Description
Gauteng Health Turnaround Strategy Towards Effective Service Delivery, Strengthening Primary Health Care And A Clean Audit In 2014
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS
EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
TABLE OF CONTENTS
1. INTRODUCTION 5
2. OBJECTIVES 8
3. THE EIGHT CORE CHALLENGE AREAS ADDRESSED
THROUGH THE GAUTENG HEALTH TURNAROUND STRATEGY 8
4. THE FIVE PILLARS OF THE GAUTENG HEALTH TURNAROUND
STRATEGY 12
5. TEN POINT ACTION PLAN FOR THE GAUTENG HEALTH
TURNAROUND STRATEGY (2012 -2014): 13
6. CONTEXT 13
6.1 The Profle Of Health In Gauteng And The Priorities Impacting
On This Turnaround Strategy 13
7. GAUTENG HEALTH TURNAROUND STRATEGY 14
7.1 FInAnce And FInAncIAl MAnAGeMenT 14
7.1.1 Challenge 14
7.1.2 The Plan 15
7.2 HuMAn ReSOuRceS MAnAGeMenT And develOPMenT 17
7.2.1 The Challenge 17
7.2.2 The Plan 18
7.3 dISTRIcT HeAlTH SeRvIceS FOR PRIMARy HeAlTH cARe 19
7.3.1 The Challenge 19
7.3.2 The Plan 20
7.4 HOSPITAl MAnAGeMenT 22
7.4.1 The Challenge 22
7.4.2 The Plan 23
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
4 5
7.5 MedIcO-leGAl SeRvIceS And lITIGATIOn 24
7.5.1 The Challenge 24
7.5.2 The Plan 25
7.6 HeAlTH InFORMATIOn MAnAGeMenT And HeAlTH
InFORMATIOn SySTeMS 26
7.6.1 The Challenge 26
7.6.2 The plan 27
7.7 cOMMunIcATIOn And SOcIAl MOBIlISATIOn 28
7.7.1 The challenge 28
7.7.2 The plan 29
7.8 HeAlTH InFRASTRucTuRe MAnAGeMenT And
develOPMenT 30
7.8.1 The Challenge 30
7.8.2 The Plan 31
8. WAY FORWARD 32
APPendIx [1] 33
APPendIx [2] 35
GAUTENG HEALTH
TURNAROUND STRATEGY:
“TOWARdS eFFecTIve SeRvIce delIveRy,
STRenGTHenInG PRIMARy HeAlTH cARe And A
cleAn AudIT In 2014.”
1 INTRODUCTION
The challenges, solutions and plans identifed and acknowledged throughout this
Turnaround Strategy refect the inputs of the Gauteng Provincial Government,
the Memorandum of Agreement with national Government, and the contribution
of GdoH employees and stakeholders. They refect the realization that the
department is facing a serious situation entering the new fnancial year, and that
there are challenges, particularly related to fnancial management. The Gauteng
department of Health (GdoH) seeks to intensify the realization of the objectives
articulated in the department’s Strategic Plan for the Fiscal years 2009-2014.
The department has achieved considerable success in recent years through
health-related interventions focussed on specifc high-priority areas:
- An increase in life expectancy (56.9 in 2005 to 60.5 in 2011) attributable
to the roll out of antiretroviral drugs since 2004
- A substantial reduction in AIdS-related deaths;
- A fall in the rate of increase in HIv infections;
- HIv-related maternal mortality is 15% below the national average in
2008-2010; and
- TB cure rates are improving
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
6 7
Previous turnaround strategies of the department have focused on improving
these outcomes and have borne some fruits. The recently adopted Provincial
Strategic Plan for HIv, TB and STIs should ensure sustained and improved
progress regarding these diseases.
However, there has been less progress nationally and in the province on
improving health system effectiveness. It is clearly the area where the GdoH is
facing challenges.
These challenges are outlined in the Auditor General’s (AG) reports of 2009/10
and 2010/11. In 2009/10, the AG’s report returned a disclaimer on a broad range
of issues.
The AG audit opinion improved in 2010/11 to a qualifed audit with 3 qualifcations,
focused on fnance and fnancial management:
? Tangible assets
? Revenue and Receivables
? employee benefts.
In addition, an opinion on the Audit of Performance Information (2010/11)
identifed serious challenges:
? The reported performance information was defcient in respect of
validity, accuracy and completeness
? Suffcient appropriate evidence in relation to the selected programmes
could not be obtained.
? Suffcient appropriate evidence to support the reasons for major
variances between the planned and the actual reported targets could
not be obtained.
The Gauteng Provincial Government analysed these challenges. The Premier’s
Budget council (PBc) and the Provincial executive council (excO) approached
the national government with a request for assistance in the areas mainly of
fnance management to ensure adherence to the Public Finance Management
Act (PFMA) and to ensure availability of resources for Health in the Province.
engagements on the situation of the Health department within the Province and
with the national government pointed to the urgent need for the development
and vigorous implementation of a Turnaround Strategy for Health in Gauteng.
The Turnaround Strategy is to cover 2012 to 2014 of the current Medium Term
expenditure Framework (MTeF) period and should be implemented from June
2012.
The Turnaround Strategy will address the challenges identifed by the
department, the AG, the PBc and the Provincial excO. The 8 core problem
areas that the strategy is focused on are:
1. Finance and fnancial management;
2. Human resources Management and development;
3. district health services for Primary Health care;
4. Hospital management;
5. Medico-legal services and litigation;
6. Health information management and health information systems;
7. communication and social mobilization; and
8. Health infrastructure Management and development
A provincial consultation conference on the Turnaround was held on 1 and 2
March 2012 in order to understand the specifc challenges in each of these
problem areas in more detail. This conference was attended by service providers,
services users and other critical partners, whose input has enhanced the content
and direction of this Turnaround Strategy. Implementation of the interventions
described in this document should provide a common vision, introduce internal
discipline, ensure a stronger, healthier, more effcient organization, and ultimately
improved service delivery for even better health outcomes in the Province.
The on-going support of the Gauteng Provincial Government in this process is
acknowledged. The executive Authority through the Accounting Offcer takes
personal responsibility for implementation of the measures outlined in this
document, and will ensure regular reports.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
8 9
2 OBJECTIVES
The Turnaround Strategy coincides with the appointment of the new Head of
department (Hod) for Health and the Provincial excO decision to demerge the
departments of Health and Social development.
The interventions outlined in this turnaround strategy should lead to more
effective utilization of available resources by the department; the clearing of
debt and accruals; delivery within allocated budgets; improvement of health
outcomes, entrenchment of the desired organization culture and enhanced
internal discipline throughout the organization; and improved public and partner
confdence.
The Turnaround Strategy will build on work that is already under way through
the departmental Strategy 2009-2014 to tackle some of the issues described in
this document, including work resulting from:
- A Memorandum of Agreement (MOA) between the GPG and the
national Government’s departments of Health and Finance to address
issues relating to Health in Gauteng Province
- The decisions of the Premier’s Budget council (PBc) meeting of
October 2011; and
- The Provincial Finance lekgotla held in december 2011.
The detail of these agreements and the work that has resulted from them is in
Appendix 1 to this document.
3 THE EIGHT CORE CHALLENGE AREAS
ADDRESSED THROUGH THE GAUTENG
HEALTH TURNAROUND STRATEGY
1. Finance and Financial management
• effective Budget implementation and management.
• clearing Accruals and debt.
• ensure adequate funding for Health Services.
• effcient and effective contract management.
• value for money / cost containment.
• effcient Revenue / debt collection.
• Improving management of assets.
• Adherence to PFMA requirements for risk reduction.
• Re-engineering of the Medical Supplies depot (MSd) to address
procurement and management concerns
• effective management of conditional grants.
2. Human Resources Management and Development
• Rationalisation of staff establishment to management expenditure on
employees and provide good quality health services.
• Accelerate flling of vacant funded posts in key health professional categories
(e.g. professional nurses, doctors, pharmacists, and pharmacist assistants).
• Increase productivity and accountability through effective performance
management.
• Tighten management of overtime and RWOPS for best value for the
organisation.
3. District Health Services for Primary Health Care
• Align budget and human resources to priorities to support district Health
Services.
• Standardisation of levels of management in PHc facilities including district
hospitals.
• effective integration and standardization of community Health Workers.
• Provide supportive health infrastructure development for district Health Services.
• Streamline the provision of Primary Health care across all spheres of
government.
• ensure responsive emergency Medical Services and infrastructure systems
including for Planned Patient Transportation.
• Train more PHc clinicians, advanced midwives and pharmacy assistants.
4. Hospital Management
• Strengthen management of resources (human, fnancial and material) in
hospitals.
• Intensify public education for appropriate utilisation of health services and
establishment of effective district-based referral systems.
• Build Health Information Systems (management programme and
infrastructure).
• Provide and maintain the necessary hospital physical infrastructure.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
10 11
5. Medico legal services and litigation
• Reduce rates of adverse events and medical negligence, especially in
Obstetrics and Gynaecology, Surgery, emergency units and Orthopaedics.
• Reduce contingent liabilities from litigation costs.
• Reduce work environment related risk - source constraints (e.g. breakdowns
of equipment, unavailability of commodities or equipment); human resources
issues such as high patient / health professional ratios, health professional
burnout and low morale, health professionals (nurses) ignorance of patients
and the seriousness of patients medical condition; increased patient volume
and disease burden, and utilization of junior staff (Interns and community
Service doctors) with poor supervision and Support.
• command necessary support from the Offce of the State Attorney.
6. Health Information Management and Health Information System
• update technology equipment and lAn, and provide support and
maintenance on equipment.
• enhance connectivity in all facilities to improve effciency.
• Streamline systems for unifed Health Information System.
• develop and implement a unifed Patients’ records across the system.
• Mainstream Information Management and accountability.
• Overhaul MedSAS to improve effciency of Pharmaceutical Services
throughout the system.
7. Communication and Social Mobilisation
• clearly articulated communication strategy
• Mainstreaming of communication management throughout the organization.
• Access to credible and reliable information to reduce the risk of
miscommunication.
• Streamline responses to complaints from the public for positive media
publicity.
8. Health Infrastructure Management and Development
• Health infrastructure refurbishment and rehabilitation.
• Improve expenditure on capital projects (construction and maintenance).
• ensure accountability for infrastructure project planning to reduce the risk of
delays and scope and budget increases.
• Raise capacity for effective project management.
• Manage critical stakeholders such as the department of Infrastructure
development (dId) to improve performance on health infrastructure.
The detailed interventions to address these challenges are described in detail
in [chapters 3 to 10].
Work done with KPMG on Change Management will support the implementation
of the Turnaround Strategy.
Recommendatons will cover the following work streams:
• Strategic leadership as it pertains to;
o The relationship between the department’s corporate leadership
and the leadership of the healthcare delivery organizations
throughout the system; in particular;
? delegation and decision making
? Support and trust
? The impact of these factors on service delivery
o Monitoring mechanisms for organisational performance and
management
o The culture and values of the department and how they
translate to service delivery organizations
• Organisational performance and HR management
o Workforce analysis focused on absenteeism, replacement cost
and overtime
o HR processes relating to appointments, payroll, overtime and
budgeting
o A high-level HR function delivery plans and departmental
strategic goals
o Performance agreements
o An assessment of how cultural challenges impact upon patient
care.
• Finance
o The ability of the Finance unit to focus on key priorities
o challenges identifed by the AG and in the Turnaround
consultative conference
o Annual Financial Statement preparation report, inclusive of
supporting schedules
o Transaction controls involving revenue
o Budget support.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
12 13
• Supply chain and procurement
o Analysis of the supply chain as an end-to-end process and
existing procurement processes
o Assessment of value for money achieved on the highest impact
procurement items
o Analysis of the current procurement strategy and supply chain
management policy.
4 THE FIVE PILLARS OF THE GAUTENG HEALTH
TURNAROUND STRATEGY
? Strategic leadership and desirable organisational culture
? environmental controls for good governance
? communication and Social Mobilisation
? Human resources management and development
? Health Infrastructure development and rehabilitation.
5 TEN POINT ACTION PLAN FOR THE GAUTENG
HEALTH TURNAROUND STRATEGY (2012 -2014):
1. Provide Strategic leadership
2. Resource Health Services with intensifed focus on Primary Health
care Services
3. Manage fnances and people
4. effective management of contracts and partners
5. Provide Information communication and Technology Infrastructure
6. Manage Information
7. Rehabilitate and Revitalise Health Infrastructure
8. communicate and Mobilise communities
9. Generate Revenue
10. Improve Health Outcomes
6 CONTEXT
6.1 The profle of health in Gauteng and the priorities impacting
on this Turnaround Strategy
Gauteng is the largest province with a population estimated at 11.1 million people,
or 22% of the South African population, with 19.3% (3 million) being younger
than 15 years of age. While Gauteng has a comparatively large proportion of
people who have private health insurance (25%), 7.7 million are uninsured and
depend entirely on the public health sector.
Gauteng is highly urbanised, with 97% of the population living in urban centres,
and is characterised by high levels of inequality, with (formal) unemployment at
23%, and 22% of the population living in informal housing. Gauteng has a high
proportion of migrants and immigrants, and provides services to thousands from
other provinces and countries.
The province is faced with a quadruple burden of disease: illnesses of poverty
(communicable diseases) existing side by side with illnesses of developed
countries (non-communicable diseases). The burden of disease is exacerbated
by the impact of the HIv and AIdS epidemic and TB, including MdR and xdR
TB, and also by injuries resulting from violence and trauma.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
14 15
Health services in the Province are provided through regional, district, tertiary,
specialised and central hospitals; across fve health districts, both rural and
urban; and through community health centres and clinics run by both the
department of Health and by local government.
The challenges described in this document and the initiatives to tackle them
must all be considered in light of the priorities set for the department by:
- The Millennium development Goals;
- The national Health System Priorities 2009-14 (the 10-point plan);
- The negotiated Service delivery Agreement (nSdA) of the ndoH;
- The draft Service Transformation Plan (2010-2020); and
- The Gauteng Provincial Government outcomes 2009-14
Healthcare delivery in the province is therefore complex and making signifcant
performance improvement throughout the whole system requires the
collaboration of all of the organisations involved in the system, as well as a
range of important stakeholders.
Further details about the profle of the health system in Gauteng and the details
of the priorities that shape the strategic direction of the department are set out
in Appendix 2.
7 GAUTENG HEALTH TURNAROUND STRATEGY
7.1 FINANCE AND FINANCIAL MANAGEMENT
7.1.1 Challenge
• Maximisation of outputs and deliverables with the limited inputs and
available resources - Target cost savings to the value of R2bn in 2012/13
• Avoid Accruals and debt.
• ensure adequate budget for Health in 2013/2014
• effective and effcient revenue and debt management
• Improving Asset Management.
• Risk Reduction Management
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
16 17
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7.2 HUMAN RESOURCES MANAGEMENT AND DEVELOPMENT
7.2.1 The Challenge
• Rationalisation of staff establishment to manage expenditure on
employees and provide good quality health services.
• Accelerate flling of vacant funded posts in key health professional
categories (e.g. professional nurses, doctors, pharmacists, and pharmacist
assistants).
• Increase productivity and accountability through effective performance
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• Tighten management of overtime and RWOPS for best value for the
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• Align Human Resource development Plans with the Strategic direction
of the department
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
18 19
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7.3 DISTRICT HEALTH SERVICES FOR PRIMARY HEALTH CARE
7.3.1 The Challenge
• Align budget and human resources to prioritise district Health Services
and implement the Primary Health care Re-engineering programme.
• Standardisation of levels of management in PHc facilities including district
hospitals.
• effective integration and standardization of community Health Workers.
• Provide supportive health infrastructure development for district Health
Services.
• Streamline the provision of Primary Health care across all spheres of
government.
• ensure responsive emergency Medical Services and infrastructure
systems including for Planned Patient Transportation.
• Train more PHc clinicians, advanced midwives and pharmacy assistants.
• Mobilise and support leadership structures of society and communities
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
20 21
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
22 23
7.4 HOSPITAL MANAGEMENT
7.4.1 The challenge
• Strengthen governance and environmental control systems in hospitals.
• Build facilitative relationships among all cadres of Health Service
Providers.
• Pay special attention to challenges confronted by nurses.
• Intensify public education for appropriate utilisation of health services and
establishment of effective district-based referral systems.
• Build Health Information Systems (management programme and
infrastructure).
• Provide and maintain the necessary hospital physical infrastructure.
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
24 25
7.5 MEDICO-LEGAL SERVICES and LITIGATION.
7.5.1 The Challenge
• Reduce rates of adverse events and medical negligence, especially in
Obstetrics and Gynaecology, Surgery, emergency units and Orthopaedics.
• Build capacity for effective management of medico-legal cases.
• command the necessary support from the Offce of the State Attorney.
7
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
26 27
7.6 HEALTH INFORMATION MANAGEMENT AND HEALTH
INFORMATION SYSTEMS.
7.6.1 The Challenge
• Provide Strategic direction for Health Information Systems
• update technology equipment and lAn, and provide support and
maintenance on equipment.
• enhance connectivity in all facilities to improve effciency.
• Streamline systems for unifed Health Information System.
• develop and implement a unifed Patients’ records across the system.
• Mainstream Information Management and accountability.
• Overhaul MedSAS to improve effciency of Pharmaceutical Services
throughout the system.
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
28 29
7.7 COMMUNICATION AND SOCIAL MOBILISATION
7.7.1 The challenge
• clearly articulated communication strategy
• Mainstreaming of communication management throughout the
organization.
• Access to credible and reliable information to reduce the risk of
miscommunication.
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publicity.
7
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
30 31
7.8 HEALTH INFRASTRUCTURE MANAGEMENT AND
DEVELOPMENT
7.8.1 The Challenge
• Health infrastructure refurbishment and rehabilitation.
• Improve expenditure on capital projects (construction and maintenance).
• ensure accountability for infrastructure project planning to reduce the risk
of delays and scope and budget increases.
• Raise capacity for effective project management.
• Manage critical stakeholders such as the department of Infrastructure
development (dId) to improve performance on health infrastructure.
• Mainstream economic opportunity identifcation for localization,
benefaction and ownership of local communities
7
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
32 33
8 WAY FORWARD
The Gauteng Health Turnaround Strategy will be introduced to a broad
stakeholder workshop for buy-in. Performance agreements of all senior
managers, ceOs of hospitals, district and facility managers will include result
areas for the implementation of the Turnaround Strategy. It will be made available
on the intranet to all employees. Road shows will be conducted in all districts
and central hospitals
All operational plans will mainstream the implementation of the Gauteng Health
Turnaround Strategy.
A Monitoring and evaluation Framework to track progress and report on
outcomes is being developed.
Quarterly reports will be provided to the Gauteng Provincial Government
executive council.
Appendix 1
There are a number of important agreements and resolutions that have informed
this Turnaround Strategy:
• From the MOA, obligations of the GPG are to undertake to;
• Restructure the Provincial dHSd and establish the Provincial
department of Health as a standalone Provincial department,
• Put special measures in place to ensure that the Provincial doH
does not contravene the PFMA when planning and implementing
the budget,
• ensure that there is a comprehensive turnaround strategy by the
end of March 2012, ready for implementation in 2012/13,
• Recover all debts owed to the provincial dHSd within the 2012/13
fnancial year and develop a sustainable reimbursement mechanism.
• From the MOA, obligations of the National Government are to
undertake to;
• Assist the provincial department of health with appropriate analysis
of the base data for problem diagnosis and intervention,
• Support the provincial department of health with appropriate
institutional and procedural arrangements for the intervention areas
identifed,
• Support the provincial department of health with the effcient
administration of central hospitals,
• Provide support for the effcient administration and management of
central hospitals and their transition towards an integrated national
approach consistent with the national Health Act
• Assist the provincial department of health with the development
and implementation of a migration plan of the Health Information
System (HIS),
• Provide integrated support to the provincial department of health and
strengthening primary health care (PHc) services as preparation
towards national Health Insurance (nHI).
• national Treasury to provide assistance and guidance in areas of
supply chain management in the provincial department of health.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
34 35
• PBC Decisions (October 2011)
• Increase delegations for ceOs to manage maintenance at hospital
level
• Resolve procurement and management concerns at the Medical
Supplies depot
• Strengthen management and outcomes of emergency Medical
Services
• Address medico-legal and litigation issues
• Provide a plan around continuing with the provincialisation process
• Act on corruption
• Address Human Resources issues, including rationalization and
strengthening controls of overtime.
• Extended Finance Lekgotla Decisions (11 November 2011)
• GdF to identify possible under spending and ensure surrender to
Provincial Revenue Fund for possible reallocation to Health
• Infrastructure slow spending to identify projects that can be fast
tracked and show quick wins
• GdF should develop a process to clear and minimize accruals
within the current budget and over the MTeF
• Allocation of infrastructure budget only to project that are ready
• 5% top slice health personnel budget 2012/13
• GdF and Health to collaborate the ensure that the central hospitals
are functional
• 3% top slice (hair –cut) in provincial equitable Share budget to
fnance, and set aside in the Provincial Revenue Fund (PRF) for
paying accruals
• dGF and Health to manage debt and collect about R800 million
owed
• GdF and Health to formulate an action plan for clearing accruals
• engage service providers with regards to their payments and
negotiating uninterrupted supply of goods and services
• Stringent conditions to be put in place to ensure that no further
accruals are incurred after the intervention
• clearing of accruals will be managed with Treasury.
Appendix 2
The context of health in Gauteng
Vital statistics
• life expectancy at birth: 60.5 (2011)
• Maternal mortality rate: Preliminary data for the period 2008-2011 shows
an improvement in the maternal mortality rate, suggesting it is now 147 per
100,000 live births for the triennium 2008 -2010 (compared to 167/100,000
in the previous Triennial Report 2004-07)
• Perinatal Mortality Rate: 33.5 / 1 000
• neonatal Mortality Rate: 11.7 / 1 000
• under fve mortality Rate: 34 / 1000
• HIv prevalence: 15.2% among 15-49 years old (HSRc 2008)
• TB cure rate: 82%.
Non-communicable diseases: top 11 diagnoses upon admission to
hospital in Gauteng:
• Respiratory conditions, such as bronchopneumonia, pneumonia and lower
respiratory tract infection (18.4%)
• carcinoma (15.8%)
• cardiac disease (14%)
• Renal disease (11.2%)
• Hypertension (7.6%)
• epilepsy (6.9%)
• diabetes (3.2%)
• Mental health conditions (2.8%).
• A quarter (23.3%) of adult women and 8.3% of adult men were found to be
obese (dept of Health & MRc 2008).
Service Platform
Health services in the Province are provided through:
? 137 provincial and 180 local government clinics (with mobile units in
some instances)
? Thirty fve community Health centres
? Five Health districts
? eleven district hospitals
? eight Regional Hospitals
? Three (3) Tertiary Hospitals
? Four central Hospitals
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
36 37
? Six specialised hospitals (4 Psychiatric, 1 Rehab and 1 MdR)
? Three (3) Oral Health centres.
Additional project-based work is done by various not-for-proft organisations the
province.
The priorities informing the strategic direction of the Department
The strategic direction of the department is shaped by the following priorities:
Millennium Development Goals (MDGs)
All the eight MdGs and in particular;
• Goal 4: Reduce child Mortality
? Reduce by two-thirds, between 1990 and 2015, the under-
fve mortality rate: Targets: Reduce child mortality from 43 per
1000 (2009) to 30 per 1000, and infant mortality from 34 per
1000 (2009) to 25 per 1000 by 2014.
• Goal 5: Improve Maternal Health
• Reduce by three-quarters, between 1990 and 2015, the
maternal mortality rate Targets: Reduce the maternal mortality
ratio from 167.6 per 100,000 (2009) to 100 per 100,000 by
2014.
• Goal 6: combat HIv and AIdS, malaria and other diseases
• Have halted by 2015, and begin to reverse the spread of HIv
and AIdS
• Have halted by 2015, and begin to reverse the incidence of
malaria and other major diseases
• Targets: Reduce new HIV infections by 50% by 2014, and
increase the TB cure rate from 76% in 2009 to 83% in 2014.
National Health System Priorities 2009-14 (10 Point Plan).
1. Provision of Strategic leadership and creation of Social compact for
better health outcomes.
2. Implementation of the national Health Insurance.
3. Improving the Quality of Health Services.
4. Overhauling the health care system and improve its management.
5. Improvement of Human Resources.
6. Revitalization of infrastructure.
7. Accelerated implementation of the HIv and AIdS strategic plan and the
increased focus on TB and other communicable diseases.
8. Mass mobilisation for the better health for the population.
9. Review of drug policy.
10. Research and development.
Negotiated Service Delivery Agreement (NSDA) of the NDOH.
All the four agreed priorities and in particular the focus of the current fnancial
year on improving health system effectiveness.
• Increasing life expectancy (reducing mortality rates)
• combating HIv and AIdS
• Reducing the burden of disease from TB
• Improving health system effectiveness.
Draft Service Transformation Plan (2010-2020)
? The draft STP sets out the infrastructure and human resource
requirements that would be necessary to re-engineer Primary Health
care and shift the focus from a hospi-centric model to a focus on PHc;
? The STP aims to increase utilisation of PHc services through
extended hours, offering the full package of services, providing
additional clinics and extra consulting rooms, and improving quality.
? It also aims to implement referral systems, provide and/or expand
PHc and level 1 hospitals in under-serviced areas, and increase
‘outreach’ from hospitals to other facilities to take services to where
people are.
Gauteng Provincial Government outcomes 2009-14
1. Quality basic education.
2. A long and healthy life for all South Africans.
3. decent employment through inclusive economic growth.
4. All people in South Africa are and feel safe.
5. vibrant, equitable, sustainable rural communities contributing towards
food security for all.
6. Sustainable human settlements and improved quality of household life
education.
7. Responsive, accountable, effective and effcient local Government
system.
8. An effcient, effective and development oriented public service and an
empowered, fair and inclusive citizenship.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
38
The Strategic Plan of the Gauteng Department of Health and Social
Development 2009-2014
Vision
To be the best provider of quality health and social services to the people in
Gauteng.
Mission
The GdHSd aims to provide excellent, integrated health and social development
services in partnership with stakeholders to contribute towards the reduction of
poverty, vulnerability and the burden of disease in all communities in Gauteng.
Values
? Batho Pele principles
? excellence
? Integrity
? Humility
? Selfessness
? Respect
? Social Justice
Goals and Strategic Objectives
1. Improved health and well being with an emphasis on vulnerable groups.
2. a) Reduce the rate of new HIv infections by 50% in youth, adults and babies
b) Reduce deaths from TB and AIdS by 20%
3. Increased effciency of service implementation.
4. Human capital management and development (for better service delivery
outcomes).
5. Organisational excellence.
doc_149339651.pdf
Gauteng Health Turnaround Strategy Towards Effective Service Delivery, Strengthening Primary Health Care And A Clean Audit In 2014
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS
EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
TABLE OF CONTENTS
1. INTRODUCTION 5
2. OBJECTIVES 8
3. THE EIGHT CORE CHALLENGE AREAS ADDRESSED
THROUGH THE GAUTENG HEALTH TURNAROUND STRATEGY 8
4. THE FIVE PILLARS OF THE GAUTENG HEALTH TURNAROUND
STRATEGY 12
5. TEN POINT ACTION PLAN FOR THE GAUTENG HEALTH
TURNAROUND STRATEGY (2012 -2014): 13
6. CONTEXT 13
6.1 The Profle Of Health In Gauteng And The Priorities Impacting
On This Turnaround Strategy 13
7. GAUTENG HEALTH TURNAROUND STRATEGY 14
7.1 FInAnce And FInAncIAl MAnAGeMenT 14
7.1.1 Challenge 14
7.1.2 The Plan 15
7.2 HuMAn ReSOuRceS MAnAGeMenT And develOPMenT 17
7.2.1 The Challenge 17
7.2.2 The Plan 18
7.3 dISTRIcT HeAlTH SeRvIceS FOR PRIMARy HeAlTH cARe 19
7.3.1 The Challenge 19
7.3.2 The Plan 20
7.4 HOSPITAl MAnAGeMenT 22
7.4.1 The Challenge 22
7.4.2 The Plan 23
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
4 5
7.5 MedIcO-leGAl SeRvIceS And lITIGATIOn 24
7.5.1 The Challenge 24
7.5.2 The Plan 25
7.6 HeAlTH InFORMATIOn MAnAGeMenT And HeAlTH
InFORMATIOn SySTeMS 26
7.6.1 The Challenge 26
7.6.2 The plan 27
7.7 cOMMunIcATIOn And SOcIAl MOBIlISATIOn 28
7.7.1 The challenge 28
7.7.2 The plan 29
7.8 HeAlTH InFRASTRucTuRe MAnAGeMenT And
develOPMenT 30
7.8.1 The Challenge 30
7.8.2 The Plan 31
8. WAY FORWARD 32
APPendIx [1] 33
APPendIx [2] 35
GAUTENG HEALTH
TURNAROUND STRATEGY:
“TOWARdS eFFecTIve SeRvIce delIveRy,
STRenGTHenInG PRIMARy HeAlTH cARe And A
cleAn AudIT In 2014.”
1 INTRODUCTION
The challenges, solutions and plans identifed and acknowledged throughout this
Turnaround Strategy refect the inputs of the Gauteng Provincial Government,
the Memorandum of Agreement with national Government, and the contribution
of GdoH employees and stakeholders. They refect the realization that the
department is facing a serious situation entering the new fnancial year, and that
there are challenges, particularly related to fnancial management. The Gauteng
department of Health (GdoH) seeks to intensify the realization of the objectives
articulated in the department’s Strategic Plan for the Fiscal years 2009-2014.
The department has achieved considerable success in recent years through
health-related interventions focussed on specifc high-priority areas:
- An increase in life expectancy (56.9 in 2005 to 60.5 in 2011) attributable
to the roll out of antiretroviral drugs since 2004
- A substantial reduction in AIdS-related deaths;
- A fall in the rate of increase in HIv infections;
- HIv-related maternal mortality is 15% below the national average in
2008-2010; and
- TB cure rates are improving
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
6 7
Previous turnaround strategies of the department have focused on improving
these outcomes and have borne some fruits. The recently adopted Provincial
Strategic Plan for HIv, TB and STIs should ensure sustained and improved
progress regarding these diseases.
However, there has been less progress nationally and in the province on
improving health system effectiveness. It is clearly the area where the GdoH is
facing challenges.
These challenges are outlined in the Auditor General’s (AG) reports of 2009/10
and 2010/11. In 2009/10, the AG’s report returned a disclaimer on a broad range
of issues.
The AG audit opinion improved in 2010/11 to a qualifed audit with 3 qualifcations,
focused on fnance and fnancial management:
? Tangible assets
? Revenue and Receivables
? employee benefts.
In addition, an opinion on the Audit of Performance Information (2010/11)
identifed serious challenges:
? The reported performance information was defcient in respect of
validity, accuracy and completeness
? Suffcient appropriate evidence in relation to the selected programmes
could not be obtained.
? Suffcient appropriate evidence to support the reasons for major
variances between the planned and the actual reported targets could
not be obtained.
The Gauteng Provincial Government analysed these challenges. The Premier’s
Budget council (PBc) and the Provincial executive council (excO) approached
the national government with a request for assistance in the areas mainly of
fnance management to ensure adherence to the Public Finance Management
Act (PFMA) and to ensure availability of resources for Health in the Province.
engagements on the situation of the Health department within the Province and
with the national government pointed to the urgent need for the development
and vigorous implementation of a Turnaround Strategy for Health in Gauteng.
The Turnaround Strategy is to cover 2012 to 2014 of the current Medium Term
expenditure Framework (MTeF) period and should be implemented from June
2012.
The Turnaround Strategy will address the challenges identifed by the
department, the AG, the PBc and the Provincial excO. The 8 core problem
areas that the strategy is focused on are:
1. Finance and fnancial management;
2. Human resources Management and development;
3. district health services for Primary Health care;
4. Hospital management;
5. Medico-legal services and litigation;
6. Health information management and health information systems;
7. communication and social mobilization; and
8. Health infrastructure Management and development
A provincial consultation conference on the Turnaround was held on 1 and 2
March 2012 in order to understand the specifc challenges in each of these
problem areas in more detail. This conference was attended by service providers,
services users and other critical partners, whose input has enhanced the content
and direction of this Turnaround Strategy. Implementation of the interventions
described in this document should provide a common vision, introduce internal
discipline, ensure a stronger, healthier, more effcient organization, and ultimately
improved service delivery for even better health outcomes in the Province.
The on-going support of the Gauteng Provincial Government in this process is
acknowledged. The executive Authority through the Accounting Offcer takes
personal responsibility for implementation of the measures outlined in this
document, and will ensure regular reports.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
8 9
2 OBJECTIVES
The Turnaround Strategy coincides with the appointment of the new Head of
department (Hod) for Health and the Provincial excO decision to demerge the
departments of Health and Social development.
The interventions outlined in this turnaround strategy should lead to more
effective utilization of available resources by the department; the clearing of
debt and accruals; delivery within allocated budgets; improvement of health
outcomes, entrenchment of the desired organization culture and enhanced
internal discipline throughout the organization; and improved public and partner
confdence.
The Turnaround Strategy will build on work that is already under way through
the departmental Strategy 2009-2014 to tackle some of the issues described in
this document, including work resulting from:
- A Memorandum of Agreement (MOA) between the GPG and the
national Government’s departments of Health and Finance to address
issues relating to Health in Gauteng Province
- The decisions of the Premier’s Budget council (PBc) meeting of
October 2011; and
- The Provincial Finance lekgotla held in december 2011.
The detail of these agreements and the work that has resulted from them is in
Appendix 1 to this document.
3 THE EIGHT CORE CHALLENGE AREAS
ADDRESSED THROUGH THE GAUTENG
HEALTH TURNAROUND STRATEGY
1. Finance and Financial management
• effective Budget implementation and management.
• clearing Accruals and debt.
• ensure adequate funding for Health Services.
• effcient and effective contract management.
• value for money / cost containment.
• effcient Revenue / debt collection.
• Improving management of assets.
• Adherence to PFMA requirements for risk reduction.
• Re-engineering of the Medical Supplies depot (MSd) to address
procurement and management concerns
• effective management of conditional grants.
2. Human Resources Management and Development
• Rationalisation of staff establishment to management expenditure on
employees and provide good quality health services.
• Accelerate flling of vacant funded posts in key health professional categories
(e.g. professional nurses, doctors, pharmacists, and pharmacist assistants).
• Increase productivity and accountability through effective performance
management.
• Tighten management of overtime and RWOPS for best value for the
organisation.
3. District Health Services for Primary Health Care
• Align budget and human resources to priorities to support district Health
Services.
• Standardisation of levels of management in PHc facilities including district
hospitals.
• effective integration and standardization of community Health Workers.
• Provide supportive health infrastructure development for district Health Services.
• Streamline the provision of Primary Health care across all spheres of
government.
• ensure responsive emergency Medical Services and infrastructure systems
including for Planned Patient Transportation.
• Train more PHc clinicians, advanced midwives and pharmacy assistants.
4. Hospital Management
• Strengthen management of resources (human, fnancial and material) in
hospitals.
• Intensify public education for appropriate utilisation of health services and
establishment of effective district-based referral systems.
• Build Health Information Systems (management programme and
infrastructure).
• Provide and maintain the necessary hospital physical infrastructure.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
10 11
5. Medico legal services and litigation
• Reduce rates of adverse events and medical negligence, especially in
Obstetrics and Gynaecology, Surgery, emergency units and Orthopaedics.
• Reduce contingent liabilities from litigation costs.
• Reduce work environment related risk - source constraints (e.g. breakdowns
of equipment, unavailability of commodities or equipment); human resources
issues such as high patient / health professional ratios, health professional
burnout and low morale, health professionals (nurses) ignorance of patients
and the seriousness of patients medical condition; increased patient volume
and disease burden, and utilization of junior staff (Interns and community
Service doctors) with poor supervision and Support.
• command necessary support from the Offce of the State Attorney.
6. Health Information Management and Health Information System
• update technology equipment and lAn, and provide support and
maintenance on equipment.
• enhance connectivity in all facilities to improve effciency.
• Streamline systems for unifed Health Information System.
• develop and implement a unifed Patients’ records across the system.
• Mainstream Information Management and accountability.
• Overhaul MedSAS to improve effciency of Pharmaceutical Services
throughout the system.
7. Communication and Social Mobilisation
• clearly articulated communication strategy
• Mainstreaming of communication management throughout the organization.
• Access to credible and reliable information to reduce the risk of
miscommunication.
• Streamline responses to complaints from the public for positive media
publicity.
8. Health Infrastructure Management and Development
• Health infrastructure refurbishment and rehabilitation.
• Improve expenditure on capital projects (construction and maintenance).
• ensure accountability for infrastructure project planning to reduce the risk of
delays and scope and budget increases.
• Raise capacity for effective project management.
• Manage critical stakeholders such as the department of Infrastructure
development (dId) to improve performance on health infrastructure.
The detailed interventions to address these challenges are described in detail
in [chapters 3 to 10].
Work done with KPMG on Change Management will support the implementation
of the Turnaround Strategy.
Recommendatons will cover the following work streams:
• Strategic leadership as it pertains to;
o The relationship between the department’s corporate leadership
and the leadership of the healthcare delivery organizations
throughout the system; in particular;
? delegation and decision making
? Support and trust
? The impact of these factors on service delivery
o Monitoring mechanisms for organisational performance and
management
o The culture and values of the department and how they
translate to service delivery organizations
• Organisational performance and HR management
o Workforce analysis focused on absenteeism, replacement cost
and overtime
o HR processes relating to appointments, payroll, overtime and
budgeting
o A high-level HR function delivery plans and departmental
strategic goals
o Performance agreements
o An assessment of how cultural challenges impact upon patient
care.
• Finance
o The ability of the Finance unit to focus on key priorities
o challenges identifed by the AG and in the Turnaround
consultative conference
o Annual Financial Statement preparation report, inclusive of
supporting schedules
o Transaction controls involving revenue
o Budget support.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
12 13
• Supply chain and procurement
o Analysis of the supply chain as an end-to-end process and
existing procurement processes
o Assessment of value for money achieved on the highest impact
procurement items
o Analysis of the current procurement strategy and supply chain
management policy.
4 THE FIVE PILLARS OF THE GAUTENG HEALTH
TURNAROUND STRATEGY
? Strategic leadership and desirable organisational culture
? environmental controls for good governance
? communication and Social Mobilisation
? Human resources management and development
? Health Infrastructure development and rehabilitation.
5 TEN POINT ACTION PLAN FOR THE GAUTENG
HEALTH TURNAROUND STRATEGY (2012 -2014):
1. Provide Strategic leadership
2. Resource Health Services with intensifed focus on Primary Health
care Services
3. Manage fnances and people
4. effective management of contracts and partners
5. Provide Information communication and Technology Infrastructure
6. Manage Information
7. Rehabilitate and Revitalise Health Infrastructure
8. communicate and Mobilise communities
9. Generate Revenue
10. Improve Health Outcomes
6 CONTEXT
6.1 The profle of health in Gauteng and the priorities impacting
on this Turnaround Strategy
Gauteng is the largest province with a population estimated at 11.1 million people,
or 22% of the South African population, with 19.3% (3 million) being younger
than 15 years of age. While Gauteng has a comparatively large proportion of
people who have private health insurance (25%), 7.7 million are uninsured and
depend entirely on the public health sector.
Gauteng is highly urbanised, with 97% of the population living in urban centres,
and is characterised by high levels of inequality, with (formal) unemployment at
23%, and 22% of the population living in informal housing. Gauteng has a high
proportion of migrants and immigrants, and provides services to thousands from
other provinces and countries.
The province is faced with a quadruple burden of disease: illnesses of poverty
(communicable diseases) existing side by side with illnesses of developed
countries (non-communicable diseases). The burden of disease is exacerbated
by the impact of the HIv and AIdS epidemic and TB, including MdR and xdR
TB, and also by injuries resulting from violence and trauma.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
14 15
Health services in the Province are provided through regional, district, tertiary,
specialised and central hospitals; across fve health districts, both rural and
urban; and through community health centres and clinics run by both the
department of Health and by local government.
The challenges described in this document and the initiatives to tackle them
must all be considered in light of the priorities set for the department by:
- The Millennium development Goals;
- The national Health System Priorities 2009-14 (the 10-point plan);
- The negotiated Service delivery Agreement (nSdA) of the ndoH;
- The draft Service Transformation Plan (2010-2020); and
- The Gauteng Provincial Government outcomes 2009-14
Healthcare delivery in the province is therefore complex and making signifcant
performance improvement throughout the whole system requires the
collaboration of all of the organisations involved in the system, as well as a
range of important stakeholders.
Further details about the profle of the health system in Gauteng and the details
of the priorities that shape the strategic direction of the department are set out
in Appendix 2.
7 GAUTENG HEALTH TURNAROUND STRATEGY
7.1 FINANCE AND FINANCIAL MANAGEMENT
7.1.1 Challenge
• Maximisation of outputs and deliverables with the limited inputs and
available resources - Target cost savings to the value of R2bn in 2012/13
• Avoid Accruals and debt.
• ensure adequate budget for Health in 2013/2014
• effective and effcient revenue and debt management
• Improving Asset Management.
• Risk Reduction Management
7
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
16 17
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7.2 HUMAN RESOURCES MANAGEMENT AND DEVELOPMENT
7.2.1 The Challenge
• Rationalisation of staff establishment to manage expenditure on
employees and provide good quality health services.
• Accelerate flling of vacant funded posts in key health professional
categories (e.g. professional nurses, doctors, pharmacists, and pharmacist
assistants).
• Increase productivity and accountability through effective performance
management.
• Tighten management of overtime and RWOPS for best value for the
organisation.
• Align Human Resource development Plans with the Strategic direction
of the department
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
18 19
7
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7.3 DISTRICT HEALTH SERVICES FOR PRIMARY HEALTH CARE
7.3.1 The Challenge
• Align budget and human resources to prioritise district Health Services
and implement the Primary Health care Re-engineering programme.
• Standardisation of levels of management in PHc facilities including district
hospitals.
• effective integration and standardization of community Health Workers.
• Provide supportive health infrastructure development for district Health
Services.
• Streamline the provision of Primary Health care across all spheres of
government.
• ensure responsive emergency Medical Services and infrastructure
systems including for Planned Patient Transportation.
• Train more PHc clinicians, advanced midwives and pharmacy assistants.
• Mobilise and support leadership structures of society and communities
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
20 21
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.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
22 23
7.4 HOSPITAL MANAGEMENT
7.4.1 The challenge
• Strengthen governance and environmental control systems in hospitals.
• Build facilitative relationships among all cadres of Health Service
Providers.
• Pay special attention to challenges confronted by nurses.
• Intensify public education for appropriate utilisation of health services and
establishment of effective district-based referral systems.
• Build Health Information Systems (management programme and
infrastructure).
• Provide and maintain the necessary hospital physical infrastructure.
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.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
24 25
7.5 MEDICO-LEGAL SERVICES and LITIGATION.
7.5.1 The Challenge
• Reduce rates of adverse events and medical negligence, especially in
Obstetrics and Gynaecology, Surgery, emergency units and Orthopaedics.
• Build capacity for effective management of medico-legal cases.
• command the necessary support from the Offce of the State Attorney.
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
26 27
7.6 HEALTH INFORMATION MANAGEMENT AND HEALTH
INFORMATION SYSTEMS.
7.6.1 The Challenge
• Provide Strategic direction for Health Information Systems
• update technology equipment and lAn, and provide support and
maintenance on equipment.
• enhance connectivity in all facilities to improve effciency.
• Streamline systems for unifed Health Information System.
• develop and implement a unifed Patients’ records across the system.
• Mainstream Information Management and accountability.
• Overhaul MedSAS to improve effciency of Pharmaceutical Services
throughout the system.
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
28 29
7.7 COMMUNICATION AND SOCIAL MOBILISATION
7.7.1 The challenge
• clearly articulated communication strategy
• Mainstreaming of communication management throughout the
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• Access to credible and reliable information to reduce the risk of
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• Streamline responses to complaints from the public for positive media
publicity.
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
30 31
7.8 HEALTH INFRASTRUCTURE MANAGEMENT AND
DEVELOPMENT
7.8.1 The Challenge
• Health infrastructure refurbishment and rehabilitation.
• Improve expenditure on capital projects (construction and maintenance).
• ensure accountability for infrastructure project planning to reduce the risk
of delays and scope and budget increases.
• Raise capacity for effective project management.
• Manage critical stakeholders such as the department of Infrastructure
development (dId) to improve performance on health infrastructure.
• Mainstream economic opportunity identifcation for localization,
benefaction and ownership of local communities
7
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GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
32 33
8 WAY FORWARD
The Gauteng Health Turnaround Strategy will be introduced to a broad
stakeholder workshop for buy-in. Performance agreements of all senior
managers, ceOs of hospitals, district and facility managers will include result
areas for the implementation of the Turnaround Strategy. It will be made available
on the intranet to all employees. Road shows will be conducted in all districts
and central hospitals
All operational plans will mainstream the implementation of the Gauteng Health
Turnaround Strategy.
A Monitoring and evaluation Framework to track progress and report on
outcomes is being developed.
Quarterly reports will be provided to the Gauteng Provincial Government
executive council.
Appendix 1
There are a number of important agreements and resolutions that have informed
this Turnaround Strategy:
• From the MOA, obligations of the GPG are to undertake to;
• Restructure the Provincial dHSd and establish the Provincial
department of Health as a standalone Provincial department,
• Put special measures in place to ensure that the Provincial doH
does not contravene the PFMA when planning and implementing
the budget,
• ensure that there is a comprehensive turnaround strategy by the
end of March 2012, ready for implementation in 2012/13,
• Recover all debts owed to the provincial dHSd within the 2012/13
fnancial year and develop a sustainable reimbursement mechanism.
• From the MOA, obligations of the National Government are to
undertake to;
• Assist the provincial department of health with appropriate analysis
of the base data for problem diagnosis and intervention,
• Support the provincial department of health with appropriate
institutional and procedural arrangements for the intervention areas
identifed,
• Support the provincial department of health with the effcient
administration of central hospitals,
• Provide support for the effcient administration and management of
central hospitals and their transition towards an integrated national
approach consistent with the national Health Act
• Assist the provincial department of health with the development
and implementation of a migration plan of the Health Information
System (HIS),
• Provide integrated support to the provincial department of health and
strengthening primary health care (PHc) services as preparation
towards national Health Insurance (nHI).
• national Treasury to provide assistance and guidance in areas of
supply chain management in the provincial department of health.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
34 35
• PBC Decisions (October 2011)
• Increase delegations for ceOs to manage maintenance at hospital
level
• Resolve procurement and management concerns at the Medical
Supplies depot
• Strengthen management and outcomes of emergency Medical
Services
• Address medico-legal and litigation issues
• Provide a plan around continuing with the provincialisation process
• Act on corruption
• Address Human Resources issues, including rationalization and
strengthening controls of overtime.
• Extended Finance Lekgotla Decisions (11 November 2011)
• GdF to identify possible under spending and ensure surrender to
Provincial Revenue Fund for possible reallocation to Health
• Infrastructure slow spending to identify projects that can be fast
tracked and show quick wins
• GdF should develop a process to clear and minimize accruals
within the current budget and over the MTeF
• Allocation of infrastructure budget only to project that are ready
• 5% top slice health personnel budget 2012/13
• GdF and Health to collaborate the ensure that the central hospitals
are functional
• 3% top slice (hair –cut) in provincial equitable Share budget to
fnance, and set aside in the Provincial Revenue Fund (PRF) for
paying accruals
• dGF and Health to manage debt and collect about R800 million
owed
• GdF and Health to formulate an action plan for clearing accruals
• engage service providers with regards to their payments and
negotiating uninterrupted supply of goods and services
• Stringent conditions to be put in place to ensure that no further
accruals are incurred after the intervention
• clearing of accruals will be managed with Treasury.
Appendix 2
The context of health in Gauteng
Vital statistics
• life expectancy at birth: 60.5 (2011)
• Maternal mortality rate: Preliminary data for the period 2008-2011 shows
an improvement in the maternal mortality rate, suggesting it is now 147 per
100,000 live births for the triennium 2008 -2010 (compared to 167/100,000
in the previous Triennial Report 2004-07)
• Perinatal Mortality Rate: 33.5 / 1 000
• neonatal Mortality Rate: 11.7 / 1 000
• under fve mortality Rate: 34 / 1000
• HIv prevalence: 15.2% among 15-49 years old (HSRc 2008)
• TB cure rate: 82%.
Non-communicable diseases: top 11 diagnoses upon admission to
hospital in Gauteng:
• Respiratory conditions, such as bronchopneumonia, pneumonia and lower
respiratory tract infection (18.4%)
• carcinoma (15.8%)
• cardiac disease (14%)
• Renal disease (11.2%)
• Hypertension (7.6%)
• epilepsy (6.9%)
• diabetes (3.2%)
• Mental health conditions (2.8%).
• A quarter (23.3%) of adult women and 8.3% of adult men were found to be
obese (dept of Health & MRc 2008).
Service Platform
Health services in the Province are provided through:
? 137 provincial and 180 local government clinics (with mobile units in
some instances)
? Thirty fve community Health centres
? Five Health districts
? eleven district hospitals
? eight Regional Hospitals
? Three (3) Tertiary Hospitals
? Four central Hospitals
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
36 37
? Six specialised hospitals (4 Psychiatric, 1 Rehab and 1 MdR)
? Three (3) Oral Health centres.
Additional project-based work is done by various not-for-proft organisations the
province.
The priorities informing the strategic direction of the Department
The strategic direction of the department is shaped by the following priorities:
Millennium Development Goals (MDGs)
All the eight MdGs and in particular;
• Goal 4: Reduce child Mortality
? Reduce by two-thirds, between 1990 and 2015, the under-
fve mortality rate: Targets: Reduce child mortality from 43 per
1000 (2009) to 30 per 1000, and infant mortality from 34 per
1000 (2009) to 25 per 1000 by 2014.
• Goal 5: Improve Maternal Health
• Reduce by three-quarters, between 1990 and 2015, the
maternal mortality rate Targets: Reduce the maternal mortality
ratio from 167.6 per 100,000 (2009) to 100 per 100,000 by
2014.
• Goal 6: combat HIv and AIdS, malaria and other diseases
• Have halted by 2015, and begin to reverse the spread of HIv
and AIdS
• Have halted by 2015, and begin to reverse the incidence of
malaria and other major diseases
• Targets: Reduce new HIV infections by 50% by 2014, and
increase the TB cure rate from 76% in 2009 to 83% in 2014.
National Health System Priorities 2009-14 (10 Point Plan).
1. Provision of Strategic leadership and creation of Social compact for
better health outcomes.
2. Implementation of the national Health Insurance.
3. Improving the Quality of Health Services.
4. Overhauling the health care system and improve its management.
5. Improvement of Human Resources.
6. Revitalization of infrastructure.
7. Accelerated implementation of the HIv and AIdS strategic plan and the
increased focus on TB and other communicable diseases.
8. Mass mobilisation for the better health for the population.
9. Review of drug policy.
10. Research and development.
Negotiated Service Delivery Agreement (NSDA) of the NDOH.
All the four agreed priorities and in particular the focus of the current fnancial
year on improving health system effectiveness.
• Increasing life expectancy (reducing mortality rates)
• combating HIv and AIdS
• Reducing the burden of disease from TB
• Improving health system effectiveness.
Draft Service Transformation Plan (2010-2020)
? The draft STP sets out the infrastructure and human resource
requirements that would be necessary to re-engineer Primary Health
care and shift the focus from a hospi-centric model to a focus on PHc;
? The STP aims to increase utilisation of PHc services through
extended hours, offering the full package of services, providing
additional clinics and extra consulting rooms, and improving quality.
? It also aims to implement referral systems, provide and/or expand
PHc and level 1 hospitals in under-serviced areas, and increase
‘outreach’ from hospitals to other facilities to take services to where
people are.
Gauteng Provincial Government outcomes 2009-14
1. Quality basic education.
2. A long and healthy life for all South Africans.
3. decent employment through inclusive economic growth.
4. All people in South Africa are and feel safe.
5. vibrant, equitable, sustainable rural communities contributing towards
food security for all.
6. Sustainable human settlements and improved quality of household life
education.
7. Responsive, accountable, effective and effcient local Government
system.
8. An effcient, effective and development oriented public service and an
empowered, fair and inclusive citizenship.
GAUTENG HEALTH TURNAROUND STRATEGY: “TOWARDS EFFECTIVE SERVICE DELIVERY, STRENGTHENING
PRIMARY HEALTH CARE AND A CLEAN AUDIT IN 2014.”
38
The Strategic Plan of the Gauteng Department of Health and Social
Development 2009-2014
Vision
To be the best provider of quality health and social services to the people in
Gauteng.
Mission
The GdHSd aims to provide excellent, integrated health and social development
services in partnership with stakeholders to contribute towards the reduction of
poverty, vulnerability and the burden of disease in all communities in Gauteng.
Values
? Batho Pele principles
? excellence
? Integrity
? Humility
? Selfessness
? Respect
? Social Justice
Goals and Strategic Objectives
1. Improved health and well being with an emphasis on vulnerable groups.
2. a) Reduce the rate of new HIv infections by 50% in youth, adults and babies
b) Reduce deaths from TB and AIdS by 20%
3. Increased effciency of service implementation.
4. Human capital management and development (for better service delivery
outcomes).
5. Organisational excellence.
doc_149339651.pdf