The Revitalisation Project Unit at the National Department of Health has the following organogram:
Following the facilities audit that was done in 1996 by the National Department of Health a programme called Hospital Rehabilitation and Reconstruction (HRR) was introduced. The objective of the programme was to address the facilities backlog caused by neglect during the apartheid regime. The programme focused only on infrastructure. The National Department of Health noted that improved infrastructure did not necessarily give rise to improved service delivery. This led to a decision to initiate a new programme that addressed not only the infrastructure, but also health technology (health equipment), organizational development, and quality assurance. In the 2003/04 financial year, the Minister launched the Hospital Revitalisation Programme that addressed the above-mentioned components.
Legal documents to control the Management of the Grant
The Hospital Revitalisation Grant is managed, by law, through the Hospital Revitalisation Framework, which forms part of the Division of Revenue Act. The Division of Revenue Act and its frameworks are reviewed on an annual basis. Due to the inextricable link between the practical management of the grant, the grant framework, and the PIM, the Project Implementation Manual is deemed to form part of the Hospital Revitalisation Grant framework as enacted in the Division of Revenue Act (forthwith “DoRA”). The PIM aims to provide broader definitions to the purpose, conditions and responsibilities as prescribed in the DoRA grant framework.
The purpose of the Hospital Revitalisation Grant is the following:
The PIM, through discussions in all its components, its processes, reporting formats and templates continuously keep in mind the following vision of Revitalisation:
Hospital Revitalisation is one of the themes of the Ten Point Plan Strategic Framework document of the Health Department. Within the 10-point plan, the Revitalisation of Hospital Services includes
The decentralisation of hospital management component explicitly targets the improvement of quality of care. Although the improvement of quality of care is a programme in its own right, it is so central to the purpose of the delivery of services that the Hospital Revitalisation Programme (HRP) includes the improvement of quality of care as a component.
The major capital programme involved in hospital revitalisation is a long-term goal, and cannot be completed within the medium term of the Health Sector Strategic Framework.
Hospital Revitalisation consists of the following 4 components:
- Infrastructure
- Health Technology
- Organisational Development and Management
- Quality Assurance
4.1 Health Infrastructure
The Health Infrastructure Planning component of revitalisation includes the process to briefing, design, development of master plan, cash flow projection, tender, construction, handover, maintenance and design evaluation. For detailed information on this component, see the Project Implementation Manual (PIM).
4.2 Health Technology
Health Technology (HT) component focuses on auditing and subsequent purchasing of equipment based on service packages, development of sustainable systems for HT planning and subsequent general management and maintenance of technologies throughout the lifecycle of the equipment. For detailed information on this component see the PIM.
4.3 Organisational Development and Management
Organisational development and management strengthening as a component is aimed at:
- Strengthening institutional and operational efficiency of public hospitals, which have been selected as revitalisation projects, through improving their management systems, structures and processes.
- Decentralisation and restructuring of management at provincial and hospital level.
This is to be done through the integration of fourteen (14) broad focus areas:
- Organizational Strategy
- Organisational structures
- Organizational Culture and Values
- Delegation of Authority
- Planning and budgeting
- Hospital Governance
- Human resources Management
- Hospital financial Management
- Hospital Information Management
- Hospital Information Technology
- Patient Administration
- Clinical Governance
- Pharmacy
- Communication Strategy
For detailed information on this component, refer to the PIM.
4.4 Quality Assurance
Quality assurance involves the modification of hospital systems in order to improve the quality of services that are provided. This component involves improvement and sustainability thereof, of the quality of services provided in public hospitals through the:
- Establishment of a hospital based Quality Assurance (QA) Management Team
- Implementation of appropriate national packages of services with its accompanying norms and standards
- Introduction of peer review and clinical audit
- Establishment of sound supervisory systems
- Setting up of an adverse event reporting system
- Assessment of client satisfaction
- Training of hospital staff in the QA methodology, the principles and the tools
- Implementation of the Batho Pele Policy and ensuring that the community being served by the hospital is empowered thorough, Patients’ Rights Charter, Complaints Procedure, Help Desk and Hospital Boards, and
- Adjustment of the hospital’s internal information system to enable the measurement of quality.
For detailed information on this component, see the PIM.
4.5 Monitoring and Evaluation
The Monitoring and Evaluation of revitalisation projects is a necessity for producing consistent information that will allow the NDOH accomplishments to be determined within the context of the implementation of projects. M&E ensures that accountability is a critically important issue based on transparent procedures, oversight, and data based reporting. The PIM discusses the structures that are required to be in place to manage the Hospital Revitalisation Grant.
Monitoring and Evaluation practices explore five criteria that are applicable to project monitoring and evaluation. The following five criteria are used in combination to provide the decision-maker with essential information in connection with present and future decision in projects:
To accomplish this, M&E have to link the NDOH strategic themes with the revitalisation projects objectives. This division will use both qualitative and quantitative methods to assess all hospital revitalisation projects. The Monitoring and Evaluation component will be also involved in the following areas:
- Impact: measures the positive and negatives, foreseen and unforeseen, changes to and effects on society caused by the projects.
- Effectiveness: measures the extent to which the objectives have been achieved.
- Efficiency: assesses the outputs in relation to inputs, looking at costs, implementing time, economic and financial results.
- Relevance: gauges the degree to which the project at a given time is justified within the national (or provincial) development priorities.
- Sustainability: measures the extent to which benefits continue from a particular project after external assistance has ended.
- Track down and evaluate the submission of Business Case, brief, design and IPIP
- Coordinate peer review meetings
- Assess Initial Project Implementation Plans
- Assess Annual Project Implementation Plans
- Track down the submission of quarterly progress reports and financial monthly reports
- Collection, analyse and compilation of project data for preparing periodical, quarterly and annual progress reports
- Field inspection of projects for on-the-spot verification of implementation status and such other coordination works as may be necessary for the removal of implementation problems, if any.
- Implement the exit strategy
4.5.1 Compliance
According to the Division of Revenue Act provinces are expected to submit Monthly Financial Reports, Quarterly Progress Reports as well as Annual Reports for their revitalisation projects on all components of revitalisation. Should there be non-compliance with the Act, the National Department of Health issues a 7-day written notice to the provinces and National Treasury of the intention to delay transfer payments. A written presentation within those seven days must be made to the National Department of Health by the affected Provincial Departments of Health to indicate why the transfers should not be delayed.
Every financial year, the National Department of Health does a comprehensive budget bid to National Treasury for the Hospital Revitalisation Grant. The budget bid for Hospital Revitalisation is based on information received from the provinces. The information requested is in the form of projected cash flows per project covering the lifetime of the projects. The Revitalisation Framework requests submission of revised cash flows over MTEF period, including for remainder of the year.
The PMF comprises of specialised persons of the participating provinces and NDOH. The specialised units to form part of the PMF should be Health Technology, Hospital Management, Health Facilities Planning & Commissioning, Quality of Care and Project Management units. The main function of the PMF is to mobilize NDOH and PDOH directorates and clusters, and to review technical aspects of annual work-plans. It will also be responsible for advising on technical issues affecting project implementation. The PMF will be the first point of call for providing expertise required by any implementing province. The Project Management Forum meets quarterly and is hosted by provinces on a rotational basis. The planning and budgeting cycle of National Treasury as well as the planning cycle for Hospital Revitalisation will determine the agenda for each PMF meeting. This would typically result in only certain members of the PMF being invited to attend. The PMF is hosted by provinces, with the cost of the PMF being funded through Grant Management budget.
Since HRP started the following hospitals were fully revitalised:
| Province | Hospital Name |
EC |
Madzikane KaZule Memorial Hospital (Marry Teresa) |
LP |
Lebowakgomo and Jane Furse Hospitals |
MP |
Piet Retief Hopsital |
NC |
Manie DIpico (Colesburg) and Abraham Esau (Calvinia) |
NW |
Swartruggens Hospital |
WC |
George Hospital |
