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Ministry of Health and Social Services REPUBLIC OF NAMIBIA REPORT OF THE AUDITOR-GENERAL ON PERFORMANCE AUDIT STUDY ON MINISTRY OF HEALTH AND SOCIAL SERVICES PROVISION OF HEALTH SERVICES FOR THE FINANCIAL YEARS 2006, 2007 AND 2008 Published by authority Price (Vat excluded) N$ 45.97 Report no 750 REPUBLIC OF NAMIBIA TO THE HONOURABLE SPEAKER OF THE NATIONAL ASSEMBLY I have the honour to submit herewith my performance audit report on the Ministry of Health and Social Services – Provision of health services for the financial years 2006, 2007 and 2008 in terms of Article 127(2) of the Namibian Constitution. The report is transmitted to the Honourable Minister of Finance in terms of Section 27(1) of the State Finance Act, 1991, (Act 31 of 1991) to be laid upon the Table of the National Assembly in terms of Section 27(4) of the Act. JUNIAS ETUNA KANDJEKE WINDHOEK, October 2009 AUDITOR-GENERAL TABLE OF CONTENTS ABBREVIATIONS ........................................................................................................... 3 EXECUTIVE SUMMARY ................................................................................................ 4 CHAPTER 1 1.1 Introduction................................................................................................................ 5 1.2 Reason for the audit ................................................................................................... 5 1.3 Background................................................................................................................ 5 1.4 Mandate of the Ministry ............................................................................................ 5 1.5 The Department’s mission statement......................................................................... 5 1.6 Vision statement ........................................................................................................ 5 1.7 Goals and objectives of tertiary health care services................................................. 5 1.8 Goal and objectives of regional & social welfare...................................................... 5 1.9 Organization structure................................................................................................ 6 1.10 Staffing....................................................................................................................... 7 CHAPTER 2 2.1 Audit design............................................................................................................... 8 2.1.1 Audit scope ................................................................................................................ 8 2.2 Audit methodology .................................................................................................... 8 2.2.1 Interviews................................................................................................................... 8 2.2.2 Document analysis..................................................................................................... 9 2.2.3 Physical observations................................................................................................. 9 CHAPTER 3 3. Process description .................................................................................................... 10 3.1 Description of health and social services system....................................................... 10 3.1.1 Health workers........................................................................................................... 10 3.1.2 Medical equipment .................................................................................................... 11 3.1.3 Transport.................................................................................................................... 12 3.1.4 Wards occupancies .................................................................................................... 12 3.1.5 Examination and treatment ........................................................................................ 12 CHAPTER 4 4. Findings ..................................................................................................................... 13 4.1 Human resources........................................................................................................ 13 4.1.1 Recruitment process................................................................................................... 13 4.1.2 Allocation of staff ...................................................................................................... 15 4.1.3 Accommodation for health workers .......................................................................... 15 4.1.4 Additional programmes ............................................................................................. 16 4.2 Medical equipment .................................................................................................... 16 4.2.1 Repairs of medical equipment ................................................................................... 16 4.3 Transport.................................................................................................................... 17 4.4 Wards occupancy....................................................................................................... 17 4.5 Examination & treatment of patients......................................................................... 18 i CHAPTER 5 5. Conclusion ................................................................................................................. 21 5.1 General conclusion .................................................................................................... 21 5.1.1 Human resources........................................................................................................ 21 5.1.2 Medical equipment .................................................................................................... 21 5.1.3 Transport.................................................................................................................... 21 5.1.4 Wards occupancies .................................................................................................... 21 5.1.5 Examination and treatment ........................................................................................ 21 CHAPTER 6 6. Recommendations...................................................................................................... 22 6.1 General recommendation........................................................................................... 22 6.1.1 Human resources........................................................................................................ 22 6.1.2 Medical equipment .................................................................................................... 22 6.1.3 Transport.................................................................................................................... 22 6.1.4 Wards occupancies .................................................................................................... 22 6.1.5 Examination and treatment ....................................................................................... 22 APPENDIXES ii LIST OF ABBREVIATIONS CEW Clinical Engineering Workshop R-CEW Regional Clinical Engineering Workshop PPM Planned Preventive Maintenance RMT Regional Management Team MEM Medical Equipment Management EMO Equipment Management Officer WCH Windhoek Central Hospital NHCTP National Health Care Technology Policy ARV Antiretroviral TB Tuberculosis MOHSS Ministry of Health and Social Service OPM Office of the Prime Minister SD Sub-Division PS Permanent Secretary PMS Public Service Management PMTCT Prevention of Mother To Child Treatment Ministry Ministry of Health and Social Services EXCUTIVE SUMMARY The Office of the Auditor-General is authorized to carry out performance audits in terms of Section 26 (1) (b) (iv) of the State Finance Act of 1991, (Act 31 of 1991), which reads as follows: (The Auditor- General) “may investigate whether any moneys in question have been expended in an efficient, effective and economic manner”. This audit report concentrated on the state health services and facilities within the Department of Regional Health and Social Services and Directorate of Tertiary Health Care and Clinical Support Services (Division of Windhoek Central Hospital and Medical Equipment Management Sub- division). FINDINGS Human resources The MOHSS (Ministry of Health and Social Services) is experiencing a shortage of Health professionals more especially, doctors, social workers, registered nurses and pharmacists. The shortage of staff in state health facilities is mostly caused by the unavailability of health professionals in the country as a result most of the posts are filled by foreigners. Recruitment process on promotional posts and entry posts filled by non-Namibians Vacant posts in the MOHSS are supposed to be filled within four months, but the audit revealed that it takes the MOHSS up to14 months to fill promotional posts and to recruit foreign health workers. Allocation of staff The audit revealed that, due to unavailability of health workers in the country, some clinics have only one nurse and an institutional worker while there was suppose to be at least two nurses, a registered nurse and one enrolled nurse. Accommodation for health workers The allocation of health professions at health facilities is mostly affected by a shortage of health professionals as well as unavailability of accommodation,
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