health portfolio committee nhls as a provider of public health laboratory services john robertson...

Health Portfolio Committee

NHLS as a Provider of Public Health Laboratory Services

John Robertson CEO

Health Portfolio Committee

NHLS as a Provider of Public Health Laboratory Services

John Robertson CEO

PurposePurpose

Provide cost-effective health laboratory services

Provide training for health science education

Support health research

OfficesOffices

Head Office & NICDHead Office & NICD

NHLS SitesNHLS Sites

StructureStructureNHLS Board

Operations Corporate Surveillance

Central RegionGerrit Coetzee

Coastal RegionSipho Mahlati

Northern regionJoyce Mogale

Finance & AdministrationSuliman Minty

Human ResourcesElsje Greyling

Information TechnologyStelios Michas

Quality Assurance &

Academic AffairsMartin Hale

NICDBarry Schoub

NIOHMary Ross

CEOJohn Robertson

Kwazulu Natal

National Cancer Registry

NHLS ServicesNHLS Services

Community Clinics

Community Hospitals

Regional Hospitals

Tertiary Hospitals

National Institute for Communicable Diseases

National Institute for Occupational Health

FacilitiesFacilities

Laboratories

265 laboratories across nine provinces

Personnel

3800 Total personnel +1000 KZN

1530 Technologists and Technicians

138 Pathologists

137 Registrars

NHLS Service ModelNHLS Service Model

Fee for Service

Sole Provider

Training

Research

Financial Financial DimensionsDimensions

Income 0.5% Derived from teaching

2.0% Research grants

5.8% Derived from govt grants

91.1% Derived from fees

0.6% Other income

Expenditure 7% Teaching and Research

3% Occupational Health

5% Surveillance & Epidemiology

74% Laboratory Services

11% Administration

Laboratory ServicesExpenditure by Province 04-05

WC NC FS GP MP NW EC KZN LP RSA

Payments & Estimates 04-05 R 4,739 R 815 R 2,745 R 8,731 R 2,306 R 2,599 R 5,410 R 9,036 R 4,241 R 40,622

NHLS Invoicing incl Vat R 225 R 33 R 108 R 343 R 62 R 70 R 132 R 200 R 70 R 1,243

Population Census 2001 4,524 823 2,707 8,837 3,123 3,669 6,437 9,426 5,274 44,820

# NHLS labs 22 5 12 40 17 27 54 52 36 265

Population per Laboratory 205,652 164,545 225,565 220,929 183,705 135,902 119,199 181,270 146,490 169,131

Health Expenditure per Capita R 1,048 R 990 R 1,014 R 988 R 738 R 708 R 840 R 959 R 804 R 906

Lab Expenditure per Capita R 50 R 40 R 40 R 39 R 20 R 19 R 21 R 21 R 13 R 28

Lab Expenditure % Budget 4.7% 4.0% 3.9% 3.9% 2.7% 2.7% 2.4% 2.2% 1.7% 3.1%

Provincial Spend and per Provincial Spend and per Capita SpendCapita Spend

R 0

R 50

R 100

R 150

R 200

R 250

R 300

R 350

GP WC KZN EC FS LP NW MP NC

R m

-

10

20

30

40

50

60

R p

er

pe

rso

n

NHLS Invoicing incl Vat Lab Expenditure per Capita

Provincial Vote and % Spend Provincial Vote and % Spend on Laboratory Serviceson Laboratory Services

R 0

R 1,000

R 2,000

R 3,000

R 4,000

R 5,000

R 6,000

R 7,000

R 8,000

R 9,000

R 10,000

WC NC FS GP MP NW EC KZN LP

R m

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

% o

f b

ud

ge

t

Healthcare spend LabSpend as a % of budget

Tariff DevelopmentTariff Development

Discipline 2004 2005 CMS

Chemistry R 445,894,444 R 455,619,266 2.18% R 608,767,874 33.61%

Microbiology R 321,762,966 R 337,151,430 4.78% R 412,698,133 22.41%

Haematology R 174,943,443 R 192,039,256 9.77% R 263,564,238 37.24%

Anatomical R 93,891,245 R 98,159,466 4.55% R 104,815,349 6.78%

Human Genetics R 12,022,756 R 12,646,865 5.19% R 13,312,501 5.26%

R 1,048,514,854 R 1,095,616,283 4.49% R 1,403,158,095 28.07%

Test Description

CD4 PLG R 60.00 R 147.80 146%

EasyQ Viral Load R 300.00 R 590.60 97%

Micro TB Misc. R 35.10 R 54.00 54%

R/M Culture TB R 82.60 R 108.70 32%

EXF Cytology (Gynae) R 62.20 R 88.80 43%

Financial Impact of extension Financial Impact of extension of servicesof services

Turnover 2003-2004 (000's) R 891,056

7.8% Tariff Increase 2004 R 71,284

CCTP R 49,000

NIOH Grant R 12,000

4% Increased Service Delivery R 35,642

Total R 1,058,983

Turnover 2004-2005 R 1,060,670

Difference R 1,687

Summary of Group ResultsSummary of Group Results

Summary of Group Results (R'000s)2001-2005

Cumulative12 months

200512 months

200418 months

2003

External revenue R 2,870,894 R 1,060,670 R 891,056 R 919,168

Cost of sales R 1,769,827 R 649,993 R 592,719 R 527,115

Gross profit R 1,101,067 R 410,677 R 298,337 R 392,053

Operating Expenses R 1,238,112 R 398,857 R 369,830 R 469,425

Other operating Income R 183,880 R 86,694 R 58,350 R 38,836

Operating profits (loss) R 46,835 R 98,514 R 13,143 R 38,536

Transfer payments for CCTP R 40,000 R 20,000 R 20,000

Income from SAIMR trust R 30,000 R 30,000

Investment Income R 7,279 R 158 R 70 R 7,367

Provision for post retirement medical-aid R 149,523 R 20,945 R 25,309 R 103,269Net profit (loss) R 25,409 R 97,411 R 18,382 R 104,438

Investment in property plant & equipment R 96,283 R 56,859 R 22,583 R 16,841

Working capital R 41,701 R 84,711 R 29,709 R 13,301

Non cash Items R 50,175 R 20,122 R 17,329 R 12,724

Grants received R 59,837 R 2,216 R 17,808 R 39,813

Provision for post retirement medical-aid R 149,523 R 20,945 R 25,309 R 103,269

Disposal of investment R 4 R 4

Transfer of cash from SAIMR R 14,382 R 14,382

Ascquisition University of Pretoria IP R 21,933 R 21,933Net increase in cash R 88,595 R 876 R 49,194 R 40,277

Financial Structure NHLSFinancial Structure NHLS

• At inception• Post Retirement liabilities measured at fair value

Employees transferred from Provincial Departments of Health were transferred without funding for post retirement benefits

• Retirement age of employees were not uniform

• Assets were acquired at no or low historical cost

• Actions• Acturial valuation of post retirement medical aid liability

• Revaluation of Land & Buildings

• Negotiate uniform conditions of service

• Obtain approval of stakeholders and legislative authorities

Annual ReportAnnual Report

A M J J A S O N D J F M A M J J A S O N D J F M A M J J A

2003 Financial audit



Audit period Post retirement Retirement age Revaluation Properties Treasury Submission

Annual Report2003 2004 2005

NHLS People Management NHLS People Management PhilosophyPhilosophy

Creation of a culture of growth & accountability

Continuous organisational development and empowerment

Attraction, retention and development of highly talented people

Respect for human values, diversity and relations

Human ResourcesHuman Resources

OverviewOverview

• Headcount:Headcount:

– March 2003: 3 509March 2003: 3 509

– March 2004: 3 797 March 2004: 3 797

– March 2005: 3 880March 2005: 3 880

• Payroll:Payroll:

– March 2003: R 489 971 millionMarch 2003: R 489 971 million



Human ResourcesHuman Resources

Achievements 2003 to 2005Achievements 2003 to 2005

• Developed and implemented comprehensive Human Developed and implemented comprehensive Human Resources Strategic Plan (2003 to 2006).Resources Strategic Plan (2003 to 2006).

• Developed, consulted and implemented a wide range of Developed, consulted and implemented a wide range of new Human Resources Management policies and new Human Resources Management policies and collective agreements.collective agreements.

• Developed and implemented macro organisational Developed and implemented macro organisational structure.structure.

• Completed transfer and absorption of all designated staff Completed transfer and absorption of all designated staff (excluding KZN).(excluding KZN).

Human Resources Human Resources Achievements 2003 to 2005Achievements 2003 to 2005

• Single set of conditions of employment implemented for Single set of conditions of employment implemented for all staff all staff

• Development and implementation of single job grading, Development and implementation of single job grading, career advancement and remuneration systemscareer advancement and remuneration systems

• Implementation of performance scorecards for Executive Implementation of performance scorecards for Executive ManagementManagement

• Employment Equity Plan negotiated with unions in the Employment Equity Plan negotiated with unions in the Labour Forum and implementedLabour Forum and implemented

Workforce ProfileWorkforce Profile

OVERALL NHLS: 2004 TO 2008

0

5

10

15

20

25

30

35

40

African male African female Coloured male Coloured female Indian male Indian female White male White female

Race and Gender

Per

cent

age

March 2004

March 2005

March 2008

EMPLOYMENT EQUITY INDICATORS: 2004 TO 2008

0

10

20

30

40

50

60

70

80

90

100

Black employees Designated employees Non designated employees

Indicator

Per

cent

age

March 2004

March 2005

March 2008


EXECUTIVE MANAGEMENT: 2004 TO 2008

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

African male African female Indian male White male White female

Race and Gender

Per

cen

tag

e

Mar-04

Mar-05

Mar-08


SENIOR MANAGEMENT: 2004 TO 2008 (Business managers and senior corporate managers)

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0


Race and Gender

Per

cen

tag

e

Mar-04

Mar-05

Mar-08


MEDICAL DOCTORS AND SPECIALISTS: 2004 TO 2008

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0


Race and Gender

Per

cen

tag

e

Mar-04

Mar-05

Mar-08


REGISTRARS: 2004 TO 2008

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0


Race and Gender

Per

cen

tag

e

Mar-04

Mar-05

Mar-08


MEDICAL TECHNOLOGISTS: 2004 TO 2008

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0


Race and Gender

Per

cent

age

Mar-04

Mar-05

Mar-08


STUDENT MEDICAL TECHNOLOGISTS: 2004 TO 2008

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0


Race and Gender

Per

cen

tag

e

Mar-04

Mar-05

Mar-08


Skills DevelopmentSkills Development

SKILLS TRAINING EXPENDITURE: 2003 TO 2005

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Skills courses Conferences Bursaries

Category

Ran

d March 2003

March 2004

March 2005

INTERNS AND REGISTRARS: 2004 AND 2005

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

40,000,000

45,000,000

Interns Registrars

Category

Ran

d

March 2004

March 2005

Skills DevelopmentSkills Development

TrainingTraining

Affiliated to 9 Medical Universities

Affiliated to 11 Technikons

50 HoD’s Training Under & Post Graduate

Graduate 25 Pathologists annually

Graduate 100 Technologists annually

Training DimensionsTraining Dimensions

Income

R 5m Universities

R 50m NHLS

R 55m Total

Expenditure

R 32m Heads of Department

R 23m Principal, Senior & Registrars

R 55m Total

Lab support services

Technicians

Technologists

Medical scientists

Specialists

Sub specialists

National Health Laboratory Service

Pathology Service Delivery

Internal Trainees

Medical students

Dental students

Subspecialists

Nurses

Specialists

Biom

edical HC

W

National Health Laboratory Service

Health Care Delivery

External Trainees

ResearchResearch

6 MRC units

1 NRF Centre of Excellence

Cancer Registry

183 Scientists

400 Research publications annually

Research DimensionsResearch Dimensions

Income

R 17m NHLS

R 50m Funding Agencies

R 67m Total

Expenditure

R 67m HIV, TB, Malaria, Cancer etc

R 67m Total

NATIONAL INSTITUTE FOR NATIONAL INSTITUTE FOR COMMUNICABLE DISEASECOMMUNICABLE DISEASE

1. Surveillance & monitoring of communicable diseases

2. Outbreak response & management

3. Communication & consultation

4. International

5. Research – applied & operational

6. Academic & training

7. Quality assurance & reference

1.1. SURVEILLANCE & MONITORING SURVEILLANCE & MONITORING OF COMMUNICABLE DISEASES - OF COMMUNICABLE DISEASES - MEASLESMEASLES

Weeks

3233

3435

3637

3839

4041

4243

4445

4647

4849

5051

521

23

45

678

910

1112

1314

1516

171819

2021

2223

2425

2627

2829

3031

3233

3435

3637

3839

4041

4243

4445

4647

4849

5051

521

23

45

67

8910

1112

1314

1516

1718

1920

2122

2324

2526

2728

2930

3132

330

20

40

60

80

100

Aug 2003 - 29 August 2005 per week

Measles IgM positive results

Aug 2003 Jan 2004 Jan 2005

MPP

KZP

ECP

WCP

Mass Immunizationcampaign

GAP

1.1. SURVEILLANCE & MONITORING SURVEILLANCE & MONITORING OF COMMUNICABLE DISEASES - OF COMMUNICABLE DISEASES - MEASLES MEASLES

2003

2004

2005

41415

116191938

22

101143

1977314287

4728

35

6935

5447

9439

12

No. of isolates received

ZimbabweUganda

TogoTanzania

SwazilandSudan

SomaliaSouth Africa

SenegalSierra Leone

RwandaRDC

NigerNigeria

MozambiqueMalawi

MaliLiberiaKenya

GuineaGhana

EthiopiaEritreaCongo

Cote D'IvoireChad

Central african republicCameroon

BurundiBotswana

Burkina FasoBenin

Angola

0 500 1000 1500 2000

Poliovirus samples received in 2004

1.1. SURVEILLANCE & MONITORING SURVEILLANCE & MONITORING OF COMMUNICABLE DISEASES - OF COMMUNICABLE DISEASES - POLIOPOLIO

1.1. SURVEILLANCE & MONITORING SURVEILLANCE & MONITORING OF COMMUNICABLE DISEASES - OF COMMUNICABLE DISEASES - POLIOPOLIO

1.1. SURVEILLANCE & SURVEILLANCE & MONITORING OF MONITORING OF COMMUNICABLE DISEASES - COMMUNICABLE DISEASES - MALARIAMALARIA

2. 2. OUTBREAK OUTBREAK RESPONSE & RESPONSE & MANAGEMENTMANAGEMENT

Dr Gillian de JongDr Gillian de JongEpidemiology UnitEpidemiology Unit

National Institute for Communicable National Institute for Communicable Diseases (NICD) Diseases (NICD)

A Laboratory Based Outbreak Network A Laboratory Based Outbreak Network for South Africafor South Africa

3. 3. COMMUNICATION & COMMUNICATION & CONSULTATIONCONSULTATION

44. INTERNATIONAL. INTERNATIONAL

• WORLD HEALTH ORGANIZATION– Collaborating Centres– Regional Reference Laboratory (AFRO)– Training Courses (AFRO)– EQA Programmes (AFRO)– Expert Advisory Committee

• CDC (USA)

• RESEARCH COLLABORATIONS

5. 5. RESEARCH - APPLIED & RESEARCH - APPLIED & OPERATIONALOPERATIONAL

.10

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E_TH253G_G6165

G_NG083G_HH8793

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J_SE9280-9

H_VI991

B_MNB_LAI B_D31

B_896

B_OYIB_SF2

B_CAM1

D_Z2Z6

D_ELI

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F_VI850

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K.CM.MP535

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97TZ0496BW0402

96BW040796BW0409

96BW110696BW1104

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100

100

100

100

100

100

100

100 100 84

100

100

100100

100

100100

10096100

100

100

100

1009782

Full length HIV genome phylogenetic tree Full length HIV genome phylogenetic tree

Subtype CSubtype C

J van Harmelen, et al, 2001

South AfricaSouth Africa

IndiaIndia

5. RESEARCH – APPLIED & 5. RESEARCH – APPLIED & OPERATIONALOPERATIONAL

KEY AREA :Scaling Up Access for Infant Diagnosis for KEY AREA :Scaling Up Access for Infant Diagnosis for HIV: Dried Blood Spots (DBS) Plus AutomationHIV: Dried Blood Spots (DBS) Plus Automation

A simple protocol using DBS to identify HIV infection status in infants and children less than 1.5 yrs of age

6. ACADEMIC & TRAINING6. ACADEMIC & TRAINING

Functions of Functions of NIOHNIOH

Advisory servicesAdvisory services

Information servicesInformation services

Technical and specialist servicesTechnical and specialist services

LaboratoriesLaboratories

Health hazard evaluationsHealth hazard evaluations

Clinical servicesClinical services

Applied researchApplied research

SurveillanceSurveillance

Development of OH professionalsDevelopment of OH professionals

Statutory autopsy serviceStatutory autopsy service

Occupational Health Occupational Health ResourcesResources

National Priorities and Statutory National Priorities and Statutory ObligationsObligations

Capacity Development

DOH, MPH, MMed, MTech

Workshops, seminars

Courses

On-site, in-service training

National reference facilities

Surveillance

PATHAUT

SORDSA, SAMOSA

Sentinel industry surveys

Research

Priority OH problems

30 concurrent projects

Workplace surveys

Statutory Examination of cardio-

respiratory organs under

Occupational Diseases in Mines and

Works Act 1973 – 3000 per year.

Diagnose compensable occupational

cardio-respiratory disease

Pathology

Advisory Services

Serve on panels

International training site

PATHOUT database

90 000 autopsy results

Annual surveilance reporting

Internationally recognised applied

research

Diagnostic Services

Extension of service to all Extension of service to all the communities in the the communities in the countrycountry

• Transport logistics deployed to service the Transport logistics deployed to service the Primary Health Care (PHC) facilitiesPrimary Health Care (PHC) facilities

• Extend consultation and outreach Extend consultation and outreach pprogrammes to rural provinces rogrammes to rural provinces

Primary Health Care Primary Health Care CoverageCoverage

BranchBranch Total number of clinics Total number of clinics (Incl small hospitals)(Incl small hospitals)

Number Number

Clinics coveredClinics covered

% %

Clinics coveredClinics covered

CentralCentral 10841084 870870 80%80%

CoastalCoastal 21702170 15561556 70%70%

NorthernNorthern 900900 848848 90%90%

TotalTotal 41544154 32743274 79%79%

Provision of Quality Provision of Quality ServiceService

ProgrammeProgramme

• Quality Assessment conducted in all laboratories Quality Assessment conducted in all laboratories

• Turn-around-Times of laboratory results Turn-around-Times of laboratory results measured measured

• Training programs conducted for HCW’sTraining programs conducted for HCW’s

• Regular communication meetings with clients Regular communication meetings with clients

• Client satisfaction surveys conducted and Client satisfaction surveys conducted and remedial action taken on areas of poor remedial action taken on areas of poor performanceperformance

Provincial ProgramsProvincial Programs

• Support both national and provincial health Support both national and provincial health programsprograms

• Information resource to provincial coordinators.Information resource to provincial coordinators.

• Focussed TB, Cervical Cancer Screening, CD4 and Focussed TB, Cervical Cancer Screening, CD4 and Viral load managementViral load management

Cytology

Cervical cancer in SACervical cancer in SA

• Cancer of the cervix one of the commonest cancers in SA.

• NDoH policy: 3 pap smears in a lifetime at 10 yearly intervals starting at age 30 for all women

• Cervical screening programmes, where effectively implemented, have markedly reduced cervical cancer.

• NHLS building capacity for implementation of NDoH policy.

Cytology in the NHLSCytology in the NHLS

Cytology 2004 2005Serious

AbnormalityMinor

Abnormality

Pap Smears 168,209 210,160 24.9% 5,265 2.5% 11,558 5.5%

Non Gynae 71,829 70,255 -2.2%

Total 240,038 280,415 16.8% 5,265 1.9% 11,558 4.1%

Fine needle aspiration Fine needle aspiration biopsy (FNAB)biopsy (FNAB)

Breast FNAB 2005Malignant

Breast

Tygerberg 1,282 247 19.3%

Johannesburg 3,333 469 14.1%

Total 4,615 716 15.5%

The Comprehensive Care Management and

Treatment Programme for HIV and AIDS

CD4 Data CD4 Data 2004/20052004/2005

Total number CD4 tests per month

0

10000

20000

30000

40000

50000

60000

Month

Nu

mb

er

CD

4 t

es

ts

Viral load data 2004/2005Viral load data 2004/2005

Total number of viral loads performed per Month

0

2000

4000

6000

8000

10000

12000

Month

Nu

mb

er

VL

tests

per

sit

e

HIV PCR tests 2004/2005HIV PCR tests 2004/2005

Number of HIV PCR tests done per province

19 38 164 154 11 43

9781

6140

0

2000

4000

6000

8000

10000

12000

LP FSP NWP ECP NCP MP WCP GP

Province

Num

ber

of P

CR

test

s

TB and HIVTB and HIV

• TB incidence increasing: Now 550 per TB incidence increasing: Now 550 per 100 000 population100 000 population

• HIV prevalence (2004 antenatal survey) HIV prevalence (2004 antenatal survey) 29.5% of population29.5% of population

• MRC survey: 55% of TB cases are HIV MRC survey: 55% of TB cases are HIV positivepositive

• HIV increases risk of developing TB from HIV increases risk of developing TB from a 10% lifetime risk to 10% annual riska 10% lifetime risk to 10% annual risk

Volume of TB microscopy Volume of TB microscopy

2,004 2,005 Negative Positive

Microscopy 1,167,362 1,290,123 10.5% 1,079,432 83.7% 210,691 16.3%

2,004 2,005 Negative Positive

Microscopy 34,425 200,853 483.5% 164,754 82.0% 36,099 18.0%

Fee for Service

Flat Rate

TB smears per 100 000 TB smears per 100 000 population 2005population 2005

0

2,000

4,000

6,000

8,000

10,000

Per

100

000

Positive TB smear rate per 100 Positive TB smear rate per 100 000 population 2005000 population 2005

0

200

400

600

800

1,000

1,200

1,400

1,600

NHLS IT Network

ENDEND

health portfolio committee nhls as a provider of public health laboratory services john robertson...

Documents

laboratory services

structure slide

occupational health

relations slide

ministration slide

rm culture tb r

easyq viral load r

exf cytology gynae r