figure 3: Mobile unit to be used during the NHI Pilot Project………………………………….……….………..…….24 PICTURES Picture 1: CC TV monitoring system in the office of supervisor pharmacist at Kwanokuthula CDC………......……9 Picture 2: Neatly packed Pharmacy of Kwanokuthula CDC with working air-conditioning system……...….....……9 Picture 3: Working refrigerators for safe-keeping of medicines at Cloetesville CDC………………………......…....10 Picture 4: The Registry at Kayamandi secured with burglar bars…………………………………..………………….11 Picture 5: Well-ordered and professional filing system at Cloetesville CDC………………………………………....13 Picture 6: Oxygen equipment and wheelchairs at Cloetesville CDC…………………………………………………..14 Picture 7: Equipment at Kwanokuthula CDC in excellent condition…………………………………….…………….14 Picture 8: The waiting area at Rawsonville Clinic……………………………………….……….……………………...18 Picture 9: Construction of the Rawsonville Clinic underway………………………………………….………………..19 Pictures 10 & 11: Consultation area (Above) and waiting area (Below) at Kayamandi Clinic…………...………….20 Picture 12: The grounds of Kayamandi Clinic required gardening attention………………..………………………..21 ANNEXURES ANNEXURE A: list of facilities visited and officials that were engaged…..............................................................26 ANNEXTURE B: announced inspections in the visited facilities………………………………………………………28 ANNEXURE C: unannounced inspections in the visited health facilities…………………………………..………….35 ANNEXURE D: the status on implementation of recommendations of the PSC’s inspections conducted in 20091………………………………………………………………………………………………………………………….37 1 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of Health. 2010. Report on Service Delivery Inspection of Hospitals and Clinics: DoH: Western Cape Province iii FOREWORD South Africa’s burden of disease, consisting amongst others of a high rate of HIV/AIDS is consistent with health challenges affecting many developing countries which are characterized by high levels of poverty. Thus, health care is one of the key government priorities as well as an essential service which should be accessible to all the citizens of the country. Key to ensuring a long and healthy life for all is having sustainable health care infrastructure that is responsive to the needs of the citizens. To this end, primary health care facilities have been established to ensure that citizens receive health services at the local level. Furthermore, the National Health Insurance (NHI) has been established to ensure equal access to quality health care for all citizens. Amongst others, it is important that health care facilities should at all times have sufficient medicines as well as adequate medical equipment for timeous and quality treatment, if government is to succeed in mitigating the burden of disease and ensuring a long and healthy life for all citizens. Furthermore, health facilities should function in a manner that is in line with the Batho Pele principles of service delivery. It is against this background that the Public Service Commission (PSC) deemed it necessary to conduct inspections to determine the availability of medicines and medical equipment. Furthermore, the inspections sought to determine the implementation of the PSC’s previous recommendations in this area and readiness of the health care facilities for the imminent roll out of the NHI. The findings of the inspection show that despite concerns of limited space and delays in the process of disposing of and replacing obsolete medical equipment, especially at clinic level, the WCDoH has ensured constant availability of medicines and medical equipment at the inspected facilities, and thus providing sustainable quality service delivery. The 100% implementation of the PSC’s previous recommendations is also a commendable achievement. As a result, it is the PSC’s view that the visited health facilities were capable of providing the required health care service and as such, ready for the roll-out of the NHI. It is a pleasure to present the Report on Service Delivery Inspection of Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Western Cape. We believe that the inspections remain a valuable monitoring mechanism which findings could contribute towards service delivery improvement. The PSC wishes to thank officials of the Western Cape Department of Health (WCDoH) for their cooperation and willingness to share information. We trust that the findings will help the WCDoH in its efforts to improve service delivery for sustainable and quality health care. Report on Service Delivery Inspection of Hospitals and Clinics: DoH: Western Cape Province iv LIST OF ACRONYMS AIDS Acquired Immune Deficiency Syndrome AO Accounting Officer CCTV Closed Circuit Television CDC Community Development Centre CEO Chief Executive Officer CHC Community Health Centre DDV Direct Delivery Voucher DHS District Health System EA Executive Authority EDL Essential Drugs List FEFO First Expired, First Out HIV Human Immunodeficiency Virus ICT Information Communication and Technology MEC Member of the Executive Council MMS Middle Management Service NEDLC National Essential Drugs List Committee NEMLC National Essential Medicine List Committee NDoH National Department of Health NDPSA National Drugs Policy of South Africa NHA National Health Act NHI National Health Insurance PFMA Public Finance Management Act PHC Primary Health Care PPPFMA Preferential Procurement Policy Framework Act PSC Public Service Commission PTC Pharmaceutical and therapeutic Committee
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