STATEMENT BY MR HOPE PAPO, GAUTENG MEC FOR HEALTH ON THE REPORT BY SECTION 27

04 March 2013

We have noted a report, from Section 27. which paints a grim picture of the state of hospitals and clinics in the province (see health-e article / full report here - PDF).

While accepting the right of any individual or organisation to state their views about health, we would have liked an opportunity to have a direct engagement with the authors before the report was published. We believe that if we were given an opportunity, we would have been able to bring to the attention of the authors progress which has been made and is still being made in addressing the matters contained in their report.

The report is unfortunately based on matters that the department has addressed. Some of these issues have been resolved or are at different stages of being resolved.

These are the steps we have taken in 2012 when we started to implement the Turn Around Strategy 2012-14 to address the issues contained in the report:

Human Resources: The department appointed 2 259 personnel to critical posts to enable health facilities to perform their work effectively. These included 752 nurses, 595 clinical professionals, 528 allied professionals, 41 allied support staff, 71 management staff, 397 administration staff and 144 support staff.

In December 2012, 920 medical and allied trainees who completed their community service were absorbed against funded vacant funded posts. This included 739 professional nurses, 80 medical practitioners, 30 pharmacists and others.

The appointment of anaesthesiologists and nurses at Steve Biko was fast tracked to ensure the re-activation of three theatres and intensive care units.

Chris Hani Baragwanath appointed 141 nurses, four pharmacists, 20 cleaners, 10 porters and 10 security officers. The capacity of the neonatal intensive care unit has been increased to improve care for very ill children with low birth weight.

Charlotte Maxeke was also assisted to employ about 250 nurses, doctors as well as administration and support staff. The majority of the new employees were nurses (150) and doctors (56).

Infrastructure: Infrastructure maintenance and provisioning of electro-mechanical equipment was notably improved in 2012.

At Charlotte Maxeke Johannesburg Academic hospital there are 14 autoclaves, 12 generators, 5 chillers, 6 gas sterilizers and 5 boilers in working order. The hospital is scheduled to have 16 lifts replaced. Fourteen of these lifts are already on site and work will start this week. Equipment at the Oncology Unit has been repaired and the Unit is fully functional.

At Chris Hani Baragwanath Academic Hospital, medical and intensive care unit (ICU) wards have been refurbished and new lifts installed. Chillers and boilers have been installed. To eliminate challenges in theatres during power outages, new generators were put  in place and permanent onsite maintenance officials have been appointed. All autoclaves at the hospital were serviced in 2012.

Maintenance work was done in the following areas at Dr George Mukhari hospital. Five autoclaves were replaced in 2010/11 and a further 4 were repaired last year. A big chiller to replace two smaller ones has been delivered on site. One boiler is currently being replaced.

Maintenance of Oncology equipment at the Steve Biko Academic hospital improved last year after the department moved the maintenance contract from Phambili to Siemens. In addition, 40 bedpan washers were serviced last month and are all functional. Maintenance work was also done on chillers, autoclaves and generators.

The department spent more than R12 million to provide critical equipment to its central hospitals. These included cardiac monitors, thorascopy sets, paediatric bronchoscopy, lapascopic camera system, blood warmers and others.

An equipment survey is currently underway to identify old and defunct equipment, inform the purchasing of new equipment and the maintenance. A proposal has been approved in the interim that will allow institutions to acquire urgently needed equipment.

We are currently planning an overhaul of the health information system, to gather accurate demographic and epidemiological data that can be accessed in real-time to inform evidence-based interventions and allow accurate and transparent monitoring and evaluation of programs and facilities. 

Availability of medicine: focussed attention was paid on improving the availability of drugs in 2012. This resulted in the improvement of essential drugs from 40% in April to 76% in December 2012. Payment of medical suppliers was improved and most are now paid within 30 days of invoicing.

The challenges that were experienced with the supply of medicine last year were as a result of suppliers experiencing difficulties with manufacturing. There were instances where contracted suppliers could not supply due to mandatory upgrade of manufacturing facilities in order to implement quality remediation plans. This affected the availability of Augmenting for instance.

In some instances manufacturers experienced batch failures.  The availability of Pentaxim, a vaccine, was affected by this as well as the freezing stock en route to South Africa.

Other drugs such as insulin, Phenytoin, Warfarin, Morhphine and paracetamol are available.

The department has also started preparations for the introduction of fixed dose combination of anti-retroviral drug. The department is expecting to receive 60 000 units of the drug this month in preparation for the introduction of this drug in April.

Budgeting and financial management: Great strides were made to clear accruals and stabilise the finances of the department. By the end of January this year R4,2 billion has been paid to service accruals. A total of 34 927 invoices were paid within 30 days in the period between April 2012 and January this year.

For the same period last year, the department was reporting amounts owed to suppliers in the region of R1.5 billion.  Currently the department is reporting an amount of R250 million that is awaiting cash to be released to suppliers. 

The department has therefore settled approximately 99% of the total accruals that were owed. A minority of invoices relating to prior financial years but processed in the current financial year is undergoing a prepayment audit.  This is to ensure that only legitimate invoices are paid after verification that goods and services have indeed been received.

Reforms have been implemented within budget management. The participation of programme managers and hospital management teams in the budget process has been improved to ensure that budget allocations are informed by health services required.  Tools for cost-based budgeting have been developed and introduced to managers.

The department is actively engaging in consultation with health care providers, to address questions of quality and unfair contracts. This will ensure that the department can provide the best results possible from its relationship with the private sector. 

Supply Chain Management: Measures were put in place last year to deal with corruption within supply chain management. All supply chain officials were put through a vetting process to minimise corruption. A new procure to pay process has been established to minimise incidents of fraudulent transactions and possible collusion by officials with suppliers. A supply chain management charter has also been developed and is being implemented.

Accountability and discipline: Following on the Special Investigating Unit (SIU) investigation into a case of tender fraud, the department has taken disciplinary action against three senior management officials. These cases are at different stages of finalisation. It should also be indicated that the SIU is expected to complete its investigation on all the contracts they are investigating this month. Their report will be given to the President and we will get it after that. We are prepared to act on whatever issue we are required to act on. Working with the Office of the Premier, we are also currently developing a comprehensive plan of action to act on the recommendations made in the Forensic Audit Report of the Medical Supplies Depot (MSD). This will include disciplinary action against some people. Lastly, there are several disciplinary cases involving our staff the department has processed in 2012 which are at different stages, including appeals.

Neonatal deaths: The following measures have been put in place to reduce neonatal deaths in the province. Retired nurses have been appointed to assist with infection control, and support interventions to prevent spread of nosocomial infection in neonatal units. Morbidity and mortality meetings are held weekly and monthly in 90% of institutions, to identify missed opportunities and avoidable factors leading to morbidity and mortality. The perinatal mortality rate (death of neonates from birth to 28 days) for quarter 3 (2012/13) has shown decline in the third quarter (October to December) of 2012 compared to the same period in the previous year. The rate was 26.7/1000 in 2012 a reduction from 28.7/1000 for the same period in 2011. Mother to Child Transmission of HIV (MTCT) is currently 2.5% for the Gauteng Province.   

A new ward (Ward 185) was opened at Charlotte Maxeke to prevent over-crowding of babies. The number of neonatal beds was increased to 25 with four dedicated isolation cubicles.  Equipment was ordered and delivered and additional staff was appointed.

An additional 10 neonatal beds were established at Natalspruit hospital, resulting in 54 neonatal beds available at the hospital. Professional nurses, enrolled nurses and auxiliary nurses were employed in line with extra beds. Critical equipment was procured and delivered

There is continuous training on infection prevention and control measures in all hospitals, and monthly reports submitted by our Quality Assurance Unit. The availability of adequate supply of hand towels and antiseptic soap is monitored closely.

Supervision of lodger mothers is conducted in all hospitals with regards to hand washing and change of clothing and ensuring that they wear protective clothing.

Doctors, interns, midwives and nurses have been trained in Essential Management of Obstetric Emergencies to save mothers and babies. Visits to new mothers by a health professional within 6 days, 6 weeks and 6 months has increased to 90%.

District Clinical Specialist Teams have been appointed for our five health districts, to monitor and evaluate maternal and child health programmes by providing clinical governance. Immunisation coverage has been maintained above 90%. We continue to encourage parents to come forward to get their babies and children to be immunised.

We would still appreciate an opportunity to interact directly with Section 27 on the matters so that we may come to the same understanding on what we have done and what further steps we will be taking to further turn the department around. Our 2012-14 Turn Around Strategy is slowly but surely succeeding. It requires the support of all stakeholders including Section27/TAC. 

Statement issued by Simon Zwane, Gauteng Department of Health, March 4 2013

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