This section deals with the transformation of a range of support services - the health information system, research and surveillance, the laboratory network, mortuary services, blood transfusion services and the medical schemes regulator - and specific medium-term objectives were set in 1999 in relation to each.
TRANSFORMING LABORATORY SYSTEMS
Five-year objective
Key objectives for 2001/2
In September 2001, President Mbeki signed a proclamation that established the National Health Laboratory Service (NHLS) on 1 October 2001. The former South African Institute for Medical Research (SAIMR), provincial health laboratories and the National Institute for Virology (NIV) ceased to exist on that date and became part of the new organisation. The first board was appointed and Mr Cassim Gassiep became the first chief executive officer of the NHLS, with responsibility for steering it through this critical formative period.
Linked to the formation of the NHLS was the establishment of the National Institute for Communicable Diseases (NICD) on the foundation of the NIV.
Professor Barry Schoub was appointed director of this new organisation. All work of the NIV will be carried forward through the NICD plus that of some of the microbiological components of the former SAIMR. The sophisticated Biosafety Level 4 Laboratory at the NICD is about to be upgraded to international requirements.
It is envisaged that the National Centre for Occupational Health, the forensic chemistry laboratories and the forensic pathology laboratories will in future be incorporated into the NHLS.
TRANSFERRING MORTUARY SERVICES
Five-year objective
Key objectives for 2001/2
Although Cabinet had approved the transfer, in the year 2001/2 Treasury allocated only R10-million for this purpose. Provincial health authorities were unwilling to assume responsibility for this important service without adequate funding and the transfer did not commence. Representations were made to Treasury for increased funding in 2002/3.
TRANSFORMING BLOOD TRANSFUSION SERVICES
Five-year objective
Key objective for 2001/2
After two years of negotiation and planning, six out of the seven regional services dissolved on April 2001 to form a new section 21 company, the South African National Blood Service (SANBS).
Professor Anthon Heyns was appointed as the chief executive officer of the service.
The new organisation provides more than 80% of blood transfusion services nationally. Discussions continued with the Western Province Blood Transfusion Service, the only entity outside the national service, with a view to its incorporation
The establishment of the SANBS meets WHO guidelines and is consistent with blood transfusion practices internationally. The existence of a national service presents opportunities for a more cost-effective service, for better access to products that are supplied entirely by public donation and for improved distribution of blood products.
REORGANISING THE OFFICE OF THE REGISTRAR OF MEDICAL SCHEMES
Five-year objective
The objective was achieved in the first year of the 1999 - 2004 planning cycle with the establishment of the Council for Medical Schemes. The Registrar is the chief executive of the Council.
The Minister appoints members of the Council and the Director-General serves as an ex officio member. There is a dynamic link between the Department and the Council in terms of reviewing and amending the legislation from which the Council derives its mandate as a regulator. The Medical Schemes Act was amended at the end of 2001 (See page 87).
ASSURING THE FUTURE OF THE STATE VACCINE INSTITUTE
Key objective for 2001/2
Ensuring the long-term viability of the State Vaccine Institute became an important objective after a study by the Council for Scientific and Industrial Research concluded that a substantial capital investment was necessary for the SVI to meet international production standards.
The Department of Arts, Culture, Science and Technology had made a grant for laboratory upgrading. But additional funding remained essential to put the Institute in a position to comply with WHO standards. The route adopted was the formation of a private sector partnership to ensure the expansion of the SVI.
A tender was accordingly published and towards the end of the financial year a consortium headed by a local company, Biovac, was announced as the preferred bidder. The consortium comprises South African, British and Cuban interests. The award of the tender should be completed by August 2002.
TABLE 23: BREAKDOWN OF SAMPLES ANALYSED BY FORENSIC CHEMISTRY LABORATORY
| Sample type* | 1999 | 2000 | 2001 |
| Blood alcohol | 17 699 | 17 033 | 17 269 |
| Food samples | 2 963 | 2 866 | 3 338 |
| Toxicology | 960 | 887 | 908 |
| Pesticide residue | 14 120 | 14 218 | 15 895 |
*Blood alcohol samples in samples taken before and after death. Toxicology samples include samples of human organs, body fluids and non-human exhibits. Food samples include samples of dairy, meat and marine products plus sauces, beverages and peanut butter. Pesticide residue samples are often drawn from fresh, dried and canned fruit and tea products.
It is envisaged that the SVI will become an independent company with government retaining a majority shareholding.
The Institute currently employs a small number of personnel who have been consulted at all stages of the restructuring.
ACCREDITING THE FORENSIC CHEMISTRY LABORATORY
Key objectives for 2001/2
The Forensic Chemistry Laboratory provides scientific support for actions taken in terms of a variety of laws - such as the Inquest Act, the Criminal Procedures Act, the Road Traffic Act and the Foodstuffs, Cosmetics and Disinfectants Act. The volume and type of work is reflected in Table 23.
The laboratory is seeking accreditation with the South African National Accreditation Service and preparatory measures, that include compiling aquality manual and aligning practices with this manual, began in 2001. The first assessment will take place late in 2002.
BUILDING THE HEALTH INFORMATION SYSTEM
The building of a comprehensive health information system to assist in the planning and management of health services is seen as the joint responsibility of health districts, provinces, private sector organisations and the national Department.
Five-year objectives
TABLE 24: TRENDS IN DEATHS RECORDED IN THE POPULATION REGISTER
| Year | Deaths recorded | Annual increase |
| 1997 | 260 273 | -- |
| 1998 | 299 077 | 14,9% |
| 1999 | 326 618 | 9,2% |
| 2000 | 362 450 | 11% |
Source: StatsSA, 2001
Key objectives for 2001/2
Telemedicine
A decision was taken to maximise utilisation of the existing 28 sites before expanding and in accordance with this:
Registering births and deaths
The Departments of Health and Home Affairs launched a very successful joint initiative some years ago to improve the recording of births and deaths in the Population Register, thereby effecting a fundamental improvement to the information available for planning.
The number of recorded deaths has increased substantially over the past three years, as reflected in Table 24.
The number of deaths recorded in 2000 was 100 000 higher than the number in 1997. It is difficult to separate the increase in death reporting from the increase in the total number of deaths (which is certainly occurring). However, the fact that the number of births also increased substantially after the inception of the project suggests that improved registration is a major factor.
The recording of births in the Population Register increased from 1 216 337 to 1 407 833 (15,7%) in the period 1998 to 2000, according to StatsSA. There was a sharp increase in the proportion of births registered within the year of birth rather than at a later stage. This reflects the considerable efforts of health workers to register newborn babies.
Goals for the year ahead are to improve coverage in the remote rural areas and to include in this programme the Department of Social Development's campaign to increase registration for social grants, especially the Child Support Grant.
National Health Care Management Information System
Patient administration and billing Outsourced computerised hospital information systems are in operation in six provinces, providing management information at institution level. The Gauteng system also includes a patient record system that stores records centrally, thus avoiding duplication of records and history-taking procedures.
In the other provinces the Patient Administration and Billing (PAAB) system is used to register patients and effect billing. This is a potential tool to improve revenue collection.
Geographic information systems (GIS) Steps were taken during the year to realise the objective of a functional GIS.
The plan is to achieve this in two phases:
District Health Information Systems
Some measures taken to improve the District Health Information System are described in the section on primary health care and district development. It should be noted that Gauteng will only switch to the standard software in 2003.
The quality of data gathered was reasonably good, although collection was affected by the new boundary demarcation for health districts.
Primary health care data is available in report form for the period 1998 to 2001 and it covers the following elements:
Utilisation of facilities; ante-natal attendances; growth monitoring; cases of diarrhoea; immunisation; sexually transmitted infections; incidence of male urethral discharge; condom distribution.
Further development of the software enabled the capture of additional data relating to priority health programmes in the last year. This should enhance assessment of whether these key programmes are achieving their targets and objectives.
A priority goal for the year ahead is the extensive rollout of the standard DHIS software to local government health facilities.
Behind the scenes in PHCHow attainable are the comprehensive service packages that planners have declared as the “standard” to be provided? The Primary Health Care Clinic Survey set out to establish this by identifying services that are currently provided in our clinics and the personnel available for the job. Questionnaires were sent to all clinics and 58% - 1 713 – responded.
In broad terms, a high proportion provided general services and those linked to priority health programmes. The more specialised services were only offered at a minority of clinics. Sixteen out of 25 PHC services were provided by mainly medical officers and nine mainly by professional nurses. Yet, 698 out of 819 doctors were part-time or temporary, while 90% of professional nurses were full-time. Enrolled nursing assistants performed numerous tasks. The researchers concluded that better service was attainable if existing personnel were utilised more effectively. This would require revision of professional scopes of practice. |
Appropriate and reliable research is a fundamental element in many of the Department's initiatives to improve health status, build more effective delivery systems and enhance quality of care.
Equally important are the systems for surveillance, that provide periodic comparable data, and programme monitoring and evaluation. The Department has built in-house capacity for some of these functions. In addition, it plays a key role in commissioning and co-ordinating research and surveillance.
The Department also develops policy for research in the health sector, addressing issues of ethical conduct, research priorities and accountability. The Health Research Ethics Committee, appointed by the Minister of Health in the previous year, has begun to function. It produced national guidelines for ethical conduct of research, which will be published in 2002/3.
Key objectives for 2001/2
Research and surveillance
A considerable amount of work was doneduring the year in support of the National HIV, AIDS and STI Programme.
This included;
Support for management of outbreaks took the form of:
In terms of maternal and women's health, monitoring and research focused on:
A study on the impact of primary health care services on the health status of the population was also commissioned during the year.
Monitoring and evaluation
The Department has adopted the WHO Framework on Health Systems Performance as a guide to developing its monitoring and evaluation framework.
The critical areas of focus are:
These broad areas will be adapted to suit the major health programmes undertaken by the Department and its processes of transforming service delivery systems.
As far as possible, the framework will be applied in both the public and private health care sectors.
Progress recorded by the Department in relation to monitoring and evaluation in 2001/2 included:
The Department collaborates with other sectors in respect of joint monitoring and evaluation. In particular, it contributes regularly to the work of the Monitoring and Data Collection Task Team of the National Programme of Action for Children. During the year key indicators were contributed to two major publications on children: the End Decade Report and Children in 2001, both published by the Presidency.