1. NHI Pilot Districts 12 months progress report
Parliament
4 June 2013

2. 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

3. 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

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

5. 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)

6. 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

7. 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%

8. 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%

9. 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%

10. 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

11. 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

12. 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%

13. 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

14. 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%

15. 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

16. 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)

17. 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