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Annual Report 2012/2013Western Cape Government Health

Annual Report 2012/13 Contents

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Contents

PART A: GENERAL INFORMATION

1. Departments General Information 1

2. List of Abbreviations/Acronyms 2

3. Strategic Overview 13

3.1 Vision 13

3.2 Mission 13

3.3 Values 13

3.4 Strategic Outcome Orientated Goals 13

4. Legislative and Other Mandates 14

5. Organisational Structure 16

6. Entities Reporting to the Minister/MEC 18

7. Foreword by the Minister/MEC of the Department 18

8. Overview of the Accounting Officer 20

PART B: PERFORMANCE INFORMATION

1. Statement of Responsibility for Performance Information 25

2. Auditor-Generals Report: Predetermined Objectives 25

3. Overview of Departmental Performance 26

3.1 Service delivery environment 26

3.2 Service delivery improvement plan 32

3.3 Organisational environment 36

3.4 Key policy developments and legislative changes 39

4. Strategic Outcome-oriented Goals 46

5. Performance Information by Programme 55

5.1 Programme 1: Administration 55

5.2 Programme 2: District Health Services 68

5.3 Programme 3: Emergency Medical Services 100

5.4 Programme 4: Provincial Hospital Services 110

5.5 Programme 5: Central Hospital Services 153

5.6 Programme 6: Health Sciences and Training 193

5.7 Programme 7: Health Support Services 203

5.8 Programme 8: Health Facilities Management 223

6. Summary of Financial Information 231

6.1 Departmental receipts 231

6.2 Programme expenditure 232

6.3 Transfer payments, excluding public entities 233

6.4 Public entities 239

6.5 Conditional grants and earmarked funds received 239

6.6 Donor funds 261

Vote 6: Health Western Cape Government ________________________________________________________________________________________________

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6.7 Capital investment, maintenance and asset management plan 264

PART C: GOVERNANCE

1. Introduction 281

2. Risk Management 281

3. Fraud and Corruption 282

4. Minimising Conflict of Interest 282

5. Code Of Conduct 283

6. Health Safety And Environmental Issues 283

7. Internal Control Unit 284

8. Audit Committee Report 286

PART D: HUMAN RESOURCE MANAGEMENT

1. Legislation that govern HR Management 291

2. Introduction 291

3. Human Resource Oversight Statistics 301

3.1 Personnel related expenditure 301

3.2 Employment and vacancies 303

3.3 Job evaluation 305

3.4 Employment changes 307

3.5 Employment equity 312

3.6 Signing of performance agreements by SMS members 318

3.7 Filling of SMS posts 318

3.8 Employee performance 320

3.9 Foreign workers 323

3.10 Leave utilisation for the period 1 January 2012 to 31 December 2012 324

3.11 HIV and AIDS & Health promotion programmes 327

3.12 Labour relations 333

3.13 Skills development 335

3.14 Injury on duty 337

3.15 Utilisation of consultants 337

PART E: FINANCIAL INFORMATION

1. Report of the Accounting Officer 341

1.1 General review of the state of financial affairs 341

1.2 Services rendered by the Department 358

1.3 Capacity constraints 360

1.4 Utilisation of donor funds 360

1.5 Trading entities and public entities 360

1.6 Organisations to whom transfer payments have been made 361

Annual Report 2012/13 Contents

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1.7 Public private partnerships (PPP) 361

1.8 Corporate governance arrangements 361

1.9 Discontinued activities/activities to be discontinued 362

1.10 New/proposed activities 362

1.11 Asset management 363

1.12 Inventory 363

1.13 Events after the reporting date 363

1.14 Information on predetermined objectives 364

1.15 SCOPA resolutions 368

1.16 Prior modifications to audit report 376

1.17 Exemptions and deviations received from the National Treasury 376

1.18 Interim financial statements 376

1.19 Other 376

1.20 Approval 381

2. Statement of Responsibility for Annual Financial Statements 382

3. Report of the Auditor-General 383

4. Annual Financial Statements 388

4.1 Appropriation Statement 388

4.2 Notes to the Appropriation Statement 409

4.3 Statement of Financial Performance 414

4.4 Statement of Financial Position 415

4.5 Statement of Changes in Net Assets 416

4.6 Cash Flow Statement 417

4.7 Notes to Financial Statements (including Accounting policies) 418

4.8 Disclosure Notes to the Annual Financial Statements 440

4.9 Unaudited Supplementary Schedules (Annexures) 463

Western Cape Government Health Annual Report 2013/2014

Part A General Information

Annual Report 2012/13 Part A: General information

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1. DEPARTMENTS GENERAL INFORMATION

Full name of Department: Western Cape Government: Health

Physical address of Head Office: 4 Dorp Street

Cape Town

8001

Postal address of Head Office: PO Box 2060

Cape Town

8000

Contact telephone numbers: +27 21 483 3245 (Directorate: Communications)

Fax number: +27 21 483 6169

E-mail address: [email protected]

Website address: http://www.westerncape.gov.za


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2. LIST OF ABBREVIATIONS/ACRONYMS

ABET Adult basic education and training

ACLS Advanced cardiovascular life support

ACT Assertive community team

ACTS Advise, consent, test and support

ACSM Advocacy, communication and social mobilisation

ACVV Afrikaanse Christelike Vrouevereniging

AFS Annual financial statements

AGSA Auditor-General of South Africa

AIDS Acquired immune deficiency syndrome

ALOS Average length of stay

AMS Air Mercy Service

AO Accounting officer

APL Approved post list

APP Annual performance plan

ART Anti-retroviral treatment / therapy

ARV Anti-retroviral

ASSA Actuarial Society of South Africa

ATA Assistant to artisan

ATLS Advanced trauma life support

BANC Basic antenatal care

BAS Basic Accounting System

BAUD Bar coded asset audit software

BBBEE Broad based black economic empowerment

BCA Best care always

BFHI Baby friendly hospital initiative

BLS Basic life support

BMI Budget management instrument

BMS Business management system

BOE Board of executors

BPD Bipolar disorder

CADAC Communication assistive devices advisory committee

CANSA Cancer Association of South Africa

CAP Compliance acceleration plan

CARA Criminal assets recovery account

CBO Community-based organisation

CBR Community-based response


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CBS Community-based services

CCW Community care worker

CD Chief Director

CD4 Cluster of differentiation 4 (lymphocyte)

CDC Community day centre

CDU Chronic dispensing unit

Ce-I Centre for e-Innovation

CEO Chief executive officer

CFO Chief financial officer

CG Conditional grant

CHC Community health centre

CHIP Child health information programme

CI Confidence interval

CIDB Construction Industry Development Board

CIMCI Community integrated management of childhood illness

CISD Critical incident stress debriefing

CKDO Central Karoo District Office

CMART Certificate in the management of patients on anti-retroviral and tuberculosis treatment

CMD Cape Medical Depot

CME Continuing medical education

CMI Compliance monitoring instrument

CMI-PO Compliance monitoring instrument for predetermined objectives

CNP Clinical nurse practitioner

CoCT or CCT City of Cape Town

COID Compensation for occupational injuries

COIDA Compensation for Occupational Injuries and Diseases Act

COP 17 The 17th Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC)

COPD Chronic obstructive pulmonary disease

COSATU Congress of South African Trade Unions

CPD Continuous professional development

CPI Consumer price index

CPS Construction procurement system

CPUT Cape Peninsula University of Technology

CRADLE Central Reporting of All Delivery Data on Local Establishment

CSIR Council for Scientific and Industrial Research

CSP Comprehensive Service Plan


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CSS Client satisfaction survey

CSSD Central sterile supply department

CT Computerised tomography

CTICC Cape Town International Convention Centre

CWDO Cape Winelands District Office

D or Dir Director

DBSA Development Bank of Southern Africa

DBE Department of Basic Education

DDG Deputy Director-General

DDV Direct delivery voucher

DEDT Department of Economic Development and Tourism

DG Director-General

DHA District health authorities

DHMIS District health management information system

DHS District health system / services

DHS & HP District health services and health programmes

DICU Devolved internal control unit

DMT District Management Team

DNA Deoxyribonucleic acid

DO District office

DoH Department of Health

DORA Division of Revenue Act

DOTS Directly observed treatment, short course

DPSA Department of Public Service Administration

DR Drug resistant

DRP Disaster recovery plan

DVD Digital versatile/video disc

EAP Employee assistance programme

EC Emergency centre

ECC Emergency control centre

ECD Early child development

ECM Enterprise/electronic content management

EDI Electronic data interchange

EDO Eden District Office

EEV Emergency equipment vehicles

EHW Employee health and wellness

EHWP Employee health and wellness programme

EMC Emergency medical care


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EMS Emergency medical services

ENT Ear, nose and throat

EPS Electronic purchase system

EPWP Expanded public works programme

ERM Enterprise risk management

ERMCO Enterprise risk management committee

ESMOE Essential Steps in the Management of Obstetric Emergencies

ETR.net Electronic Tuberculosis Register

EU European Union

FBU Functional business unit

FIFA Fdration Internationale de Football Association

FIFO First in, first out

FIU Forensic investigation unit

FMC Financial monitoring committee

FOREX Foreign exchange rate

FPL Forensic pathology laboratory

FPS Forensic pathology services

FTE Full-time equivalent

FPD Foundation for Professional Development

GAAP Generally accepted accounting practice

GEMC 3 Emergency medical services information system

GEMS Government Employees Medical Scheme

GF Global Fund

GG Government garage

GIAMA Government Immovable Asset Management Act

GMT Government motor transport

GP General practitioner

GP% Gross profit percentage

GPSSBC General Public Service Sector Bargaining Council

GSA Geographical service area

GSH Groote Schuur Hospital

GVI Oncology An organisation providing cancer care

H1N1 Swine flu (sub-type of influenza A)

HAART Highly active anti-retroviral therapy

HAST HIV and AIDS, STI and tuberculosis

HBC Home-based care

HCBC Home community-based care

HCRW Health care risk waste


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HCT HIV counselling and testing

HDI Historically disadvantaged individuals

HEI Higher education institutions

HFA Health care facility assessment

HFRG Health facility revitalisation grant

HH Households

HIA Health impact and assessment

HIG Health infrastructure grant

HIS Hospital Information System

HIV Human immunodeficiency virus

HMIMMS Hospital major incident medical management and support

HO Head office

HoD Head of department

HP Health programmes

HPCSA Health Professions Council of South Africa

HPTDG Health professions training and development grant

HR Human resources

HRD Human resource development

HRG Hospital Revitalisation Grant

HRH Human resources for health strategy

HRM Human resource management

HRMC Human resource monitoring committee

HRP Hospital revitalisation programme

HSRC Human Sciences Research Council

HST Health Systems Trust

HTA High transmission area

HWSETA Health and Welfare Sector Education and Training Authority

IA Internal assessment

IAPB International Agency for the Prevention of Blindness

IAR Immovable asset register

IAS International accounting standards

ICAS Independent Counselling and Advisory Services

ICD-10 International classification of disease (10th revision)

ICT Information and communication technology

ICU Intensive care unit

ICU Information compliance unit

ID Infectious diseases

IDC Infectious diseases clinic


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IDIP Infrastructure delivery improvement programme

IDS Industrial Development Strategy

IDU Infectious disease unit

IDMS Infrastructure Delivery Management System

IEC Information Education and Communication

IFRIC International financial reporting interpretations committee

IFRS International financial reporting standards

IG Incentive grant

IMCI Integrated management of childhood illness

IMLC Institutional management labour committees

iMOCOMP Improvement and maintenance of competencies of medical practitioners

IMR Infant mortality rate

IOD Injuries on duty

IPC Infection prevention and control

IT Information technology

IUCD Intrauterine contraceptive device

IUSS Infrastructure unit support system

IYM In-year monitoring

JAC Pharmaceutical management system

JIMI Joint information management initiative

KMC Kangaroo Mother Care

KVA Kilovolt-ampere

L1 Level 1 (primary)

L2 Level 2 (secondary)

L3 Level 3 (tertiary)

LG Local government

LGBTI Lesbian, gay, bisexual, transgender and intersex

LOGIS Logistic Information Systems

LRA Labour Relations Act

M Million

M & E Monitoring and evaluation

M & M Morbidity and mortality

MADAC Mobility and communication assistive devices committee

MBFHI Mother and baby friendly hospital initiative

MCC Medicine Control Council

MCWH Maternal, child and womens health

MCWH&N Maternal, child and womens health and nutrition

MDG Millennium development goal


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MDHS Metro District Health Services

MDR Multi-drug resistant

MEC Member of the executive council

MEDSAS Medical Stores Administration System

MIMMS Major incident medical management system

MMC Medical male circumcision

MMS Middle management service

MOD Mass participation, opportunity and access, development and growth

MOU Midwife obstetric unit

MPSA Minister of Public Service and Administration

MRC Medical Research Council of South Africa

MRI Magnetic resonance imaging

MSAT Multi-sectorial action teams

MTEF Medium-term expenditure framework

N Number

NACOSA Networking AIDS Community of South Africa

NCG Nursing colleges and schools grant

NCS National core standards

NDoH National Department of Health

NDP National Development Plan

NEMA National Environmental Management Act

NHFC National Housing Finance Corporation

NHI National Health Insurance

NHLS National Health Laboratory Services

NHS National Health Systems

NIMART Nurse initiated management of ART

NIMS Nursing Information Management System

NMS Non-medical site

NPC National Planning Commission

NPO Non-profit organisation

NRF National Revenue Fund

NQF National Qualifications Framework

NSDA Negotiated service delivery agreement

NSRI National Sea Rescue Institute

NTSG National tertiary services grant

ODO Overberg District Office

OHC Oral health centre

OHS Occupational health and safety


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OPC Orthotic and Prosthetic Centre

OPD Outpatient department

OSD Occupation specific dispensation

OVC Orphans and vulnerable children

P1 Priority 1

P2 Priority 2

PAA Public Audit Act

PACS Picture archive communication system

PACS/RIS Picture archive communication system and Radiological imaging system

PACU Post-anaesthetic care unit

PALS Paediatrics advanced life support

PALSA PLUS Practical approach to lung health and HIV/AIDS and STIs in South Africa

PAY Premiers advancement of youth (project)

PCC Provincial co-ordinating committee

PCCA Prevention and Combating of Corrupt Activities Act

PCR Polymerase chain reaction

PCV Pneumococcal conjugate vaccine

PDA Protected Disclosures Act

PDE Patient day equivalent

PDP Public driving permit

PE Peer education

PEAP Provincial employee AIDS programme

PEP Post exposure prophylaxis

PERMIS Performance Management Information System

PERSAL Personnel and Salary Information System

PES Provincial equitable share

PET Positron emission tomography

PFMA Public Finance Management Act

PHC Primary health care

PHCIS Primary Health Care Information System

PICT Provider initiated counselling and testing

PILIR Policy on incapacity leave and ill-health retirement

PIPP Perinatal Problem Identification Program

PLWHA People living with HIV and AIDS

PMTCT Prevention of mother-to-child transmission

PM Programme management and strengthening

PMG Paymaster General

PMT/Refund & Rem- Payment made as an act of grace


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Act/Grace

PN Practice note

PPE Property, plant and equipment

PPHC Personal primary health care

PPP Public private partnership

PPPFA Preferential Procurement Policy Framework Act

PPPFA/BBBEE Preferential Procurement Policy Framework Act / Broad based black economic empowerment

PPT Planned patient transport

PPTC Provincial Pharmaceutical and Therapeutic Committee

PREHMIS Primary Health Care Management Information System

PSA Public Service Act

PSA Public Service Administration

PSCBC Public Service Co-ordinating Bargaining Council

PSR Public service regulations

PTB Pulmonary tuberculosis

PTMS Provincial transversal management system

PTI Provincial Treasury instruction

QA Quality assurance

QAP Quality assured products

QIC Quality improvement committee

RAF Road Accident Fund

RCC Global Fund Rolling Continuation Channel

RCWMCH Red Cross War Memorial Childrens Hospital

RIS Radiological imaging system

RPM Rational portfolio management

RTC Regional training centre

RV Rotavirus

RWOPS Remunerative work outside the Public Service

SA South Africa

SABS South African Bureau of Standards

SAL Salary

SANC South African Nursing Council

SAPS South African Police Service

SBA Study by assignment

SCM Supply chain management

SCOA Standard chart of accounts

SCOPA Standing Committee on Public Accounts


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SCUBA Self-contained breathing apparatus

SDA Service delivery agreement

SDC Step-down care

SDIP Service delivery improvement plan

SEAT Safe environment around toilets

SETA State Education and Training Authority

SG Superintendent General

SHERQ Safety, health, environment, risk and quality management

SINJANI Standard Information Jointly Assembled by Networked Infrastructure

SITA State Information Technology Agency

SLA Service level agreement

SMME Small medium and micro enterprises

SMS Senior management service

SMS Short message service

SOP Standard operating procedure

SP Sub-programme

SPES Specialised and emergency services

SPMS Staff performance management system

SSD Surface supplied diver

SSO Sub-structure office

SSS Staff satisfaction survey

StatsSA Statistics South Africa

STI Sexually transmitted infection

SYSPRO Software package used by central hospitals for supply chain management and asset management.

TB Tuberculosis

TBH Tygerberg Hospital

TIK Methamphetamine (crystal meth)

TIKZN Trade and Investment Kwa-Zulu Natal

TR Treasury regulations

Train & Dev Training and development

TV Television

U5MR Under-five mortality rate

U-AMP User asset management plan

UCT University of Cape Town

UNICEF United Nations International Childrens Fund

UPFS Uniformed Patient Fee Schedule

US University of Stellenbosch


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UV Ultra-violet

UVGI Ultra-violet germicidal irradiation

UWC University of the Western Cape

VCT Voluntary counselling and testing

VHF Very high frequency

VIC Victim identification centre

WAD World AIDS day

WC Western Cape

WC-IDMS Western Cape infrastructure demand management system

WCA Workers compensation assistance

WCBD Western Cape Bid Documents

WCCN Western Cape College of Nursing

WCDO West Coast District Office

WCDoH Western Cape Department of Health

WCG Western Cape Government

WCRC Western Cape Rehabilitation Centre

WCSD Western Cape Supplier Database

WISN Workload indicators of staffing needs

WHO World Health Organisation

XDR Extreme drug resistant

YDA Youth Development Association

YLL Years of potential life lost

YMCA Young Men's Christian Association


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3. STRATEGIC OVERVIEW

3.1 Vision

Quality health for all.

The vision statement is in the process of being reviewed as part of the consultation of the 2030 framework.

3.2 Mission

We undertake to provide equitable access to quality health services in partnership with the relevant stakeholders within a balanced and well managed health system to the people of the Western Cape and beyond.

3.3 Values

The core values of the Department are:

(1) Caring

(2) Competence

(3) Accountability

(4) Integrity

(5) Responsiveness

(6) Respect

3.4 Strategic Outcome Orientated Goals

The Departments strategic goal statements are:

(1) Address the burden of disease.

(2) Improve the quality of health services and the patient experience.

(3) Ensure and maintain organisational strategic management capacity and synergy.

(4) Develop and maintain a capacitated workforce to deliver the required health services.

(5) Develop and maintain appropriate health technology, Infrastructure and ICT.

(6) Optimal financial management to maximise health outcomes.


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4. LEGISLATIVE AND OTHER MANDATES

National Legislation

(1) Allied Health Professions Act, 63 of 1982

(2) Atmospheric Pollution Prevention Act, 45 of 1965

(3) Basic Conditions of Employment Act, 75 of 1997

(4) Births and Deaths Registration Act, 51 of 1992

(5) Broad Based Black Economic Empowerment Act, 53 of 2003

(6) Childrens Act, 38 of 2005

(7) Chiropractors, Homeopaths and Allied Health Service Professions Act, 63 of 1982

(8) Choice on Termination of Pregnancy Act, 92 of 1996

(9) Compensation for Occupational Injuries and Diseases Act, 130 of 1993

(10) Constitution of the Republic of South Africa, 1996

(11) Constitution of the Western Cape, 1 of 1998

(12) Construction Industry Development Board Act, 38 of 2000

(13) Correctional Services Act, 8 of 1959

(14) Criminal Procedure Act, 51 of 1977

(15) Dental Technicians Act, 19 of 1979

(16) Division of Revenue Act (Annually)

(17) Domestic Violence Act, 116 of 1998

(18) Drugs and Drug Trafficking Act, 140 of 1992

(19) Employment Equity Act, 55 of 1998

(20) Foodstuffs, Cosmetics and Disinfectants Act, 54 of 1972

(21) Government Immovable Asset Management Act, 19 of 2007

(22) Hazardous Substances Act, 15 of 1973

(23) Health Professions Act, 56 of 1974

(24) Higher Education Act, 101 of 1997

(25) Inquests Act, 58 of 1959

(26) Intergovernmental Relations Framework, Act 13 of 2005

(27) Institution of Legal Proceedings Against Certain Organs of State Act, 40 of 2002

(28) International Health Regulations Act, 28 of 1974

(29) Labour Relations Act, 66 of 1995

(30) Local Government: Municipal Demarcation Act, 27 of 1998

(31) Local Government: Municipal Systems Act, 32 of 2000

(32) Medical Schemes Act, 131 of 1997

(33) Medicines and Related Substances Control Amendment Act, 90 of 1997

(34) Mental Health Care Act, 17 of 2002

(35) Municipal Finance Management Act, 56 of 2003


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(36) National Health Act, 61 of 2003

(37) National Health Laboratories Service Act, 37 of 2000

(38) Non Profit Organisations Act, 71 of 1977

(39) Nursing Act, 33 of 2005

(40) Occupational Health and Safety Act, 85 of 1993

(41) Older Persons Act, 13 of 2006

(42) Pharmacy Act, 53 of 1974

(43) Preferential Procurement Policy Framework Act, 5 of 2000

(44) Promotion of Access to Information Act, 2 of 2000

(45) Promotion of Administrative Justice Act, 3 of 2000

(46) Promotion of Equality and Prevention of Unfair Discrimination Act, 4 of 2000

(47) Protected Disclosures Act, 26 of 2000

(48) Prevention of and Treatment for Substance Abuse Act, 70 of 2008

(49) Public Audit Act, 25 of 2005

(50) Public Finance Management Act, 1 of 1999

(51) Public Service Act, 1994

(52) Road Accident Fund Act, 56 of 1996

(53) State Information Technology Agency Act, 88 of 1998

(54) Skills Development Act, 97 of 1998

(55) Skills Development Levies Act, 9 of 1999

(56) South African Medical Research Council Act, 58 of 1991

(57) South African Police Services Act, 68 of 1978

(58) Sterilisation Act, 44 of 1998

(59) Tobacco Products Control Act, 83 of 1993

(60) Traditional Health Practitioners Act, 35 of 2004

(61) University of Cape Town (Private) Act, 8 of 1999

Provincial Legislation

(1) Communicable Diseases and Notification of Notifiable Medical Condition Regulations published in Proclamation R158 of 1987

(2) Exhumation Ordinance 12 of 1980; Health Act, 63 of 1977

(3) Regulations Governing Private Health Establishments published in PN 187 of 2001

(4) Training of Nurses and Midwives Ordinance 4 of 1984

(5) Western Cape Ambulance Services Act, 3 of 2010

(6) Western Cape Direct Charges Act, 6 of 2000

(7) Western Cape District Health Councils Act, 5 of 2010

(8) Western Cape Health Care Waste Management Act, 7 of 2007

(9) Western Cape Health Facility Boards Act, 7 of 2001


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(10) Western Cape Health Services Fees Act, 5 of 2008

(11) Western Cape Land Administration Act, 6 of 1998

Changes to legislation

(1) The Western Cape Health Facility Boards Amendment Act, 2012 (Act 7 of 2012) was assented to on 7 December 2012 and published under Provincial Notice 370/2012 in Provincial Gazette No. 7069.

(2) The Western Cape District Health Councils Amendment Bill (B6-2013) has been published in the Provincial Gazette for public comment.

(3) The Draft Western Cape Independent Health Complaints Committee Bill, 2013, is being processed.

For more detail on the changes to legislation, please refer to the section on Key policy developments and legislative changes in Part B (Performance information) of this document.

5. ORGANISATIONAL STRUCTURE

The organisational structure (organogram) reflects the senior management service (SMS) members as at 31 March 2013. A list of the budget programme managers during 2012/13 is provided below:

Table 5.1: Budget programme managers during 2012/13

Budget programme manager Budget programme

(1) Dr E Engelbrecht Deputy Director General: Specialised and Emergency Services

Programme 5: Central Hospital Services

(2) Dr S Kariem Chief Director: General Specialist and Emergency

Programme 3: Emergency Medical Services Programme 4: Provincial Hospital Services

excluding Sub-programme 4.2

Sub-programme 7.3: Forensic Pathology Services

(3) Dr J Cupido Deputy Director General: District Health Services and Programmes

Programme 2: District Health Services Sub-programme 4.1: Tuberculosis Hospitals

(4) Dr L Angeletti Du Toit Chief Director: Infrastructure Management

Programme 7: Health Care Support Services excluding Sub-programme 7.3

Programme 8: Health Facilities Management

(5) Mrs B Arries Chief Director: Human Resources

Programme 1: Administration Programme 6: Health Sciences and Training

Annual Report 2012/13

Part A: General information

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Vote 6: Health Western Cape Government __________________________________________________________________________________________

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6. ENTITIES REPORTING TO THE MINISTER/MEC

The Cape Medical Depot (CMD) previously functioned as a trading entity. However, the Provincial Capital Fund Ordinance 3 of 1962 was repealed in Provincial Gazette Extraordinary No 7029 on 4 September 2012. As a result the CMD was retrospectively incorporated into the Department as of 1 April 2012. The CMD is now funded through an expenditure budget under Sub-programme 7.5 which is now called the Cape Medical Depot. The purpose of the Sub-programme is to manage the supply of medicine and medical supplies to health facilities.

The operational functioning of the CMD remains unchanged, with its core function being that of purchasing medicines and consumable items in bulk, storing this stock and, as required, repackaging it into smaller quantities for distribution to health facilities and sites.

7. FOREWORD BY THE MINISTER/MEC OF THE DEPARTMENT

Within the framework of the Western Cape Governments fourth strategic objective of Increasing Wellness, the Department has moved into the arena of addressing health issues in a transversal manner. This transversal approach heralds a new approach to governance. The whole of society approach recognises the increasing need to work across traditional boundaries to deliver results. This requires a unified ethos across the public service, and is in line with the vision for this provincial government to be the best run regional government in the world.

The 2012/13 Annual Report reflects the service delivered by Western Cape Government Health on this road. The Department has made significant progress towards achieving the provincial strategic objective of Increasing Wellness. This is evidenced by the fact that life expectancy at birth in the Western Cape is increasing. The Province suffers from the quadruple burden of HIV and TB, child and maternal ill-health, non-communicable diseases and injuries. Chronic diseases are the third leading cause of premature years of life lost in the Province. It follows that Increasing Wellness is central to reducing this burden to our health system.

It is likely that the increase in life expectancy is due to the reducing HIV and TB-specific mortality rates. The Western Cape had the lowest mother-to-child-transmission rate (1.7 per cent) and the highest TB cure rate in South Africa. The risk for new infections remains a serious challenge and much work is required to change behaviour and address misconceptions at an individual level as well as efforts to address the more systemic and societal challenges.

The Western Cape Department of Health is about to embark on a second round of public consultation before tabling the Healthcare 2030 strategic framework before the provincial cabinet for approval. The framework, which provides direction to the Department for the next two decades, will contain flexible planning tools that match health service delivery to the needs of local communities.

Patient-centred care plays a vital role in the Western Cape Department of Healths values-driven vision of providing quality health for all and is one of the fundamental principles of Healthcare 2030.

In order to better understand and improve the patient experience, the Department piloted a SMS and telephonic hotline for certain facilities during 2012/13 where complaints were logged and tracked to ensure resolution. The hotline proved to be a great success and will be rolled out across all facilities going forward.

The Department also embarked upon a change management programme to improve staff engagement with patients and advance the aim of becoming a values-based organisation.


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In order to address the financial challenge, a reprioritisation exercise was undertaken in 2012/13. Shifts in services, greater efficiencies in goods and services, reduction in incentives, agency and personnel expenditure were introduced in order to realise savings in various areas. Reductions in service levels as a result of insufficient funding can only be prevented through further improvements in operational efficiencies and an enhanced focus on preventative medicine.

A highlight during the past financial year was the Department receiving an award from the Auditor-General in recognition of the continual improvements made to financial management processes. Appropriate budget allocation to provide required services, however, remains a challenge.

In closing, in my view the annual report is characterised by the objectives and achievements that we set as a government to achieve positive change in the lives of the people who reside in the Western Cape. These achievements required individual commitment, innovation and flexible and networked approaches.

I would like to thank and congratulate every employee of the Department for their participation towards the successes achieved in 2012/13, in particular under the leadership of the top management.


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8. OVERVIEW OF THE ACCOUNTING OFFICER

New developments

The highlight of the past financial year was the opening of the Khayelitsha District Hospital which is situated in one of the poorest communities of the Western Cape and which has the highest burden of disease. The hospital functioned at full capacity within the first few months of opening. This hospital is also a first on many counts. It was the first hospital in decades to be built not only within Khayelitsha but on the Cape Flats. It was the first hospital to use green building design principles from inception and became a flagship project together with Lentegeur Hospital for the Premiers 110% Green Campaign. It was the first hospital within the Province to use Enterprise Content Management from inception to digitally manage and store patient records. An analysis of service shifts within the Cape Metropole has shown that Khayelitsha patients having moved from Groote Schuur Hospital, Mowbray Maternity Hospital, Red Cross War Memorial Childrens Hospital, Karl Bremer and GF Jooste Hospitals to Khayelitsha Hospital and its referral partner, Tygerberg Hospital. The analysis further shows a net increase in the number of Khayelitsha patients accessing the hospitals services.

The construction of the Mitchells Plain Hospital has been completed and the hospital will be commissioned in 2013/14. This is another landmark development in the history of the local community and the Department.

Services under pressure

The health service generally remained under pressure during 2012/13 especially the district hospitals in the Metro and certain hospitals in the rural districts. New Somerset and Tygerberg Hospitals showed increased workloads. A multi-year analysis indicates that the workload continues to increase annually.

Service outputs

The Department admitted approximately 504 445 patients to acute hospitals and managed 1 932 542 outpatients. The Department handled a total of 14.8 million headcounts in 2012/13. The PHC utilisation rate decreased, which can be explained by a number of factors. In previous years, PHC visits in hospitals were counted as PHC headcounts, while in 2012/13 these were counted as OPD visits to hospitals as per a national directive. In addition, the home-based care (HBC) programme was strengthened and these patient visits have increased, resulting in a service shift from PHC to HBC. However, the quality of data and data collection systems in HBC has to be improved.

A total of 478 365 patients were transported by ambulances of whom 109 720 priority 1 patients were transported within 15 minutes in urban areas and 22 454 priority 1 patients within 40 minutes in rural areas. The EMS did well to achieve this response time for P1 patients with the increased load of almost 50 per cent necessitated by the re-prioritisation of all calls involving mothers and children as priority 1 calls. The number of hours that hospitals diverted patients was drastically reduced compared to the previous year, with the exception of Tygerberg Hospital, which confirmed the service pressure experienced by the hospital. The capacity of EMS was significantly increased by the appointment of 246 additional staff and 130 interns through a learnership programme. The fleet received a boost by the replacement of 86 vehicles and addition of 8 new vehicles.

134 000 patients were receiving ART at the end of the financial year. A concern is the increasing proportion of ART patients who are not retained in care. The mother-to-child transmission rate was reduced to 1.7 per cent which is one of the lowest in the country. The aim is that no single child should contract HIV during and after the birth process.


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21

The TB smear positive cure rate reached 81.7 per cent. This is close to the WHO target of 85 per cent. However, this is in the context of an HIV epidemic where almost 50 60 per cent of TB patients are smear negative and therefore not included in the above indicator. The TB defaulter rate was 7 per cent.

The Department immunised 87.2 per cent of all children under one year of age, while 89.5 per cent received their first dose of measles vaccine. The immunisation rates must be improved and the Department will focus on this as a major priority in the 2013/14 financial year. The recorded mortality from diarrhoeal disease in children has steadily decreased over recent years.

Quality of care

A common pattern of suboptimal adherence to treatment was evident across a range of chronic disease conditions such as TB, AIDS and non-communicable diseases such as diabetes and hypertension. Addressing this will require a concerted effort on the part of the health service as well as patients to improve performance.

There were 15 inspections conducted to assess compliance with the national core standards in 2012/13 and areas for improvement in infection control, occupational health and safety, and clinical governance were identified. A Services Charter has been developed that will publicly commit the Department to certain quality standards. The Department received a total of 4 011 complaints, comprising 0.03 per cent of the headcount seen in the year compared to 7 498 compliments which formed 0.05 per cent of the headcount. The main areas for complaint were waiting times, waiting lists for surgical procedures and staff attitudes. However, the client satisfaction survey conducted in 78 facilities showed that more than 85 per cent of the respondents felt that doctors were polite and nurses listened to their problems.

A manual has been developed and piloted to improve reception services in facilities as part of an overall strategy to improve patient experience. The Department has a multi-pronged strategy to reduce waiting times. Firstly, the Department has endorsed the implementation of Enterprise Content Management (ECM) in an incremental manner within the available resources, which will improve folder management. Secondly, the full roll out of an appointment module at the PHC facilities will address the distribution of patients throughout the working day and consequently reduce the queues that increase in the early part of the day. Thirdly, the roll-out of the Chronic Dispensing Unit service will fast-track the collection of medicines by chronic patients at clinics.

Finance

The Departments annual expenditure came within less than one per cent of the allocated budget for the year. Fifty per cent of this under expenditure was on capital infrastructure projects largely due to factors outside of the Department. A concern was the absolute increase in number of cases of fraud and non-compliance with legislative prescripts. A Fraud Implementation Plan has been developed and its implementation is driven by the office of the chief financial officer. The Department achieved an unqualified audit for 2011/12 and the improvement in the Departments audit performance was recognised by the Auditor-General.

Human resources

The staff of the Department increased with 455 to a total of 31 462 at the end of the financial year. An increased proportion of posts are now filled within 60 days of the advertisement. Agency expenditure increased by about R68 million largely due to the need to fill posts rapidly with the commissioning of Khayelitsha Hospital. The Department will be redirecting these funds to the filling of full time posts in the coming financial year. The vacancy rates of medical doctors, nurses and pharmacists reduced over the year though the attrition of these categories of staff in absolute numbers slightly increased. The main problems with which staff accessed the employee wellness service were relationship issues and stress.


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Infrastructure

The Department completed the following main capital projects in 2012/13: Du Noon Temporary Clinic, George Hospital Revitalisation Phase 3, Grabouw Community Day Centre (CDC) extensions, Groote Schuur Hospital Linear Accelerator Unit, Knysna CDC, Leeu Gamka Ambulance Station, Mitchells Plain Hospital, and Tulbagh Ambulance Station.

Maintenance backlogs have historically been a challenge. The Department has re-valued its backlog to an amount of R480 million. This is based on an assessment of the condition of buildings used by the Department. The Infrastructure and Technical Management Chief Directorate has strengthened its capacity to provide clear guidance and leadership in this area, while technical capacity within the services has been incrementally strengthened. A new directorate of Health Technology was established in the latter part of the year, which will systematically address the health technology challenges as well as explore the advances and opportunities in this area. The major challenges in Infrastructure continue to be the scarcity of built environment professionals and skilled technical resources as well as contract management capacity.

ICT

The Department has made good progress in the implementation of ICT projects. The PHCIS was rolled out to 50 sites in 2012/13 and the PACS/RIS was successfully implemented in the three central hospitals. JAC, which is a pharmacy dispensing and stock control system and historically only implemented in hospitals, was successfully piloted at Michael Mapongwane CDC and rolled out to a further 27 facilities.

Public private partnerships

The Minister launched a Health Foundation, which aims to provide a structured interface between the private sector and the Department to develop initiatives and direct fund raising to improve the service and revenue streams. The Public Private Health Forum is well established as a vehicle for robust dialogue and two-way communication between the Department and the private sector parties. A campaign to undertake cataract surgery in outlying hospitals in Eden and the Central Karoo was a partnership between the Department, the World Health Organisation and the International Agency for the Prevention of Blindness.

Strategic Objective 4: Wellness

The Department continues to make progress, despite various challenges, in addressing upstream factors impacting on health. The six focus areas of this strategic objective are HIV/TB, Healthy Lifestyles, Injuries, Mental Health, Womens Health and Child Health. Partnering with and supporting initiatives in civil society is a key success factor. The preparatory work to set up wellness centres in co-operation with private pharmacies has been completed and the first of these centres will be launched in 2013/14.

2030 (previously 2020) Strategy

The Department received extensive comments on the first draft of the then 2020 document and appreciates the positive response and constructive comments received. The second draft will be released in early June 2013 for further public comments and incorporates many of the comments received on the first draft. The revised document further deepens the technical work around the service delivery platform and more extensively considers the support services required to enable the envisaged vision. The Department has decided to extend the time horizon from 2020 to 2030 given the complexity of the changes required and the long-term nature of proposed infrastructure projects.


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23

In conclusion, I would like to sincerely thank the management team and all the staff in the Department whose hard work and commitment contributes to the provision of the health service and who contribute to increasing the wellness of the people of the Western Cape and beyond. I would also like to thank Minister Botha for his unfailing support of the management and his commitment to improving the quality of health services rendered to the people of the Western Cape. It has truly been Better together!

Western Cape Government Health Annual Report 2013/2014

Part B Performance Information

Annual Report 2012/13 Part B: Performance Information

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1. STATEMENT OF RESPONSIBILITY FOR PERFORMANCE INFORMATION

Statement of Responsibility for Performance Information for the year ended 31 March 2013

The Accounting Officer is responsible for the preparation of the Departments performance information and for the judgements made in this information.

The Accounting Officer is responsible for establishing and implementing a system of internal control designed to provide reasonable assurance as to the integrity and reliability of performance information.

In my opinion, the performance information fairly reflects the performance information of the Department for the financial year ended 31 March 2013.

2. AUDITOR-GENERALS REPORT: PREDETERMINED OBJECTIVES

The Auditor-General of South Africa (AGSA) currently performs the necessary audit procedures on the performance information to provide reasonable assurance in the form of an audit conclusion. The audit conclusion on the performance against predetermined objectives is included in the report to management, with material findings being reported under the Predetermined Objectives heading in the Report on other legal and regulatory requirements section of the auditors report.

Refer to page 384 to page 385 of the Report of the Auditor-General, published in Part E: Financial Information.


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3. OVERVIEW OF DEPARTMENTAL PERFORMANCE

3.1 Service delivery environment

Services delivered directly to the public

The Western Cape Department of Health provides the following health services to a population of 5.9 million, of which 4.6 million are uninsured:

(1) Community-based services (CBS)

Non-acute health services, which include home-based care, preventive and adherence health programmes, mental-health and intermediate care, are rendered at non-health facilities, homes, mental health institutions, early child development (ECD) centres, prisons, old age homes and schools.

The service is currently rendered by lay people who are not registered health professionals but appropriately trained people employed by non-profit organisations (NPOs), who are in turn sub-contracted by the Western Cape Department of Health. Some NPOs offer services for tuberculosis (TB) and anti-retroviral treatment (ART) adherence. At the end of March 2013, 3 058 home carers were appointed by NPOs.

(2) Primary Health Care (PHC) services

Clinical nurse practitioners (CNPs) provide child and adult curative care, preventive services, antenatal care, postnatal care, family planning, mental health, TB, HIV and AIDS, and chronic disease management at fixed and non-fixed facilities.

The promotion of screening for cervical and breast cancer, strengthening of family planning, earlier antenatal care and prevention of mother-to-child transmission are areas of focus for the Department.

There are 284 PHC facilities across the Province (225 fixed clinics, 50 community day centres and 9 community health centres). Of these facilities, 92 are under the authority of the City of Cape Town (CoCT).

During 2012/13 approximately 14.8 million patients were seen for PHC services of which 2.2 million (15.0 per cent) were children under the age of five years.

(3) Acute district hospital services

Emergency centres, adult and child inpatient and outpatient care, obstetric care as well as a varying quantum of general specialist services are provided at the Departments 34 district hospitals.

In 2012/13 there were 260 187 inpatient separations and 878 760 patients were seen in outpatient departments at district hospitals.

(4) Emergency medical services (EMS) and planned patient transport

Ambulance, rescue and patient transport services are provided from fifty two stations in five rural district EMS services and four Cape Town divisional EMS services with a fleet of 250 ambulances, 1 610 operational personnel and 127 supervisors (officers).

477 718 emergency cases were attended to in 2012/13.


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(5) Regional and specialised hospital services

The Departments four acute hospitals (New Somerset, Paarl, Worcester and George) provide the full package of general specialist services and Mowbray Maternity provides a maternal and neonatal health service to the population of the Western Cape.

These services are also located at Groote Schuur and Tygerberg Hospitals, serving the patients from the surrounding communities referred to these hospitals for general specialist services.

In 2012/13 there were 108 914 inpatient separations and 243 365 patients were seen in outpatient departments at regional hospitals.

The Department provides the following specialised services:

TB hospital services at six hospitals and an infectious disease palliative centre at Nelspoort Hospital. There are three designated drug-resistant tuberculosis (DR-TB) units which are located at Brewelskloof, Harry Comay and Brooklyn Chest Hospitals. Brooklyn Chest and DP Marais Hospitals form the Metro TB Complex while Malmesbury ID and Sonstraal Hospitals form the West Coast TB Complex. During 2012/13 3 764 inpatients were treated at TB hospitals and a further 6 302 patient contacts were attended to at outpatient departments.

Four psychiatric hospitals and two sub-acute facilities, all of which are located in the Cape Town Metro District, provide a provincial psychiatric service. These facilities collectively attended to 6 079 inpatient separations and 28 611 patient contacts at outpatient departments.

The Western Cape Rehabilitation Centre (WCRC) provides specialised rehabilitation services including orthotics and prosthetics for people with physical disabilities. In 2012/13 the WCRC had 889 inpatient separations and 10 363 outpatient headcounts.

The oral health centres provides primary, secondary, tertiary and quaternary dental services at Tygerberg Oral Health Centre, Groote Schuur Hospital, Red Cross War Memorial Childrens Hospital and the Mitchells Plain Oral Health Centre. There were 105 439 oral health patient visits during 2012/13.

(6) Tertiary and quaternary health services at central hospitals

Highly specialised tertiary and quaternary services are rendered on a national basis at the Departments three central hospitals, Groote Schuur, Tygerberg and Red Cross War Memorial Childrens Hospital. From 1 April 2013 Red Cross War Memorial Childrens Hospital will be reclassified as a tertiary hospital.

In 2012/13 there were 135 344 inpatient separations and 810 417 patients were seen in outpatient departments at central hospitals.

(7) Forensic pathology services (FPS)

Specialised forensic pathology services are rendered via eighteen forensic pathology facilities across the Province in order to establish the circumstances and causes surrounding unnatural death.

During the 2012/13 financial year 9 939 medico-legal cases were admitted, resulting in 9 779 post mortem examinations in the Western Cape.


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For more detail on the health services rendered by the Department and the number of patients seen, refer to section 5: Performance Information by Programme, in Part B of this report.

Problems encountered and corrective steps taken

This section provides more detail on the problems encountered by the Department when providing the relevant services and the corrective steps taken in dealing with such problems.

(1) Community-based services (CBS)

There are discussions taking place at the level of the National Department of Health about introducing significant changes to community-based services. In addition, organisational changes to strengthen community-based services are due to be implemented at a provincial level. New policies are therefore being developed and piloted in preparation for the 2013/14 financial year.

(2) Primary Health Care (PHC) services

The entire provincial primary health care platform is in the latter stages of a significant change to a service model based on decentralisation (i.e. district management).

The focus is thus on improving quality of clinical care (through the deployment of family physicians) and improving facility-level management. In addition there is on-going re-organisation of services (e.g. nurse-driven-doctor-supported practices as well as strengthening community-based services) in order to improve patient wellness and education and also ensure that appropriate patients get access to PHC services. Clinical and corporate governance systems are being developed and strengthened.

Since there are two health authorities in the Cape Town Metro District, service provision is fragmented and inefficient. Bilateral management forums have been set up to align priorities and administer the dual authority model. Such meetings do however, of themselves, contribute to on-going inefficiencies and over-use of managerial time. CoCT reporting continues to improve marginally, but there are still problems with timeliness of data submissions from CoCT.

The ability to roll out new anti-retroviral treatment (ART) service points is an on-going challenge and is dependent on the speed of rolling out infrastructure, the appointment of staff and up-skilling of these appointees. The Department has implemented a drive for identified PHC infrastructure sites to be fast-tracked for implementation and this will have a positive impact on, amongst others, ART service points.

Chronic stable ART patients (patients who have been on treatment for more than 18 to 24 months and who do not have significant clinical pathology) still need to attend facilities on the PHC platform to receive their medication, arguably crowding out sicker patients who require acute services more. Alternative models for dispensing ART through community structures and the chronic dispensing unit are therefore being piloted.


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(3) Acute district hospital services

The opening of the Khayelitsha Hospital and the addition of twenty beds at Eerste River Hospital resulted in increased patient day equivalents (PDEs) across the Province during 2012/13. The activity levels, as indicated by an increase in day patient and inpatient numbers, continue to increase at the Khayelitsha, Karl Bremer and Helderberg Hospitals, which are all in the Khayelitsha/Eastern sub-district.

(4) Emergency medical services (EMS) and planned patient transport

The reclassification of all maternal patients as priority 1 (P1) resulted in an unexpected 49.2 per cent increase in P1 cases. EMS however maintained their predicted performance despite this increased workload through improved efficiencies in both operational and communications components and implementation of the EMS learnership programme.

The EMS learnership programme not only increased the available working hours, it also resulted in a disproportionate increase in entry level Basic Life Support (BLS) qualified employees. The Department is therefore reviewing the current skills mix in order to maintain a high quality of care.

The HealthNET booking system requires significant upgrade if it is to deliver on the planned patient transport efficiencies. The Department has seconded the programming resource to this project and is currently engaged with the District Health Service stakeholders around mapping the processes in the new workflow in an effort to better understand the user specific requirements.

(5) Regional and specialised hospitals

Regional hospitals are pivotal in strengthening the district health system and protecting the highly specialised services. Retaining minimum specialist staffing levels have been a challenge. Additional efforts in recruitment have been applied.

There was a significant increase in the number of cataract surgeries performed in rural hospitals as a result of a targeted campaign in rural areas during the third quarter. George Hospitals ophthalmology team and local ophthalmologists in private practice performed cataract surgery in outlying hospitals across the Eden and Central Karoo Districts as part of a joint programme of the World Health Organisation (WHO) and the International Agency for the Prevention of Blindness (IAPB). The team treated 447 patients at outlying hospitals and performed 97 cataract surgeries at George Hospital during this period.

The TB hospitals outpatient headcount and admissions dropped during 2012/13 due to decentralisation of multi-drug resistant treatment, with uncomplicated cases being managed at sub-district level within the Metro.

Conversely, the number of patients with comorbid mental illness and infectious disease requiring careful pharmacological management increased, resulting in increased average length of stays and more frequent admissions. The Department put active ambulatory support services in place to support treatment adherence and sobriety and monitored re-admissions within 90 days, using this indicator as a proxy for effective care pathway evaluation.


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The growth in the burden of mental illness has put strain on the whole care pathway from primary care facilities to psychiatric hospitals. Ambulatory care strategies, improved patient referral mechanisms and systems strengthening strategies were applied. Psychiatric hospitals furthermore experienced increased referrals for forensic assessment of children and adolescents and growth in the waiting list of awaiting trial prisoners for the male observation service, leading to overcrowding of the minimum and medium secure wards. The Department has therefore engaged with the Department of Justice on this issue.

(6) Tertiary and quaternary health services at central hospitals

The recruitment and retention of highly skilled medical and nursing staff remained a challenge during 2012/13.

The shortage of professional nurses, in particular those with post basic qualifications in theatre technique, intensive care, paediatrics, mental health and advanced midwifery, impacted on the Departments capacity and ability to provide highly specialised services. The Department incurred additional agency staff expenditure in order to deliver these services.

Furthermore, the shortage of skilled clinical technologists to provide key support services, of nurses specialised in theatre and critical care, and anaesthetists combined with budget constraints and the high costs of consumables limited the reduction of theatre waiting lists for certain procedures.

The Department provided training programmes and opportunities for key staff such as nurses to improve skills and achieve deployment in essential services like critical care, theatres and paediatrics. Strategies leveraging on bursary and training posts were used to improve recruitment of clinical technologists.

(7) Forensic pathology services (FPS)

The ability to appoint qualified forensic pathology specialists is limited by available funding. Management of the bodies of unidentified persons was a challenge during 2012/13. During this period, numerous unidentified bodies, declared as paupers for internment, were stored for an extended period due to delayed pauper internment processes at municipal level.

The relationship between the South African Police Services (SAPS) and FPS to prioritise cases is being managed on an on-going basis in order to maintain an improvement. However, the level of scientific investigation required for a scientific means of identification increases the time before the deceased can be released for internment.

Draft amendments to the FPS regulations in the National Health Act, which would reduce the period for internment, are in the process of being developed.

External developments that impacted on services or service delivery

This paragraph provides more details on any significant developments, external to the Department, that may have impacted either on the demand for the Departments services or on the Departments ability to deliver those services.


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(1) Chronic medication dispensing

At the beginning of April 2012 the new service provider informed the Department of backlogs in the dispensing and production processes at their new facility resulting in delays in the delivery of patient medicine parcels to facilities. The delay was caused by the complexity of the patient data transfer (from the previous contractor to the new contractor), the implementation of new business processes and the commissioning of sophisticated equipment by the new contractor. In response to the delay, medicines were manually dispensed and a helpline was established to assist patients with questions and advice regarding the nearest 24-hour facility in the event of an urgent need or emergency. This situation created inconvenience for patients and put additional stress especially on the pharmacy staff at facilities. The Department publicly apologised to all concerned and appreciated the efforts of all role-players to address the situation.

The provision of chronic medicine dispensing services stabilised and from September 2012 to the end of the reporting period the number of patients receiving medicines using this alternate service mechanism has grown to an average of 185 000 prescriptions per month. This service will be expanded to rural districts and the roll-out commenced with the balance of the West Coast District.

(2) Drug availability

During October to December 2012 the Cape Medical Depot also experienced the following challenges in acquiring medication timeously:

Many national tenders expired during the 2012 year.

The late award of pharmaceutical tenders (i.e. after the previous contract/tender expired) by the National Department of Health, coupled with new suppliers taking full advantage of the 90 day lead time at the commencement of a contract, led to the many challenges experienced in the procurement of medication required to meet service needs from the market.

Some of the suppliers that were awarded the recent national contracts had questionable quality standards and the CMD voiced its concerns with utilising these products to the National Department of Health.

Alternative models for dispensing ART through community structures and the chronic dispensing unit are being piloted.

Management put the following measures in place to minimise the impact of the above challenges on service delivery:

Tenders close to expiry were identified.

The National Department of Health and the Provincial Pharmaceutical and Therapeutic Committee (PPTC) were notified of products that will not be available for long periods of time for alternative arrangements to be made. The clinical experts on the PPTC advised on alternate agents where appropriate.

Bridging orders were placed before tenders expire and where possible staggered delivery was arranged with suppliers.

The National Department of Health acceded to the request to import certain medication from other sources, that met both the quality and service needs, in order to ensure a supply of the required medication.


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(3) Infrastructure requirements

The implementation and institutionalisation of the Standard for an Infrastructure Delivery Management System and the Standard for a Construction Procurement System (as published by Provincial Treasury on 01 April 2012 and regulated by Provincial Treasury Instructions Chapters 16A and 16B) requires extensive changes to current infrastructure planning and delivery processes within the Chief Directorate: Infrastructure and Technical Management, as well as the setting up of entirely new processes. Similar requirements apply to the WCG: Transport and Public Works, the implementing department of WCG: Health. A work stream group process has been set up to implement the standards and work stream groups have been established with representatives from effected departments as well as the Infrastructure Delivery Improvement Programme (IDIP). In addition, a Compliance Acceleration Plan (CAP) has been prepared in order to ensure compliance to the prescripts of Provincial Treasury Instructions Chapters 16A and 16B. The process is on-going and it is anticipated that implementation and institutionalisation will have been substantially achieved by the end of the 2013/14 financial year.

The infrastructure requirements in the Province, especially in relation to primary health care and district services, remain extensive. The new Health Facility Revitalisation Grant (as published in the Division of Revenue Act 2013) is used to fund the infrastructure requirements through the construction of new facilities, as well as the upgrading and extension of existing facilities. However, given the scale of requirements in relation to available funds, it will take many years before the backlog will be adequately addressed.

Some challenges are still experienced with the implementation of projects. It is anticipated, however, that with the implementation and institutionalisation of the Standard for an Infrastructure Delivery Management System and the Standard for a Construction Procurement System, such challenges will largely be eradicated.

Ensuring the timeous preparation of provincial space planning norms and standards, standard drawings and technical specifications, design guidelines, and cost norms, this is being addressed through the Norms and Standards Work Stream Group, working in conjunction with the National Department of Healths Infrastructure Unit Systems Support (IUSS).

3.2 Service Delivery Improvement Plan

All departments are required to develop a Service Delivery Improvement Plan (SDIP). The following tables reflect the components of the SDIP as well as progress made in the implementation of these plans.

The report in Tables 3.2.1 to 3.2.5 below responds to the areas identified in the 2009 2013 SDIP.

Patient-centred care is identified as a core area of focus in Healthcare 2030. It is encompassed in the Departments values-driven vision, and is recognised as playing a vital role in improving quality of health care within the health services. The goal is to provide a superior experience to all patients.

To move towards achieving this, the Department has developed a framework for a patient-centred experience which consists of five domains:


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(1) Reception services

(2) Clinical governance

(3) Continuity of care

(4) Community participation

(5) Staff wellness

Reception services are the service area which will be addressed in the 2013 2016 SDIP in order to improve the patient experience. The SDIP will be implemented at three sites, namely Khayelitsha Hospital, Michael Mapongwana CHC and Khayelitsha Site B Clinic.

Within the reception services domain, key areas identified for intervention are:

(1) A welcoming protocol

(2) Environmental ambience

(3) Risk profiling and client services manager

(4) Patient registration

(5) Folder management

(6) Appointment system

A patient-centred reception services manual was developed and piloted at six sites. The aim of the manual is to guide users in the improvement of reception services in order to make reception areas and processes more patient centred. The manual will be made available to managers as a tool for reception services staff. A patient discharge/referral summary is nearing finalisation which will improve continuity of care.

The National Department of Health, following on the baseline audits conducted in 2011/12 whereby facilities were assessed for compliance against a set of national core standards, conducted pilot audits in twelve facilities to test a revised tool during 2012/13.

In addition to the national audits, a number of facilities conducted self-assessments to determine their level of compliance against the standards. Based on the results of these audits, facilities developed quality improvement plans to address areas of non-compliance.

The Department has developed a Service Charter which signals a public commitment to service standards. This will be displayed in all facilities.

Table 3.2.1: Main services provided and standards

Main services Actual customers Potential customers Standard of service Actual achievement

against standards

To ensure a clean,

effective and functional

environment in all

restrooms and bathroom

at George Hospital and

Helderberg Hospital.

The public and

employees attending

George and Helderberg

Hospitals.

Not applicable. Monitor the effectiveness

of the Safe Environment

Around Toilets (SEAT)

policy and the security

plan that was

implemented at George

and Helderberg

Hospitals. Report bi-

annually on above-

mentioned.

The SEAT project was

implemented

successfully. The

cleanliness and neatness

of the public restrooms

visually improved during

the past three years. The

Client Satisfaction Survey

of 2012 also reflected

the improvement at

these facilities.


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Main services Actual customers Potential customers Standard of service Actual achievement

against standards

Service level agreements

(SLAs) to be put in place

with outside service

providers rendering

cleaning services at


Hospitals.

Service level agreements

have been put in place

with outsourced

cleaning companies.

Monitor and evaluate

the cleaning and

servicing of restrooms

and bathrooms based

on specific standards as

indicated in SLA.

Service standards were

well adhered to with

regard to public

restrooms in both

hospitals.

Monitor the effectiveness

of the security plan

implemented at George

and Helderberg Hospitals

to prevent the theft and

damage of restroom

and bathroom

equipment. Report bi-

annual on above-

mentioned.

There has been a

noticeable decrease in

theft from and damage

to public restrooms at

both hospitals.

Note: There was a change in terminology for 2012/13 with actual customers replacing the term actual service beneficiaries and potential customers replacing additional beneficiaries reported in previous years.

Table 3.2.2: Consultation arrangements with customers

Type of arrangement Actual customers Potential customers Actual achievements

Ensure a clean, effective and

functional environment in all

restrooms and bathrooms at


Hospitals.

Complaints and compliments

system.

The public and employees

attending George and

Helderberg Hospitals.

Not applicable. Complaints and compliments

systems are in place. Public,

patients and staff are

knowledgeable regarding the

complaints and compliments

processes and utilise the various

methods of consultation.

Direct feedback. The public and employees



Not applicable. Both hospitals received many

positive verbal compliments

with regard to the general

cleanliness and hygiene of the

facility as a whole.


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Type of arrangement Actual customers Potential customers Actual achievements

Client Satisfaction Survey (CSS). The public and employees



Not applicable. There has been an

improvement in the overall

satisfaction of patients and the

public with regard to toilet

cleanliness since the survey

conducted in 2011.

Facility board meetings and

staff meetings.

The public and employees



Not applicable. SEAT audit results and

developments are discussed at

facility board and staff

meetings.

Table 3.2.3: Service delivery access strategy

Access strategy Actual achievements

Ensure a clean, effective and functional environment in all

restrooms and bathrooms (SEAT).

George Hospital, Davidson Road, George.

Helderberg Hospital, Lourensford Road, Somerset West.

Monthly audits and daily checklists were used at both hospitals to

monitor progress.

CSSs shows overall improvement since the survey conducted in

2012.

Table 3.2.4: Service information tool

Types of information Actual achievements


restrooms and bathrooms (SEAT) at George and Helderberg

Hospitals.

a) Feedback on:

Complaints and compliments system.

Client satisfaction survey.

a) No complaints or compliments received with regard to the

restroom at George Hospital. Fewer complaints were

received at Helderberg Hospital.

b) Direct feedback, regular update of notice boards and

through the press.

b) Direct feedback is given and the complaints and

compliments procedure is displayed on notice boards.

c) Staff meetings. c) Feedback and progress with SEAT is given at staff meetings.

d) Verbal and written communication. d) Written feedback provided in quarterly Quality Assurance

(QA) reports. Verbal communication is provided on a regular

basis.

e) Facility board meetings. e) QA reports are discussed at facility board meetings.

f) Website. f) Not provided.

g) Visual and personal experience of the service. g) Feedback from staff, managers, patients and members of

the public indicated that a general improvement of the

cleanliness, neatness and hygiene of the public restrooms

was noticeable.

h) Written feedback on complaints, posters and pamphlets

regarding SEAT, the publics responsibility towards the

environment and the service level standard.

h) Notices placed in restrooms with regard to personal and

public responsibility for restroom use, cleanliness and

hygiene. Service level standard provided in all restrooms.


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Table 3.2.5: Complaints mechanism

Complaints mechanism Actual achievements


restrooms and bathrooms (SEAT) at George and Helderberg

Hospitals.

a) Complaints and compliments systems. a) Complaints and compliments received are addressed.

b) Direct feedback. b) Provided on daily basis when complaints are received.

c) Verbal and written communication. c) Notices placed in restrooms w.r.t personal and public

responsibility for restroom use, cleanliness and hygiene.

Service level standard provided in all restrooms.

3.3 Organisational Environment

The organisation and post structure of the Department is based on its Strategic Plan and reflects the core and support functions to be executed in achieving the strategic objectives of the Department.

Resignations and/or appointments in Senior Management Service

The following changes occurred in the senior management service (SMS) during 2012/13 as a result of attrition:

Terminations and transfers out of WCG: Health

I Smith, Director: Supply Chain Management, transferred 1 April 2012.

L Tloubatla, Director: Human Resource Development, resigned 30 September 2012.

JK Hough, Manager medical physicist, retired 30 September 2012.

NE Msindo-Mayeng, Director: District Health Services, early retirement 30 November 2012.

LR August, Chief Executive Officer: GF Jooste Hospital, resigned 31 January 2013.

MJ Ledwaba, Chief Director: Health Programmes, transferred 31 January 2013.

GM Perez, Director: Eastern and Khayelitsha, resigned 31 January 2013.

Ms R van Haaght, Director: Supply Chain Management dismissed 6 February 2013.

New appointments

GC Carrick, Director: Management Accounting, 7 January 2013.

H van Heerden, Director: Engineering and Technical Services, 7 January 2013.

E Vosloo, Chief Executive Officer: Worcester Hospital, transferred to WCG: Health 1 February 2013.

Promotions

RM Basson, Senior Manager Nursing Level 3 (Tygerberg Hospital) 1 October 2011.

R Crous, Chief Director: Rural District Health Services, 1 March 2012.

WM Kamfer, Director: Overberg District, 1 April 2012.

MJH Ross, Senior Manager Nursing Level 3 (Groote Schuur Hospital) 1 April 2012.


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H Schumann, Director: Eden District, 1 September 2012.

PG Olckers, Director: Mitchells Plain and Klipfontein, 1 September 2012.

M de Beer, Chief Specialist Scientist, 1 November 2012.

BMA Blackburn, Director: Infrastructure Programme Delivery, 1 February 2013.

HJ Human, Chief Executive Officer: GF Jooste Hospital, 1 February 2013.

PFR Hurst, Director: Financial Accounting, 1 February 2013.

A Kharwa, Chief Executive Officer: Khayelitsha Hospital, 1 February 2013.

Restructuring

Post structures are monitored to ensure that staff members are functioning according to the new organisational design. Priority projects for structural amendments as well as new organisational design are identified annually to address efficiency, based on service needs and operational requirements.

The Department has recognised that the current organisational structure, consisting of two service divisions, and eight budget programmes is not conducive to a holistic and systemic approach to delivering patient centred care.

The current divisions are:

District Health Services and Health Programs (DHS & HP) which provides community-based services, primary health care services, health programmes and district and TB hospital services.

Specialised and Emergency Services (SPES) which includes: regional, secondary and psychiatric hospital services, the Western Cape Rehabilitation Centre, dental training hospitals, and central hospitals, emergency medical services and the forensic pathology service.

To address the above, a review of the macro structure of the Department in terms of purpose and function, responsibility, span of control, job description and level has commenced with the view to promote better cohesion in service delivery.

The Department supported the need for dedicated strategic focus on pharmacy services and the delivery of an effective pharmaceutical service. For this purpose, the Directorate: Pharmacy Services was established.

The Directorates functions include:

Pharmaceutical related services including the management of the chronic dispensing unit services to the Department.

The management of the Cape Medical Depot which is responsible for the procurement and distribution of medicines and supplies to the various health service rendering entities in the Department.

Provide strategic direction and support the planning, policy development and monitoring of drug management and pharmacy related services.


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The Chief Directorate: Infrastructure and Technical Management was redesigned to address new/amended legislation, changes to the institutional and operational environment, as well as new roles and responsibilities. The Chief Directorate revised establishment consists of the following directorates:

Directorate: Infrastructure Planning.

Directorate: Infrastructure Programme Delivery.

Directorate: Health Technology.

Directorate: Engineering and Technical Support.

In terms of the PFMA, optimal financial management is critical to ensure effective governance with respect to financial administration and supply chain management. Due to new developments within the financial management regulatory framework, it became necessary to review the structure of the Chief Directorate: Financial Management. Specific additions to the structure included:

Financial statements and debt administration.

Supply chain management risk and performance management and strategic sourcing.

To deliver a more cost efficient service to patients a new organisational structure was also developed and implemented for Mowbray Maternity Hospital. In addition, two