Improving the quality of care - both in terms of effective treatment and in terms of respecting the rights and the feelings of patients - is an important aspect of health sector transformation.
Five year objectives
Key objectives for 2001/2
It is difficult to separate quality initiatives from programmes designed to reduce mortality and morbidity, torevitalise our hospitals and to develop a good system of primary health care. In all of these, there are elements that relate to the objectives set out above.
The development of clinical guidelines and training of personnel in relation to these is a strategy used by various programmes that focus on reducing mortality and morbidity.
The Comprehensive Primary Health Care Package that was formulated the previous year and launched in 2001/2 defines the range of services to be delivered in clinics and sets clear norms and standards for these services. It is therefore an important tool in assuring quality on a national scale. It appears that provinces and local authorities are using it as a yardstick in improving their clinics.
An equivalent package of services and set of norms was developed during the year for district hospitals.
The technology audit that was conducted in hospitals in two provinces (see page 68) serves a similar purpose of highlighting prevailing practice in relation to accepted norms.
Campaigns were undertaken in several provinces to deepen public awareness and understanding of patients' rights and responsibilities in terms of the national Patients' Rights Charter. Some provinces also undertook training of personnel on the Batho Pele Principles. This is an ongoing process as the Principles and the Charter were launched some years ago.
The manual that will enable facilitators in provinces and local government to undertake training to reinforce adherence to these basic quality instruments was finalised.
COMPLAINTS MECHANISMS
Provincial complaints systems have been developed or standardised largely in line with the model recommended by the national Department. Many facilities have introduced suggestion boxes and there were instances where exit surveys were conducted to collect information of patient experiences in institutions.
The Department operated an informal "hot line" for complaints from service users and facilitated responses from service providers in provinces and municipalities.
National Policy on Quality
The national policy on quality was endorsed by a number of forums, including wide stakeholder meetings and the key political decision-making body, the Health Minmec.
During the past year, there were developments at provincial level that suggest quality assurance is being effectively institutionalised. Quality assurance units in some provinces began to draft provincial policies on quality that complement the national policy.
Structures to ensure quality are growing at district and facility level. These structures are known by a variety of names - such as, quality assurance committees, clinical committees, service improvement teams, regional hospital inspection teams - but they all serve the purpose of defining, measuring and improving quality.
Quality of care was a major theme at the Health Summit (page 90) and the discussion focused on practical proposals for action.
Improving health, improving satisfactionThe remote Taung sub-district of the North West has already achieved the nation's TB goals for 2005. Between 1999 and 2000, the TB cure rate increased from 70% to 84,8% and the treatment interruption rate dropped from 11,62% to 4,2%. They did it by going all-out to implement directly observed treatment. And by treating the whole patient within his or her social reality. TB treatment is firmly linked to poverty alleviation.
Another quality programme with clear clinical pay-offs exists at Piet Retief Hospital in Mpumalanga. The hospital has reduced mortality among newborn babies simply by making relevant protocols available to their nurses, training them in the use of protocols and teaching nurses how to monitor mortality rates. When it comes to "softer" issues of customer care, western Gauteng shows the way. A priority has been to reduce waiting times, by using systems of booking and categorising patients. At Kagiso C Clinic, the waiting time for acute cases has been reduced to 20 minutes - in a facility where about 120 patients are seen daily by just three professional nurses and a nursing assistant. At Carletonville Hospital management and personnel have cultivated a climate of accountability to their customers. All personnel wear nametags and key managers are identified on a board near the entrance. There is a help desk and suggestion boxes are regularly opened. The suggestions are reviewed jointly by management and community health committee members. |
The Department now makes awards for excellence in two major areas: District health development and nursing.
The district awards were instituted several years ago and outstanding initiatives in several categories are recognised. The winners during this year were:
The national Cecilia Makiwane Award for Nursing was run for the first time in 2001/2. All provincial finalists had been chosen by the end of the financial year.
While the award ceremony and the announcement of the overall winner happened two weeks beyond the year in review, it is a matter of public knowledge that KwaZulu-Natal's Philisiwe Magubane took the overall prize for outstanding work in training and supporting community health workers.
Most provinces have instituted their own service excellence awards.