Capacity Under Which This Rfi Is Signed

INVITATION FOR BID

YOU ARE HEREBY INVITED TO SUBMIT INFORMATION FOR THE REQUIREMENTS OF NATIONAL HEALTH LABORATORY SERVICE

BID NUMBER: RFI 001/15-16

CLOSING DATE: 22 April 2016

CLOSING TIME: 11:00AM DESCRIPTION: REQUEST FOR INFORMATION: APPLYING THE ITSDM MODEL TO SMALL DISTRICT HOSPITALS TO ADDRESS REQUESTS FOR A LABORATORY SERVICE BY THE GAUTENG DEPARTMENT OF HEALTH

RFI MUST BE MARKED WITH THE FOLLOWING: OR DEPOSITED IN THE BID BOX SITUATED AT: Procurement Controller: MS A Shusha RFI 001/15-16 NHLS MAIN RECEPTION Bidders Name: ______1 Modderfontein Road, Sandringham, RFB: Enclosed-Regret (delete N/A) Johannesburg. Closing Date: ______

Respondents should ensure that responses are delivered in time to the correct address. If the response is late, it will not be accepted for consideration. The bid box is generally accessible 24 hours a day, 7 days a week.

02d2e6f38f3ebbfc852255e7ca1f2602.doc THE FOLLOWING PARTICULARS MUST BE FURNISHED:

NAME OF RESPONDENT

CONTACT PERSON

TELEPHONE NUMBER

FAX NUMBER

POSTAL ADDRESS

PHYSICAL ADDRESS

SIGNATURE OF RESPONDENT: ………………………………………………………………

DATE: ……………………………………………………………

CAPACITY UNDER WHICH THIS RFI IS SIGNED: ………………………………………

02d2e6f38f3ebbfc852255e7ca1f2602.doc CONTENTS

GENERAL TERMS AND CONDITIONS

1 Introduction 4 2 Definitions 4 3 Acronyms, abbreviations and technical definitions 5 4 Confidentiality 6 5 Preferential Procurement Reform 7 6 News and Press Releases 7 7 Precedence of documents 7 8 Language 8 9 Gender 8 10 Headings 8 11 The manner for submission of the RFI 8 12 Instructions for the submission of the RFI 9 13 Oral presentations and briefing session 10 14 Information required 10 15 Evaluation criteria 10 11

02d2e6f38f3ebbfc852255e7ca1f2602.doc GENERAL TERMS AND CONDITIONS

1. Definitions

2.1 “RFI” - means a Request for information, which is a written official enquiry document encompassing all the terms and conditions of the information in a prescribed or stipulated form. 2.2 “RFI response” - means a written response in a prescribed form in response to an RFI. 2.3 “ Acceptable RFI” - means any RFI, which, in all respects, complies with the specifications and conditions of the Request for RFI as set out in this document. 2.4 “Vendors” - means any enterprise, consortium or person, partnership, company, close corporation, firm or any other form of enterprise or person, legal or natural, which has been invited by NHLS to submit a bid in response to this RFI. 2.5 “Client” - means Government departments, provincial and local administrations that participate in NHLS procurement processes. 2.6 “ Comparative Price” - means the price after deduction or addition of non-firm price factors, unconditional discounts, etc. 2.7 “Consortium” - means several entities joining forces under an umbrella to gain a strategic collaborative advantage by combining their expertise, capital, efforts, skills and knowledge for the purpose of executing a tender. 2.8 “Goods” – means any work, equipment, machinery, tools, materials or anything of whatever nature to be rendered to NHLS or Government in terms of a bid. 2.9 “ Hosting Partners” - means companies who entered into an agreement with NHLS in the areas of application management; application hosting, application service provision, and marketplace hosting are incorporated in this category. 2.10 “Internal Collaboration” - means collaborative arrangements within a group of companies or within various strategic business units/subsidiaries/operating divisions in order to gain a strategic position whilst sharing resources, profits and losses as well as risks. 2.11 “Management” - in relation to an enterprise or business, means an activity inclusive of control, and performed on a daily basis, by any person who is a principal executive officer of the company, by whatever name that person may be designated, and whether or not that person is a director. 2.12 “Organ of State” - means a constitutional institution defined in the Public Finance Management Act, Act 1 of 1999. 2.13 “Person (s)” - refers to a natural and/or juristic person (s). 2.14 “ Rand Value” - means the total estimated value of a contract in Rand denomination, which is calculated at the time of information invitations and includes all applicable taxes and excise duties. 2.15 “Respondent” – means any person (natural or juristic) who forwards an acceptable RFI in response to this RFI with the intention of being the main contractor should the RFI be awarded to him.

3. Acronyms, abbreviations and technical definitions

02d2e6f38f3ebbfc852255e7ca1f2602.doc The following acronyms and abbreviations are used in this information and must be similarly used in the information submitted in response and shall have the meaning ascribed thereto below.

Term Definition BEE Black Economic Empowerment as defined by Act 5 of 2000. CPI Consumer Price Index GITOC Government IT Officers Council HDI Historically Disadvantaged Individuals ICT Information and Communication Technology

IMS Information Management System IS Information Systems ISO International Standards Organization IT Information Technology LAN Local Area Network OEM Original Equipment Manufacturer (see Brand owner, Legal entity) PPPFA Preferential Procurement Policy Framework Act RSA Republic of South Africa NHLS National Health Laboratory Services

4. Confidentiality

4.1. The information contained in this document is of a confidential nature, and must only be used for purposes of responding to this RFI. This confidentiality clause extends to all respondent or associates whom you may decide to involve in preparing a response to this RFI. 4.2. For purposes of this process, the term “Confidential Information” shall include all technical and business information, including, without limiting the generality of the foregoing, all secret knowledge and information (including any and all financial, commercial, market, technical, functional and scientific information, and information relating to a party’s strategic objectives and planning and its past, present and future research and development), technical, functional and scientific requirements and specifications, data concerning business relationships, demonstrations, processes, machinery, know-how, architectural information, information contained in a party’s software and associated material and documentation, plans, designs and drawings and all material of whatever description, whether subject to or protected by copyright, patent or trademark, registered or un-registered, or otherwise disclosed or communicated before or after the date of this process. 4.3. The receiving party shall not, during the period of validity of this process, or at any time thereafter, use or disclose, directly or indirectly, the confidential information of NHLS (even if received before the date of this process) to any person whether in the employment of the receiving party or not, who does not take part in the performance of this process. 4.4. The receiving party shall take all such steps as may be reasonably necessary to prevent NHLS’s confidential information coming into the possession of unauthorised third parties. In protecting the 02d2e6f38f3ebbfc852255e7ca1f2602.doc receiving party’s confidential information, NHLS shall use the same degree of care, but no less than a reasonable degree of care, to prevent the unauthorised use or disclosure of the confidential information as the receiving party uses to protect its own confidential information. 4.5. Any documentation, software or records relating to confidential information of NHLS, which comes into the possession of the receiving party during the period of validity of this process or at any time thereafter or which has so come into its possession before the period of validity of this process:

 Shall be deemed to form part of the confidential information of NHLS,

 Shall be deemed to be the property of NHLS;

 Shall not be copied, reproduced, published or circulated by the receiving party unless and to the extent that such copying is necessary for the performance of this process and all other processes as contemplated in; and

 Shall be surrendered to NHLS on demand, and in any event on the termination of the investigations and negotiations, and the receiving party shall not retain any extracts.

5. Preferential Procurement Reform

5.1 NHLS supports Black Economic Empowerment as an essential ingredient of its business. In accordance with government policy, NHLS insists that the private sector demonstrates its commitment and track record to Black Economic Empowerment in the areas of ownership (shareholding), skills transfer, employment equity and procurement practices, (SMME Development) etc. 5.2 No preference certificate shall be completed for this RFI.

6. News and Press Releases

6.1 Vendors or their agents shall not make any news releases concerning this RFI or the awarding of the same or any resulting agreement(s) without the consent of, and then only in co-ordination with NHLS.

7. Precedence of documents

7.1 This RFI consists of a number of sections (see list). Where there is a contradiction in terms between the clauses, phrases, words, stipulations or terms and herein referred to generally as stipulations in this RFI and the stipulations in any other document attached hereto, or the RFI submitted hereto, the relevant stipulations in this RFI shall take precedence.

7.2 Where this RFI is silent on any matter, the relevant stipulations addressing such matter and which appears in the NHLS Procurement Policy and Procedures (which are NHLS’s general conditions for Procurement) shall take precedence. RFI shall refrain from incorporating any additional stipulations in its RFI submitted in terms hereof other than in the form of a clearly marked recommendation that NHLS may in its sole discretion elect to import or to ignore. Any such inclusion shall not be used for any purpose of interpretation unless it has been so imported or acknowledged by NHLS

02d2e6f38f3ebbfc852255e7ca1f2602.doc 7.3 It is acknowledged that all stipulations in the NHLS Procurement Policy and Procedures are not equally applicable to all matters addressed in this RFI. It however remains the exclusive domain and election of NHLS as to which of these stipulations are applicable and to what extent. The vendors are hereby acknowledging that the decision of NHLS in this regard is final and binding. The onus to enquire and obtain clarity in this regard rests with the vendors. The vendors shall take care to restrict its enquiries in this regard to the most reasonable interpretations required to ensure the necessary consensus.

8. Language

Responses shall be submitted in English.

9. Gender

Any word implying any gender shall be interpreted to imply all other genders.

Headings

Headings are incorporated into this RFI and submitted in response thereto, for ease of reference only and shall not form part thereof for any purpose of interpretation or for any other purpose.

The manner for submission of the RFI

11.1 Vendors shall submit RFI response in accordance with the prescribed manner of submissions as specified below. 11.2 Vendors shall submit one (1) original copy, 1 (one) hard copy and 1(one) electronic copy (on a single CD/DVD) in DOC or PDF format. 11.3 The original copy must be signed IN INK by an authorised employee, agent or representative of the respondent and initialised on each and every page of the information. 11.4 Respondents are requested to complete their responses in electronic format, in the spaces provided for answers within this document. 11.5 The CD / DVD must be marked with the responding organisation’s name and RFI number. The CD / DVD must be enclosed in a cover that is also marked with the responding organisation’s name and RFI number. 11.6 The CD / DVD and cover must be enclosed and sealed in a padded envelope that is marked with the responding organisation’s name and RFI number. 11.7 All additions to the information documents i.e. appendices, supporting documentation, photographs, technical specifications and other support documentation covering suggested solutions etc. shall be neatly bound as part of the schedule concerned. No product information or company profiles will be considered.

02d2e6f38f3ebbfc852255e7ca1f2602.doc Instructions for submission of the RFI 12.1 RFI responses must be submitted in a prescribed format herewith reflected as Response Format, and be sealed in an envelope addressed as follows:

RFI number: RFI001/15-16

RFI Description: REQUEST FOR INFORMATION: APPLYING THE ITSDM MODEL TO SMALL DISTRICT HOSPITALS TO ADDRESS REQUESTS FOR A LABORATORY SERVICE BY THE GAUTENG DEPARTMENT OF HEALTH

Addressed to: The Head: Procurement NHLS Head Office 1 Modderfontein Road Sandringham Johannesburg 2131

12.2 Vendors shall submit information responses in accordance with the prescribed manner of submissions as specified above. 12.3 RFI Responses must be deposited into NHLS’s Tender box on or before 22 April 2016 not later than 11h00 South African Time. The Tender Box is situated at the Main Reception area of NHLS Head Office in Sandringham. 12.4 The physical size of the envelope must be limited to 750mm x 300mm x 90mm as the Tender Box aperture cannot accommodate larger sizes. Alternative arrangements for the submission of the information shall be made with the Tender Office at telephone number: (011) 386 6165. 12.5 All responses in this regard shall only be accepted if they have been placed in the tender box before or on the closing date and stipulated time. 12.6 RFI responses sent by post or courier must reach this office at least 36 hours before the closing date to be deposited into the information box. Failure to comply with this requirement will result in your information being treated as “late response” and will not be entertained. Such responses will be returned to the respective vendors. 12.7 No information shall be accepted by NHLS if submitted in any manner other than as prescribed above. 12.8 NHLS will not disqualify any vendor for purposes of this Request for Information. Apart from the RFI document in its original format, no mandatory documents are required in the RFI response. The R500 fee payable for receipt of bids is not applicable for this RFI. 12.9 There will be NO PUBLIC OPENING of the RFI responses received and; however, the list of bids received may be published on the NHLS website. Any subsequent discussions shall be at the discretion of NHLS. 12.10 Unless specifically provided for in the information document, responses submitted by means of telegram, telex, facsimile or similar means will not be considered.

02d2e6f38f3ebbfc852255e7ca1f2602.doc 12.11 No response from any vendor with offices within the RSA will be accepted if sent via the Internet or e- mail. However responses from international vendors with no office or representation in the RSA will be accepted if received via the Internet or E-mail before the closing date and time. 12.12 NHLS will not be liable for any costs incurred by the respondents in the preparation of response to this RFI. The preparation of responses will be made without obligation to accept any of the suggestions included in any response, or to discuss the reasons why such suggestions were accepted or rejected. 12.13 Responses are non-binding on both NHLS and the respondent. 12.14 Respondents may respond only to selected parts of the document, should they choose to do so. 12.15 All questions in respect of this RFI must be forwarded to [email protected]

Oral presentations and briefing sessions 13.1 Vendors who respond to this RFI may be required to give an oral presentation. 13.2 No briefing session will be held for this RFI.

Information requested

The objective of this Request for Information (RFI) is to obtain information from Industry regarding the applying the ITSDM model to small district hospitals to address requests for a laboratory service by the Gauteng Department of Health.

Evaluation criteria 15.1 No awards will be done in terms of this RFI

02d2e6f38f3ebbfc852255e7ca1f2602.doc ANNEX A: RFI DETAILS

1. Background

The NHLS laboratory service provides a wide range of pathology testing to NDOH clinics and state hospitals across South Africa. The latter include district, regional and tertiary hospitals as per classification by NDOH. District hospitals are further classified by the number of beds into small (50-150), medium (150-300) and large (300-500) facilities and typically these facilities provide emergency, trauma, paediatric and obstetric care. However, geographical location and distance to the nearest testing facility (laboratory) may also impact the total basket of tests offered at this hospital level.

2. . Statement of Need This notice is issued by the NHLS, as a Request for Information (RFI) to solicit responses from interested parties.

This notice, which is for information and planning purposes only, allows industry the opportunity to provide feedback on their ideas for the provision of services noted above. This document will also verify reasonableness and feasibility of future program requirements and promote competition. NHLS intends to set up and implement these new innovative technologies as soon as feasible and is looking for a service provider that provides solutions and support for the issues listed below.

This RFI is not to be construed as a commitment by NHLS, nor will NHLS pay for the information submitted in response. This RFI is being used to obtain information for planning purposes only. Please note that, responses to this notice are not considered offers and cannot be accepted by the NHLS to form a binding contract. NHLS does not intend to pay for information furnished in response hereto.

The National Health Laboratory Service (NHLS) National Priority Programme (NPP) Unit has developed an Integrated Tiered Service Delivery Model (ITSDM) to ensure universal access to CD4 testing across South Africa using a full coverage approach (1). This model, utilizes daily testing volumes to guide the placement of appropriate equipment, with the requisite capacity, to match service requirements (1). It incorporates 5 testing tiers and a sixth tier, as a coordinating/overseeing tier (1)(refer to figure below).

02d2e6f38f3ebbfc852255e7ca1f2602.doc Figure 1: ITSDM (left) indicating the proposed tiers of service delivery, indicated on a map to show coverage.

According to the World Health Organisation classification, a district hospital should provide diagnostic, treatment, care, counselling and rehabilitation services(2). It should cover the following clinical disciplines at a generalist level(2):

Table 1 : WHO recommendation for clinical disciplines to be provided at district hospitals

Family Rehabilitation Medicine MedicineSurgery Obstetrics Paediatrics Psychiatry Eye care Geriatrics Primary health care

02d2e6f38f3ebbfc852255e7ca1f2602.doc The table below links the ITSDM developed for CD4 testing for the District Health System facility classification as well as the level of testing stipulated in the Maputo declaration:

Table 2 : Linking the ITSDM tier to facility classification and tests to be performed according to the Maputo declaration

Tests to be Services performed ITSDM Tier NDOH DHS Provided (Maputo Declaration)

Tier 1 Primary Health Based on the PHC Decentralised POC Care (PHC) Package of Level I Tier 2 Community Services and Health Centre facility POC Hub (CHC) classification

Tier 3 Small-Medium District Hospitals Community Labs (<150 Beds) Generalist Level II Level I Tier 4 Large District Hospitals (<600 District Labs Beds)

Regional

Tier 5 Hospitals Super Level III and Metro Labs (200-800 Beds) Specialist IV Tertiary Hospitals

(400-800 Beds)

The norms and standards defined in the district hospital package for South Africa stipulate the requirement for emergency laboratory facilities to conduct the laboratory tests listed in the table below (2):-

Table 3 : Laboratory testing requirements set out the norms and standards for the district hospital package

Chemical Pathology Haematology Microbiology Urine/blood pregnancy Full blood count (FBC) Microscopy of testing Erythrocyte CSF/stool/urine Bilirubin AFB microscopy Sedimentation Rate Liver function test (LFT) Malaria(ESR) screen Syphilis screen and quantitative tests 02d2e6f38f3ebbfc852255e7ca1f2602.doc Cardiac enzymes Partial thromboplastin Gram stain Urea, creatinine & time Preparation of culture Prothrombin electrolytes (U&E) specimens Calcium, phosphate Fibrinogen Typhoid serology Amylase Preparation of bone Emergency HIV testing Lipids marrow specimens Glucose Uric acid

Not all of the tests listed above need to be provided at the district hospital, the clinical service requires access to the tests above through the laboratory network, i.e. more specialised tests are referred within the laboratory network. This is well described in the Maputo declaration that recommends also tiered laboratory network which consists of an integrated network of laboratories organized in alignment with the public health delivery network in the country (3).

In the Maputo declaration, four levels of laboratories are described (3):-

 Level I: Primary Health Care laboratories that primarily serve outpatients.

 Level II: District laboratories with intermediate referral facilities (e.g., district hospitals).

 Level III: Regional/Provincial laboratories in a regional/provincial referral hospital that may be part of a regional or provincial health bureau.

 Level IV: National/Multi-country reference laboratory for one or more countries.

The tiered levels of a laboratory system and the testing performed at each level may vary depending on the population served (e.g., infants, adults), level of service available, physical infrastructure, electricity, water, road conditions, and the availability of trained technical personnel in-country (3).

In annexure D of the Maputo declaration, the tests to be performed at each of the laboratory tiers described above is listed (3). The level II recommended laboratory tests are listed in the table below, along with example of kits and reagents proposed in 2008 (3).

Table 4 : NHLS test baskets by laboratory tier (from Annexure D: Maputo Declaration) (3)

02d2e6f38f3ebbfc852255e7ca1f2602.doc 02d2e6f38f3ebbfc852255e7ca1f2602.doc The aim of this business case is to apply the ITSDM model to small district hospitals in the Gauteng province to assess the feasibility of providing a laboratory service. The district hospitals in the Gauteng provide are listed in the table below:-

Table 5 : District hospitals in Gauteng by district and sub-district with hospital beds

Source: http://www.hst.org.za/sites/default/files/District%20Hopsital%20Performance %20Assessment%20Report_Gauteng%20Province.pdf

02d2e6f38f3ebbfc852255e7ca1f2602.doc Methodology

The following steps were followed:-

 An on-site visit to the Pretoria West and Bronkhorspruit district hospitals was undertaken on the 2nd of February 2016 to assess laboratory service requirements.

 Secondary Corporate Data Warehouse (CDW) TrakCare test volumes were extracted between August and October 2015 for each health facility in the Gauteng province for the defined list of tests listed in the table below.

 Individual test names were then categorized in to test groups, e.g. .sodium, chloride, etc. into the Urea and Electrolytes test group/panel.

 The Gauteng province district hospitals listed in table above were categorized using Microsoft Access to obtain test volumes for the specified district hospital locations. This data did not include laboratory test volumes which would include primary health care (PHC) tests referred to the local laboratory, i.e. only local district hospital test volumes were analysed.

 For the U&E and LFT test group, the maximum test volume per test method was assumed for the test group.

 For the remaining test groups, the total test volume across all test methods was assessed. This was based on local knowledge of how these tests are coded in the TrakCare laboratory information system (LIS). It was also an attempt to reconcile test volume back to test orders on the laboratory request form.

 For the daily volumes, the average across the three month period was assessed (assumed 3 months and 21.73 days per month).

02d2e6f38f3ebbfc852255e7ca1f2602.doc The table below lists the logic used to group test names to a logical test group:-

Table 6 : TrakCare test groupand test method names for which test volumes were extracted

TEST_GROUP TEST_METHOD_NAME TEST_GROUP TEST_METHOD_NAME AMYLASE AMYLASE LFT ALANINE TRANSAMINASE (ALT) CK CREATINE KINASE (CK) ALBUMIN

CRP C-REACTIVE PROTEIN ALKALINE PHOSPHATASE (ALP) D-DIMER D-DIMER ASPARTATE TRANSAMINASE (AST) FBC AND DIFF CONJUGATED BILIRUBIN FBC FULL BLOOD COUNT LACTATE DEHYDROGENASE (LD) HAEMATOCRIT TOTAL BILIRUBIN HAEMOGLOBIN TOTAL PROTEIN

PLATELET COUNT MALARIA RED CELL COUNT MALARIA RAPID SCREEN MALARIA WHITE CELL COUNT PI&PTT INT NORMALISED RATIO (INR)

GLUCOSE (120 MIN) BICARBONATE GLUC GLUCOSE (60 MIN) U&E CHLORIDE GLUCOSE (FASTING) CREATININE (PLUS MDRD)

GLUCOSE (RANDOM) POTASSIUM

HEPATITIS A IGM SODIUM HEPATITIS HEPATITIS B CORE IGM UREA

HEPATITIS B CORE TOTAL AB

HEPATITIS B E AB HEPATITIS B E AG HEPATITIS C ANTIBODY

02d2e6f38f3ebbfc852255e7ca1f2602.doc The table below list all the hospitals included in the data analysis. From this list, only the district hospitals in the Gauteng province were analysed.

Figure 2 : List of district hospitals included in the data analysis (highlighted)

FACILITY_NAME Bertha Gxowa Hospital ODI Community Hospital Bronkhorstspruit Phc Clinic Pholosong Hospital Carletonville Hospital Pretoria West Hospital Charlotte Maxeke Hospital Rahima Moosa Mother And Child Chris Hani Baragwanath Hosp HospitalSebokeng Hospital Dr George Mukhari Hospital Sizwe Tropical Diseases Hosp Dr Yusuf Dadoo Hospital South Rand Hospital Edenvale Hospital St John's Eye Hospital Far East Rand Hospital Sterkfontein Hospital Heidelberg Hospital Steve Biko Academic Hospital Helen Joseph Hospital Tambo Memorial Hospital Jubilee Hospital Tara H Moross Hospital Kalafong Hospital Tembisa Hospital Kopanong Hospital Thelle Mogoerane Regional Hospital Leratong Hospital Tshwane District Hospital Mamelodi Hospital Weskoppies Hospital Milpark Hospital Wits Oral And Dental Hospital

02d2e6f38f3ebbfc852255e7ca1f2602.doc Results

The results will be reported as follows:-

 Findings from the on-site visits

 Analysis of Gauteng district hospitals: bed size and mean daily FBC and U&E

 Proposed ITSDM Model for small/medium district hospitals in Gauteng

 Analysis of mean daily test volumes for 4 small-medium hospitals that request 25-50 FBC/U&E per day

5.1 Findings from the on-site visits

Significant challenges with the current laboratory service were highlighted, the key aspects discussed at the meeting are summarised below:-

02d2e6f38f3ebbfc852255e7ca1f2602.doc Table 7 : Summary findings from the on-site visits

Pretoria West District Hospital Bronkhorspruit District Hospital Currently operating as a depot, with an on- Small district hospital offering emergency, site data capturer accident and MOU services, planned Expanding service package to include expansion of services to include high-care. theatre and neonatal services

Currently have 4 courier collections per day Patients that cannot be managed due to the as well as the SkyNet after hours urgent absence of a laboratory service are referred to service the Mamelodi hospital Have network points for TrakCare webview. Unfortunately, the GDOH was Tests required: FBC, U&E, CRP, Malaria, unable to procure computers. Cardiac enzymes, D-Dimer, LFT and INR The previous laboratories repertoire primarily consisted on FBC, U&E, LFT and Glucose

Multiple wards are making use of POCT in the absence of a laboratory (no POCT data available).

Require an on-site laboratory

Complaint report compiled by Dr Boswell highlighting impact on patient outcome

Major issue: access to bilirubin for neonates

Need a Yes/No decision from the NHLS

Additional new district hospitals include Daveyton, Soshanguve and Lillian Ngoyi

02d2e6f38f3ebbfc852255e7ca1f2602.doc 5.2 Analysis of Gauteng district hospitals: bed size and mean daily FBC and U&E

There are multiple small-medium district hospitals that request between 25 and 50 tests per day that would benefit from smaller testing platforms (figure only includes data for the hospitals listed in table four). There seems to be a correlation between bed size and daily testing volumes.

350 Large District Hospitals

250 e z i S

B 200 Medium District Hospitals

50 Small District Hospitals

0 - 10 20 30 40 50 60 70 80 90 100 110 Mean FBC, U&E and LFT specimens

Figure 3 : Scatter plot of hospital bed size and mean daily Full Blood Count (FBC) and Urea & Electrolytes (U&E)

02d2e6f38f3ebbfc852255e7ca1f2602.doc 5.2 Proposed ITSDM Model for small/medium district hospitals in Gauteng

The following ITSDM model is proposed for small and medium hospitals. Hospitals requesting less than 25 U&E and LFT specimens per day could cope with improved logistics. The new tier involved small hospitals that request between 25 and 50 tests per day. For these laboratories, a limited repertoire of tests is proposed. Additionally, with the low daily volumes POC testing or low capacity analysers are proposed. Additionally, the impact of clinic volumes must also be considered. Finally, where a hospital offers clinical services that require short turn-around-time, e.g. high care, a district laboratory service has to be provided.

Assess Assess Clinical impact of Services Offered Clinic volumes

High-Care services not High-Care, etc. services offered offered that require testing with a short TAT (6hrs District Package) Tiered- Laboratory Service

FBC/U&E 51-450 p/d Provide district Routine District Lab

laboratory Stat service FBC FBC/U&E 26-50 p/d INR & PTT Small STAT District Lab LFT Procalcitonin rapid Troponin T Urea, elecs, creat, glu FBC/U&E <= 25 p/d Improve logistics

02d2e6f38f3ebbfc852255e7ca1f2602.doc Applying this methodology four district hospitals in Gauteng were identified as potential small STAT district laboratories, i.e. Heidelberg, Pretoria West, Yusuf Dadoo and Carletonville hospitals. These are specifically based on test

5.3 Analysis of mean daily test volumes for 4 small-medium hospitals that request 25-50 FBC/U&E per day

Daily mean testing volumes were analysed for the Heidelberg, Pretoria West, Yusuf Dadoo and Carletonville hospitals. The range of daily volumes is provided in the table below:-

Figure 4 : Mean daily test volumes for four small-median district hospitals in Gauteng

Min Daily Max Daily Test Basket Vols Volumes AMYLASE/AMYLASE 1 1 CK/CREATINE KINASE (CK) 0 2 CRP/C-REACTIVE PROTEIN 7 24 D-DIMER/D-DIMER 0 2 FBC 27 50 GLUC 0 3 HEP 2 5 LFT 14 21 MALARIA 0 2 PI&PTT 1 5 PROCALCITONIN - - TROP-T - 2 U&E 35 43 Hospitals in Sample: Carletonville, Yusuf Dadoo, Heidelberg and Pretoria West

These hospitals would perform between 27 and 50 FBC tests per day using a haematology analyser. Similar, the chemistry analyser would perform between 35 and 43 for the U&E test and 14 and 21 LFT tests per day. Overall, for these tests no hospital requested more than 50 tests per day. For the remaining tests, daily volumes were very low, mostly <=5 per day.

02d2e6f38f3ebbfc852255e7ca1f2602.doc Proposed way forward

Submit a request for information for platforms that meet the following daily testing thresholds:-

Daily Testing Test Basket Volume Full Blood Count (FBC) 25-50 Urea & Electrolytes (U&E) with Creatinine Liver Function Tests (LFT) Amylase/Lipas Creatinine Kinase (CK) C-Reactive Protein (CRP) D-Dimer Glucose <=5 Hepatitis Rapid Malaria Rapid Prothrombin Index (PI)/INR Procalcitonic Rapid Trop-R Rapid

In the supplier responses we also require information about the following aspects:-

 Batch size

 Reagent stability (expiry dates, shelf life and storage conditions)

 Number of controls to be run daily

 Daily/Weekly maintenance required

 Reagent pack size

 Cost per test

 Capital costs for outright purchase

 Equipment rental cost

 Any preventative service required

 Ability to scale up to cater for higher daily test volumes

02d2e6f38f3ebbfc852255e7ca1f2602.doc 02d2e6f38f3ebbfc852255e7ca1f2602.doc