24 April 2008, Tembisa Hospital
Programme Director
Local government councillors
Registrar of the Health Professions Council of South Africa
Union representatives
Experts and academics
Officials of the Department of Health
Members of the community of Tembisa
Ladies and Gentlemen
I have just come from a SADC meeting in Zambia where we were looking at progress in the implementation of SADC Protocol on health and various health programmes in the region. We also used this meeting to prepare for the international conference on Primary Health Care which takes place in Burkina Faso next week and the World Health Assembly which meets in Geneva next month.
Programme Director, we are meeting here in Tembisa today to launch an initiative that is critical in determining the quality of services we deliver to millions of people of South Africa. We are launching the national Core Standards for Health Establishments in South Africa.
Over the past 13 years, several policies, guidelines and pieces of legislation have been developed to facilitate transformation of the health care system in South Africa. Many of these interventions were aimed at improving access to care, quality and efficiency of the health system.
I can say with confidence that significant progress has been made in increasing access to health services. The utilization of primary health care services, for instance, almost doubled over the past eight years with 101 million visits to clinics recorded in the financial year 2006/07 compared to 67 million visits received in 1998/99. The increase in utilization of PHC clinics can be attributed to improved access as result of construction of more than 1 600 clinics closer to where communities live, the removal of user fees and improved package of care available at clinics.
Various efforts have been made to improve the quality of services in public health facilities including the adoption of primary health care package, quality assurance and infection control policies.
We also have the Hospital Revitalization Programme that does not only improve the hospital infrastructure, but provides for the necessary equipment and management capacity needed to delivery quality services. For the current financial year, we have allocated R2, 8 billion for revitalization of 47 hospitals across the country. Efforts are also being to mobilize more resources so that we can extend the coverage for this programme to other facilities including this facility (Tembisa Hospital).
Programme Director, one of the critical interventions we have made in improving quality of services was the launch of the Patients' Rights Charter 1999 which spelt out the rights and responsibilities of patients and other healthcare users. As a result of popularisation of this Charter, we saw an increase in awareness amongst patients about their rights as users of the health services and there is also more understanding amongst health workers about Charter.
Programme Director, one of the challenges we have faced in assessing progress in implementation of these interventions is that there has not been a set of core national standards against which all establishments and services can benchmark themselves.
Expected performance is reflected in a wide range of policies, regulations, protocols or through indicators used for monitoring. The gap between the standards and the actual level of compliance has not been documented through a structured and nationally accepted measurement system.
Previous initiatives have also highlighted the critical roles of provincial and national policies and management support in enhancing facility performance. It is clear that, at least in some instances, the resolution of problems lies beyond the capacity and authority of the facility management. We therefore have to continue with delegations of authority to facility management and ensure that there is adequate capacity and skills to assume added responsibilities through support from district, provincial and national levels.
The is an increasing recognition of the essential role of national governments in seeting standards and ensuring that such standards are met throughout the health system, as a key component of the stewardship role of the national government. The United Kingdom, Australia, Italy and Canada have progressed relatively far along this road, while developing countries in Latin America, Asia and Africa are developing this important mechanism for improving the delivery of services and the quality of care.
It is within this context that the Department of Health has established a set of core national standards reflecting the degree of excellence we require in delivering acceptable and quality health services. These standards are going to be used to measure and benchmark performance of health facilities by means of an appraisal.
These standards cover a broad range of performance areas. For instance under safety, we will look at safe handling (and storage) of medicines, patient safety system, infection prevention and control. Other core-standards cover:
A total of 27 hospitals and four (4) community health centres have been identified as initial focus points for appraisals based on these core-standards. The initial group of facilities covers all provinces and all levels of care from community health centres up to specialised hospitals.
We are going to extend to other facilities over time through a phased approach. This approach should enable us to strengthen support that might otherwise be overstretched if we were to cover all facilities at once. This approach will also facilitate maximum coordination and synergy among different initiatives that are happening at each individual facility and thus harness all possible resources.
Programme Director, the results from these appraisals are intended to be used as a tool to enable facility management to design and implement successful plans for improvement focussed on the areas of most concern for their institution.
We believe these appraisals will also identify areas excellence which will then be used as benchmarks or examples for others. The uniform, comparable and detailed results will assist managers at all levels to better assess themselves, recognising that the performance of individual facilities also reflects on the performance of the health system as a whole.
The hospital CEOs (and CHC managers) are of course the essential and critical actors in the success of this initiative. They will receive the appraisal reports and should become the champions of the processes set in motion to improve the weak areas and strengthen or profile best practices.
Joint national-provincial facility support teams will provide ongoing support, oversee the work and ensure progress. Provincial and national facilitation team members will be responsible for identifying and resolving those constraints and blockages that are not within the capacity of the facility manager and maintain close monitoring of progress.
We believe that this process of conducting appraisal of facilities will provide objective and comparable measurements of the performance of health facilities against the set standards.
While it is easy for an incident of improper conduct to make headlines, there is a lot of dedication to the principle of Patients' Right Charter that go unnoticed. We also believe that there are many cases of excellence that are not acknowledged.
This process should assist us to identify all these instances, address shortfall in meeting the standards and profile excellence with the aim of replicating these. We are also confident that through this initiative, we will strengthen and streamline the many efforts already under way to improve the quality of services.
This is our demonstration of commitment to a vision of a better health for all
Thank you