1. SCOPA - Health
16 May 2018

2. Findings on the pre-determined objectives
Programme 2: District Health Services
Indicator: Dtap-IPV/Hpv 3- Measles first dose drop-out rate The Department did not have an adequate performance management system to maintain records that enabled reliable reporting on achievement of targets. Sufficient appropriate audit evidence could not be provided in some instances, while in other cases the evidence that was provided did not agree to the recorded achievements. This resulted in a misstatement of the target achievement reported as the evidence provided indicated that it was 11,5% and not 13,8% (as stated). The AGSA was also unable to confirm the reported achievement by alternative means. Consequently, the AGSA was unable to determine whether any further adjustments were required to the reported achievements as reported in the annual performance report.
Interventions and progress:
Approval was requested and received from the NDOH and DotP to remove the indicator from the APP as it did not add value and due to a number of issues could not be logically interpreted (i.e. campaigns, stock outs, changed immunization schedule) resulting in a risk for the department. The APP was amended accordingly.
The indicator is still monitored operationally and as the roll out of the integrated stationery and PHCIS system progresses, electronic reporting using system rules will be possible resulting in more accurate data and evidence. (see next slide for detail on this)

3. Findings on the pre-determined objectives
Integrated stationery:
The department has developed, piloted and is in the process of implementing new integrated stationery which:
Facilitates continuity of care through it’s longitudinal design (last four encounters seen at once)
Promotes integration of care by prompting screening for and management of all chronic and episodic conditions
Facilitates the electronic capturing of clinical information directly from folder
Makes clinical audits easier
Allows for a ‘single document flow process’ for all folders – do not have to think about which folders need capturing and which don’t
Does away with paper registers and the requirement for the clinician to calculate days/weeks/months/years etc
PHCIS (Primary Health Care Information system):
The department has developed and piloted the next phase of PHCIS which can capture the data from the integrated stationery. PHCIS has been piloted, and further development and roll out will take place this year. Once data is captured, PHCIS can apply rules to identify services that comply with the data element/indicator definitions without relying on clinicians to check the correct box

4. Findings on the pre-determined objectives
Programme 2: District Health Services
Indicator: Mother postnatal visit within six days rate The reported achievement for the target mother postnatal visit within six days rate was misstated as the evidence provided indicated 51,4% and not 60% as reported in the annual performance report. This was due to postnatal visits after six days also being reported on.
Interventions and progress:
From a public health perspective, a visit occurring after 6 days still has the desired impact. However, the definition of the indicator does not allow for this flexibility when reporting. During the indicator review this year we will request the NDOH to build some flexibility into the definition to accommodate “late” visits.
Continuous training of staff on definitions.
Continuous checking of data by the internal control unit
Definitions in APP made available to clinicians on cell phones to check definitions
The indicator is still monitored operationally and as the roll out of the integrated stationery and PHCIS system progresses, electronic reporting using system rules will be possible resulting in more accurate data and evidence.