CORE NORMS AND STANDARDS FOR HEALTH CLINICS

1. The clinic renders comprehensive integrated PHC services using a one-stop approach for at least 8 hours a day, five days a week.

2. Access, as measured by the proportion of people living within 5km of a clinic, is improved.

3. The clinic receives a supportive monitoring visit at least once a month to support personnel, monitor the quality of service and identify needs and priorities.

4. The clinic has at least one member of staff who has completed a recognised PHC course.

5. Doctors and other specialised professionals are accessible for consultation, support and referral and provide periodic visits.

6. Clinic managers receive training in facilitation skills and primary health care management.

7. There is an annual evaluation of the provision of the PHC services to reduce the gap between needs and service provision using a situation analysis of the community’s health needs and the regular health information data collected at the clinic.

8. There is annual plan based on this evaluation.

9. The clinic has a mechanism for monitoring services and quality assurance and at least one annual service audit.

10. Community perception of services is tested at least twice a year through patient interviews or anonymous patient questionnaires.

1.1 Standard treatment guidelines and the essential drug list (EDL) manual.
1.2 A library of useful health, medical and nursing reference books kept up to date.
1.3 All relevant national and provincial health related circulars, policy documents, acts and protocols that impact on service delivery.
1.4 Copies of the Patients Charter and Batho Pele documents available.
1.5 Supplies of appropriate health learning materials in local languages.

2.1 A diagnostic set.
2.2 A blood pressure machines with appropriate cuffs and stethoscope.
2.3 Scales for adults and young children and measuring tapes for height and circumference.
2.4 Haemoglobinometer, glucometer, pregnancy test, and urine test strips.
2.5 Speculums of different sizes
2.6 A reliable means of communication (two-way radio or telephone).
2.7 Emergency transport available reliably when needed.
2.8 An oxygen cylinder and mask of various sizes.
2.9 Two working refrigerators one for vaccines with a thermometer and another for medicines. If one is a gas fridge a spare cylinder is always available.
2.10 Condom dispensers are placed where condoms can be obtained with ease.
2.11 A sharps disposal system and sterilisation system.
2.12 Equipment and containers for taking blood and other samples.
2.13 Adequate number of toilets for staff and users in working order and accessible to wheelchairs.
2.14 A sluice room and a suitable storeroom or cupboard for cleaning solutions, linen and gardening tools.
2.15 Suitable dressing/procedure room with washable surfaces.
2.16 A space with a table and ORT equipment and needs
2.17 Adequate number of consulting rooms with wash basins, diagnostic light (one for each professional nurse and medical officer working on the same shift).

3.1 Suitable medicine room and medicine cupboards that are kept locked with burglar bars.
3.2 Medicines and Supplies as per the essential drug list for Primary Health Care, with a mechanism in place for stock control and ordering of stock.
3.3 Medicines and Supplies always in stock, with a mechanism for obtaining emergency supplies when needed.
3.4 A battery and spare globes for auroscopes and other equipment.
3.5 Available electricity, cold and warm water.

Organising the clinic

4.1 Staff are able to

4.1.1 map the clinic catchment area and draw specific and achievable PHC objectives set using district, national and provincial goals and objectives as a framework.
4.1.2 Organise outreach services for the clinic catchment area.
4.1.3 Organise the clinic to reduce waiting times to a minimum and initiate an appointment system when necessary.
4.1.4 Train community health care promoters to educate caretakers and facilitate community action.
4.1.5 Plan and implement a district focused and community based activities, where health workers are familiar with their catchment area population profile, health problems and needs and use data collected at clinic level for this purpose.

Caring for patients

4.2 Staff are able to follow the disease management protocols and standard treatment guidelines, and provide compassionate counselling that is sensitive to culture and the social circumstances of patients.
4.3 Staff are positive in their approach to patients, evaluating their needs, correcting misinformation and giving each patient a feeling of always being welcome.
4.4 Patients are treated with courtesy in a client-oriented manner to reduce the emotional barriers to access of health facilities and prevent the breakdown in communication between patients and staff.
4.5 The rights of patients are observed.

Running the clinic

4.6 A clear system for referrals and feedback on referrals is in place.
4.7 All personnel wear uniforms and insignia in accordance with the South African Professional Councils’ specifications.
4.8 The clinic has a strong link with the community, civic organisations, schools and workplaces in the catchment area.
4.9 The clinic is clean, organised and convenient and accommodates the needs of patients’ confidentiality and easy access for older persons and people with disability.
4.10 Every clinic has a house keeping system to ensure regular removal and safe disposal of medical waste, dirt and refuse.
4.11 Every clinic provides comprehensive security services to protect property and ensure safety of all people at all times.
4.12 The clinic has a supply of electricity, running water and proper sanitation.
4.13 The clinic has a written infection control policy, which is followed and monitored, on protective clothing, handling of sharps, incineration, cleaning, hand hygiene, wound care, patient isolation and infection control data.

5.1 Staff are able to approach the health problems of the catchment area hand in hand with the clinic health committee and community civic organisations to identify needs, maintain surveillance of cases, reduce common risk factors and give appropriate education to improve health awareness.
5.2 Culturally and linguistically appropriate patients’ educational pamphlets are available on different health issues for free distribution.
5.3 Appropriate educational posters are posted on the wall for information and education of patients.
5.4 Educational videos in those clinics with audio-visual equipment are on show while patients are waiting for services.

6.1 The clinic utilises an integrated standard health information system that enables and assists in collecting and using data.
6.2 The clinic has daily service registers, road to health charts, patient treatment cards, notification forms, and all needed laboratory request and transfer forms.
6.3 All information on cases seen and discharged or referred is correctly recorded on the registers.
6.4 All notifiable medical conditions are reported according to protocol.
6.5 All registers and monthly reports are kept up to date.
6.6 The clinic has a patient carry card or filing system that allows continuity of health care.

7.1 There is a functioning community health committee in the clinic catchment area.
7.2 The clinic has links with the community health committee, civic organisations, schools, workplaces, political leaders and ward councillors in the catchment area.
7.3 The clinic has sensitised, and receives support from, the community health committee.
7.4 Staff conduct regular home visits using a home visit checklist.

8.1 All patients are referred to the next level of care when their needs fall beyond the scope of clinic staff competence.
8.2 Patients with a need for additional health or social services are referred as appropriate.
8.3 Every clinic is able to arrange transport for an emergency within one hour.
8.4 Referrals within and outside the clinic are recorded appropriately in the registers.
8.5 Merits of referrals are assessed and discussed as part of the continuing education of the referring health professional to improve outcomes of referrals.

9.1 Clinic staff collaborate with social welfare for social assistance and with other health related public sectors as appropriate.
9.2 Clinic staff collaborate with health orientated civic organisations and workplaces in the catchment area to enhance the promotion of health.

10.1 Each clinic has a vision/mission statement developed and posted in the clinic.
10.2 Core values are developed by the clinic staff and posted.
10.3 An operational plan or business plan is written each year.

11.1 New clinic staff are oriented.
11.2 District personnel policies on recruitment, grievance and disciplinary procedures are available in the clinic for staff to refer to.
11.3 The staff establishment for all categories is known and vacancies discussed with the supervisor.
11.4 Job descriptions for each staff category are in the clinic file.
11.5 There is a performance plan/agreement and training plan made and a performance appraisal carried out for each member of staff each year.
11.6 The on-call roster and the clinic task list with appropriate rotation of tasks are posted.
11.7 An attendance register is in use.
11.8 There are regular staff meetings (at least once a month).
11.9 Services and tasks not carried out due to lack of skills are identified and new training sought.
11.10 In-service training takes place on a regular basis.
11.11 Disciplinary problems are documented and copied to supervisor.

12.1 The clinic, as a cost centre, has a budget divided into main categories.
12.2 The monthly expenditure of each main category is known.
12.3 Under and over spending is identified and dealt with including requests for the transfer of funds between line items where permitted and appropriate.

13.1 A weekly or monthly transport plan is submitted to the supervisor or transport co-ordinator.
13.2 The telephone or radio is working.
13.3 The ambulance can be contacted for urgent patient transport to be available within two hours.

14.1 There is a schedule of monthly visits stating date and time of supervisory support visits.
14.2 There is a written record kept of results of visits.

15.1 The community is involved in helping with clinic facility needs.
15.2 The community health committee is in place and meets monthly.

16.1 There is an up-to-date inventory of clinic equipment and a list of broken equipment.
16.2 There is a list of required repairs (doors, windows, water) and these have been discussed with the supervisor and clinic committee.

17.1 Stocks are secure with stock cards used and up-to-date.
17.2 Orders are placed regularly and on time and checked when received against the order.
17.3 Stocks are kept orderly, with FEFO (first expiry, first out) followed and no expired stock.
17.4 The drugs ordered follow EDL principles.

18.1 New patient cards and medico-legal forms are available.
18.2 The laboratory specimen register is kept updated and missing results are followed up.
18.3 Births and deaths are reported on time and on the correct form.
18.4 The monthly PHC statistics report is accurate, done on time and filed/sent.
18.5 Monthly and annual data are checked, graphed, displayed and discussed with staff and the health committee.
18.6 There is a catchment area map showing the important features, location of mobile clinic stops, DOTS supporters, CHWs and other outreach activities.