BuaNews (Tshwane)
Gabi Khumalo
24 September 2008
The Public Hospitals Performance Report released by Health Minister Manto Tshabalala-Msimang has succeeded in providing baseline information on the standard of medical facilities in South Africa so that benchmarks can be set and performance improved.
In April, the Minister launched the "Core Standards for Health Facilities in South Africa", setting out the expected performance for hospitals and primary care facilities.
The standards and the criteria were formulated to give a comprehensive and high level statement of expected and acceptable service delivery with a focus on the basics including patient safety, patient dignity and basic management practices.
Using these criteria, several teams focusing on different areas assessed 27 public hospitals and four community health centres from June to August 2008 during one to three-day site visits.
Within the domain covering the safety of care, the report said the required procedures and training requirements related to medicine packaging and storage and the licensing and acceptable use of potentially hazardous equipment, were generally followed.
In the area of clinical care, the report discovered that there were many departments in hospitals where doctors and specialists were making sure that the very best care was delivered with available resources.
"Practices and procedures for ensuring care are delivered in accordance with standards and best practice, for example the regular analysis of our outcomes or measures to resolve delays in provision of supplies or maintenance of equipment is not always followed.
"This is a third area of priority where we will be using this process to take forward the recommendations already made by several highly-regarded national Committees for the needed practices to reduce preventable deaths through providing the best care," the minister said.
In the area of governance, also covering management and leadership, some hospitals demonstrated good performance in relation to the standards. This demonstrated the impact of efforts to improve planning and general procedures and in relation to financial and supply-chain management.
However hospital plans were weakened by the poor linkages between the overall plans and the human resource and financial plans.
The minister said that stock management and the high-level management control of procurement processes needed strengthening.
This domain also demonstrates the variability across provinces in relation to the degree of delegated authority and the efficiency of the administrative support systems for facilities and the urgent need to fast-track improvements in some instances, Minister Tshabalala-Msimang said.
The domain covering the patient experience of care in general showed that the efforts to improve the information provided to patients, including on their rights and the establishment of mechanisms for complaints are bearing fruit, with many facilities scoring very well.
With regard to patient access to care, many facilities did not perform well with low staff numbers in relation to demand frequently cited. However, some hospitals had instituted systems to monitor waiting times and successfully reduce them in spite of facing similar challenges.
It was also found that most facilities did have the information and procedures needed for a functioning referral system however, many of the self-appraisals recorded serious problems in this regard.
Several facilities had really excellent health promotion programmes running and many also have disaster management plans in place.
However, the degree to which hospitals are planning their activities jointly with institutions in the communities they serve in order to improve outcomes and reduce inequities is very limited.
The infrastructure and the environment were found to be the weakest of all.
The report said cleanliness and absence of litter was not generally a strong point and a number of hospitals were rated as weak.
Services such as the laundry and kitchens showed problems in some hospitals and are of great concern to the public while general maintenance of buildings and basic security measures were one of the most problematic areas.
The report however, showed that prevention of transmission of Tuberculosis (TB) within the public institutions has become a major concern.
"The appraisal showed that we are not taking enough measures yet in this regard, especially in relation to the physical measures to reduce airborne infection.
"This has therefore been identified as one of our top priorities in nearly all the facilities that were appraised," Minister Tshabalala-Msimang said.
Responding on the report, the minister said the results are already being used to develop plans to improve services adding that in almost all cases the hospital management team has immediately started correcting what has been pointed out to them and is within their control.
"We are also providing additional support to them and closely monitoring implementation in this process to identify and learn from any blockages or constraints that are found," she said.
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