NHI Pilot Districts 12 months progress report Parliament 4 June 2013

Background August 2011: NHI Green Paper – action plan April 2012: NHI pilot districts to prepare for: Purchasing of services; Engaging the private sector; Introducing a district health authority; April 2013: Rapid appraisal to: Assess progress in preparing for NHI Provide a framework for monitoring

NHI domains appraised Human Resources NHI management Health information District Management Teams Conditional Grant Referral Contracting Private Providers NHI management Hospitals Quality Primary Health Care re-engineering Infrastructure & Equipment

Tabular summary per District Key   Nearly or completely achieved (where numerical data available >75%) Partially achieved (where numerical data available 25 - 74%) Minimally, or not achieved (where numerical data available <25%) No data available Not applicable

NHI management & coordination Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane Full-time NHI Project Managers (NB interim managers in all other districts)

Hospital Reform District hospitals re-designated 6\6 3\3 9\9 7\9 5\5 Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane District hospitals re-designated 6\6 3\3 9\9 7\9 5\5  no data 4\4 0\3 Full-time CEOs in post 2\9 4\9 1\3 3\4 3\9 CEOs orientated at Leadership and Management Academy 0\6 1\2 2\4 2\5 1\1 6 2\3

Quality Facility Improvement Team in place Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane Facility Improvement Team in place OSC overall score for PHC facilities inspected in 2013 (%) 55% 57% 48% 51% 70% 56% 58% 62% 32% 47% 72% OSC overall score for hospitals inspected in 2013 (%) 68% 50% 73% No data 63% 86%

PHC facility OSC inspections Baseline and 2013 follow-up scores and differences for each district Eight districts showed a fall in scores (five less than 5%) Two districts showed significant improvements (17% and 8%) District Number of PHC facilities inspected Baseline Score % 2013 follow- up Score difference % Vhembe 12 53.1% 32.0% - 21.1% Oliver Tambo 25 63.9% 48.1% - 15.8% Dr Kenneth Kaunda 10 60.2% 47.2% - 13.0% City of Tshwane 13 78.4% 69.8% - 8.5% Amajuba 59.8% 55.5% - 4.4% Umzinyathi 7 66.4% 62.4% - 4.0% Eden 1 56.9% 54.7% - 2.2% uMgungundlova 58.6% 58.4% - 0.2% Thabo Mofutsanyane 11 68.1% 72.7% 4.6% Pixley ka Seme 6 48.4% 56.8% 8.4% Gerte Sibande 17 33.9% 51.2% 17.2%

PHC Re-engineering Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane District Clinical Specialist Teams: members in post (7 posts) 4 3 7 2 Ward-based Outreach Teams: Required number of teams in place No data 61% 22% 6% 3% 16% 28% 17% 36% 11% School health: Required number of teams in place 100% 0% 92% 32% 12% 60% 29%

Infrastructure Facility maintenance plans in place Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane Facility maintenance plans in place Hospitals: Major refurbishment over past 12 months 6\6 0\3 3\9 2\9 2\8 3\3 No data 4\4 2\5 0\9 PHC facilities: Major refurbishment over past 12 months

Equipment Audit in Primary Health Care Facilities Summary of facilities assessed in NHI pilot districts District Total Complete Remaining OR Tambo 131 43 88 Thabo Mofutsanyane 73 23 50 City of Tshwane 60 Amajuba, Umzinyathi, uMgungundlova 91 45 46 Vhembe 112 47 65 Gerte Sibande 55 30 25 Dr Kenneth Kaunda 27 20 7 Pixley ka Seme 29 6 Eden 31 10 21 609 301 308

Human Resources for Health Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane Hospital: Doctors 92% 72% 60%  58% No data 80% 89% 69% 29% 97% 63% PHC Facilities: Nurses 95% 85% 37% 58%  93% 30% 99% Requisite number of data capturers in post 100% 86% 74% 96% 59% 36% 83%

Health Management Information Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane Time for DHS data to reach province (target 15 days) 15 7 20 13 22 3 District officers trained in use of NHIRD Districts with access to NHIRD

District Management Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane Annual district health expenditure review completed District NHI master plan in place NHI Conditional grant: % spent up to 30th March 2013 (inc. commitments) 86% 114% 95% 55% 52%  37%  78%  78% 50% 77%  88%

Referral systems Referral system protocols in place Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane Referral system protocols in place Planned patient transport system in place Emergency transport system in place

GPs in districts on national contract Eden Pixley ka Seme OR Tambo Gert Sibande City of Tshwane Amajuba uMgungundlova Umzinyathi Vhembe Dr Kenneth Kaunda Thabo Mofutsanyane Facilities identified by District Facilities assessed as being ready for GPs 80% 65% 2% 20% 23% No data 76% 15% 45% 22% Number GPs on national contract (model ready, contracting due in 2013/14)

Summary NHI management and coordination in place and DHMTs realigning their priorities NHI Conditional Grants have contributed to progress Quality improvement interventions underway Hospital reform being introduced Referral mechanisms are in place PHC Re-engineering: Three streams (DCSTs, WBOT and School Health) teams not yet complete Health staff is insufficient; WHO WISN norms and standards being used to motivate increased funding, Private providers – districts ready for private GPs to work alongside nurses in primary health care facilities