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

3. Background

4. WHY DID THE NDOH START THE IDEAL CLINIC PROGRAMME?

5. 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

10. 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

11. WHAT IS ANIDEAL CLINIC?

12. 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.

13. 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

14. 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

15. THE STUDY PHASE

16. 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

20. 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 We will also pilot this methodology to improve service delivery in our clinics nationwide, promoting Minister Motsoaledi’s Ideal Clinic Initiative.

21. IMPLEMENTATION STARTING APRIL 2015

22. 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

24. STATUS MAY AND DECEMBER 2015

27. 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

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

31. WHY WE WILL DO BETTER IN 2016/17

32. 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

33. 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

34. 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 ?

35. 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

36. THANK YOU FOR YOUR ATTENTION!