Presentation to the Portfolio Committee on Health THE IDEAL CLINIC 02 MARCH 2016

Background

WHY DID THE NDOH START THE IDEAL CLINIC PROGRAMME?

The next four slides depict: A matrix summarising the situation in 2272 clinics assessed by the Health Systems Trust in 2011 Findings of the OHSC in 2013 A toilet in a clinic in Gert Sibande District in 2013 Another clinic in Gert Sibande district in 2014 showing how a clinic should look and function in every aspect

In 2011, the results of the HST baseline assessment was shared with clinic operational managers (or staff where there was no manager) immediately, with the understanding that weaknesses will be addressed immediately Yet the OHSC in 2013 found the same and even more weaknesses For this reason NDoH decided that we will have to go down to the ground to clinic level (3 feet level in Operation Phakisa language) to see exactly why these weaknesses persist. To see if we define for provincial, district and clinic managers in detail what clinics should look like and how they should function, if clinics can be made to be IDEAL

WHAT IS ANIDEAL CLINIC?

DEFINITION An Ideal Clinic is a clinic that provides good clinical care to the patients it serves and it also gives the patients a good experience of care. It does this because it cooperates and consults with the community it serves. It has good infrastructure, adequate staff, adequate medicine and supplies, good administrative processes and adequate bulk supplies. It use applicable clinical policies, protocols, guidelines as well as partner and stakeholder support, to ensure the provision of quality health services to the community. An Ideal Clinic will cooperate with other government departments as well as with the private sector and non-governmental organizations to address the social determinants of health. PHC facilities must be maintained to function optimally and remain in a condition that can be described as the “Ideal Clinic”. Integrated clinical services management (ICSM) will be a key focus within an Ideal Clinic. ICSM is a health system strengthening model that builds on the strengths of the HIV programme to deliver integrated care to patients with chronic and/or acute diseases or who came for preventative services by taking a patient-centric view that encompasses the full value chain of continuum of care and support.

The Ideal PHC Facility within the District Health System Specialist NCD care Specialist Hospital care Mental Health Unit Emergencies MDR-TB Control Obstetrics Surgery Provincial Support District Health System Good Governance Leadership Management PHC Facilities Quality, comprehensive, person-centred care School Health EMS and ambulatory transport DCSTs Social and psychologyservices Training Ward-based PHC Outreach Env Health NGO services Research Institutions Diagnostic services Contracted service providers Health Campaigns Universities Laboratories Community Imaging Research Councils

THE DISTRICT HEALTH SYSTEM BURDEN OF DISEASE/KEEP HEALTHY COMMUNITIES HEALTH UNIVERSAL HEALTH COVERAGE THROUGH NHI DHMT Standardised Organogram Regulated job Descriptions DHS Facilities PHC (Clinics, CHCs) District Hospitals Ideal Clinic Dashboard Package of Service Community Based Services Environmental Health School Health Teams WBPHCOTs SERVICE CONFIGURATION FOR IMPLEMENTATION OF HEALTH PROGRAMMES: Supported by an effective referral system KNOWLEDGE MANAGEMENT AND TRAINING SYSTEM: Obtain competencies required through Regional Training Centers – Support relevant research CLINICAL QUALITY IMPROVEMENT: DCSTs COMMUNITY PARTICIPATION: Clinic committees and Hospital Boards

THE STUDY PHASE

PREREQUISITES Have the required administrative processes to ensure efficiency and effectiveness Have good infrastructure (building in good form, adequate space, essential equipment, and information and communication network and tools) to provide the required services Ensure continuity of care through an effective patient information system Integrate the services and functions of the district clinical specialist team (DCST), school health team and municipal ward based primary health care outreach teams (WBPHCOT) to improve population health outcomes Provide integrated chronic disease management (ICDM) to deliver integrated, patient centered care to patients with chronic diseases, encompassing the full value chain of continuum of care and support through the application and use of up-to-date clinical guidelines and protocols Have the required medicines, supplies and laboratory support Have adequate staff who have the required skills and uphold high standards of professional etiquette Have a doctor available for the required sessions per week Co-operate with stakeholders in the community to ensure quality comprehensive PHC services Have the required District Health Support Systems available to it

Statement by President Zuma 20 June 2014 “We will next month launch an adaptation of the Big Fast Results methodology that we have been discussing with the government of Malaysia... The methodology involves setting clear targets and following up with on-going monitoring of progress and making the results public. Using this implementation methodology, the Government of Malaysia was able to register impressive results within a short period. In South Africa, we have renamed the Malaysian approach Operation Phakisa, to emphasise its critical role in fast-tracking delivery on the priorities included in the National Development Plan 2030... We will also pilot this methodology to improve service delivery in our clinics nationwide, promoting Minister Motsoaledi’s Ideal Clinic Initiative.

IMPLEMENTATION STARTING APRIL 2015

Scale – up Plan 2015/16 PROVINCE Total # of facilities 30% of tot # YEAR 1 YEAR 2 YEAR 3 2015/16 % of total 2016/17 2017/18 Eastern Cape 773 232 226 29% 249 32% 296 38% Free State 221 66 100 45% 52 24% 69 31% Gauteng 367 110 175 48% 119 70 19% KwaZulu-Natal 623 187 204 33% 205 30% Limpopo 479 144 134 28% 98 20% 151 Mpumalanga 300 90 84 82 27% 115 North West 321 96 94 80 25% Northern Cape 210 63 60 53 54 26% Western Cape 384   0% GRAND TOTAL 3678 1103 1077 938 1038

STATUS MAY AND DECEMBER 2015

Sharps containers are disposed of when they reach the limit mark V HF 2) Integrated Clinical Services Management (ICSM) 58 Sharps containers are disposed of when they reach the limit mark V HF YF 59 Sharps are disposed of in impenetrable, tamperproof containers 3) Pharmaceuticals and Laboratory Services 78 There is at least one functional wall mounted room thermometer in the medicine storage room/dispensary 79 The temperature of the medicine storage room/dispensary is kept is recorded daily 80 The temperature of the medicine storage room/dispensary is maintained within the safety range PF 81 There is a thermometer in the medicine refrigerator 82 The temperature of the medicine refrigerator is recorded daily 83 The temperature of the medicine refrigerator is maintained within the safety range 85 90% of the tracer medicines are available 90 Required functional diagnostic equipment and concurrent consumables are available 6) Infrastructure 147 Resuscitation room is equipped with functional basic equipment for resuscitation NF 148 Restore the emergency trolley daily or after every time it was used 149 There is a sealed sterile emergency delivery pack 151 Oxygen supply is available 153 There is consistant supply of clean, running water to the facility

Challenges that remain Infrastructure HRH (staff numbers, skills, management and leadership) Supply Chain At least 60% of budget for DHS

WHY WE WILL DO BETTER IN 2016/17

Plan for 2016/17 already in place National workshop in first week of April 2016 to ensure that national, 9 provinces and 52 districts all understand the plan and how it should be executed Peer Review served as additional training for district scale-up teams ICRM Manual Dedicated funding for ICRM

Funding and Support Partners Catalytic funding for: Automation of patient registration and filing systems European Union →HISP and HST ICSM European Union and CDC → HST, AURUM, BROADREACH USAID → BROADREACH Improving procurement of equipment CDC → ITECH ends March 2016 USAID → April 2016? Improving financial management at district and facility level USAID – SCMS

Funding and Support Partners Catalytic funding for: Improving Pharmaceutical supplies GLOBAL FUND set up of control tower USAID → SCMS supply chain systems CDC → HST CCMDD GATES FOUNDATION → Visual analytics network CHAI → Development of a system for contract management of manufacturers Issues relating to Human Resources for Health CDC → ITECH, BROADREACH, HST, ARUM, HISP Improving waiting times USAID → JSI Ideal Clinic Manual CDC → AURUM Pilot and guideline development of Ideal Clinic Branding CDC → Itech Change Management incorporating required training CDC → HST, AFRICA HEALTH PLACEMENTS? USAID ?

SPECIFIC PLAN FOR 2016/17 Work on 1000 additional clinics Clinics from 2015/16 must be added Focus on the NHI pilot districts with national funding because of Treasury Funding Framework Enable knock-on effect to other districts

THANK YOU FOR YOUR ATTENTION!