REPORT ON A SERVICE DELIVERY INSPECTION OF DISTRICT ...

REPORT ON A SERVICE DELIVERY INSPECTION OF DISTRICT HOSPITALS AND

CLINICS REGARDING AVAILABILITY OF MEDICINES AND MEDICAL EQUIPMENT AND THE ROLE OF HEALTH DISTRICT OFFICES

DEPARTMENT OF HEALTH: FREE STATE PROVINCE

APRIL 2014

TABLE OF CONTENTS

FOREWORD.......................................................................................................................... iii LIST OF ACRONYMS ........................................................................................................... iv 1. INTRODUCTION .......................................................................................................... 1 2. OBJECTIVES OF THE INSPECTIONS ....................................................................... 2 3. SCOPE AND METHODOLOGY................................................................................... 3 3.1 Scope ........................................................................................................................... 3 3.2 Methodology ............................................................................................................... 3 4. LIMITATIONS OF THE STUDY ................................................................................... 3 5. KEY FINDINGS ON ANNOUNCED INSPECTIONS .................................................... 4 5.1 Contextual background.............................................................................................. 4 5.2 Management of medicines......................................................................................... 5 5.3 Management of medical equipment........................................................................ 13 5.4 Governance of health facilities................................................................................ 15 5.5 Challenges................................................................................................................. 16 6 KEY FINDINGS ON UNANNOUNCED INSPECTIONS ............................................. 18 7. IMPLEMENTATION OF PSC RECOMMENDATIONS .............................................. 25 8. READINESS OF THE INSPECTED FACILITIES FOR THE ROLL-OUT OF

NATIONAL HEALTH INSURANCE (NHI).................................................................. 25 9. RECOMMENDATIONS: ............................................................................................. 26 9.1 Announced Inspections ........................................................................................... 26 9.2 Unannounced Inspections ....................................................................................... 26 10. CONCLUSION............................................................................................................ 27 11. ACKNOWLEDGEMENT............................................................................................. 27

ANNEXURE A: A LIST OF FACILITIES VISITED AND OFFICIALS THAT WERE ENGAGED ............................................................................................................................ 28 UNANNOUNCED INSPECTIONS IN THE CLINICS ............................................................ 30 ANNEXURE B1: Availability of medical equipment at inspected clinics ....................... 30 ANNEXURE B2: Availability of medical equipment at the inspected hospitals ............ 32 ANNEXURE C1: Availability of medicines at inspected clinics ...................................... 33 ANNEXURE C2: Availability of medicines at inspected hospitals ................................. 35 ANNEXURE D: THE STATUS ON THE IMPLEMENTATION OF RECOMMENDATIONS OF THE PSC'S INSPECTIONS CONDUCTED IN 2009 ...................................................... 36

Tables

Table 1: Objectives of inspections ......................................................................................................... 2 Table 2: Sites and dates of inspections ................................................................................................. 3

Figures

Figure 1: Medicine management cycle .................................................................................................. 6 Figure 2: Availability of tracer drugs at health facilities ......................................................................... 11

Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical

Equipment and the Role of Health District Offices in the Department of Health: Free State Province

i

Pictures Picture 1: Pharmacies of Phuthaditjhaba and Bophelong clinics with burglar doors to ensure

controlled access and safety of medicines.......................................................................... 8 Picture 2: Medicines and medical consumables packed neatly on the shelves at Tokollo District

Hospital................................................................................................................................ 9 Picture 3: Medicines stored in a refrigerator with controlled temperature at Brentpark Clinic............. 9 Picture 4: (left) Medical waste bucket still in use at Brentpark clinic. (Right) Medical waste buckets

sealed and safely stored for safe removal by a medical waste management company. .. 10 Picture 5: (Left) Reception area at Tokollo Hospital. (Right). Neat bedding in a ward at Tokollo

Hospital.............................................................................................................................. 18 Picture 6: The wall (left) and floor (right) at Bophelong clinic show a crack which poses a health and

safety risk........................................................................................................................... 19 Picture 7: The grounds of Brentpark clinic need proper gardening. .................................................. 19 Picture 8: Cluttered sluice room used to store wheelchairs and other essentials. ............................ 20 Picture 9: A store room for medicines is also used to keep food for staff. ........................................ 20 Picture 10: The water tank at Brentpark clinic which needs to be installed......................................... 21 Picture 11: Poster in Sesotho and depicting tips on how to wash hands to promote hygiene. ........... 22 Picture 12: Business hours displayed at Brentpark Clinic. .................................................................. 23

Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical

Equipment and the Role of Health District Offices in the Department of Health: Free State Province

ii

FOREWORD

South Africa's burden of disease, consisting amongst others of a high rate of HIV/AIDS is consistent with health challenges affecting many developing countries which are characterized by high levels of poverty. Thus, health care is one of the key government priorities as well as an essential service which should be accessible to all the citizens of the country.

Key to ensuring a long and healthy life for all is having sustainable health care infrastructure that is responsive to the needs of the citizens. To this end, primary health care facilities have been established to ensure that citizens receive health services at the local level. Furthermore, the National Health Insurance (NHI) will ensure equal access to quality health care for all citizens. Amongst others, it is important that health care facilities should at all times have sufficient medicines as well as adequate medical equipment for timeous and quality treatment, if government is to succeed in mitigating the burden of disease and ensuring a long and healthy life for all citizens. Furthermore, health facilities should function in a manner that is in line with the Batho Pele principles of service delivery.

It is against this background that the Public Service Commission (PSC) deemed it necessary to conduct inspections to determine the availability of medicines and medical equipment. The inspections also sought to determine the implementation of the PSC's previous recommendations in this area and readiness of the health care facilities for the imminent roll out of the NHI. Generally, it was found that despite supply chain challenges, medicines and medical equipment were largely available at the sites visited. Out of 17 PSC's recommendations, 16 (94%) were implemented. Based on the findings and observations, it is the PSC's view that the visited health facilities were ready for the roll out of the NHI. However, they require urgent attention relating to shortages of health care professionals.

It is with pleasure to present the Report on Service Delivery Inspection of Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Free State. We believe that the inspections remain a valuable monitoring mechanism whose findings could contribute towards service delivery improvement.

The PSC wishes to thank officials of the Free State Department of Health (FSDoH) for their cooperation and willingness to share information. We trust that the findings will help the FSDoH in its efforts to improve service delivery for sustainable and quality health care.

Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical

Equipment and the Role of Health District Offices in the Department of Health: Free State Province

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LIST OF ACRONYMS

AIDS AO ARV BP CEO CHC CPU DAP DDV DHP DHS EA EDL FEFO FSDoH HIV HoD MCC MEC NEDLC NEMLC NDP NDPSA NHA NHI PHC PMCC PSC PTC RDM SCM SLA SOPs STG TB WHO

Acquired Immune Deficiency Syndrome Accounting Officer Antiretroviral Blood Pressure Chief Executive Officer Community Health Centre Central Processing Unit District Acquisition Plan Direct Delivery Voucher District Health Plan District Health System Executive Authority Essential Drugs List First In, First Out Free State Department of Health Human Immunodeficiency Virus Head of Department Medicine Control Council Member of the Executive Council National Essential Drugs List Committee National Essential Medicine List Committee National Development Plan National Drugs Policy of South Africa National Health Act National Health Insurance Primary Health Care Provincial Medical Consumables Committee Public Service Commission Pharmaceutical and Therapeutic Committee Remote Demander Module Supply Chain Management Service Level Agreement Standard Operating Procedures Standard Treatment Guidelines Tuberculosis Wealth Health Organisation

Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical

Equipment and the Role of Health District Offices in the Department of Health: Free State Province

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