consolidated report on service delivery inspections … · 2015-11-25 · consolidated report on...

CONSOLIDATED REPORT ON SERVICE DELIVERY

INSPECTIONS OF DISTRICT HOSPITALS AND

CLINICS REGARDING AVAILABILITY OF MEDICINES

AND MEDICAL EQUIPMENT AND THE ROLE OF

HEALTH DISTRICT OFFICES

DEPARTMENTS OF HEALTH:

FREE STATE, LIMPOPO, NORTH WEST AND

WESTERN CAPE PROVINCES

MARCH 2015

Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of

medicines and medical equipment and the role of Health District offices. Page i

FOREWORD

The Public Service Commission (PSC) derives its mandate from Chapter 10 (Section 196) of

the Constitution to, amongst others, promote the values and principles set out in Section

195, and to propose measures in ensuring effective and efficient performance within the

Public Service1. Furthermore, Section 9 of the PSC Act, 1997 (Act 46 of 1997), provides that

“the Commission may inspect departments and other organizational components in the

Public Service and has access to official documents or may obtain such information from

heads of those departments or organizational components as may be necessary for the

performance of the functions of the Commission under the Constitution or Public Service

Act”2.

Health care is one of the key government priorities which should be accessible to all the

citizens of the country in order to achieve its delivery outcome: a long and healthy life for

all. This outcome is predicated on a sustainable health care infrastructure that is responsive

to the needs of the citizens. For this reason, the PSC has during the 2013/2014 financial

year conducted the inspections at selected service delivery sites of the Department of Health

in the Free State, Limpopo, North West and Western Cape Provinces. The purpose of the

inspections was to determine the availability of medicines and medical equipment at these

sites as well as the role of health district offices in this regard. The inspections also sought to

follow up on the implementation of its previous recommendations in this area at the health

facilities3.

Overall, it was found that the sampled provinces were experiencing various challenges such

as supply chain management issues, poor quality of medical equipment, unavailability of

certain critical medicines and lack of space for storage thereof. Of the 38 recommendations

the PSC issued in all the visited provinces in 2010, 29 (76%) were implemented. These

findings could be used as a basis for further work in assessing the readiness of health

facilities in rolling out the National Health Insurance (NHI) system.

It is a pleasure to present the Consolidated report on Service Delivery Inspection of

Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the

Role of Health District Offices. Inspections remain a valuable monitoring mechanism whose

findings and recommendations could contribute towards service delivery improvement. The

PSC wishes to thank officials of the Free State, Limpopo, North West and Western Cape

Provincial Departments of Health for their cooperation and willingness to share information.

RK SIZANI

DEPUTY CHAIRPERSON: PUBLIC SERVICE COMMISSION

1 Republic of South Africa. Constitution of the Republic of South Africa, 1996. 2 Republic of South Africa. Public Service Commission Act, 1997. 3 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of

Health. 2010.


medicines and medical equipment and the role of Health District offices. Page ii

FOREWORD ......................................................................................................................... i

LIST OF ACRONYMS ......................................................................................................... iv

EXECUTIVE SUMMARY ...................................................................................................... v

CHAPTER ONE: INTRODUCTION ....................................................................................... 1

1.1 INTRODUCTION AND BACKGROUND ................................................................... 2

1.2 OBJECTIVES OF THE INSPECTIONS ..................................................................... 2

1.3 SCOPE AND METHODOLOGY ................................................................................ 3

1.3.1 Scope ........................................................................................................................ 3

1.3.2 Methodology .............................................................................................................. 4

1.4 LIMITATIONS OF THE STUDY................................................................................. 5

CHAPTER TWO: OVERVIEW OF THE FINDINGS .............................................................. 6

2.1 KEY FINDINGS ON ANNOUNCED INSPECTIONS .................................................. 7

2.1.1 Contextual Background ............................................................................................. 7

2.1.2 Management of Medicines ......................................................................................... 7

2.1.3 Management of Medical Equipment ........................................................................ 12

2.1.4 Governance of Health Facilities ............................................................................... 13

2.1.5 Challenges .............................................................................................................. 13

2.2 KEY FINDINGS ON UNANNOUNCED INSPECTIONS ........................................... 14

2.2.1 Observing facilities .................................................................................................. 14

2.2.2 Observing access to information.............................................................................. 14

2.2.3 General observations .............................................................................................. 15

2.2.4 Talking to citizens .................................................................................................... 15

2.3 IMPLEMENTATION OF PSC RECOMMENDATIONS ............................................ 15

CHAPTER THREE: CONCLUSION AND RECOMMENDATIONS ..................................... 17

3.1 INTRODUCTION ..................................................................................................... 18

3.2 CONCLUSION ........................................................................................................ 18

3.3 RECOMMENDATIONS ........................................................................................... 18

3.3.1 Announced inspections ........................................................................................... 18

3.3.2 Unannounced inspections ....................................................................................... 19

3.4 ACKNOWLEDGEMENT.......................................................................................... 20

ANNEXURES

ANNEXURE A: FINDINGS FROM FREE STATE PROVINCE ............................................ 21

ANNEXURE B: FINDINGS FROM LIMPOPO PROVINCE .................................................. 27

ANNEXURE C: FINDINGS FROM NORTH WEST PROVINCE .......................................... 32


medicines and medical equipment and the role of Health District offices. Page iii

ANNEXURE D: FINDINGS FROM WESTERN CAPE PROVINCE ...................................... 37

ANNEXURE E: STATUS ON THE IMPLEMENTATION OF RECOMMENDATIONS OF THE

PSC’S INSPECTIONS CONDUCTED IN 2009 .......................................... 45

ANNEXURE F: FEEDBACK ON IMPLEMENTATION OF THE PSC’S RECOMMEN-

DATIONS CONTAINED IN THE REPORTS ON INSPECTIONS OF

DISTRICT HOSPITALS AND CLINICS REGARDING AVAILABILTY OF

MEDICINES AND MEDICAL EQUIPMENT AND THE ROLE OF HEALTH

DISTRICT OFFICES IN THE DEPARTMENTS OF HEALTH IN THE FREE

STATE, LIMPOPO, NORTHWEST AND WESTERN CAPE PROVINCES . 50

TABLES

Table 1: Objectives of inspections .................................................................................................... 3

Table 2: List of provinces, inspected sites and dates of inspections .......................................... 3

FIGURES

Figure 1: Medicine management cycle ............................................................................................ 8

Figure 2: Statistical analysis of medicine availability based on reporting against the DHPs .. 11


medicines and medical equipment and the role of Health District offices. Page iv

LIST OF ACRONYMS

AIDS Acquired Immune Deficiency Syndrome

AO Accounting Officer

ARV Antiretroviral

BP Blood Pressure

CCTV Closed Circuit Television

CDC Community Day Centre

CEO Chief Executive Officer

CHC Community Health Centre

DAP District Acquisition Plan

DDV Direct Delivery Voucher

DHP District Health Plan

DHS District Health System

DoE Department of Education

EA Executive Authority

EDL Essential Drugs List

EMS Emergency Medical Services

FSDoH Free State Department of Health

GDoH Gauteng Department of Health

HIV Human Immunodeficiency Virus

HoD Head of Department

HPCSA Health Professional Council of South Africa

LPDoH Limpopo Province Department of Health

MoA Memorandum of Agreement

MSD Medical Supply Depot

NDoH National Department of Health

NDPSA National Drugs Policy of South Africa

MEC Member of the Executive Council

NEDLC National Essential Drugs List Committee

NEMLC National Essential Medicine List Committee

NHA National Health Act

NHI National Health Insurance

NWDoH North West Department of Health

PHC Primary Health Care

PSC Public Service Commission

PTC Pharmaceutical and Therapeutic Committee

RDM Remote Demander Module

SAPC South African Pharmacy Council

SCM Supply Chain Management

SLA Service Level Agreement

SOPs Standard Operating Procedures

STGs Standard Treatment Guidelines

TB Tuberculosis

WHO Wealth Health Organisation

WCDoH Western Cape Department of Health


medicines and medical equipment and the role of Health District offices. Page v

EXECUTIVE SUMMARY

INTRODUCTION

Since 1994 the provision of equitable and quality health care services to all citizens has

been paramount in the government’s health programme in order to adequately mitigate the

burden of disease. Hence, the adoption of “A long and healthy life for all South Africans”

during the Cabinet Lekgotla of 2010 as one of government’s key priorities. By devolving

certain responsibilities for health services to the provincial and local government levels

through the District Health System (DHS)4, government aimed to improve access to quality

health care to communities at the local level. For this reason, Health District Offices are

expected to play a critical supportive role of ensuring that health care facilities are

adequately resourced at all times for the optimal provision of quality health care to citizens.

In line with its oversight role, the Public Service Commission (PSC) has over the years been

conducting inspections to assess Public Service performance and provide advice on

pertinent steps to be taken to ensure the required improvement. During 2013/14 the PSC

conducted inspections in the Departments of Health in four provinces, viz. Free State,

Limpopo, North West and Western Cape, to assess the availability of medicines and medical

equipment at selected health facilities, as well as to determine the role of the relevant Health

District Offices in this regard. The inspections at the selected health facilities also aimed to

follow up on the implementation of the PSC’s previous recommendations in this regard5.

Reports with recommendations have been forwarded to the Executive and Accounting

Authorities of the said departments in the four provinces for implementation, and they are

also available on the PSC website (www.psc.gov.za). Following engagements with the

respective departments on implementation of the recommendations, feedback has been

received and is attached as ANNEXURE F.

METHODOLOGY

To initiate the inspection process, letters were forwarded to the Executive Authorities (EAs)

and the Accounting Officers (AOs) of the National and Provincial Departments of Health,

informing them about the PSC’s intention to conduct inspections in the selected hospitals

and clinics. Furthermore, engagements were held with officials of the National and Provincial

Departments to set the scene for the inspections.

Both the announced and unannounced inspections were conducted in line with the

protocol for conducting inspections 6 . The inspections sought to understand challenges

experienced by the citizens in accessing quality health care especially regarding the

availability of medicines and medical equipment at the sites visited and the role of the health

district offices in this regard. These inspections took place at selected Health District Offices,

District Hospitals and clinics in the four provinces. In the Western Cape selected Regional

4 Republic of South Africa. National Department of Health. White Paper for the transformation of the Health

System in South Africa . 1997. 5 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of

Health. 2000. 6 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007.

http://www.psc.gov.za/


medicines and medical equipment and the role of Health District offices. Page vi

hospitals and Community Day Centres (CDCs) were also inspected for their role in providing

primary health care services.

KEY FINDINGS ON ANNOUNCED INSPECTIONS

Findings of the announced inspections are presented into two thematic areas, which are the

management of medicines and the management of medical equipment. Detailed findings on

these inspections are attached as ANNEXUREs A1, B1, C1 and D1.

Management of Medicines

The management of medicines is categorised into five key functions namely, product

selection, procurement, distribution and rational use, and management support.

Product selection

Officials of the visited provincial Departments of Health (i.e. FSDoH, LDoH, NDoW and

WCDoH) indicated that the selection of medicines or drugs was a national competence. The

function was handled by the National Essential Drugs List Committee (NEDLC) or National

Essential Medicines List Committee (NEMLC) appointed by the Minister of Health and

determines which medicines were essential to be included in the Essential Drugs List (EDL).

Pharmaceutical and Therapeutic Committees (PTCs) were further established at Provincial,

District and hospital levels and made recommendations of new drugs based on their

scientific efficacy and safety. The PSC found the process to be well institutionalized and

contributed effectively towards the availability of medicines at health care facilities.

Procurement

In all provinces the primary supply of medicines to the visited health care facilities was done

through Medical Depots. However, district hospitals were allowed, subject to permission and

based on the urgency of cases, to use either the “buy out” or Direct Delivery Voucher (DDV)

methods. The “buy-out” method is a process whereby orders were made directly to the

suppliers or pharmaceutical companies on a quotation basis. The DDV method involved

hospitals ordering through the depots, however, the ordered stock was then delivered

directly to the facilities. District hospitals often took advantage of this flexibility in the process,

which allowed for efficient acquisition of urgently needed medicines, and thereby ensuring

stock availability.

Distribution and storage

Distribution: It was observed in all provinces that medical depots were responsible for the

distribution of medicines to the health care facilities as advocated in the National Drug Policy

of South Africa (NDPSA). However, provinces such as the Free State and North West, at

some stage experienced challenges with the timely delivery of ordered stock to the health

care facilities resulting in the facilities being forced to use own transport to fetch their orders

from the depots. In the case of Free State the issue was due to the non-payment of service

providers.


medicines and medical equipment and the role of Health District offices. Page vii

Storage: There was general compliance with the NDPSA and the applicable Standard

Operating Procedures (SOPs) in all the visited health facilities as the pharmacies were

always locked and thus prohibiting unauthorized access. In the Western Cape these security

measures were augmented with Closed Circuit Television (CCTV) systems and alarm

systems as observed at Kwanokuthula Community Development Centre (CDC) to enhance

the safety of medicines. Refrigerators were also sufficiently available for storing medicines

requiring constant cool temperature such as vaccines and insulin and their temperatures

monitored regularly. In addition, waste buckets were provided for safekeeping of medical

waste, which were collected by a medical waste management company once full for

incineration.

Rational use, monitoring and evaluation

Rational use: In the Free State, North West and Western Cape provinces, guidelines for the

district pharmacists were developed for purposes of visits to the health facilities on monthly

basis, while in the Limpopo, district offices relied on the Handbook for Clinic and Community

Health Centre (CHC) Managers7. The purpose of the visits is to oversee the operations and

provide pharmaceutical support, especially in ensuring that the dispensing of medicines is in

accordance with the Standard Treatment Guidelines (STGs). However, only the Western

Cape was found to adhere to its guidelines with district pharmacists conducting regular

workshops and comprehensive analysis of the stock levels, which empowered the facilities

to maintain quality service delivery in line with the NDPSA. No evidence of such visits could

be found in the case of the Free State, Limpopo and North West provinces despite the

district officials and nursing staff indicating that they were taking place.

Monitoring and evaluation: Various systems were used to monitor and evaluate the

availability of medicines in the visited provinces. The stock cards system relied upon by the

North West and Limpopo provinces was regarded as highly ineffective. In the case of

Limpopo the finding was corroborated during scrutiny of the Waterberg District’s progress

reports against its DHP, which showed that the district failed to meet the 95% target of

availability of medicines. Officials in the Free State questioned the reliability of the findings of

the province’s Tracer Drugs system, which indicated that both the inspected districts

achieved the 95% target of availability of essential medicines, due to the small sample

selected by the system.

Management support

Information technology (IT) system: Although medical depots in all the visited provinces

were found to have electronic system for capturing orders, not all the inspected health care

facilities had similar systems. In Limpopo all the visited health care facilities were using a

particular form for ordering medicines, while in the Free State and North West provinces only

district hospitals were using the RX solution (i.e. an electronic ordering system), and the

systems were linked to the respective medical depot via the Remote Demander Module

(RDM). In the Western Cape all its health facilities were using the WINRDM electronic

7 Republic of South Africa. Department of Health. Handbook for Clinic/Community Health Centres Managers. October

1999.


medicines and medical equipment and the role of Health District offices. Page viii

system for ordering and managing availability of stock, and it was linked to the Cape Medical

Supply Depot (MSD). These IT systems were found to be effective in expediting requisitions

by health facilities, as opposed to the cumbersome manual system used by the facilities in

Limpopo.

Training: Generally, some form of training for staff had taken place in all the provinces.

However, evidence of focused training on dispensing of medicines or for pharmacists was

only found in the North West and Western Cape provinces.

Staffing: Shortage of health professionals was a common concern at all the visited facilities,

especially of doctors and nursing staff, which impacted negatively on the delivery of quality

health care services.

Management of Medical Equipment

Procurement: Officials of the LDoH, FSDoH and NWDoH indicated that this function was

centralized at the Provincial Head Office and undertaken in terms of the Preferential

Procurement Policy Framework Act, 2000 (PPPFA)8. However, officials at all the visited

health facilities in the above-mentioned provinces were concerned about the delays of

procuring new or replacing broken equipment. On the contrary, District Offices in the

WCDoH informed the inspection team that the procurement of medical equipment in the

province had been decentralized to ensure that needed items were timeously procured for

the facilities.

Asset control: This function was the responsibility of District Offices in the Free State,

Limpopo and North West provinces. In the Western Cape it had been devolved to the heads

of administration or operational managers of the health facilities with the appropriate

delegations in place. Generally, there was proper asset management control at the sites

visited except at Unit 9 clinic (North West) where the inspection team found broken

equipment lying around the clinic yard.

Maintenance of equipment: Only the Western Cape was found to have an effective

arrangement in that sufficient capacity in this regard had been established at District,

Regional and Tertiary hospitals to assist all other facilities. In the Free State, Limpopo and

North West provinces, staff raised concerns about the turnaround times for maintenance of

equipment.

Disposal of medical equipment: It was found in the Free State, North West and Western

Cape that the function rests with District Offices, whereas in Limpopo it was located in the

Provincial Head Office. The broken equipment found lying around at Unit 9 Clinic in the

North West raised questions of the process in place being adhered to. Some of the items

posed serious risks of injury to staff and the citizens.

Governance of health facilities

8 Republic of South Africa. National Treasury. Preferential Procurement Policy Framework Act, 2000 (PPPFMA).


medicines and medical equipment and the role of Health District offices. Page ix

Hospital boards: In all the visited provinces the inspected hospitals had hospital boards as

required by the National Health Act (NHA), with those of the Free State and Western Cape

functioning effectively. In Limpopo and North West the staff at the inspected hospitals raised

concerns of interference in administration matters by the hospital boards.

Clinic Committees: Only the clinic committees in the Free State were found to be

functioning effectively. The lack of functioning of these structures in Limpopo, North West

and Western Cape not only contravened section 42(1) of the NHA, but also deprived the

community of the constitutional avenue to contribute to improved service delivery at the

clinics.

Challenges

Infrastructure: There was a general lack of space at most of the inspected facilities.

Messina District Hospital in Limpopo was worst affected as some infants and their mothers

were found sleeping on the floor due to the insufficient wards and beds. In the Free State the

inspected facilities within Thabo Mofutsanyana District, which is serviced by the Maluti-A-

Phofung Local Municipality, experienced intermittent power failures and mostly did not have

back-up generators.

Emergency Medical Services: Emergency medical services (EMS) were found to be poor

in the visited districts in the North West, with concerns of response times being inordinately

long and in some instances ambulances failing to arrive, and thus putting the lives of

patients at risk. The PSC in its report on EMS found that generally there was a shortage of

resources ranging from emergency care practitioners to vehicles, which impacted on the

delivery of quality EMS services9.

KEY FINDINGS ON UNANNOUNCED INSPECTIONS

The unannounced inspections were based on Batho Pele framework as a key strategy for

the transformation of Public Service delivery10. These inspections sought to determine the

extent to which the visited health care facilities adhered to the principles of Batho Pele.

Detailed findings of these inspections are attached as ANNEXUREs A2, B2, C2 and D2.

Observing facilities

Condition of buildings: The buildings of Bophelong Clinic (Free State), Messina District

Hospital (Limpopo) and Unit 9 and Tlapeng clinics (North West) required urgent refurbishing.

In Limpopo the Bela-Bela Clinic is a makeshift structure of containers, which was not

conducive for providing quality health care.

Records management system: The filing system at Ellisras Hospital in Limpopo was

cluttered and raised serious questions of easier location of patients’ files. It also posed a

9 Republic of South Africa. Report on the Assessment of the Quality of Support provided by the Department of Health to

Emergency Medical Service Practitioners. 2009. 10 Republic of South Africa. Department of Public Service and Administration. The Batho Pele White Paper on the

Transformation of Public Service Delivery, 1997.


medicines and medical equipment and the role of Health District offices. Page x

serious safety risk in case of fire breaking out, which was further exacerbated by the lack of

servicing of the hospital’s fire extinguishing equipment.

Observing access to information

Information: In all the visited provinces the inspected facilities had displayed key

information on health issues, business hours and service charters in line with the Batho Pele

principle of Information.

Suggestion/complaint boxes: These boxes were found to be available and strategically

placed in all the inspected facilities in all the selected provinces, which facilitated the process

of lodging complaints or suggestions in line with the Batho Pele principle of Redress.

Complaint procedures were also found to be in place to enable citizens to lodge complaints.

General observations

Water and sanitation: Generally, there was no challenge of water and sanitation in most

inspected facilities in visited provinces. However, in the Free State province the Brentpark

Clinic experienced a poor supply of water from the Moqhaka Local Municipality, while

Bophelong Clinic’s quality of water led to a number of cases of diarrhoea. The toilets

facilities at Unit 9 Clinic in the North West required urgent refurbishing since sanitation pipes

were damaged such that an unbearable smell filled the waiting area, and thus posing a

health risk.

Conducive working environment: Air conditioning systems were not adequate in all the

inspected facilities in Limpopo, mostly because they needed maintenance.

Parking facilities and security: Parking facilities were not adequate at Bela-Bela and

Namakgale clinics in Limpopo. The fencing at the Namakgale Clinic in Limpopo appeared

worn-out and needed to be repaired in some areas.

Talking to citizens

Availability of medicines and medical equipment: Interviewed citizens in the visited

facilities were generally satisfied with the availability of medicines and medical equipment.

However, key observations were made regarding challenges involving lack of maintenance

of equipment as well as the procurement of poor quality equipment such as in Limpopo

where Messina District Hospital’s X-ray machine was broken and in the North West several

broken equipment items were found lying around at Unit 9 Clinic.

Waiting time: There was a general concern with the waiting time of two (2) to four (4) hours

before consultation as being unreasonably long. However, in the Western Cape the citizens

were satisfied with the time taken to collect their medicines, which ranged from 10 to 45

minutes.

Access: Challenges of accessing the health care facilities were raised at Phuthaditjhaba

Clinic (Free State), Marishane Clinic (Limpopo) and Sedgefield Clinic (Western Cape), with


medicines and medical equipment and the role of Health District offices. Page xi

interviewed citizens at Phuthaditjaba Clinic indicating that they travelled between 10km to

20km to access a clinic.

IMPLEMENTATION OF PSC RECOMMENDATIONS

In line with its oversight role the PSC followed up on the implementation of its previous

recommendations emanating from the inspections of primary health care facilities conducted

in 200911. Of the 38 recommendations, 29 (76%) were implemented with Limpopo and

Western Cape achieving 100%. The implementation rate in the Free State was 94%, while

the North West was trailing at 58%. Specific details of the status on implementation of these

recommendations are attached as ANNEXURE E.

RECOMMENDATIONS

The following recommendations should apply to all health facilities that may be experiencing

similar challenges and not only those that were visited: Specific recommendations as

contained in the relevant reports have been forwarded to the Departments concerned.

Announced Inspections

Electronic information systems, which are linked to the medical depots’ ordering

systems, should be established in all the health care facilities. Computers and

network points should be provided as well.

The FSDoH, LDoH and NWDoH should collaborate with the provincial Departments

of Education (DoE), DPW and Human Settlements to devise strategies for the

recruitment and retention of medical professionals, especially in view of the challenge

of shortage of accommodation in these areas.

The FSDoH, LDoH and NWDoH should ensure that District Offices regularly visit

health facilities. In this regard, the visits should be linked to the applicable

performance management system.

The FSDoH and NWDoH should strengthen their SCM processes for procurement of

medical equipment and ensure that systems of blacklisting suppliers of poor quality

of medical equipment were implemented.

In addition, an audit of equipment should be conducted at all the facilities in all the

visited provinces to determine their needs, especially the procurement of new X-ray

equipment for Tokollo and Ellisras hospitals.

The FSDoH should ensure that suppliers are paid on time as required by the

Treasury regulations to ensure availability of medicines at the Medical Depot and

facilities.

Security measures should be improved at the health facilities, which should include

CCTV systems and/or alarm systems.

11 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of

Health. 2010.


medicines and medical equipment and the role of Health District offices. Page xii

The LDoH should urgently investigate the veracity of the allegations of malpractices

relating to conduct of the Nurse-in-Charge reported at Messina Hospital.

Training should be provided to the staff in the necessary protocols of dispensing

medication especially in the management of adverse drug events.

The LDoH should engage the provincial Department of Public Works to address the

poor condition of buildings and lack of space experienced by health care facilities

especially at Ellisras and Messina hospitals as well as at Bela-Bela and Namakgale

clinics.

The LDoH should also immediately ensure that the pharmaceutical license of the

MSD is renewed as required by the SAPC to ensure that the operations of the depot

are legal and in line with section 22 of the Pharmacy Act, 1974.

The LDoH should ensure that DHPs are in place, especially in the Capricorn,

Mopani, Sekhukhune and Vhembe districts, in line with the provisions of the NHA..

The NWDoH should immediately ensure that asset management unit of the Ngaka

Modiri Molema District Office attend to the broken equipment found at Unit 9 Clinic in

terms of the relevant SCM prescripts.

Back-up generators should be provided to the Taung Station, Tlapeng and Unit 9

clinics in order to prevent disruption of services in case of power failure.

Unannounced Inspections

An audit of the state of buildings of health facilities should be conducted in order to

ensure proper maintenance, eradication of dilapidated buildings and to address the

challenge of space. Most importantly, provision should be urgently made for

additional maternity wards and beds at Messina District Hospital in Limpopo.

Improved outside signage that is visible from the main roads should be provided, in

collaboration with the provincial Departments of Roads and Transport, especially for

Helene Franz Gateway Clinic.

Training on the necessary protocols of patient care and customer care should be

provided to the staff, especially on Batho Pele.

The general challenge of waiting time should be addressed through consultation

processes in line with Batho Pele with the citizens.

All facilities should be equipped with air-conditioning systems.

The records management system at Brentpark Clinic (Free State) and Ellisras District

Hospital (Limpopo) should be overhauled to align these with the applicable prescripts

and best practices.

A system of feedback or action taken following receipt of any complaint or suggestion

lodged should immediately be in place to ensure at all facilities, especially inspect of

Namakgale Clinic in Limpopo.

Parking facilities should be provided for members of the public, especially at

Namakgale and Bela-Bela clinics in Limpopo.


medicines and medical equipment and the role of Health District offices. Page xiii

Back-up generators should be provided to the facilities, especially at Ellizabeth Ross

Hospital (Free State), to ensure that services were not disrupted during power failure.

The FSDoH should engage the Maluti-A-Phofung and Moqhaka Local Municipalities

to address the identified challenges of power disruptions and water supply.

The Department should urgently ensure the general maintenance of Great Brak River

Clinic and Alma CDC, including painting of the external walls, to address their

unattractive appearance.

The general challenge of maintenance, disposal and replacement of medical

equipment should be addressed. In the case of Unit 9 Clinic, the NWDoH should

urgently take measures to address the identified obsolete equipment found lying

around the premises.

CONCLUSION

The PSC’s inspections mechanism aims to entrench accountability in the Public Service

through observing first-hand service delivery and involving key stakeholders. It is hoped that

the findings and recommendations will assist the provincial Departments of Health in

improving the delivery of services and contribute towards a long and healthy life for the

citizenry.


medicines and medical equipment and the role of Health District offices. Page 1

CHAPTER ONE: INTRODUCTION



1.1 INTRODUCTION AND BACKGROUND

Health care is one of government’s key priorities as well as an essential service which

should be accessible to all citizens of the country. Hence, government adopted as one its

outcomes “A long and healthy life for all South Africans”. The foregoing is predicated on a

sustainable quality health care infrastructure. The National Department of Health (NDoH)

developed various policies and guidelines to ensure the availability of key resources for the

delivery of quality health care services. Amongst these policies is the National Drug Policy of

South Africa (NDPSA) of 1996, formulated in line with the World Health Organization (WHO)

guidelines. The NDPSA, through the Essential Drugs List (EDL) and Standard Treatment

Guidelines (STG), ensures that medicines are available at health facilities.

Furthermore, our constitutional imperatives dictated that government should devolve certain

responsibilities for health services to the provincial and local government levels12. As a

consequence, the District Health System (DHS) was established in terms of section 29(1) of

the National Health Act, 2003 to ensure that communities at local level have access to the

quality health care that they are entitled to13. Accordingly, the Provincial Departments of

Health created District Health Offices to facilitate the delivery of health services by hospitals

and clinics at district level. In this regard, District Offices are expected to play a critical

supportive role of ensuring that health facilities are adequately resourced at all times for the

optimal provision of quality health care to citizens. It follows, therefore, that the citizens

expect health facilities to always have medicines in sufficient quantities as well as necessary

medical equipment to ensure that quality health care is accessible to them.

It is against this background that during 2013/14 the PSC decided to conduct inspections in

in selected health care facilities of the Free State, Limpopo, North West and Western Cape

Provincial Departments of Health focusing on availability of medicines and medical

equipment. These inspections further aimed to determine the role of Health District Offices

with regard to ensuring the necessary support. The inspections also aimed to establish the

extent to which the provincial departments of Health have implemented the PSC

recommendations emanating from the inspections of primary health care facilities conducted

in 200914. Reports with findings and recommendations emanating from the inspections in the

four provinces have been forwarded to the relevant Executive Authorities and Accounting

Officers for implementation of the recommendations. The reports are available on the PSC

website www.psc.gov.za. Subsequently, the PSC engaged the respective authorities of the

departments on progress regarding implementation of its recommendations. Feedback in

this regard has been received and is attached as ANNEXURE F.

1.2 OBJECTIVES OF THE INSPECTIONS

According to the PSC’s protocol on announced and unannounced inspections, the broad aim

of inspections is to assess the quality of services rendered by departments, the state of

facilities and the conditions at service delivery sites, in order to ensure adherence to

12 Republic of South Africa. National Department of Health. White Paper for the transformation of the Health

System in South Africa . 1997. 13 Republic of South Africa. National Health Act. 2003. 14 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of

Health. 2000.



stipulated regulations and other government frameworks15 . Table 1 below provides the

specific objectives of an inspection as defined in the PSC Protocol as well as those

pertaining to these inspections on the availability of medicines and medical equipment.

Table 1: Objectives of inspections

Objectives of an inspection Objectives of inspections on the availability of medicines and medical equipment

To afford a personal opportunity to experience the level of service delivery first-hand and to see what kind of service delivery challenges are facing staff.

To determine the availability/adequacy of medicines and equipment at clinics and district hospitals.

To engender a sense of urgency and seriousness among officials regarding service delivery.

To establish the role of district health offices in ensuring the availability of adequate medicines and equipment at clinics and district hospitals.

To introduce objective mechanisms to identify both weaknesses and strengths towards improving service delivery.

To establish whether provincial departments of Health have developed guidelines and procedures to manage the selection, procurement, distribution and use of medicines.

To report serious concerns about the quality of service delivery and compliance with Batho Pele requirements.

To establish whether provincial departments of Health have developed guidelines to manage the procurement, distribution and maintenance of medical equipment.

To carry out investigations of serious failures as pointed out by inspections; and

To determine the plans of the provincial departments of Health to resolve any identified problems experienced in relation to the procurement, distribution and use of medicines as well as maintenance of medical equipment.

To improve service user care relations in order to promote a user-oriented public service.

To establish the specific institution’s compliance with the implementation of the Batho Pele Framework in relation to medicines and equipment.

To determine the challenges experienced by the district offices of health in ensuring that medicines and equipment are available at the health institutions.

To establish whether the provincial departments of Health have implemented the PSC recommendations emanating from the inspections of primary health care facilities conducted in 200916.

1.3 SCOPE AND METHODOLOGY

1.3.1 Scope

The inspections were conducted in 11 District Offices, 2 Regional hospitals, 7 District

hospitals, 21 clinics and 6 Community Day Centres (CDCs). The table below represents the

sites visited as well as the dates of inspections.

Table 2: List of provinces, inspected sites and dates of inspections

Provincial/District Office Component/Institution Date of Inspection

FREE STATE

Provincial Office Sub-Directorate: Pharmaceutical Services 19/09/2013 Fezile Dabi District Office 30/09/2013 Brentpark Clinic 30/09/2013

15 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007. 16 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of

Health. 2000.



Provincial/District Office Component/Institution Date of Inspection

Bophelong Clinic 30/09/2013 Tokollo District Hospital 01/10/2013 Thabo Mofutsanyana District Office 07/10/2013 Elizabeth Ross District Hospital 08/10/2013 Phuthaditjhaba Clinic 08/10/2013 Bluegumbosch Clinic 09/10/2013 Medical Depot 29/10/2013

LIMPOPO

Sekhukhune District Marishane Clinic 14/10/2013 Waterberg District Bela-Bela Clinic 15/10/2013 Ellisras District Hospital 15/10/2013

Mopani District Namakgale Clinic (Zone A) 16/10/2013 Vhembe District Messina District Hospital 17/10/2013 Capricorn District Helene Franz Gateway Clinic 18/10/2013 Provincial Office/District Offices Polokwane Provincial Office and five (5) District

Offices 30/10/2013

Medical Supply Depot 30/10/2013 NORTH WEST

Mmabatho Provincial Office 21/10/2013 Tlapeng Clinic 21/10/2013 Unit 9 Clinic 21/10/2013 Bojanala District Office 22/10/2013

Brits District Hospital 22/10/2013 Dr Kenneth Kaunda District Office 28/10/2013 Klerksdorp District Hospital 28/10/2013 Taung Clinic 29/10/2013

Dryhartz Clinic 29/10/2013 WESTERN CAPE

Provincial Office Directorate: Communications 11/10/2013 Eden District District Office 17/10/2013 Sedgefield Clinic, Sedgefield 16/10/2013 Knysna District Hospital, Knysna 16/10/2013 Kwanokuthula CDC, Plettenberg Bay 16/10/2013 George Regional Hospital, George 17/10/2013 Alma CDC, Mossel Bay 17/10/2013 Great Brak River Clinic, Mossel Bay 17/10/2013 Thembalethu CDC, George 17/10/2013 George CDC, George 17/10/2013 Cape/Winelands District District Office 08/11/2013 Nduli Clinic, Ceres 07/11/2013 Tulbagh Clinic, Tulbagh 07/11/2013 Touws River Clinic, Touwsriver 07/11/2013 Montague CDC, Montague 07/11/2013 Bergsig Clinic, Robertson 07/11/2013 Worcester Regional Hospital, Worcester 07/11/2013 Phola Park Clinic, Wellington 08/11/2013 Rawsonville Clinic, Rawsonville 08/11/2013 Kayamandi Clinic, Stellenbosch 08/11/2013 Cloetesville CDC, Stellenbosch 08/11/2013

1.3.2 Methodology

The methodology for conducting the inspections followed both the announced and

unannounced inspections as prescribed in the PSC’s protocol for conducting inspections17.

The inspections sought to understand the challenges experienced by the citizens in

accessing quality health care especially regarding the availability of medicines and medical

equipment at the sites visited and the role of the health district offices in this regard.

17 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007.



To initiate the inspection process, letters were forwarded to the Executive Authorities (EAs)

and Accounting Officers (AOs) of the National and selected Provincial Departments of

Health, informing them about the PSC’s intention to conduct inspections in the sampled

hospitals and clinics, as well as CDCs in the case of the Western Cape. Furthermore, the

inspection teams held engagements with the respective Provincial Departments to set the

scene for the inspections.

1.4 LIMITATIONS OF THE STUDY

The inspections were conducted at selected district offices and health care facilities and

therefore, the findings relate to views and observations made at the said sites. In this regard,

the key limitation was that the PSC inspection teams comprised members who are not

experts in the medical field and relied on the officials of the departments to identify the

medicines and medical equipment at the visited sites. It should, however, be mentioned that

the officials appreciated the importance of honesty in this regard as the availability of these

resources will enable them to function optimally.



CHAPTER TWO: OVERVIEW OF THE

FINDINGS



2.1 KEY FINDINGS ON ANNOUNCED INSPECTIONS

The findings of the announced inspections are presented into key thematic areas, which are

contextual background, the management of medicines and the management of medical

equipment. Detailed findings on availability of medicines and medical equipment are

attached as ANNEXUREs A1, B1, C1 and D1.

2.1.1 Contextual Background

It emerged during discussions with senior officials of the Departments in the visited

provinces that procurement of medicines by health care facilities was mainly undertaken

through the relevant provincial medical depots. Whilst the process was mainly deemed

effective in all the visited provinces, it was observed that some provinces experienced

challenges. For instance, it was noted in the Free State that challenges were experienced

with the delivery of medical supplies in the beginning of the 2013/2014 financial year. This

was mainly due to the FSDoH delaying to pay suppliers during the 2012/2013 financial year.

Consequently, most suppliers withdrew their services to deliver stock to the Free State

medical depot leading to a shortage of stock and thus affecting deliveries to the health

facilities. The PSC noted that the situation had since improved and at the time of the

inspection, there were very few cases of shortage of medicines.

Similarly, there were challenges with regard to obtaining medical supplies in Limpopo. The

decision to place the LDoH under administration in terms of Section 100 of the Constitution

of South Africa18 coincided with the expiry of Department’s contract with medical suppliers.

As a result, the Department was no longer able to undertake large procurement bids, which

led to the medical depot relying heavily on the quotation system. With the quotation system’s

threshold of R500 000,00 as set in Paragraph 3.3 of the National Treasury Practice No 8 of

2007/200819, the funds were acutely insufficient and resulting in a shortage of medicines.

The Department was, however, creative in partnering with the Gauteng Department of

Health (GDoH) to purchase bulk medical supplies on its behalf, which improved availability

of medicines at health facilities.

2.1.2 Management of Medicines

The management of medicines is categorised into five key functions namely, product

selection, procurement, management support, distribution and use. The diagram below

maps the critical steps of effective and efficient medicine management. (It should be noted

that for the purpose of this report, reference to medicines includes pharmaceuticals, medical

consumables and medical stationery). In this regard, the findings on the management of

medicines are structured according to this integrated process.

18 Republic of South Africa. Constitution of the Republic of South Africa, 1996. 19 Republic of South Africa. National Treasury. National Treasury Practice No. 8 of 2007/2008.



Figure 1: Medicine management cycle

(a) Product Selection

It was found during interaction with officials of the visited Departments of Health, i.e. FSDoH.

LDoH, NWDoH and WCDoH, that the selection of medicines or drugs is a national

competence. The National Essential Drugs List Committee (NEDLC) or National Essential

Medicines List Committee (NEMLC) appointed by the Minister of Health has the

responsibility to determine which medicines are regarded as essential to be included in the

Essential Drugs List (EDL). It also emerged that Pharmaceutical and Therapeutic

Committees (PTCs) were established at Provincial, District and hospital levels. The functions

of the PTCs include identifying new drugs for possible inclusion on the EDL based on

consideration of scientific evidence of efficacy, substantial safety, and risk/benefit ratio as

well as best cost advantage of the identified drug. The PSC found product selection to be

well institutionalized and contributing effectively towards the availability of medicines at

health care facilities.

(b) Procurement

In all provinces visited, the primary supply of medicines to the visited health care facilities

was done through Medical Depots. However, district hospitals were allowed in the case of

urgently needed medicines to use either the “buy out” or Direct Delivery Voucher (DDV)

methods. In terms of the buy-out method orders were made directly with the suppliers or

pharmaceutical companies on a quotation basis. The DDV method requires hospitals to

order through the depots, however, the ordered stock was then delivered directly to the

facilities. It was observed that district hospitals took advantage of these methods when

necessary to obtain medicines. This level of flexibility allowed for efficient acquisition of

urgently needed medicines at the health facilities, and thereby ensuring stock availability.

Product

selection

Rational use,

monitoring and

evaluation

Distribution

and storage

Procurement

Management support:

Information system

Organisation/staffing

Budgeting

Training



(c) Distribution and storage

Distribution: As stated in the NDPSA provincial departments were required to make own

distribution arrangements to ensure prompt, efficient, timely and equitable distribution of

essential drugs and medical supplies to all institutions. It was found that in all provinces

visited, Medical Depots were responsible for the distribution of medicines to the health care

facilities. Service level agreements (SLAs) or Memorandums of Agreement (MoAs) were in

place in this regard. Challenges were, however, experienced with the timely delivery of

ordered stock to the health care facilities, especially in the Free State and North West

provinces. These resulted in the facilities having to use own transport to fetch their orders

from the depots. In the Free State the depot failed to meet the four weeks delivery timeframe

during the 2013/2014 financial year, such that the longest delay was 8 weeks as indicated by

officials at Thabo Mofutsanyana. The distribution lapses not only contravened the applicable

SLAs or MoAs, but were also not in keeping with the NDPSA and thus impacting negatively

on service delivery, with potential serious health consequences. Of concern in the Free State

was that a serious shortage of stock was experienced by the depot in the beginning of

2013/14 due to late payment of suppliers by the FSDH. This was demoralising to the

affected suppliers especially since most of them decided to withdraw their services to the

FSDH. The late payment was in contravention of Treasury Regulation 8.2.3 which provides

that “… payments due to creditors must be settled within 30 days from receipt of invoice”.

Storage: According to the NDPSA measures should be in place for the proper storage and

safeguarding of drugs and medical supplies to ensure the maintenance of quality and

security from the time of receipt into stock up to the time of issue to the patient. It was found

that there was general compliance with the applicable Standard Operating Procedures

(SOPs) in all the visited health facilities with their pharmacies always locked and notices

displayed prohibiting unauthorized access. These security measures were augmented with

additional measures such as Closed Circuit Television (CCTV) systems and alarm systems

at some of the inspected facilities as observed at Kwanokuthula Community Day Centre

(CDC) in the Western Cape province. These additional measures were critical, in particular

dedicated security manning the entrances especially at Messina District Hospital in the

Limpopo Province where the inspection team noted reports of theft of medicines. The

inspected building of the Brits District Hospital appeared old with very little storage space.

However, it was heartening to be informed that the hospital was in the process of moving to

a newly built facility.

The majority of the facilities had sufficient refrigerators for storing medicines requiring

constant cool temperature such as vaccines and insulin and their temperatures monitored

regularly. At Tlapeng Clinic in the North West province one of the refrigerators was not used

despite being new apparently due to its inherent electrical fault that kept tripping up power

whenever it was connected. Waste buckets were also provided for safekeeping of medical

waste, which were sealed once full and safely placed where they were later collected by a

medical waste management company for incineration.



(d) Rational use, monitoring and evaluation

Rational use: The NDPSA has recognized the key educational role of pharmacists in

instructing patients in the correct use of medicines and to provide preventive health services.

It was observed that guidelines for the district pharmacists have been developed in the Free

State, North West and Western Cape provinces for clinic supervisors to visit these facilities

monthly and the clinics to keep written record in this regard. In the Limpopo province, district

offices were guided by the Handbook for Clinic and Community Health Centre (CHC)

Managers, which states that supervisors should visit these health facilities monthly20. The

purpose of the visits is to oversee the operations and provide pharmaceutical support,

especially in ensuring that the Standard Treatment Guidelines (STGs) are strictly followed by

the nursing staff. Only the Western Cape was found to adhere to its guidelines with district

pharmacists conducting regular workshops and comprehensive analysis of the stock levels.

This intervention empowered the facilities to maintain quality service delivery in line with the

NDPSA. In the case of the Free State, Limpopo and North West no evidence of such visits

could be found despite the district officials and nursing staff indicating that they were taking

place. The lack of supervision in the aforementioned provinces was not in keeping with the

developed guidelines and Handbook for Clinic and CHC Managers. In addition, the shirking

of this key responsibility by district officials in Limpopo contributed to the reported misguided

practices by some personnel at Messina District Hospital of stealing certain essential

medicines.

Monitoring and evaluation: District Offices should manage the availability and safe use of

medicines at health facilities as required by the NDPSA. The inspection team observed that

the visited provinces used varied systems to monitor and evaluate the availability of

medicines. However, systems such as the stock cards relied upon by the North West and

Limpopo were regarded as highly ineffective with District officials in Limpopo describing the

system as inaccurate, cumbersome and time-consuming.

In the Western Cape Province, the Cape/Winelands District conducted regular surveys with

citizens on their experiences on medicine availability and usage as well as operations of the

facilities. However, the Eden District relied on the PTC to assess stock levels and trends of

expired medicines. In the case of the Free State, a system called Tracer Drugs was used

which entailed a selection of a sample of essential medicines across all the facilities. Figure

2 below illustrates analysis of statistical information provided by Fezile Dabi District (Free

State), Thabo Mofutsanyana District (Free State) and Waterberg District (Limpopo) in line

with their District Health Plans (DHPs).

20 Republic of South Africa. Department of Health. Handbook for Clinic/Community Health Centres Managers. October

1999.



Figure 2: Statistical analysis of medicine availability based on reporting against the DHPs

Figure 2 above shows that analysis of the quarterly reports against the DHPs for Fezile Dabi

and Thabo Mofutsanyana districts indicated that most facilities either achieved or exceeded

the 95% set target. However, district officials questioned the validity of the results. They cited

the small sample selected by the Tracer Drugs system as presenting a skewed picture.

With regard to Limpopo, the Waterberg District failed to meet its DHP target of 95% for

availability of essential drugs with coverage of 85%, 93% and 90% in the first, second and

third quarters respectively. Capricorn, Mopani, Sekhukhune and Vhembe districts did not

provide the inspection team with their DHPs and relevant reports. However, the reported

challenges of unavailability of medicines at the inspected facilities within these districts

suggested that they were also not meeting their targets.

(e) Management support

Information technology (IT) system: In Limpopo the inspected health care facilities

ordered their stock from the Medical Supply Depot (MSD) on a particular form despite the

NDPSA requiring health institutions to have computerized inventory control systems that are

linked to similar systems in the depots. The staff at the inspected health facilities found this

mode of ordering medicines cumbersome and led to delays in the delivery of orders.

85% 85%

98% 99%

95%

99%

95%

93% 93%

98%99%

95%

99%

90% 90%

98%99%

95%

99%

75%

80%

85%

90%

95%

100%

105%

1st Quarter

2nd Quarter

3rd Quarter

Waterberg District Thabo Mofutsanyana DistrictFezile Dabi District



However, the MSD has an electronic system for capturing orders although officials were

concerned that it was slow and contributed towards delays in finalising the orders, which was

further exacerbated by insufficient personnel for capturing orders. In the North West and

Free State district hospitals were using the RX solution (i.e. an electronic ordering system),

which was linked to the Medical Depot via the Remote Demander Module (RDM), to record

and monitor stock levels, whilst clinics used the manual system of stock cards. All visited

health facilities in the Western Cape were using the WINRDM electronic system, which was

also linked in the same manner to the Cape MSD, for ordering and managing availability of

stock. These IT systems were found to be effective in expediting requisitions by health

facilities.

Training: Training plays a central role in empowering employees about what was expected

of them and also to keep them abreast of new developments in order to provide quality

services. It was observed in the North West that training on dispensing of medicines and

Batho Pele principles was provided to staff, while district pharmacists in the Western Cape

regularly conducted workshops and meetings with pharmaceutical staff within their districts.

In the Free State the training offered focused mainly on health prevention programmes.

Staffing: It was found that there was in general a shortage of health professionals at the

visited facilities in Limpopo, North West, Free State and Western Cape, which impacted

negatively on the delivery of quality health care services.

2.1.3 Management of Medical Equipment

Procurement: It was established during interviews with officials of the LDoH, FSDoH and

NWDoH that the procurement of medical equipment was centralized at the Provincial Head

Office and undertaken in terms of the Preferential Procurement Policy Framework Act, 2000

(PPPFA) 21 . However, all the visited health facilities raised concerns with the aforesaid

approach especially since it resulted in delays of procuring new or replacing broken

equipment that can no longer be repaired. On the contrary, District Offices in the WCDoH

informed the inspection team that the procurement of medical equipment in the province has

been decentralized to ensure that needed items were timeously procured for the facilities.

Concerns were also raised in the North West province about the procurement of poor quality

equipment such as blood pressure (BP) machines, which required frequent repairs or

replacement. Some of the BP machines often provided incorrect readings and resulted in

poor service delivery. The staff attributed the poor quality of equipment to the Supply Chain

Management (SCM) process of selecting the cheapest quotations.

Asset control: In the Free State, Limpopo and North West provinces, the function of asset

control was the responsibility of District Offices. On the contrary, this function in the Western

Cape had been devolved to the heads of administration or operational managers of the

health facilities with the appropriate delegations in place.

Maintenance of equipment: The Western Cape province was found to have the most

effective arrangement in that sufficient capacity in this regard had been established at

21 Republic of South Africa. National Treasury. Preferential Procurement Policy Framework Act, 2000 (PPPFA).



District, Regional and Tertiary hospitals to assist all other facilities. In the Free State and

North West provinces, the function had been entrusted to the District Offices although there

were concerns of delays in the turnaround times for maintenance of equipment. Limpopo

had centralized the function and staff at inspected facilities raised serious concerns of lack of

maintenance of equipment due to delays from the Provincial Head Office. Ellisras District

hospital was worst affected with its X-ray machine not functional.

Disposal of medical equipment: It was found that the process of disposal of equipment in

the Free State, North West and Western Cape provinces rests with District Offices, whereas

in Limpopo the function was located in the Provincial Head Office. In the case of the North

West the process in place was not being adhered to in that broken equipment was found

lying around at the Unit 9 Clinic with some items posing serious risks of injury to the citizens.

2.1.4 Governance of Health Facilities

Hospital boards: In all the visited provinces the inspected hospitals had hospital boards

with those of Free State and Western Cape functioning effectively. However, staff at the

inspected hospitals in Limpopo and North West raised concerns of instances of interference

by the hospital boards in administration matters. The foregoing points to the possibility of

lack of clear governance rules which leads to the boards overstepping their mandate.

Clinic Committees: Although these structures were established in all the provinces visited,

not all of them were found to be functioning as required. In fact, it was only in the Free State

province where the inspected clinics’ committees were found to be functioning effectively. In

Limpopo the committee members for Marishane Clinic failed to regularly attend meetings

citing transport costs and lamented the lack of a stipend to offset such costs. The lack of

functioning of these structures is not in keeping with section 42(1) of the NHA and most

importantly, deprives the community of a constitutionally enshrined avenue to contribute to

improved service delivery at these clinics.

2.1.5 Challenges

Infrastructure: In all the visited provinces there was a challenge of space at most inspected

facilities. Messina District Hospital was worst affected due to insufficient maternity wards and

beds such that some infants and their mothers were forced to sleep on the floor. In the Free

State province the inspected facilities within Thabo Mofutsanyana District, which is serviced

by the Maluti-A-Phofung Local Municipality, experienced intermittent power failures.

Unavailability of back-up generators to mitigate power failure was a concern at Taung

Station, Tlapeng, and Unit 9 clinics in the North West province.

Shortage of staff: There was generally a staffing challenge of health professionals at most

of the visited facilities in all the provinces. In the Free State, Limpopo and North West

provinces the challenge was further exacerbated by lack of accommodation and other key

amenities to attract professionals in the areas serviced by the inspected facilities.

Emergency Medical Services: It was found that the emergency medical services (EMS) in

all the districts in the North West were generally poor due to insufficient ambulances.



Response times to calls often varied from an hour to four hours and in some instances the

vehicles failed to arrive putting the lives of patients at risk. The PSC report on the EMS

raised similar challenges of lack of emergency care practitioners and insufficient vehicles

impacting negatively on service delivery in this area22.

2.2 KEY FINDINGS ON UNANNOUNCED INSPECTIONS

The findings from unannounced inspections are presented below. Batho Pele as a key

strategy for the transformation of Public Service delivery sets out specific principles that

should be adhered to at all times 23 . The purpose of unannounced inspections was to

determine the extent to which the visited health care facilities adhered to these. Detailed

findings on adherence to Batho Pele requirements are attached as ANNEXUREs A2, B2,

C2 and D2.

2.2.1 Observing facilities

Condition of buildings: In all the provinces some of the inspected facilities required

maintenance. However, buildings of Bophelong Clinic (Free State), Messina District Hospital

(Limpopo) and Unit 9 and Tlapeng clinics (North West) required urgent refurbishing. In the

Limpopo province, the Bela-Bela Clinic was found to be a makeshift structure of containers,

which was not conducive for providing quality health care.

Records management system: The filing system at Ellisras Hospital in Limpopo needed to

be overhauled due to its cluttered nature, and thus making it difficult to locate patients’ files.

The system also posed a serious safety risk in case of fire breaking out, which was further

exacerbated by the fact that its fire extinguishing equipment had passed its service date.

2.2.2 Observing access to information

Information: The Batho Pele principle of Information determines that information should be

readily provided to the public to empower them in making informed decisions. In all the

visited provinces the inspected facilities had key information on health issues, business

hours and service charters visibly displayed. Some of the information was also made

available in languages predominantly spoken in their respective areas to enhance access in

line with Batho Pele.

Suggestion/complaint boxes: These boxes were found to be available and strategically

placed in all the facilities visited in all the selected provinces to enable citizens to raise their

concerns and also to provide input on the desired quality of services in line with the Batho

Pele principle of Redress.

22 Republic of South Africa. Report on the Assessment of the Quality of Support provided by the Department of Health to

Emergency Medical Service Practitioners. 2009. 23 Republic of South Africa. Department of Public Service and Administration. The Batho Pele White Paper on the

Transformation of Public Service Delivery, 1997.



2.2.3 General observations

Water and sanitation: Generally, there was no challenge of water and sanitation in most

inspected facilities in visited provinces. However, in the Free State the Brentpark Clinic

experienced a poor supply of water from the Moqhaka Local Municipality, while Bophelong

Clinic’s quality of water led to a number of cases of diarrhoea. Furthermore, at Unit 9 Clinic,

also in the North West, the toilet facilities required urgent refurbishing since sanitation pipes

were damaged such that an unbearable smell filled the waiting area, and thus posing a

health risk.

Conducive working environment: Air conditioning systems were not adequate in all the

inspected facilities in Limpopo, mostly because they needed maintenance.

Parking facilities and security: Parking facilities were not adequate at Bela-Bela and

Namakgale clinics in Limpopo. While security measures were provided at all the inspected

facilities in all the selected provinces, the fencing at the Namakgale Clinic in Limpopo

appeared worn-out and needed to be repaired in some areas.

2.2.4 Talking to citizens

Availability of medicines and medical equipment: The majority of the interviewed citizens

in the visited facilities were satisfied that medicines and medical equipment were sufficiently

available. However, in the case of Limpopo the foregoing was not consistent with the

observations made while interviewing the nursing staff at Messina District Hospital and

Marishane Clinic. For instance, the scrutiny of the progress reports based on the DHP for

Waterberg District on availability of medicines suggested challenges in this regard as stated

in paragraph 2.1.2. Furthermore, key observations were made regarding challenges

involving lack of maintenance of equipment as well as the procurement of poor quality

equipment. For example, in Limpopo the Messina District Hospital’s X-ray machine was not

functional whilst several broken equipment items were found lying around at Unit 9 Clinic in

the North West.

Waiting time: Most citizens at the visited facilities in the selected provinces were highly

concerned that the waiting time before consultation which ranged from two (2) to four (4)

hours was too long. In the Western Cape province, interviewed citizens were satisfied with

the time waiting to collect their medicines of 10 to 45 minutes.

Access: There were challenges raised with accessing the health care facilities at

Phuthaditjhaba Clinic (Free State), Marishane Clinic (Limpopo) and Sedgefield Clinic

(Western Cape). Interviewed citizens at Phuthaditjaba Clinic indicated that they travelled

between 10km to 20km to access a clinic, which was extremely in excess of the set 5 km

radius in terms of the applicable norms and standards.

2.3 IMPLEMENTATION OF PSC RECOMMENDATIONS

During the inspections in all the selected provinces the PSC followed up on the

implementation of its previous recommendations emanating from the inspections of primary



health care facilities conducted in 200924. Overall, the findings have shown that 29 (76%) of

the 38 recommendations were implemented by the FSDoH, LPDoH, NWDoH and WCDoH,

with Limpopo and Western Cape achieving 100% and Free State implementing 94%. The

North West was trailing with 58% of the recommendations implemented. However, the

overwhelming rate of implementation of the recommendations was indicative of the

recognition of the value-add of the PSC’s work by these provincial departments. Specific

details of the status on implementation of these recommendations are attached as

ANNEXURE E.

24 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of

Health. 2010.



CHAPTER THREE: CONCLUSION AND

RECOMMENDATIONS



3.1 INTRODUCTION

This Chapter presents the recommendations and overall conclusion of the inspections of the

service delivery sites that were visited in the Departments of Health in the Free State,

Limpopo, North West and Western Cape provinces. The recommendations contained in

3.3.1 and 3.3.2 below should apply to all health facilities that may be experiencing similar

challenges and not only those that were visited. According to the PSC’s protocol on

inspections, the key success factors of the inspections include the timely communication of

their outcomes to the line Departments and other implementing agencies, as well as the

reciprocal commitment of these institutions in implementing the suggested remedial action25.

In this regard, the PSC has already disseminated the reports emanating from these

inspections to the Executive Authorities and Accounting Officers of the Departments of

Health in the Free State, Limpopo, North West and Western Cape provinces.

3.2 CONCLUSION

The findings of the inspections have shown that there are challenges related to availability of

medicines and medical equipment at some visited sites. Poor maintenance of medical

equipment and general shortage of professionals especially at rural areas was noticed by

the inspection team. Whilst the Handbook for Clinic/CHC Managers requires the District

Offices to conduct monthly visits, the inspections proved that this is lacking. The PSC trusts

that the recommendations will assist the visited provinces in ensuring that quality health care

is provided at the inspected health care facilities.

3.3 RECOMMENDATIONS

The following recommendations emanate from the inspections:

3.3.1 Announced inspections

Electronic information systems, which are linked to the medical depots’ ordering

systems, should be established in all the health care facilities. Computers and

network points should be provided as well.

The FSDoH, LDoH and NWDoH should collaborate with the provincial Departments

of Education (DoE), DPW and Human Settlements to devise strategies for the

recruitment and retention of medical professionals, especially in view of the challenge

of shortage of accommodation in these areas.

The FSDoH, LDoH and NWDoH should ensure that District Offices regularly visit

health facilities. In this regard, the visits should be linked to the applicable

performance management system.

25 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007.



The FSDoH and NWDoH should strengthen their SCM processes for procurement of

medical equipment and ensure that systems of blacklisting suppliers of poor quality

of medical equipment were implemented.

In addition, an audit of equipment should be conducted at all the facilities in all the

visited provinces to determine their needs, especially the procurement of new X-ray

equipment for Tokollo and Ellisras hospitals.

The FSDoH should ensure that suppliers are paid on time as required by the

Treasury regulations to ensure availability of medicines at the Medical Depot and

facilities.

Security measures should be improved at the health facilities, which should include

CCTV systems and/or alarm systems.

The LDoH should urgently investigate the veracity of the allegations of malpractices

relating to conduct of the Nurse-in-Charge reported at Messina Hospital.

Training should be provided to the staff in the necessary protocols of dispensing

medication especially in the management of adverse drug events.

The LDoH should engage the provincial Department of Public Works to address the

poor condition of buildings and lack of space experienced by health care facilities

especially at Ellisras and Messina hospitals as well as at Bela-Bela and Namakgale

clinics.

The LDoH should also immediately ensure that the pharmaceutical license of the

MSD is renewed as required by the SAPC to ensure that the operations of the depot

are legal and in line with section 22 of the Pharmacy Act, 1974.

The LDoH should ensure that DHPs are in place, especially in the Capricorn,

Mopani, Sekhukhune and Vhembe districts, in line with the provisions of the NHA.

The NWDoH should immediately ensure that asset management unit of the Ngaka

Modiri Molema District Office attend to the broken equipment found at Unit 9 Clinic in

terms of the relevant SCM prescripts.

Back-up generators should be provided to the Taung Station, Tlapeng and Unit 9

clinics in order to prevent disruption of services in case of power failure.

3.3.2 Unannounced inspections

An audit of the state of buildings of health facilities should be conducted in order to

ensure proper maintenance, eradication of dilapidated buildings and to address the

challenge of space. Most importantly, provision should be urgently made for

additional maternity wards and beds at Messina District Hospital in Limpopo.



Improved outside signage that is visible from the main roads should be provided, in

collaboration with the provincial Departments of Roads and Transport, especially for

Helene Franz Gateway Clinic.

Training on the necessary protocols of patient care and customer care should be

provided to the staff, especially on Batho Pele.

The general challenge of waiting time should be addressed through consultation

processes in line with Batho Pele with the citizens.

All facilities should be equipped with air-conditioning systems.

The records management system at Brentpark Clinic (Free State) and Ellisras District

Hospital (Limpopo) should be overhauled to align these with the applicable prescripts

and best practices.

A system of feedback or action taken following receipt of any complaint or suggestion

lodged should immediately be in place to ensure at all facilities, especially inspect of

Namakgale Clinic in Limpopo.

Parking facilities should be provided for members of the public, especially at

Namakgale and Bela-Bela clinics in Limpopo.

Back-up generators should be provided to the facilities, especially at Ellizabeth Ross

Hospital (Free State), to ensure that services were not disrupted during power failure.

The FSDoH should engage the Maluti-A-Phofung and Moqhaka Local Municipalities

to address the identified challenges of power disruptions and water supply.

The Department should urgently ensure the general maintenance of Great Brak River

Clinic and Alma CDC, including painting of the external walls, to address their

unattractive appearance.

The general challenge of maintenance, disposal and replacement of medical

equipment should be addressed. In the case of Unit 9 Clinic, the NWDoH should

urgently take measures to address the identified obsolete equipment found lying

around the premises.

3.4 ACKNOWLEDGEMENT

The PSC would like to express its appreciation for the cooperation received from the officials

of the Departments in all the visited sites. It is the view of the PSC that the officials were

appreciative of the importance of the inspections in supporting the work of government in its

key objective for a long and healthy life for all South Africans.

Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District

offices. Page 21

ANNEXURE A: FINDINGS FROM FREE STATE PROVINCE

ANNEXURE A1: ANNOUNCED INSPECTIONS ON AVAILABILITY OF MEDICINES AND MEDICAL EQUIPMENT

Availability of medicines at inspected clinics

X Norms and standards adhered to

0 Norms and standards not adhered to

Brent Park Clinic

Med

icin

es

Med

icin

e r

oo

m w

ith

burg

lar

bars

/lockab

le c

up

board

s

Med

icin

es a

nd

supplie

s s

tock

Mechan

ism

for

em

erg

ency s

upp

lies

Batt

ery

% s

pare

glo

bes for

auro

scopes

Med

icin

es a

s p

er

ED

L f

or

PH

C

X X X X X

Bophelong Clinic

X X X X 0

Although most medicines were found to be available at the clinic, concerns of serious shortage of Pentaxim (i.e. vaccination for 2 to 4

months old babies) and Ferrous Sulphate (used for boosting the haemoglobin level in pregnant mothers) were raised by the nursing

staff. Seriously disconcerting were reports that Ferrous Sulphate was not available despite an order having been placed with the District

Office for over two months.

Phuthaditjhaba Clinic

X X X X X

Spare globes were not available – the clinic was awaiting delivery of ordered stock, which included globes as informed during the

inspection

Bluegumbosch Clinic

X X X X X


offices. Page 22

Availability of medicines at inspected hospitals



Tokollo District Hospital

Med

icin

es

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and E

DL:

Hosp

ita

l le

vel

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and D

L:

Prim

ary

Care

level

Med

icin

es a

nd

supp

lies a

lways in

sto

ck.

Tro

lleys w

ith e

merg

ency d

rugs a

nd

resuscitation e

qu

ipm

ent

Pharm

aceutical T

hera

peutic

Com

mitte

e in p

lace

X X X X X

Elizabeth Ross District Hospital

X X X X X


offices. Page 23

Availability of medical equipment at inspected clinics

0 Norms and standards adhered to

X Norms and standards not adhered to

Brent Park Clinic

Med

ical eq

uip

men

t

Dia

gnostic s

et

Blo

od p

ressure

mach

ines

Ste

thoscope

Scale

s f

or

ad

ults &

you

ng

child

ren

Measuri

ng t

apes

Specu

lum

s o

f d

iffe

rent

siz

es

Haem

og

lob

ino

mete

r

Glu

com

ete

r

Pre

gn

ancy test str

ips

Em

erg

ency tro

lley

Oxygen c

ylin

der

an

d m

ask

Tele

pho

ne/ tw

o w

ay r

adio

Tw

o w

ork

ing r

efr

igera

tors

Sharp

s d

isposa

l syste

m

Ste

riliz

atio

n s

yste

m

Equ

ipm

ent

& c

onta

iners

for

takin

g b

lood &

oth

er

sam

ple

s

Cond

om

dis

pe

nser

pla

ced

where

easily

accessib

le

X X X X X X X X X X X X X X X X X

Bophelong Clinic

X 0 X X X X 0 0 X X X X X X X X 0

Blood pressure machines: Gets overheated after prolonged usage then produce incorrect readings.

Haemoglobinometer: Bophelong clinic had two Haemoglobinometers, one hand-held but deemed to be mostly unreliable by the

nursing staff, and the other which required glass plates for use and found to be in short supply.

Glucometer: Glucometer was in short supply in that the clinic had one such equipment used by all the nursing staff.

Furthermore, batteries for the equipment were in short supply to the extent that the nursing personnel were

forced to recharge the used batteries by placing them in the sun on the window sills.

Condom dispenser: Although the condom dispenser was available and appropriately placed where the citizens could easily access it,

there were, however, no condoms provided in the dispenser.


X X X X X X X X X 0 X X X X X X X


offices. Page 24

The clinic has a landline telephone only. A two-way radio is required as indicated by the Head of clinic for usage as backup.

Bluegumbosch Clinic

X X X X X X X X X 0 X X X X X X X

The clinic has a landline telephone only. A two-way radio is required as indicated by the Head of clinic for usage as backup.

Availability of medical equipment at the inspected hospitals




Med

ical eq

uip

men

t

Basic

equ

ipm

ent fo

r

exam

ination

of

patients

in

OP

D a

nd w

ard

s

Adu

lt a

nd c

hild

ele

ctr

on

ic

weig

hin

g s

cale

s, m

easurin

g

rods a

nd p

edia

mete

rs

Pro

cto

scopes

Lary

nscopes

Peak f

low

mete

rs

Glu

com

ete

rs

Heam

og

lob

ino

mete

rs

Lum

bar

pu

nctu

re k

its

Card

iac m

on

itori

ng

un

it

Genera

l X

-ray r

oo

m w

ith

supin

e &

bucky u

nit w

ith

scre

enin

g &

tab

le m

attre

ss

Sne

llen c

hart

Ven

o-p

unctu

re s

et

Flu

id g

ivin

g s

et

A c

linic

al w

aste

sto

rag

e

Fix

ed a

nd/o

r m

obile

oxyge

n

supply

A p

riva

te a

rea for

co

unse

ling

(e.g

. H

IV/A

IDS

)

Basic

equ

ipm

ent to

con

duct

norm

al d

eliv

eries

EC

G

Em

erg

ency e

quip

me

nt fo

r

traum

a a

nd e

merg

ency

Tro

lleys w

ith e

merg

ency d

rugs

& r

esuscitatio

n e

quip

me

nt

X X X X X X X X X 0 X X X X X X X X X X

General X-ray room: Although the X-ray equipment was found to be working, the hospital was concerned that it had almost reached the end of its lifespan and, therefore, needed to be replaced.


X X X X X X X X X 0 0 0 X X X X X X X X

General X-ray room: X-ray machine was not functioning due to unavailability of a central processing unit (CPU) that was allegedly stolen

on 25/09/13. The matter was still under investigation as informed by management during inspection. Patients were


offices. Page 25

referred to a nearby hospital, namely Manapo Regional Hospital.

Snellen chart: The hospital did not have an eye care professional.

Veno-Puncher set: Two (2) towel packs were used as an alternative.


offices. Page 26

ANNEXURE A2: UNANNOUNCED INSPECTIONS ON ADHERENCE TO BATHO PELE REQUIREMENTS

X Batho Pele requirement adhered to

0 Batho Pele requirement not adhered to

Bath

o P

ele

req

uir

em

en

ts

Reception

Outs

ide s

ign

Insid

e s

ign

Busin

ess h

ours

Prior

requir

em

ents

Cost of serv

ices

Build

ing in g

ood c

onditio

n

Ram

ps

Cle

anlin

ess

Sta

ff to g

uid

e p

eo

ple

Serv

ice c

hart

er

Serv

ice c

hart

er

in loca

l

lan

gua

ge

vis

ibili

ty o

f serv

ice c

hart

er

Info

rmation d

esk

Desk w

ith m

ate

ria

l

Desk s

taffed

Sug

gestion b

ox

Com

pla

int

pro

ced

ure

Nam

e b

adges

Nam

e b

adges o

f back

offic

e s

taff

frie

nd

liness

Pro

fessio

na

lism

Air-c

ond

itio

nin

g s

yste

ms

Park

ing

Brentpark Clinic X X X X X X 0 X X X X X X X X X X X X X X X X X

Bophelong Clinic X X X X X X 0 X X X X X X X X X X X X X X X X X


X X X X X X X X X X X X X X X X X X X X X X X X

Bluegumbosch Clinic







offices. Page 27

ANNEXURE B: FINDINGS FROM LIMPOPO PROVINCE

ANNEXURE B1: ANNOUNCED INSPECTIONS ON AVAILABILITY OF MEDICINES AND MEDICAL EQUIPMENT




Marishane Clinic

Med

icin

es

Med

icin

e r

oo

m w

ith

burg

lar

bars

/lockab

le c

up

board

s

Med

icin

es a

nd

supplie

s s

tock

Mechan

ism

for

em

erg

ency s

upp

lies

Batt

ery

% s

pare

glo

bes for

auro

scopes

Med

icin

es a

s p

er

ED

L f

or

PH

C

X X X X X

Bela-Bela Clinic

X X X X X

Namakgale Clinic

X X X X 0

Helene Franz Gateway Clinic

X X X X X


offices. Page 28




Ellisras District Hospital

Med

icin

es

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and E

DL:

Hosp

ita

l le

vel

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and D

L:

Prim

ary

Care

level

Med

icin

es a

nd

supp

lies a

lways in

sto

ck.

Tro

lleys w

ith e

merg

ency d

rugs a

nd

resuscitation e

qu

ipm

ent

Pharm

aceutical T

hera

peutic

Com

mitte

e in p

lace

X X X X X

Messina District Hospital

X X X X 0


offices. Page 29




Marishane Clinic

Med

ical eq

uip

men

t

Dia

gnostic s

et

Blo

od p

ressure

mach

ines

Ste

thoscope

Scale

s f

or

ad

ults &

you

ng

child

ren

Measuri

ng t

apes

Specu

lum

s o

f d

iffe

rent

siz

es

Haem

og

lob

ino

mete

r

Glu

com

ete

r

Pre

gn

ancy test str

ips

Em

erg

ency tro

lley

Oxygen c

ylin

der

an

d m

ask

Tele

pho

ne/ tw

o w

ay r

adio

Tw

o w

ork

ing r

efr

igera

tors

Sharp

s d

isposa

l syste

m

Ste

riliz

atio

n s

yste

m

Equ

ipm

ent

& c

onta

iners

for

takin

g b

lood &

oth

er

sam

ple

s

Cond

om

dis

pe

nser

pla

ced

where

easily

accessib

le


Bela-Bela Clinic

X X X X X X 0 0 X X X X X X X X 0

Namakgale Clinic

0 X X X X X X X X X 0 X X X X X X


X X X X X X 0 0 X X X X X 0 X X X


offices. Page 30





Med

ical eq

uip

men

t

Basic

equ

ipm

ent fo

r

exam

ination

of

patients

in

OP

D a

nd w

ard

s

Adu

lt a

nd c

hild

ele

ctr

on

ic

weig

hin

g s

cale

s, m

easurin

g

rods a

nd p

edia

mete

rs

Pro

cto

scopes

Lary

nscopes

Peak f

low

mete

rs

Glu

com

ete

rs

Heam

og

lob

ino

mete

rs

Lum

bar

pu

nctu

re k

its

Card

iac m

on

itori

ng

un

it

Genera

l X

-ray r

oo

m w

ith

supin

e &

bucky u

nit w

ith

scre

enin

g &

tab

le m

attre

ss

Sne

llen c

hart

Ven

o-p

unctu

re s

et

Flu

id g

ivin

g s

et

A c

linic

al w

aste

sto

rag

e

Fix

ed a

nd/o

r m

obile

oxyge

n

supply

A p

riva

te a

rea for

co

unse

ling

(e.g

. H

IV/A

IDS

)

Basic

equ

ipm

ent to

con

duct

norm

al d

eliv

eries

EC

G

Em

erg

ency e

quip

me

nt fo

r

traum

a a

nd e

merg

ency

Tro

lleys w

ith e

merg

ency d

rugs

& r

esuscitatio

n e

quip

me

nt

0 X 0 X 0 X X 0 X 0 X X X X X 0 X X X X


0 0 0 X 0 X X 0 X 0 0 0 0 0 X 0 0 0 0 0


offices. Page 31

ANNEXURE B2: UNANNOUNCED INSPECTIONS ON ADHERENCE TO BATHO PELE REQUIREMENTS



Bath

o P

ele

req

uir

em

en

ts

Reception

Outs

ide s

ign

Insid

e s

ign

Busin

ess h

ours

Prior

requir

em

ents

Cost of serv

ices

Build

ing in g

ood c

onditio

n

Ram

ps

Cle

anlin

ess

Sta

ff to g

uid

e p

eo

ple

Serv

ice c

hart

er

Serv

ice c

hart

er

in loca

l

lan

gua

ge

vis

ibili

ty o

f serv

ice c

hart

er

Info

rmation d

esk

Desk w

ith m

ate

ria

l

Desk s

taffed

Sug

gestion b

ox

Com

pla

int

pro

ced

ure

Nam

e b

adges

Nam

e b

adges o

f back

offic

e s

taff

frie

nd

liness

Pro

fessio

na

lism

Air-c

ond

itio

nin

g s

yste

ms

Park

ing

Marishane Clinic X X X X X X X X X X X X X X X X X X X X X X 0 X

Bela Bela Clinic X X X X X X 0 0 X X X X X X X 0 X X X X X X 0 0

Namakgale Clinic X X X X X X X X X X X X X X X X X 0 X X X X 0 0


0 X X X X X X X X X X X X X X X X X X X X X 0 X


X X X X X X 0 X X X X X X X X 0 X X X X X X 0 X


X X X X X X 0 X X X X 0 X X X 0 X X X X X X 0 X


offices. Page 32

ANNEXURE C: FINDINGS FROM NORTH WEST PROVINCE

ANNEXURE C1: ANNOUNCED INSPECTIONS ON AVAILABILITIY OF MEDICINES AND MEDICAL EQUIPMENT


Tlapeng Clinic

Med

icin

es

Med

icin

e r

oo

m w

ith

burg

lar

bars

/lockab

le

cupboard

s

Med

icin

es a

nd

supplie

s s

tock

Mechan

ism

for

em

erg

ency

supplie

s

Batt

ery

% s

pare

glo

bes for

auro

scopes

Med

icin

es a

s p

er

ED

L f

or

PH

C

X X X X X

Unit 9 Clinic

X X X X X

Taung Station Clinic

X X X X X

Dryharts Clinic

X X X X X




offices. Page 33




Brits District Hospital

Med

icin

es

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and E

DL:

Hosp

ita

l le

vel

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and D

L:

Prim

ary

Care

level

Med

icin

es a

nd

supp

lies a

lways in

sto

ck.

Tro

lleys w

ith e

merg

ency d

rugs a

nd

resuscitation e

qu

ipm

ent

Pharm

aceutical T

hera

peutic

Com

mitte

e in p

lace

X X X X X

Klerksdorp Hospital

X X X X X


offices. Page 34




Brits District Hospital*

Med

ical eq

uip

men

t

Basic

equ

ipm

ent fo

r

exam

ination

of

patients

in

OP

D a

nd w

ard

s

Adu

lt a

nd c

hild

ele

ctr

on

ic

weig

hin

g s

cale

s, m

easurin

g

rods a

nd p

edia

mete

rs

Pro

cto

scopes

Lary

nscopes

Peak f

low

mete

rs

Glu

com

ete

rs

Heam

og

lob

ino

mete

rs

Lum

bar

pu

nctu

re k

its

Card

iac m

on

itori

ng

un

it

Genera

l X

-ray r

oo

m w

ith

supin

e &

bucky u

nit w

ith

scre

enin

g &

tab

le m

attre

ss

Sne

llen c

hart

Ven

o-p

unctu

re s

et

Flu

id g

ivin

g s

et

A c

linic

al w

aste

sto

rag

e

Fix

ed a

nd/o

r m

obile

oxyge

n

supply

A p

riva

te a

rea for

co

unse

ling

(e.g

. H

IV/A

IDS

)

Basic

equ

ipm

ent to

con

duct

norm

al d

eliv

eries

EC

G

Em

erg

ency e

quip

me

nt fo

r

traum

a a

nd e

merg

ency

Tro

lleys w

ith e

merg

ency

dru

gs &

resuscitation

equ

ipm

ent

X X X X X X X X X 0 X X X X X X X X X X

General X-ray room: Although the X-ray equipment was found to be working, the hospital was concerned that it had almost reached the end of its lifespan and, therefore, needed to be replaced.

Klerksdorp Hospital

X X X X X X X X X X X X X X X X X X X X


offices. Page 35




Tlapeng Clinic

Med

ical eq

uip

men

t

Dia

gnostic s

et

Blo

od p

ressure

mach

ines

Ste

thoscope

Scale

s f

or

ad

ults &

you

ng

child

ren

Measuri

ng t

apes

Specu

lum

s o

f d

iffe

rent

siz

es

Heam

og

lob

ino

mete

r

Glu

com

ete

r

Pre

gn

ancy test str

ips

Em

erg

ency tro

lley

Oxygen c

ylin

der

an

d m

ask

Tele

pho

ne/ tw

o w

ay r

adio

Tw

o w

ork

ing r

efr

igera

tors

Sharp

s d

isposa

l syste

m

Ste

riliz

atio

n s

yste

m

Equ

ipm

ent

& c

onta

iners

for

takin

g b

lood &

oth

er

sam

ple

s

Cond

om

dis

pe

nser

pla

ced

where

easily

accessib

le


Unit 9 Clinic X 0 X X X X X X X X X X X X X X X

Blood pressure machines: Gets overheated after prolonged usage then produce incorrect readings.

Taung Station Clinic


Dryharts Clinic


There is a telephone; however, a two-way radio is required as indicated by the Head of clinic for usage as backup.


offices. Page 36

ANNEXURE C2: UNANNOUNCED INSPECTIONS ON ADHERENCE TO BATHO PELE REQUIREMENTS



* No fees payable at clinics.

Bath

o P

ele

req

uir

em

en

ts

Reception

Outs

ide s

ign

Insid

e s

ign

Busin

ess h

ours

Prior

requir

em

ents

Cost of serv

ices

Build

ing in g

ood c

onditio

n

Ram

ps

Cle

anlin

ess

Sta

ff to g

uid

e p

eo

ple

Serv

ice c

hart

er

Serv

ice c

hart

er

in loca

l

lan

gua

ge

vis

ibili

ty o

f serv

ice c

hart

er

Info

rmation d

esk

Desk w

ith m

ate

ria

l

Desk s

taffed

Sug

gestion b

ox

Com

pla

int

pro

ced

ure

Nam

e b

adges

Nam

e b

adges o

f back

offic

e s

taff

frie

nd

liness

Pro

fessio

na

lism

Air-c

ond

itio

nin

g s

yste

ms

Park

ing

Dryharts Clinic 0 X X X X -* X X X X X X X X X 0 X X X X X X X X

Taung Clinic 0 X X X X X X X X X X X X X 0 X X X X X X X X

Brits District Hospital

X X X X X X 0 X X X X X X X X 0 X X X X X X X X

Klerksdorp District Hospital

X X X X X X 0 X X X X 0 X X X 0 X X X X X X X X

Tlapeng Clinic X X X X X - 0 0 X 0 X X X 0 0 0 X X X X X X X X

Unit 9 Clinic X X X X X - 0 0 X 0 X X X 0 0 0 X X X X X X X X


offices. Page 37

ANNEXURE D: FINDINGS FROM WESTERN CAPE PROVINCE

ANNEXURE D1: ANNOUNCED INSPECTIONS ON AVAILABILITY OF MEDICINES AND MEDICAL EQUIPMENT

Availability of medicines at inspected clinics and Community Day Centres (CDCs)



Cloetesville CDC

Med

icin

es

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and E

DL:

Hosp

ita

l le

vel

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and D

L:

Prim

ary

Care

level

Med

icin

es a

nd

supp

lies a

lways in

sto

ck.

Tro

lleys w

ith e

merg

ency d

rugs a

nd

resuscitation e

qu

ipm

ent

Pharm

aceutical T

hera

peutic

Com

mitte

e in p

lace

X X X X X

Sedgefield Clinic

X X X X X

Phola Park Clinic

X X X X X

Kayamandi Clinic

X X X X X


offices. Page 38

Kwanokuthula CDC

X X X X X

Alma CDC

X X X X X

Great Brak River Clinic

X X X X X

Rawsonville Clinic

X X X X X

Montague CDC

X X X X X

Nduli Clinic

X X X X X

Bergsig Clinic

X X X X X

Thembalethu CDC

X X X X X

George CDC

X X X X X

Tulbagh Clinic

X X X X X

Touwsriver Clinic

X X X X X


offices. Page 39




Knysna District Hospital

Med

icin

es

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and E

DL:

Hosp

ita

l le

vel

Med

icin

es s

upp

ly a

ccord

ing to S

TG

and D

L:

Prim

ary

Care

level

Med

icin

es a

nd

supp

lies a

lways in

sto

ck.

Tro

lleys w

ith e

merg

ency d

rugs a

nd

resuscitation e

qu

ipm

ent

Pharm

aceutical T

hera

peutic

Com

mitte

e in p

lace

X X X X X

Worcester Regional Hospital

X X X X X


offices. Page 40

Availability of medical equipment at inspected clinics and CDCs



Med

ical E

qu

ipm

en

t

Dia

gnostic s

et

Blo

od p

ressure

mach

ines

Ste

thoscope

Scale

s f

or

ad

ults &

you

ng

child

ren

Measuri

ng t

apes

Specu

lum

s o

f d

iffe

rent

siz

es

Heam

og

lob

ino

mete

r

Glu

com

ete

r

Pre

gn

ancy test str

ips

Em

erg

ency tro

lley

Oxygen c

ylin

der

an

d m

ask

Tele

pho

ne/ tw

o w

ay r

adio

Tw

o w

ork

ing r

efr

igera

tors

Sharp

s d

isposa

l syste

m

Ste

riliz

atio

n s

yste

m

Equ

ipm

ent

& c

onta

iners

for

takin

g b

lood

& o

ther

sam

ple

s

Cond

om

dis

pe

nser

pla

ced

where

easily

accessib

le

Cloetesville CDC


Sedgefield Clinic


Phola Park Clinic


Kayamandi Clinic


Kwanokuthula CDC


Alma CDC


Great Brak River



offices. Page 41

Rawsonville Clinic


Montague CDC


Nduli Clinic


Bergsig Clinic


Thembalethu CDC


George CDC

X X X X X X X X X 0 X 0 X X X X X

Tulbagh Clinic


Touwsriver Clinic


Comments

Khayamandi Clinic – Only large and Medium size speculums, Call log for emergency transport, only one way radio.

Thembalethu Day Centre - Emergency service takes 10-20 minutes, only one electronic oxygen cylinder, no two way radio,

refrigerator used for immunization and for medication, no burglar bars in rooms, Pharmacist attend weekly meetings. No spare

autoscopes available, generators available.

George Central Day Clinic – Ambulance takes 10-15 minutes, only a telephone no two way radio, no burglar bars and no

cupboards, Generator shared with municipality.

Great Brak River Clinic – no transport stationed at clinic for emergencies, transport takes 20 minutes depending on diagnosis,

telephone and no radio. Primary care childline for adults (For all types of diagnosis for medication).

Nduli Clinic – No extra batteries available, Ambulance and GG Vehicles stationed at hospital, one two way telephone, only sharp

containers, sterilization based at hospital.

Alma Clinic – No ambulance stationed at the clinic, 10-15 minute waiting time for ambulance from Mossel Bay Hospital.


offices. Page 42




Med

ical eq

uip

men

t

Basic

equ

ipm

ent fo

r

exam

ination

of

patients

in O

PD

and w

ard

s

Adu

lt a

nd c

hild

ele

ctr

on

ic

weig

hin

g s

cale

s, m

easurin

g

rods a

nd p

edia

mete

rs

Pro

cto

scopes

Lary

nscopes

Peak f

low

mete

rs

Glu

com

ete

rs

Heam

og

lob

ino

mete

rs

Lum

bar

pu

nctu

re k

its

Card

iac m

on

itori

ng

un

it

Genera

l X

-ray r

oo

m w

ith s

upin

e

& b

ucky u

nit w

ith s

cre

enin

g &

table

mattre

ss

Sne

llen c

hart

Ven

o-p

unctu

re s

et

Flu

id g

ivin

g s

et

A c

linic

al w

aste

sto

rag

e

Fix

ed a

nd/o

r m

obile

oxyge

n

supply

A p

riva

te a

rea for

co

unse

ling

(e.g

. H

IV/A

IDS

)

Basic

equ

ipm

ent to

con

duct

norm

al d

eliv

eries

EC

G

Em

erg

ency e

quip

me

nt fo

r

traum

a a

nd e

merg

ency

Tro

lleys w

ith e

merg

ency d

rugs

& r

esuscitatio

n e

quip

me

nt



George Regional Hospital





offices. Page 43

ANNEXURE D2: UNANNOUNCED INSPECTIONS ON ADHERENCE TO BATHO PELE REQUIREMENTS



Bath

o P

ele

req

uir

em

en

ts

Reception

Outs

ide s

ign

Insid

e s

ign

Busin

ess h

ours

Prior

requir

em

ents

Cost of serv

ices

Build

ing in g

ood c

onditio

n

Ram

ps

Cle

anlin

ess

Sta

ff to g

uid

e p

eo

ple

Serv

ice c

hart

er

Serv

ice c

hart

er

in loca

l la

nguag

e

vis

ibili

ty o

f serv

ice c

hart

er

Info

rmation d

esk

Desk w

ith m

ate

ria

l

Desk s

taffed

Sug

gestion b

ox

Com

pla

int

pro

ced

ure

Nam

e b

adges

Nam

e b

adges o

f back o

ffic

e s

taff

frie

nd

liness

Pro

fessio

na

lism

Air c

on

ditio

nin

g s

yste

ms

Park

ing

Sedgefield Clinic

X X X X X 0 X X X X X X X X X X X X X X X X X X



Kwanokuthula CDC


George Regional Hospital

X X X X X X 0 X X X X X X X X X X X X X X X X X

Alma CDC X X X X X X X X X X X X X X X X X X X X X X X X

Great Brak River


Thembalethu CDC


George X X X X X X X X X X X X X X X X X X X X X X X X


offices. Page 44

CDC Nduli Clinic X X X X X X X X X X X X X X X X X X X X X X X X

Tulbagh Clinic


Touws River Clinic


Montague CDC


Bergsig Clinic

X X X X X 0 X X X X X X X X X X X X X X X X X X



Phola Park Clinic


Rawsonville Clinic


Kayamandi Clinic


Cloetesville CDC

X x X X X X X X X X X X X X X X X X X X X X X X


offices. Page 45

ANNEXURE E: STATUS ON THE IMPLEMENTATION OF RECOMMENDATIONS OF THE PSC’S INSPECTIONS CONDUCTED IN 2009

Details of the clinic Recommendations Implemented Not implemented

FREE STATE

Thabo Mofutsanyana

District Office

Ramps for people with disabilities should be erected. In

this regard a plan of action should be in place by April

2010.

No Not yet implemented

(District lack capacity; the matter

to be referred to the Department

of Public works)

Procurement processes should be improved as this

impact negatively on the functioning of clinics. In this

regard, a plan of action should be in place by April 2010.

Yes

Should have vehicles available to visit clinics. In this

regard, a plan of action should be in place by April 2010.

Yes

Phuthaditjhaba Clinic Should display outside and inside signage at their

buildings by April 2010.

Yes

Should renovate buildings. In this regard a plan of action

should be put in place by April 2010.

Partially

(Renovation of the clinic

was done partially, only the

waiting area and the

corridor were painted but

not the consulting rooms)

Clinics should be provided with medical equipment and

medication

Yes

Vacant posts are to be filled to address staff shortage at

the clinics. In this regard a plan of action should be in

place by April 2010. The clinic manager should ensure

that all service users who are in the queues are attended

to instead of being sent home because it is knock off

time. This should be done immediately.

Yes


offices. Page 46


Service Charters should be translated into the languages

spoken within the jurisdiction of clinic and not just

English. In this regard a plan of action should be put in

place by April 2010.

Yes

Staff should be provided with name tags by April 2010

and must wear them.

Yes

Bluegumbosch Clinic Should display outside and inside signage at their

buildings by April 2010.

Yes

Clinics should be provided with medical equipment and

medication immediately

Yes

Vacant posts are to be filled to address staff shortage at

the clinics. In this regard a plan of action should be in


Queue Marshall appointed

and reallocation of nurses

done in line with workload.

Clinic manager should immediately ensure that all

service users who are in the queues are attended to

instead of being sent home because it was knock-off

time.

No patients are returned

unattended and there is a

Free State circular in this

regard against returning

patients unattended.

Reception area and help desk should be clearly

identified.

Yes

A staff member should be assigned to guide and direct

citizens upon arrival. In this regard a plan of action

should be put in place by April 2010.

Queue Marshalls

appointed.

Service Charters should be translated into the languages

spoken within the jurisdiction of clinic and not just

English. In this regard a plan of action should be put in


Yes

Staff should be provided with name tags by April 2010

and must wear them.

Yes


offices. Page 47


LIMPOPO

Bela-Bela Outside signage should be displayed by April 2010. Yes

Bela-Bela Business hours should be reflected by December 2009. Yes

Bela-Bela Computers should also be provided by April 2010. Proper

training should be provided to staff to enable them to

effectively use the computers. (In this regard a plan of

action should be in place by April 2010).

Yes There is a data capturer but not all are trained

to use the system.

Marishane Computers should also be provided by April 2010. Proper

training should be provided to staff to enable them to

effectively use the computers. (In this regard a plan of

action should be in place by April 2010).

Yes There is a data capturer but not all are trained

to use the system

Marishane Business hours should be reflected by December 2009. Yes

Bela-Bela Designated help-desks manned by suitably trained

personnel and stocked with appropriate forms should be

provided (In this regard, a

plan of action should be in place by April 2010)

Yes No suitably trained personnel for the help desk

NORTH WEST

Tlapeng Clinic Ramps for people with disabilities should be erected. (In


2010).

No Not yet implemented.

Demarcated parking areas should be made available (In


2010).

No (District lack capacity). Not yet implemented.

Clinic building should be properly maintained Yes

Reception areas should be erected (In this regard a plan

of action should be in place by April 2010).


Service Charter should be translated into the local

language (In this regard a plan of action should be in

place by April 2010).


Staff should be provided with name tags by April 2010 Yes


offices. Page 48


and they must wear them

Manager should immediately arrange for proper removal

of medical waste

Yes

Clinic should be provided with functional computers, fax,

and photocopy machine. (In this regard a plan of action

should be in place by April 2010).

Only have

functional

computer.

Provision of

Fax and

photocopy

machine still

not

implemented.

Dryharts Clinic Service Charter should be translated into the local

language (In this regard a plan of action should be in



Clinic should be provided with functional computers, fax,

and photocopy machine. (In this regard a plan of action

should be in place by April 2010).

Only have

functional

computer.

Provision of

Fax and

photocopy

machine still

not

implemented

Clinic should immediately be provided with sufficient

diesel for the generator to ensure that the clinic

functions properly even when there is power failure.

Yes

Clinic should ensure that the clinic facilities remain clean

at all times. This should be done immediately.

Yes


offices. Page 49


WESTERN CAPE

Phola Park Clinic The facilities of the Phola Park clinic, such as toilets

should be refurbished and properly maintained.

The Phola Park clinic should be provided with a new key

to their complaint box.

Clinic managers should device a strategy of dealing with

the long waiting periods at the clinics.

Yes.

Yes.

Yes.

The Department has a Chronic Dispensing Unit which prepares

patient medicine packages which are delivered to the users’

nearest clinic. This measure has eradicated the practice of

patients having to queue at pharmacies and has created a

rather quick pick-up collection point for medicines.

Public Service Commission

50

ANNEXURE F: FEEDBACK ON IMPLEMENTATION OF THE PSC’S RECOMMENDATIONS CONTAINED IN THE REPORTS ON INSPECTIONS OF

DISTRICT HOSPITALS AND CLINICS REGARDING AVAILABILTY OF MEDICINES AND MEDICAL EQUIPMENT AND THE ROLE OF HEALTH

DISTRICT OFFICES IN THE DEPARTMENTS OF HEALTH IN THE FREE STATE, LIMPOPO, NORTH WEST AND WESTERN CAPE PROVINCES

Implemented

Partially implemented

Not implemented

PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS

FREE STATE ANNOUNCED INSPECTIONS

a) The FSDoH should

collaborate with the

Departments of

Higher Education

and Training, Public

Works and Human

Settlements to

devise a strategy for

the recruitment and

retention of doctors,

nursing

professionals and

pharmacists. It

follows, therefore,

that the imminent

review of the

organisational

structures of facilities

by the MEC should

incorporate inputs

relating to availability

of accommodation

and amenities. (A

plan of action should

Vacancies: Approval has since been granted to recruit

and appoint staff according to the critical needs and

availability of funds at Tokollo hospital. The department

also decentralized the appointment functions to

institutions to improve and fast-track recruitment of staff.

Further appointment will be prioritized in the new financial

year in line with allocation for compensation of

employees.

Vacant posts for operational managers and local area

managers at Bophelong and Brentpark clinics will be

prioritized in the next financial year 2015/16.

36 qualified Pharmacist Assistants were appointed on a

one year contract and will be appointed permanently

before their contracts expire in July 2015.

Accommodation: National Hospital doctors quarters

were renovated and handed over to the provincial

Department. The facility is currently being used to house

doctors and internship students.

Proof of a submission to

appoint two professional

nurses and two assistant

nurses was provided as well

as a submission to create,

funds and appoint two

clinical associates on the

staff establishment of

Tokollo/Mafube District

Hospital.

A copy of submission for the

appointment of 36

Pharmacist Assistants on a

one year contract was

provided.

The existence of the doctors

quarters at the National

Hospital were verified. The

PSC team was informed that


51


be put in place by

June 2015)

The existing structure at Manapo Nursing college is being

renovated and upgraded to alleviate accommodation

problems.

Phase 1 of the Emergency Medical Services college

accommodation has been completed and the second

phase is planned for 2015/16.

Plans to renovate Huis Idahlia at Universitas were

completed, however due to budgetary constraints this

was postponed to the next financial year 2015/16.

the place was renovated in

2013 and the doctors started

occupying the place in 2014.

It was indicated that these

quarters were reserved for

doctors who are living with

their families.

There are two existing

structures for the Nursing

College at Manapo Hospital.

It was established that one

structure is dilapidated and

will cost a lot of money to

upgrade, whilst the other

one was in the process of

being renovated and

upgraded.

b) The FSDoH should

strengthen its

monitoring system of

suppliers of

equipment to ensure

that suppliers of poor

quality equipment

were identified and

blacklisted in order

to exclude them from

future procurement

processes. A plan of

action to be in place

by June 2015.

The service rendered is monitored in terms of quality and

time that goods are delivered. Poor quality goods are not

accepted, only the right quality that meets specifications

is accepted. Timely delivery is crucial to service delivery.

Continuous follow-up on delivery of goods and services is

made until the delivery date.

Non-adherence to delivery timeframe by the contractor is

recorded as non-compliance and appropriate action is

taken against the supplier.

The visited facilities

indicated that they have not

developed a plan of action

for poor quality equipment

as this is not a crucial matter

considering they rarely

receive goods that are not

according to specifications.

c) The FSDoH should A rating system is in place for visiting of primary health The District offices utilize the


52


put a system in

place which is linked

to performance

management to

ensure that District

Offices visit health

facilities, especially

clinics, monthly as

required by the

Handbook for

Clinic/CHC

Managers. This

should be

implemented by

October 2014.

clinics by supervisors and it has been monitored quarterly

through reporting against the annual performance plan.

The target for supervisor visit rate is 85%. Although the

target was not achieved in three quarters (1st quarter =

56.9%; 2nd = 65.2% and 3rd = 68.6%) of 2013, there is

steady improvement. Progress was affected by the

limited number of dedicated clinic supervisors, hence the

arrangement to conduct clinic supervision through visits

by provincial program managers and district program

managers.

Red Flag/Regular Review

Tool for clinic visit as part of

monitoring. However, it was

found that the visits were not

done monthly as required by

the Handbook for Clinic/CHC

Managers. The last visit at

Phuthaditjhaba Clinic by the

Facility Manager was on 30

September 2014. The Team

was informed that the

District Program Manager

who is responsible for the

visits is a supervisor in 7

clinics and Facility Manager

at Bluegumbosch clinic. The

manager also has health

related challenges which

affect performance.

In an attempt to resolve the

problem of non-visits to the

clinics the Local Area

Manager convened a

meeting in February 2015 to

discuss how best they can

assist in ensuring that the

clinics are visited. The way

forward was that the Local

Area Manager should assist

the District Program

Manager with some

administrative duties so that

the visits will be done as


53


required. The minutes of the

meeting were provided to

the PSC team.

d) The FSDoH should

immediately ensure

that suppliers are

paid on time as

required by the

Treasury regulations

to ensure availability

of medicines at the

Medical Depot and

facilities. Feedback

in this regard should

be provided to the

PSC by October

2014.

The Department strives to pay suppliers within 30 days

as prescribed; however, this is sometimes affected by the

budgetary constraints. Close monitoring of payments was

implemented to ensure that payments are prioritized and

where there are challenges suppliers are engaged and

informed.

There is slight improvement since the last visit to the

medical depot and the Department has appointed the

CEO at the Medical Depot in November 2014.

The team was informed by

the Medical Depot that they

are unable to pay suppliers

within 30 days as required

by Treasury Regulations due

to budgetary constraints.

They indicated that when

they received funds they

prioritized old payments and

Small, Medium and Micro

Enterprise (SMMEs) as

there will be consequences if

they are not paid within 30

days. For example: the

companies that supply

critical medicines,

threatened to put the

account on hold if they were

not paid within 30 days.

It was, however, noted that

there is improvement in

paying the medical depot. It

was further observed that

payment was made to the

medical depot few days

before the PSC’s second

visit. The only outstanding

payment was for orders not

yet received from suppliers,

which were overdue over a


54


period of less than 60 days.

The team was also informed

that the Elizabeth Ross

Hospital was also unable to

pay the suppliers within 30

days as prescribed due to

lack of funds. Payments of

suppliers by the hospital

require prior approval by the

Provincial Head Office,

which in most cases results

in delays.

e) Training should be

provided to the staff

in the necessary

protocols of

dispensing

medication

especially in the

management of

adverse drug events.

A training

programme should

be in place by

October 2014.

As part of its orientation programme, Pharmaceutical

services undertakes training to all newly appointed

Medical Interns, Community Services and other Health

Care Professionals on Principles of Medicine Supply

Management, which includes good dispensing practices,

adverse drug reactions and other medicine related topics.

The orientation training activities on all pharmacy related

policies took place between February and May 2014.

The training activities are conducted at the beginning of

the year and midyear when the need arises. Continuing

Professional Development meeting held quarterly.

Development Partners such as Management Sciences

for Health Systems Trust also conduct these at the

request of the Districts.

Attendance registers and

training programme were

submitted as evidence that

the Pharmaceutical services

had conducted training in the

following categories:

- 44 officials underwent

Pharmacy Manual

Induction training which

includes dispensing

protocols and adverse

drug event.

- 395 officials were trained

on STG, Essential

Medicine List (EML) and

Free State Formulary

training which includes

dispensing protocols and

adverse drug event.


55



on Stock management

training.


on Cold Chain training.


on National Core

standard.

- Adverse drug events

forms part of the ARV

training conducted via

Integrated Computer-

Aided Manufacturing

(ICAM).

The training activities were

conducted in 2013/14. It was

envisaged to conduct these

activities again during the

period 2014/15, however this

did not happen due to

financial constraints.

The Pharmaceutical

Services indicated that it did

not have a structured

training programme,

however, participants were

invited whenever a need

was identified.


56


f) Computers and

network points

should be provided

at all facilities.

Provision in the

budget should be

made this regard.

This should include

the procurement of

new X-Ray

equipment for

Tokollo hospital as

well as the roll out of

the RX Solution to all

clinics. (In this

regard, a plan of

action should be put

in place by

December 2014).

Shortage of computers and network points at Tokollo

hospital is not resolved due to unavailability of suitable

contractors on the State Information Technology Agency

(SITA) database. The Provincial Information Technology

Unit is looking at other alternatives to ensure

connectivity.

A new X-ray machine was procured and installed at

Tokollo hospital.

A needs analysis to complete the roll out of RX Solution

in the province was prepared in August 2014. The cost

implications are summarized as follows:

- IT, computers, printers, networking= R27 056 000.00.

- Pharmacist Assistants= R35 308 000.00.

The total cost for the roll out is R62 364 000.00. Funds

are currently not available; however, the Department is

seeking support from the National Department and other

health partners.

The Management Sciences for Health (MSH) and Health

Systems Trust (HST), which are Non-Governmental

Organizations (NGOs), appointed a total of 4 people to

provide technical assistance and training in the Free

State to facilitate the roll-out and implementation of RX

Solution.

45% of the facilities in the Free State have computers

and the RX Solution program. The biggest limiting factor

is IT network and equipment as well as security.

56.5% of the facilities with computers and the RX

The existence of X-ray

machine at Tokollo hospital

was verified.

It was also found in both

Districts, that the rolling out

of the RX Solution to all

clinics is still a problem due

to financial constraints.

However, PSC the team was

informed at Phuthaditjhaba

District that they managed to

buy RX Solution equipment

for several clinics, including

Phuthaditjhaba and

Bluegumbosch clinics, using

the National Health

Insurance grant.

The Medical Depot

confirmed the appointment

of four people by MSH and

HST to provide technical

assistance and training in

the Free State to facilitate

the roll-out and

implementation of the RX

Solution, however, there was

a challenge with the

procurement of IT

infrastructure.


57


Solution program use the RX Solution for stock control.

The main limiting factor is availability HR capacity, IT

network and facility infrastructure.

Lejweleputswa district got permission to buy 45

computers for implementation of the RX Solution, and will

be included in the district’s acquisition plan for the

financial year 2015/16.

A submission for appointment of personnel on the

HIV/AIDS Conditional grant, including pharmacy

personnel, was approved. The appointment processes

are underway in the districts.

Pharmaceutical Services submitted a request to the

National Department of Health in February 2015 for funds

to procure the necessary IT infrastructure.

Although the following challenges also hamper full scale

implementation of RX Solution, the province will continue

to explore and implement measure to overcome them:

- In some facilities the pharmacy is small and clinics

have no storeroom or proper access control, which

makes it impossible to control the medicine stock.

- Security remains a challenge as all the sites and

facilities experience regular burglaries and theft of IT

equipment.

g) The FSDoH should

address the

concerns of waiting

time through

consultation

Clinic staff is encouraged to continuously communicate

with patients waiting to be served, especially in cases of

longer waiting periods due to staff shortage.

An action plan was developed to address the concerns

The Integrated Chronic

Disease Management

Manual was introduced in all

clinics and hospitals of

Phuthaditjhaba as part of an


58


processes in line

with Batho Pele (In

this regard, a plan of


by December 2014).

on waiting time. The plan is part of the national initiative

on ideal clinic. To date the following was achieved:

- Draft policy on waiting time is available.

- Standard operating procedure on waiting time was

developed.

- Training was conducted on management of waiting

time for all front line workers.

- The plan is currently implemented in Thabo

Mofutsanyana as National Health Insurance pilot

district and will be rolled out to other districts from

April 2015.

action plan to reduce waiting

time. Officials (Nurses and

frontline workers) were

trained on the management

of waiting time.

The Manual provides

guidance to Nurses and

frontline staff on how to

make appropriate

appointments for patients

with major ailments. For

example, patients booked on

certain dates to collect

medication do not need to

wait upon arrival at the

clinics as nurses would

already have packaged their

medication. It was observed

that the patients were

satisfied and complimented

the system.

A Non-Governmental system

under the Department of

Health System Trust

conducted training on the

Right to care for patients as

part of reducing waiting time.

The Manual was found to be

helpful and provides

guidance on how to treat

patients. For example, it

guides nurses on how to


59


treat a patient who

complains about stomach

cramps.

In addition, Phuthaditjhaba

and Bluegumbosch clinics

had an action plan in place

to reduce long waiting time

with an indication of the

challenge, recommendations

to resolve the challenge, the

person dedicated to address

the challenge and timeframe

within which to resolve the

challenge.

At Elizabeth Ross Hospital a

graph mapping monthly

statistics on waiting time was

presented to the PSC team.

According to the graph the

hospital has reduced waiting

time from 4 to 2 hours since

June 2014 after the

appointment of six additional

doctors.

UNANNOUNCED INSPECTIONS

a) The refurbishing of

Brentpark and

Bophelong clinics

should be

undertaken to

address the

challenge of lack of

Both Brentpark and Bophelong clinics were assessed by

the Department’s infrastructure unit for future

improvements. It was recommended that both should be

converted into health posts after completion of the new

clinic being built in the same area.

Hinges were planted to close the cracks which were

It was observed that cracks

that were affecting the floor

at Bophelong clinic were

repaired.

The team also found that the

grounds of both Brentpark


60


space (at Brentpark)

and the identified

crack (at

Bophelong). (In this

regard, a plan of


in place by April

2015).

affecting the floor at Bophelong clinic. The provincial

infrastructure unit was also requested to support with

fixing the crack permanently as the hinges were used to

address the problem temporarily.

Fezile Dabi district management team established a

roving team to clean the grounds in all health care

facilities in the district. This was done to ensure that the

grounds are kept clean while the district is looking into

appointing general workers for maintaining the grounds in

all facilities. The Brentpark clinic committee volunteered

to clean the grounds while awaiting the visit from the

roving team.

and Bophelong clinics were

clean. Furthermore, it was

indicated that there are

community volunteers who

assist with the cleaning

since the roving team from

Community Work

Programme only came once

or twice in 2014. In addition,

the Department of Social

Development had a cleaning

project that helped with the

cleaning at some stage.

b) Elizabeth Ross

hospital should be

provided with an

emergency

generator to ensure

that the hospital’s

functions are not

disrupted when there

is power failure. This

should be done

immediately.

A standby generator was installed in September 2014

and it is functional.

The existence of the standby

generator at Elizabeth Ross

hospital was verified and it

was fully functional. It was

indicated that the generator

was installed in September

2014.

It was further indicated that

the hospital shares the same

line of power supply with the

community. It also emerged

that the hospital has on

several occasion engaged

the Municipality to provide it

with an independent power

supply, however there has

been any positive response.

This is affecting the hospital

during power cuts and load

shedding as the generator


61


consumes lots of diesel.

c) Brentpark clinic’s

filing system should

be reviewed to

ensure

confidentiality of

information on

patients in line with

the NHA. This

should be done by

31 March 2015.

The practice of labelling patients’ files was stopped as it

was discriminating. This will never happen.

It was found that the

labelling of patient files has

been stopped. Instead, the

clinic uses dates of birth and

identity document (ID)

numbers for storage and

retrieval. As a further

confidentiality measure, files

are not handed to patients

but are taken directly by

clinic staff to the pharmacist

after consultation. However,

the clinic still experiences a

challenge of storage space.

There are still no medicine

carry bags in both clinics

which impacts on full

confidentiality.

d) The FSDoH should

engage the

Moqhaka Local

Municipality in order

to address the

challenge of water

supply experienced

by Brentpark and

Bophelong clinics. In

addition, the

Department should

approach the Maluti-

A-Phofung Local

Municipality to find a

solution to the

Fezile Dabi District Municipality is responsible for

monitoring the quality of water and ensuring supply of

quality water to all citizens. The municipality conducts

water quality inspections on a regular basis.

Brentpark clinic

Moqhaka Local Municipality has resolved the lack of

water supply around Brentpark clinic and promised to

avail water through a mobile truck should the need arise.

The donated water tank could not be installed as it was

found to be unsuitable for the purpose following an

assessment. The District will prioritize the installation of

new water tank at Brentpark clinic.

Brentpark clinic

The team observed that the

clinic has water. However,

the donated water tank was

still not installed due to the

fact that it was damaged.

The team was informed that

the District Office plans to

replace it. It was also noted

that Moqhaka Municipality

does not have a mobile truck

to supply water during water

cuts as indicated in the

report. Instead, the clinic

uses old water bottles and


62


frequent power

disruptions affecting

hospitals and clinics

in the area. This

should be done

immediately.

Feedback in this

regard should be

provided to the PSC

by October 2014.

Bophelong clinic

The clinic does not experience water shortages any

longer as the municipality addressed the problem.

buckets to store back up

supplies during water

shortage. It emerged that

when water cuts occurred,

the dental and pap sections

would close.

Bophelong clinic

It was observed that the

clinic has water, however, it

does not have a water

reservoir in case of water

cuts. It also emerged that

the Municipality does not

provide water during water

cuts.

The PSC has requested the

Member of the Executive

Council (MEC) for

Cooperative Governance

and Traditional Affairs

(CoGTA) to engage the

Maluti-a-Phofung and

Moqhaka Local

Municipalities with regard to

the experienced water and

electricity supply challenges.

LIMPOPO a) The LDoH should

engage the

provincial

Department of Public

Works to address

the poor condition of

The Development Bank of South Africa (DBSA) was

commissioned by the LDPW to conduct an assessment

of the state of all the health facilities and completed its

assessment on 30 August 2014. The DBSA is the

implementing agent for the purpose of addressing the

identified infrastructure.

Copy assessment report

provided, although the copy

was of poor quality. The

PSC is awaiting an

electronic copy of the report.


63


buildings and lack of

space experienced

by health care

facilities especially at

Ellisras and Messina

hospitals as well as

at Bela-Bela and

Namakgale clinics.

Furthermore, an

audit should be

conducted of the

state of health care

facilities in the entire

province to eradicate

all dilapidated

physical structures.

An action plan

should be devised

by 31 March 2015.

b) The LDoH should

engage the

provincial DPW to

address the

shortage of doctors’

accommodation at

Messina Hospital. In

addition, the LDoH

should explore the

possibility of an

incentive programme

aimed at offsetting

and cushioning the

property costs in

case of doctors

The process of developing and constructing a new 240

bed hospital with staff accommodation at Messina is at

an planning stage and the land has been secured. In the

meantime the Department continues to lease

accommodation for health professionals.

The Department provided a copy of its recruitment and

retention strategy, which seeks to address

accommodation challenges and explore other staff

retention incentives.

The PSC is still waiting for

the requested plan.


64


requiring to acquire

own property in

order to encourage

their recruitment and

retention. An action

plan to be in place

by 31 March 2015.

c) There is a need to

replace the X-Ray

equipment and

surgical lights at

Ellisras hospital to

ensure sustained

quality service

delivery. In addition,

the Department

should develop a

Medical Equipment

Management Plan to

ensure timeous

procurement and

regular maintenance

of such equipment at

all health facilities. A

plan of action to be

in place by 31 March

2015.

The X-ray machine has been maintained and repaired. It

is fully functional and has passed the Radiation Control

Board. Another X-ray machine was acquired from

Thabazimbi hospital. This machine is also functional and

meets the requirements of the Radiation Control Board.

The LDoH will develop and present a report on Medical

Equipment Management Plan by 31 March 2015.

It was observed that

maintenance of the X-ray

machine has been

conducted and additional

machine acquired from

Thabazimbi hospital. Both

machines are functional.

Surgical lights are also

functional.

Other observations

- Dysfunctional ventilators

reported now functional.

- Nebulizer masks for

babies are not available

in the pharmacy.

- Adults’ masks are in

stock. In the meantime

the hospital uses re-

breathers in the absence

of nebulizer masks for

babies. The hospital

indicated that they keep

on placing orders for

these masks but they

have also been told that

these masks are not


65


available in the Province.

The MSD also confirmed

that there is a problem

currently.

d) The LDoH should

ensure that an

electronic

information system

is in place at all the

inspected health

care facilities, which

is linked to the

MSD’s electronic

ordering system to

ensure speedy

processing of the

requisition of

medical supplies. An

action plan to be in

place by 31 March

2015.

The Department has recently started to roll out the new

electronic stock management system (i.e. RX Solution),

which will be implemented in hospitals This system has

already been rolled out to 6 hospitals. The Department to

implement a different application in the primary health

facilities.

The depot still uses the old

system but confirmed that

the RX Solution has already

been rolled out to

Mankweng, Mokopane,

Warmbath and Witpoort

hospitals.

e) A system should

immediately be put

in place which is

linked to

performance

management to

ensure that District

Offices visit health

care facilities,

especially clinics,

monthly as required

by the Handbook for

Clinic/CHC

Performance agreements (PAs) of both District Executive

Managers and their teams for the 2015/16 financial year

will include a key result area (KRA) on monthly support

visits to health facilities.

District Pharmacists’ PAs for the same period will also

have a KRA that binds them to provide fortnightly reports

on availability of medicine and consumables.

Furthermore, audits have been conducted in 2013/14 in

hospitals and clinics and these continued during the

2014/15 financial year.

The PSC is still waiting for

an electronic copy of the

audits conducted as the one

provided is of poor quality.


66


Managers. In

addition, District

Hospital

Pharmacists should

conduct an audit of

the extent of

shortage of

medicines and

medical supplies at

the facilities as well

as the key

contributory factors.

In this regard (A plan

of action to be put in

place by 31 March

2015.

f) The LDoH should

also immediately

ensure that the

pharmaceutical

license of the MSD

is renewed as

required by the

SAPC to ensure that

the operations of the

depot are legal and

in line with section

22 of the Pharmacy

Act, 1974.

The MSD has a valid registration certificate with the

SAPC which was issued in 2007 that allows it to function

as a public pharmacy. It is also an accredited facility for

Pharmacist Assistants’ training. The LDoH is in the

process of applying for the registration of the entity with

the National Department of Health.

The MSD is in the process of obtaining accreditation by

the MCC and has undergone several inspections and

upon accreditation it will then be empowered to operate a

pharmaceutical warehouse business in line with the

requirements.

The PSC has confirmed that

the MSD has a valid

certificate from the SAPC

and also that the entity is in

the process obtaining an

MCC license. It was further

observed that the MCC

conducted inspection of the

facility and a report on

resolving the accreditation

will be provided once

completed.


67


g) Security measures

should be improved

at all health facilities’

storerooms and/or

pharmacies by

augmenting existing

measures with

electronic equipment

and dedicated

security officials to

control authorized

access and conduct

searches. Plan of

action in place by 31

March 2015.

The Department is in the process of addressing the

matter. Dysfunctional cameras and monitors at the MSD

will be repaired and additional ones installed in strategic

areas. It will also develop a security plan for all health

facilities that store, distribute and dispense

pharmaceuticals.

The PSC observed that the

cameras and monitors at the

MSD are still not functional

and the entity is not aware of

any plan to resolve the

problem.

Other observations:

- The current control room

does not meet the

standards and needs to

be moved to a

demarcated room.

- There is no alarm

system in place in case

of an emergency to warn

staff members.

- There are no smoke

detectors.

- Officials do not have

access cards or name

tags and access control

is therefore poor.

- The entity does not have

a scanner or walk

through detector, and

relies solely on physical

searches.

- Visibility around the

MSD is poor especially

at night because there

are no lights and security

personnel are at risk at

night when they have to


68


conduct routine patrols.

- The building is not user-

friendly for people with

disabilities.

h) The LDoH should

urgently investigate

the veracity of the

allegations of

malpractices relating

to conduct of the

Nurse-in-Charge

reported at Messina

Hospital.

Report to be provided by the end of March 2015. The PSC is awaiting the

report on the outcome of the

investigation.

i) The LDoH should

ensure that DHPs

are in place

especially in the

Capricorn, Mopani,

Sekhukhune and

Vhembe districts in

line with the

provisions of the

NHA. These DHPs

should be developed

in consultation with

the health care

facilities and then be

sufficiently

disseminated to all

the health facilities.

The DHPs for 2013/14 were developed and

implemented. The DHPs for 2014/15 have also been

developed, approved and are being implemented.

Copies of the DHPs not

provided.


69



a) Outside signage for

Helene Franz

Gateway Clinic that

is visible from the

main road should be

erected immediately

by September 2014.

Furthermore, the

LDoH should

engage the local

municipality to

augment the outside

signage of health

facilities with

direction signs to

improve their

accessibility.

The Department is in the process of addressing the

signage aspects in all health facilities. A report will be

provided by 31 March 2015.

The report due on 31 March

2015 is still outstanding.

b) Training should be

provided to the staff

in the necessary

protocols of patient

care and customer

care especially

Batho Pele. Training

programme to be in

place by 31 March

2015.

Staff based training is on-going. Batho Pele Principles

workshop plan for 2014/15

submitted.

c) The LDoH should

address the

concerns of waiting

time through

consultation

Batho Pele Principles workshop also addresses this. Batho Pele Principles

workshop plan for 2014/15

submitted

I


70


processes in line

with Batho Pele (In

this regard, a plan of


by 31October 2014).

d) All facilities should

be equipped with

functional and

sufficient air-

conditioning

systems. A plan of


by 31October 2014.

Plan to be made available by end of March 2015. Most of the air conditioners

at Ellisras in the wards and

in the boardroom are not

functional.

The MSD also reported

problems with their air

conditioners. Officials

confirmed that the DBSA

conducted an assessment of

the condition of the facility.

e) The records

management system

at Ellisras Hospital

should be

overhauled to

improve retrieval of

patients’ records and

also comply with the

OHS regulations. a

plan of action must

be in place by

October 2014. in

addition, it fire

extinguishing

equipment should be

serviced urgently.

The Department is in the process of reengineering the

records management system in the province and the plan

will be submitted by 31 March 2015.

The report due on 31 March

2015 is still outstanding.

f) Provision should be

urgently made for

The process of developing and constructing a new 240-

bed hospital at Messina is at a planning stage and the

Waiting for the requested

plans


71


additional beds at

Messina Hospital.

land has been secured. In the interim overflow of patients

being managed through referrals to Tshilidzini Hospital.

g) A system should

immediately be in

place to ensure

feedback or action

following receipt of

any complaint or

suggestion lodged.

The Department is in the process of establishing patients’

complaint management system including setting up

committees in all facilities in compliance with the National

Protocol on complaints management and resolution.

Awaiting further feedback

and evidence of the

complaint management

system.

h) Adequate parking

should be provided

for members of the

public at both

Namakgale and

Bela-Bela clinics

The Department will engage municipalities concerned

regarding making land available but future designs will

prioritize parking.

Awaiting further feedback.

NORTH WEST ANNOUNCED INSPECTIONS

a) The NWDoH should,

in collaboration with

the North West

Department of Public

Works (NWDPW),

address the

shortage of

accommodation for

medical

professionals at the

Brits District

Hospital. (A plan of

action must be in


The Department of Health issued a tender for Brits staff

accommodation which closed on the 14th November

2014. Project is under adjudication and appointment of

the contractor is expected by the beginning of February

2015.

On 20 April 2015, the

NWDoH provided evidence

of the advertisement of the

tender for the Brits staff

accommodation. However,

submission for the

appointment of the

contractor is awaiting

approval.

b) The NWDoH should

ensure that all

District Offices visit

all health facilities,

Clinic supervisions are included in the Annual

Performance Plan (APP) of the Department, and also

form part of PMA of sub -district managers and CEO.

This would be monitored to enable improvement. ln the

The Department’s APP has

included a performance

target on clinic supervision

(refer to page 69 of the


72


especially clinics,

monthly as required

by the Handbook for

Clinic/CHC

Managers to

oversee their

operations and

ensure availability of

the required

medicines and other

resources. In this

regard, the visits

should be linked to

the applicable

performance

management system

by April 2015.

Ruth Segomotsi Mompati District Clinical Specialist

Teams (DCST) are visiting all facilities and managers are

also visiting facilities every Wednesdays.

APP). In addition, scrutiny of

the performance report

relating to the 4th quarter

indicated an improvement of

94% in this area.

c) The NWDoH should

immediately ensure

that asset

management unit of

the Ngaka Modiri

Molema District

Office attends to the

broken equipment

found at Unit 9 Clinic

in terms of the

relevant SCM

prescripts. In

addition, the

responsible asset

officials should be

held accountable for

the delays in

The PSC contacted the NWDoH to provide a response

regarding concerns of asset management of broken

equipment, and the following was submitted as evidence

on how the Department dealt with the matter:

- A copy of motivation for disposal of the assets.

- A copy of compliance checklist.

- A copy of a Disposal Certificate.

The PSC also observed

during its visit to the clinic on

17 April 2015 that the

obsolete equipment,

including the broken glass

doors were removed and the

grounds were tidy.


73


addressing the

matter. (In this

regard, feedback

should be provided

to the PSC by 31

December 2014).

d) The NWDoH should

strengthen its SCM

process for

procurement of

medical equipment

and ensure that a

system for suppliers

of equipment in

place to identify

those suppliers

found to provide

poor quality

equipment for

blacklisting. (A plan

of action must be in

place by 31 March

2015).

An essential audit was conducted and completed in

September 2014, gap analysis done and a plan

developed for purchase/procurement of equipment item

that were unavailable.

The Department has developed a plan for maintenance

of equipment’s through appointment and deployment of

Health Technology officers at each District.

A process will be put in place to identify non-performing

suppliers of equipment.

The PSC observed the

following:

- A copy of a letter dated

June 2014, which was

sent to the District

Clinical Specialist Team

to conduct an equipment

audit was provided as

evidence, together with a

copy of the resulting

audit report covering all

the Districts.

- A letter was provided

which directed Districts

to ensure the fast

tracking of the central

purchasing of equipment

for facilities.

- Copies of the Essential

Equipment list for

primary health facilities

and equipment

maintenance plan for

2014/15 were also

provided as evidence.

e) Back-up generators

should be provided

The Department carried out desktop audit on back-up

generators in all health facilities in November/December

- The PSC found that

there is still no back-up


74


to the Taung Station,

Tlapeng and Unit 9

clinics in order to

prevent disruption of

services in case of

power failure. (A

plan of action must

be in place by 31

March 2015).

2014. All hospitals and CHC's have generators, but some

needs maintenance.

ln the 2014/15 financial year, the Department started with

procurement of generators for 24 hour clinics and once

all facilities have been catered for, it will address the 8

hour clinics. Taung Station clinic is an 8 hours facility and

will be addressed later in the MTEF plans.

generator at Unit 9 clinic.

A generator was found

at Tlapeng clinic;

however, it has not been

working for a number of

years as it needs

repairing or replacement.

- The PSC is awaiting

evidence of the

procurement process for

back-up generators for

the 24 hour clinics.

f) The NWDoH should

immediately ensure

availability of linen at

Unit 9 Clinic.

The Department has ensured the availability of linen at

Unit 9 clinic as part of linen received and supplied by

Mafikeng provincial hospital.

The PSC has received a

Linen Inventory report

indicating that linen is

sufficiently available,

although some the items

needed replacement. The

staff at the clinic confirmed

that no new linen had been

received.

It was also observed that the

report stated that

procurement of new linen

forms part of the demand

plan of 2015/2016. The PSC

is awaiting a copy of the

demand plan as evidence.

g) Computers and

network points

should be provided

at all the health

Computers: Currently, computers have been procured

for all facilities and are functional.

Network: All hospitals currently have cable network and

The PSC has observed that

all the inspected health

facilities have computers. A

list was also submitted


75


facilities. (A plan of

action must be in

place by 31 March

(2015).

are running on LAN (Local Area Network). All

CHCs/Clinics have been provided with 3G cards as a

short term measure. The long term measure will be for

cabling, however, the Department has financial

challenges.

confirming that all the

facilities have received 3G

cards pending the necessary

LAN cabling. During the

PSC visit to Unit 9 clinic it

was confirmed that the 3G

cards were received.

h) The NWDoH should

review the human

resource plan of the

Bojanala District to

address the

shortage of staff by

31 March 2015.

The staff structure for the entire Department is under

review and therefore we shall await finalization of that

process.

A copy of the Departmental

human resource (HR) plan

has been provided.


a) The NWDoH should

engage the NWDPW

in order to address

the challenge of

space in all the

inspected health

facilities. This should

include the

refurbishing of the

buildings of Unit 9

and Tlapeng clinics.

(In this regard, a

plan of action should

be put in place by

April 2015).

Refurbishment of buildings in Unit 9 and Tlapeng clinics

Unit 9 clinic: The following were done at:

- The cracks in the wall had been repaired;

- The damaged ceiling and exposed electrical wiring

have been repaired; and

- The leaking taps and broken sewer and waste pipes

have not been repaired and the Sub District Manager

has been instructed to have these defects repaired

within 30 days.

Refurbishment of buildings in Unit 9 and Tlapeng clinics

Unit 9 clinic: It was found

on 17 April 2015 that-

- the identified cracks in

the wall have still not

been repaired;

- the broken sewer and

waste pipes had not

been repaired. However,

the leaking taps have

been repaired; and.

- The damaged ceiling

has largely been

repaired although other

areas still require


76


Tlapeng clinic: As with all other small "A" type clinics,

this clinic does not have a storeroom. However, a

bathroom is never used since maternity deliveries are not

conducted and no in-patients are admitted to the clinic. A

separate toilet is available for use by the personnel.

ln view of the above, the personnel has decided to utilize

the unused bathroom to store certain medical supplies

and equipment. The Department could not find fault with

this practice since the equipment is stored in a neat and

tidy manner.

attention.

Tlapeng clinic: It was

observed on 20 April 2015

that the unused bathroom is

used as a storeroom. The

room was also found to be

tidy with supplies and

equipment neatly stored.

The meeting set up between

the PSC and MEC for Health

on 28 April 2015 to address

the refurbishing of the clinics

did not take place.

WESTERN CAPE ANNOUNCED INSPECTIONS

a) The Western Cape

Department of

Health should

implement a

standardized

electronic system for

ordering medicines

in all the health

facilities in order to

ensure sustainable

efficient service

delivery. The

suggested roll-out of

the JAC System,

currently used in

tertiary and regional

hospitals in the

province, should be

Awaiting feedback. N/A


77


expedited. In this

regard, a plan of


in place by January

2015.

b) The WCDoH should

consider installing

improved security

measures such as

CCTV and alarm

systems at all

facilities. A plan of

action must be in

place by January

2015.

The WCDoH has identified the need to upgrade

pharmacies, part of which will address the security of

pharmacies. The upgrading will include the installation of

limited CCTV within pharmacies as well as alarm

systems as per the norms. Roll-out has already

commenced in the Metro and will be further rolled out to

the Rural districts. The project brief will be submitted to

WCGTPW within the first quarter of 2015/16 for the

appointment of consultants. It is important to note that

implementation is planned over a three year period.

N/A


a) The WCDoH should

refurbish the clinics

to address the

challenge of space

(In this regard, a

plan of action must

be in place by April

2015).

Business Cases are being prepared by the end users at

PHC facilities to indicate the need for extension of current

facilities. The highest priorities with the greatest need

have been identified. The roll-out of this will take place in

terms of available funding and within the planning

parameters as identified in the 2015/16 User Asset

Management Plan. It is important to note that the need

exceeds current financial and human resources and

priorities will continually be updated.

A copy of the 2015/16 User

Asset Management Plan has

been requested and is

awaited.

b) The Department

should urgently

ensure the general

maintenance of

Great Brak River

Clinic and Alma

CDC, including

painting of the

external walls, to

Maintenance projects have been completed at both

facilities (see photographs below). However, both

facilities have to be replaced in the long term due to the

fact that these are pre-fabricated buildings. In addition to

this, Great Brak River Clinic falls within the flood line.

The PSC observed that

general maintenance has

been conducted at both

facilities and the facilities

were found to be neat as

indicated in the pictures

provided.


78


address their

unattractive

appearance.

Picture 1: Alma CDC

Picture 2: Great Brak River Clinic

c) The delays relating

to the process of

disposal and

replacement of

medical equipment

should be addressed

urgently.

Awaiting feedback. N/A

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