global health supply chain technical assistance …

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GLOBAL HEALTH SUPPLY CHAIN – TECHNICAL

ASSISTANCE – SOUTH AFRICA

QUARTERLY REPORT

October to December 2017

NEW PICTURE

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TABLE OF CONTENTS

Item #

Executive Summary 3

Introduction 5

• Summary of Accomplishments

Project Objectives 8

Program Governance and Management 10

Work Stream Accomplishments by Objective 14

Implementation Challenges, Risks, and Mitigation

Measures 38

Key Performance Indicators 43NEW PICTURE

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EXECUTIVE SUMMARY

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Executive Summary

Information Systems

Accomplishments:

• Finalized PuLSe application

(ready to pilot in Q2)

• Completed evaluation of

EMelA functionality.

• Developed specifications;

worked with developers to

address implementation

barriers, related to

gCommerce in the Northern

Cape.

• gCommerce now ready for

deployment in Limpopo and

Mpumalanga.

Staffing AMD Strengthening Collaboration

• While Year 1 of the Global Health Supply Chain (GHSC) project featured extensive design work, Year 2 focuses on

implementation. We completed several activities in Q1 and have several initiatives in final stages of approval by Affordable

Medicines Directorate (AMD) and Sector Wide Procurement. Most notable are the new demand planning approach, the

revised Provincial Medicine Procurement Unit (PMPU), and strengthening the Contract Management Unit (CMU).

• Organizational redesign of

the CMU is underway

• Redesign of the Licensing

Unit and the Essential Drugs

Program (EDP) will follow

• Collaboration with other

partners providing assistance

to AMD has improved, with

ongoing interaction with

Health Systems Trust (HST),

Clinton Health Access

Initiative (CHAI), Project Last

Mile (PLM), Right to Care and

the Foundation for

Professional Development

(FPD).

• Interactions allows for a

better coordinated and

coherent approach to

providing support to AMD.

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INTRODUCTION

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GOALS OF THE GLOBAL HEALTH SUPPLY CHAIN-

TECHNICAL ASSISTANCE-SOUTH AFRICA PROJECT:

GHSC Goals

• Launched in September 2016, the GHSC Program seeks to leverage industry approaches and leading practices to

accelerate strengthening of the South African public health supply chain to respond to current

challenges and emerging trends that have the potential to shape or stress the health system.

• To do so, the program will provide technical assistance (TA) to build the capacity of the South African

government and other public health institutions, including the Affordable Medicines Directorate (AMD)

within the National Department of Health (NDOH) and provincial pharmaceutical services across the medicine

supply value chain, so as to improve medicine availability.

• This work directly supports the USAID/South Africa Country Development Cooperation Strategy (CDCS) results

framework by supporting Development Objective (DO) 1 – Health outcomes for South Africans

improved.

• Additionally, these improvements support the Government of South Africa’s priority strategic

interventions identified in the NDOH’s Strategy to Improve Medicine Availability (SIMA) (2016-2021) and the

NDOH’s Annual Performance Plan (APP).

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SUMMARY OF ACCOMPLISHMENTSObjective 1: Improve selection and use of

medicine

Objective 2: Support optimization of the supply

chain Objective 3: strengthen governance

• Built workforce capacity by facilitating Expert Review

Committee (ERC) and National Essential Medicines List

Committee (NEMLC) meetings discussing EMelA

feasibility tests and improving awareness of committee

functions.

• Consolidated Standard Operating Procedures (SOPs)

for EMelA into a single standardized volume to support

institutionalization of updates to the EML using EMelA

• Developed and submitted first draft of the formulary

guideline to reach common understanding relating to

formularies and improve and standardize formulary

creation.

• Assisted development of content related to the

Essential Drugs Program (EDP): Rational Medicine Use

(RMU) Communications and Awareness Plan, to be

used as information and education for relevant

stakeholders.

• Developed introductory videos on how to use the

dashboards, and RxSolution to assist with training and

institutionalization of both.

• Completed the PMPU overview and presentation to

gain consensus on design and allow for communication

to provinces.

• Demand planning process defined and signed off by

NDOH.

• Developed and began pilot of new forecasting tool for

Eastern Cape

• Presented provincial baseline assessment to KwaZulu-

Natal and Eastern Cape Provincial Department of

Health (PDOH) management team members.

• Completed a baseline assessment in KwaZulu-Natal to

determine gaps and inform capacity building efforts.

• Agreed on Key Performance Indicator (KPI)

Dictionary format and template with the

Affordable Medicines Directorate (AMD).

• Agreed and finalized Medicines Availability

KPIs to improve alignment and assist with

interpretation and harmonization of the

indicators across the dashboards.

• Designed the Transition Framework and

Pilot Framework for AMD to facilitate

governance and accountability, and improve

resource management.

Objective 4: improve workforce management

Objective 5: strengthen information systems and

information management

Objective 6: improve financial

management

• Completed nine job profiles for AMD to improve workforce and performance mgmt.

• Completed CMU strengthening baseline assessment; developed future design and strengthening activities.

• Developed change management and stakeholder communications material for CMU and gCommerce.

• Developed training policy (awaiting AMD sign-off) & completed curriculum framework.

• Provided training support to gCommerce, Demand Planning, RxSolution and EDP to support institutionalization of interventions

• Established support structures for RxSolution

• Developed RxSolution training video in support of the transition plan.

• Through our efforts to improve data acquisition, 313 Hospitals are reporting to the National Surveillance Centre (NSC) through the various Electronic Stock Management Systems (ESMS).

• GHSC played a key role in facilitating the delivery of the ‘Proof of Delivery’ module which is part of the system enhancements on SVS.

• Finalized draft gCommerce Activation Pack

• Completed ‘As-is’ financial process and budgetary assessment for AMD.

• Designed new financial SOPs and processes for AMD.

• Designed new financial dashboard.

• Training policy curriculum designed to include basic financial management and budgeting. To be used within provinces as well.

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PROGRAM OBJECTIVES

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In order to support the development of agile, robust and sustainable health supply chain that will contribute towards improving medicines availability, the Program team organized its activities into a number of projects that are aligned to its strategy.

GOAL OF THE GLOBAL HEALTH SUPPLY CHAIN-TECHNICAL

ASSISTANCE-SOUTH AFRICA PROJECT

Outcome

Improved Availability of Medicine

Objective 1Improve selection and use

of medicines

RFTOP TASKS: 4 & 5

Sub-Objective 1.1Assist with the

implementation of HTA

Sub-Objective 1.2Improve rational

medicine use

Objective 2Support optimization of the

supply chain

RFTOP TASKS: 1, 2 & 3

Sub-Objective 2.1Improve contracting

Objective 5Strengthen information

systems and information management

RFTOP TASKS: 1-6

Objective 3Strengthen governance

RFTOP TASKS: 1-6

Objective 4Improve workforce

management

RFTOP TASK: 6

Objective 6Improve financial

management

RFTOP TASK: 6

Sub-Objective 2.2 Improve contract

management

Sub-Objective 5.1Design IT system

landscape

Sub-Objective 5.4Assist with

development & implementation of IT

systems

Sub-Objective 3.1Contribute to

development of policy and legislation

Sub-Objective 3.2Support the

implementation of governance


development of standardized structures, roles, competencies &

performance management

Sub-Objective 4.2Assist to institutionalize

change management

Sub-Objective 6.1Improve forecasting

and budget information

Sub-Objective 6.2Assist to strengthen

accounting processes

Sub-Objective 6.3Assist to improve

financial monitoring & reporting

Sub-Objective 3.3Co-ordinate and

oversee stakeholder engagement and communication

activitiesSub-Objective 4.3

Contribute to upskilling and mentoring of AMD

staff

Sub-Objective 2.3Design supply chain

operating model

Sub-Objective 2.4Maintain and improve

supply chain operations

Sub-Objective 5.2Provide support to

strengthen analytics & oversight


implementation of data governance

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PROGRAM GOVERNANCE

AND MANAGEMENT

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Program Management and GovernanceOctober 27, 2017 – December 31, 2017

• Three notable changes to originally planned Q1 work products and activities:

− gCommerce implementation in Limpopo and Mpumalanga is now planned for Q3 due to unanticipated challenges

encountered during Northern Cape implementation. The challenges experienced were outside of the control of

GHSC and related to system issues not experienced during the testing phase.

− SVS engagements moved to Q2, pending finalization of the NDoH participation agreement

− RxSolution transition training was moved to Q2 per recommendation by NDOH, due to the provincial

dependencies

• The team’s new IT Strategist & Program Manager began supporting the project in November 2017 which required

adjustments to several IT landscape and Master Data related efforts.

• Regular engagement and feedback with AMD counterparts is assisting to improve delivery.

% of Q1 work products and milestones completed on time

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LOE TRACKEROctober 27, 2017 – December 31, 2017

• The radar graph below is based on the year 2 Q1 LOE – the LOE is represented against the various projects

for year 2.

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Financial Status of the Task Order:October 27, 2017 – December 31, 2017

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WORK STREAM

ACCOMPLISHMENTS

BY OBJECTIVE

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Activitie

s and

impact

in the

past

quarter

EMelA is a web-based application that digitizes the Standard Treatment Guidelines (STGs) and the Essential Medicines List (EML).

In Year 1, GHSC supported AMD by managing the final stages of EMelA development. Following the presentation of an options analysis in September

on the future of the application, AMD and GHSC jointly decided to suspend further development and further evaluate modules supporting

governance and management of review committees and review and development of STGs which appeared to offer the greatest functionality. That

evaluation included:

• Used EMelA in parallel to normal meeting processes of the disorder review process at four meetings of the Expert Review Committees (ERC) – PHC,

Adult Hospital and Tertiary – and two meetings of the National Essential Medicines List Committee (NEMLC);

• GHSC and EDP used EMelA in parallel to the existing process used for the call for applications to the Paediatric ERC. This assisted to prove that EMelA

could be used in future for this process;

• Performing simulated or mock disorder reviews including associated committee meetings and processes. Two demonstrations were held with the

developer during which EDP and the GHSC stakeholders were shown the process of how to conduct a meeting and generate reports. EDP and GHSC

stakeholders then participated in a mock disorder review process, simulating both disorder review and committee related processes to allow for EDP

to actively use the system in a simulated environment.

The above activities contributed to the development of the EMelA Evaluation Report, submitted to EDP on 20 December. During this effort team

members identified numerous bugs which were retested once fixed and refined multiple EMelA SOPs.

This quarter the team restarted a number of HTA-targeted activities, primarily driven by reduced requirements related to EMelA activities and a

more iterative approach in planning. Activities included increased face-to-face interactions with EDP staff and improved collaboration and

coordination between HTA and RMU work streams.

• Observed the ERC and NEMLC meetings to test EMelA functionality and improve our understanding of committee functions. Observations have

been used to inform potential system enhancements and updates to SOPs and processes.

• Produce the revised Draft Conflict of Interest Policy for the EDP and performed initial work supporting EDP’s recruitment of members for the

Pediatric ERC.

• Finalised and submitted the first draft of the revised reviewer’s manual to EDP.

• Completed a costing analysis with associated capacity-development for two medicines—Tretinoin and long-acting beta antagonists.

Sub-Objective 1.1 – Assist with implementation of Health Technology Assessments (HTAs) and Sub-Objective 2.1 – – Improve

Rational Medicine Use

Objective 1 – Improve selection and use of medicines.

Objective 1 encompasses both Health Technology Assessments (HTA) and Rational Medicine Use (RMU). A central component of determining what

is “rational” in South Africa is the use of locally conducted HTAs. An effective HTA function should include timely, coordinated, inclusive and efficient

processes to make decisions related to new and existing technologies and services under an adaptable framework

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Planned

activities for

the next

Quarter

• Present the EMelA Phase I Evaluation Report to relevant stakeholders within the AMD, to decide on further use of the

application. Further actions will depend on the decision taken by AMD on the future of the application.

• Provide support and build capacity with ERC Costing Analyses on identified medicine(s)

• Support iterative development and testing of the Reviewer’s Manual

• Provide continued assistance with recruitment of Pediatric Expert Review Committee

• Finalize the Conflict of Interest Policy and assist with its implementation

Lessons

Learned &

Collaboration

with other

Partners

• Thorough evaluation of an application requires testing of use multiple scenarios designed to simulate intended activities and

desired functions.

• Implementation is highly dependent on clarity of design/intended functionality and data quality. Issues with either result in

significant delays to implementation.

• Multi-stakeholder collaboration is key to success – drawing on strengths of different parties allows for robust execution of

activities.

Sub-Objective 1.1 – Assist with implementation of Health Technology Assessments (HTAs) and Sub-Objective 2.1 – –

Improve Rational Medicine Use


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Activities and

impact in the

past quarter

In Year 1, the GHSC team supported the Contracting Team to prepare for transitioning tenders to National Treasury by

documenting business rules and processes currently used, including those processes specific to Contract Price Adjustments

(CPA). CPA updates have proved to be a cause for concern for the gCommerce project, as pricing data has not been updated

in accordance with the CPA.

GHSC has provided assistance to highlight discrepancies in pricing data and is working with National Treasury to update the

gCommerce data.

Planned

activities for

the next

Quarter

• GHSC will provide a resource to work with National Treasury to update all required data for the gCommerce application

used within the provinces. This will assist to avoid pricing discrepancies which result in delayed payment of suppliers.

Lessons

Learned &

Collaboration

with other

Partners

• Alignment of master data and pricing data is essential to avoid increased administration or delays in supplier payments,

both of which have the potential to impact on future medicine availability.

Sub-Objective 2.1 – – Improve contracting

Objective 2 – Support Optimization of the Supply Chain

Optimization of the supply chain is critical to facilitate the availability of medicines and other health commodities at the right place, at the right time,

and in the right quantity. Activities undertaken by GHSC related to Objective 2 include supporting the design and institutionalization of elements of

the Visibility Analytic Network (VAN) operating model as well as the implementation of the Provincial Medicine Procurement Units (PMPUs).

Activities included within this objective also include improving contracting and contract management.

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Activities and

impact in the

past quarter

• The Contract Management Unit (CMU) strengthening project commenced in October 2017. The team completed a baseline

assessment and presented findings to AMD and Sector Wide Procurement (SWP) along with recommendations for aligning

the future state CMU to the Strategy for Improved Medicine Availability (SIMA) and NDOH strategic requirements.

• Completed planning and design of the future state CMU; awaiting final approval by NDOH.

• The team assessed and identified opportunities to improve SOPs, policies, training and development, communications,

governance and engagement, change readiness, organizational design, and workforce planning as well as AMD financial

processes and budgets.

• The team engaged with the Provincial Medicine Procurement Unit (PMPU) and Demand Forecasting technical leads to align

methodologies with the frameworks used in the CMU strengthening project, which will assist in improving contract

management nationally.

Planned

activities for

the next

Quarter

• Implement monitoring and evaluation plan on CMU progress

• Undertake regular evaluation and impact assessments of CMU

• Align framework for competency and skills matching to the identified skills required within CMU.

• Train and orient employees on new CMU structure and functions

• Implement revised workflows for all processes undertaken within the CMU

• Implement stakeholder engagement plan

• Implement communication plan with stakeholders

• Conduct review outputs from stakeholder feedback sessions

• Revise the induction pack used by AMD which is used to orientate and educate new employees to AMD and CMU (as an

ongoing activity)

Lessons

Learned &

Collaboration

with other

Partners

• CMU, PMPU and demand planning strengthening activities, need to be continually aligned in order to ensure organizational

designs support future state processes

• Regular interaction and scenario presentations to CMU leadership greatly aided the process

• Engagement with provincial project leads and stakeholders supported by effective communications and sound change

management practices are critical to achieving alignment and agreement

Sub-Objective 2.2 – Improve contract management


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Activities and

impact in the

past quarter

The GHSC team drafted an overview document that describes the ideal PMPU Blueprint detailing the core functions, structure, and

processes of the “to-be” PMPU, including processes for demand, supply and distribution planning. The document was updated with

feedback received relating to the original blueprint. This is a more concise document that can be used for communication with key

stakeholders.

• Completed design of the new Demand Planning process, which was signed off by NDOH.

• Completed data source alignment and initial data “cleanse” for Eastern Cape

• Developed and piloted new forecasting tool (R-Studio) for Eastern Cape; Presented process and tool at workshop with NDOH

and demonstrated how to generate a forecast.

• Established new KPIs for monitoring effectiveness of the new demand planning process.

• Drafted a letter of introduction to provincial HODs based on the GHSC scope and SIMA.

• Developed the PMPU/ Demand Planning baselining document, with regard to workforce planning, capability mapping/ planning

and organizational design, training and development, SOPs and processes, stakeholder engagement and communication

processes.

Planned

activities for

the next

Quarter

• Implement new Demand Planning process for the Eastern Cape at National and Provincial levels. This includes executing the

new process, tool(s), and use of proposed KPIs.

• Develop demand planning curriculum and training at CMU and Provincial level.

• Present draft enhanced supply planning process to AMD and SWP

• Present draft Ideal PMPU Blueprint Overview to AMD/CMU management teams; receive and incorporate feedback and obtain

final approval AMD/CMU.

• Present approved ideal PMPU overview at the South African Association of Hospital and Institutional Pharmacists (SAAHIP)

Conference and develop an article for publication in the South African Pharmacy Journal.

• Engage Provincial Stakeholders through AMD / CMU led roadshow and commence implementation of the ideal PMPU,

according to agreed project plans.

Lessons

Learned &

Collaboration

with other

Partners

• Data dependence is significant and data quality is not reliable

• Engaging with a Province where there is a desire for change significantly increases chances of success.

• The integration of all EE strengthening across all supply chain initiatives is critical to program success.

• NDOH and provincial activities and models need to be aligned.

• Department of Health protocols are crucial and should be observed when engaging provinces, this lesson was Learned during

the design of the supply chain model, for GP Care Cell pilot project

Sub-Objective 2.3 – Design supply chain operating model


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Activities and

impact in the

past quarter

To support sustainability, the GHSC project team successfully transitioned “as-is” PMPU operations from the legacy SCMS

project to the following provinces:

• Provincial baseline assessment approach submitted to AMD, however, no formal feedback was received

• Province Specific – Stakeholder Maps; Key Stakeholder Profiles & Communication Strategy and Plans were completed, they

will be Finalised with the provinces, as part of the stakeholder engagement process.

• Provincial baseline assessment approach was presented to KwaZulu-Natal and Eastern Cape relevant Provincial Department of

Health (PDOH) management team members. Both provinces requested urgent completion of the baseline assessment process,

AMD / CMU have been informed both requests from the provinces.

• Provincial baseline assessments completed in KwaZulu-Natal. This was used to test the baseline assessment questions and

make the necessary adjustments for future assessments.

• Supported Foundation for Professional Development (FPD) on the design of the supply chain model, for GP Care Cell pilot

project

Planned

activities for

the next

Quarter

• Perform a Provincial Baseline Assessment that will allow the GHSC Provincial project managers to customize the

implementation plan for each province

• Follow up with AMD / CMU on approval of the Provincial Baseline Assessment Approach

• Finalise Provincial project implementation governance structures with provinces

• Finalise Province-Specific Stakeholder Maps; Key Stakeholder Profiles & Communication Strategy and project implementation

plans

• Share Provincial baseline assessment approach with the remaining Provinces (Free State, Gauteng, Limpopo, Mpumalanga,

North West and Northern Cape)

• Complete Provincial baseline assessments in all remaining provinces

• Seek approval of standard CCMDD Order Management Processes completed in Year 1 and implement in all provinces

• Change management and communications activities planned; in order to facilitate the initial launch of baselining work within

provinces

Lessons

Learned &

Collaboration

with other

Partners

• Continue coordinated Steering Committee Meetings across all work streams and provinces where possible to promote

stakeholder engagement, improve communications and facilitate change

• Quality baselining and readiness assessments are critical in order to measure the impact of change initiatives.

Sub-Objective 2.4 – Maintain and improve supply chain operations


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Activities and

impact in the

past quarter

A number of activities took place during the quarter which contribute to the development of policy and legislation. These

activities included:

Legislation

• Provided to AMD in the revision of draft regulations to be published in terms of the Pharmacy Act 53 of 1974 dealing with

continuing professional development of persons registered i.t.o. that Act. After consultation with the South African

Pharmacy Council (SAPC) the draft regulations were approved by Council and submitted to the Legal Unit by AMD for

publication for public comment.

• Supported AMD in the revision of the draft guidance for the issuing of pharmacy licenses. After consultation with the Legal

Unit and a stakeholder engagement session, the document was finalised and published in the Government Gazette on 22

December 2017 for public comment.

• Completed and submitted comment on two Board notices published by SAPC relating to Pharmacy Linked Distribution

Points (PLDPs) and Competency Standards for Pharmacists. Worked with AMD on the preparation of a presentation re

input provided and participated in a stakeholder engagement on the PLDP Board Notice organised by SAPC. Input on the

PLDP proposal was of particular importance as implementation thereof could have a very serious impact on the CCMDD

programme

• Made progress on the review and revision of the resubmission of amendments to three sets of regulations published i.t.o.

the Pharmacy Act to enable the education, registration and practice of pharmacy technicians. Conducted a face-to-face

meeting with SAPC representatives to address numerous questions, that arose during the redrafting process.

• Assisted AMD in consulting with the South African Veterinary Council (SAVC) on amendments to the Medicines and

Related Substances Act 101 of 1965 regarding the new requirement that veterinarians must have a license to dispense and

compound medicines if they perform these functions.

Sub-Objective 3.1 – Contribute to development of policy and legislation

Objective 3 – Strengthen Governance

AMD’s main function is to provide oversight and set policy concerning pharmaceutical services provided in South Africa. The GHSC team will

assist the AMD in improving its governance framework by aligning supply chain policy with AMD strategy and vision. We will support the

establishment of appropriate governance structures and build capacity within AMD to provide the necessary oversight. Additionally, as policies are

the mechanism by which the AMD strategy is translated into action and reforms are institutionalized, GHSC will support the development of

relevant legislation and policies related to strategic priorities and interventions.

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Activities

and impact

in the past

quarter

Policy

• Supported AMD in various meetings with key stakeholders (e.g. office of the Chief Nursing Officer and I-Tech) relating to

implementation of the nurse prescriber policy. Numerous factors including the decision of the Department not to proceed with

further development of the Knowledge Hub, and uncertainty relating to the further role of the developers of the Knowledge Hub

(including the nurse prescriber system) has resulted in a need to rethink the approach to the development of a system to manage

the issuing of authorisations to nurses i.t.o. Section 56(6) of the Nursing Act. The possibility of incorporating the system that is

used to record training undertaken by nurses (Skillsmart) with the system to be used to manage the issuing of authorisations i.t.o.

Section 56(6) is being explored.

• Assisted AMD in presentations to the Primary Health Care ERC and NEMLC on the principles of the nurse prescriber policy.

Both engagements highlighted to need for speedy implementation of all facets of the policy (viz. legislative changes, finalisation of

the competencies of nurses, appropriate training of nurses, and the development of an IT system to assist in managing the

process).

• Worked with AMD to develop a full set of documents for the ‘Request for Proposals’ for CCMDD service provision – the RFP

was published on the NDOH website on 10 November 2017. Worked with AMD and HST on the presentation to the public

briefing session on the ‘Request for Proposals’ for CCMDD service provision published on 10 November 2017.

• Assisted AMD with a presentation on the role of pharmacy support personnel in NHI for the Gauteng Provincial Pharmaceutical

Services Conference

• Finalised and presented the 2nd draft of the Transition framework at the PIT meeting. Requested further comments and feedback

from attendees.

• Work was done on an MOU for the sharing of data from private institutions for AMR surveillance

• The TORs for PIT and Wave Governance Meetings were presented at the Wave Governance meeting after which comments and

suggestions from attendees of both meetings were included and the TORs were completed and accepted.

• Developed and presented the Pilot Framework, to be used across all streams and AMD partners.

• Developed the Training Policy Framework, and Master Training Curriculum, to be used as a guide across all streams.

Sub-Objective 3.1 – Contribute to development of policy and legislation


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Planned

activities for

the next

Quarter

• Finalise MOU on the sharing of data for AMR Surveillance

• Finalise proposed amendments to regulations for pharmacy technicians

• Continue supporting AMD negotiations with the SAVC

• Continue to support AMD implementation of the nurse prescriber policy

• Develop an SCTA TA/EE activity strengthening tool to assist in planning, implementing, and monitoring critical EE activities

across all SCTA technical streams and project plans.

• Finalise an SCTA internal SOP policy and framework.

Lessons

Learned

/Collaboration

with other

Partners

• Work with HST on issues relating to CCMDD

• Some of the challenges encountered with the Northern Cape (NC) gCommerce and SITA frameworks resulted from

incomplete application of required EE communications, stakeholder engagement, and change management activities. This has

been addressed and corrected.

Sub-Objective 3.1 – Contribute to development of policy and legislation (continued)


24

Activities and

impact in the

past quarter

Assist with deployment and use of the Permit and License Services (PuLSe) application

The PuLSe application is a self-service application for the management and issuing of dispensing licenses and permits. The

introduction of PuLSe is expected to improve efficiencies and enhance customer service provided by the AMD’s Licensing

Unit. During the quarter, GHSC continued to support implementation of the system as follows:

• Completed system set up following the development of a detailed document showing the relationships and linkages

between the declarations by applicants, supporting documents required, audit checks and conditions for each type of

certificate for all permits and licenses, and for all system wizards.

• Revised master data to include legislative changes relating to the permits which authorise the supply of medicine by

midwives. Reviewed lists of conditions that can be treated and/or medicines prescribed by holders of permits issued i.t.o.

Section 22(15) a view to standardisation with and alignment to the PHC EML/STGs.

• Amended the deployment project plan and received sign off by the Licensing Unit Deputy Director.

• Incorporated feedback from by the NDOH Corporate Communications Department and finalised the PuLSe introductory

video, poster, and web announcement which were signed off by Director AMD.

• Developed two training videos to assist external users (applicants) which were submitted for sign off.

• Developed the draft PuLSe System Administrator User Manual and submitted it for sign off.

• Revised SOPs to incorporate changes to master data, lessons learned during system set up, and comments from AMD

stakeholders.

• Provided training to Licensing Unit staff on the legislative framework with a particular emphasis on sections dealing with

issuing licenses and permits.

• The PuLSe User Acceptance Testing (UAT) plan was drafted and submitted for approval. Commended internal testing.

• Completed URL registration, email gateway, no reply email address, and security certificate.

Sub-Objective 3.2 – Support the Implementation Of Governance


25

Planned

activities for the

next Quarter

• Conduct internal and external UAT involving staff of the Licensing Unit and subsets of licence/permit holders. Address

findings and prepare UAT report.

• Support AMD’s negotiating hosting of PuLSe with CSIR. Once agreement has been reached and UAT is complete,

support migration of PuLSe to the live/production environment.

• Finalise SOPs and train staff on use PuLSe in accordance with SOPs

• Provide assistance in sending out communication packs for on boarding licence and permit holder groups as scheduled.

Commence on boarding of Yellow Fever and first cluster of licence and permit holders.

• Develop framework for ongoing monitoring and evaluation

• Set date and prepare for official launch of the system

Lessons Learned

& Collaboration

with other

Partners

• Comprehensive end to end testing of a system must be conducted prior to sign off by the developer

Sub-Objective 3.2 – Support the Implementation Of Governance (continued)


26

Activities and

impact in the

past quarter

Activity: Support to the Essential Drugs Programme (EDP) to improve governance of Third Line ARV

Treatment (TLART)

• Per a direct request from AMD for support, GHSC assisted EDP to improve governance in management of requests for

initiation of TLART and provincial procurement activities for associated commodities. Work on the TLART was initiated

with agreement being reached with EDP on the high level work plan, detailing the governance and system development

activities. System development will be undertaken by Right to Care.

• Conducted a situation analysis to provide a clear, detailed understanding of the current status, processes followed, and

identify risks and opportunities to improve efficiencies. The team shadowed TLART application processing by the EDP

Secretariat, to gain a deeper understanding of the processes followed.

• A draft revised TOR for the relevant committee was prepared and submitted to EDP (also contributes to sub-objective 3.2

activity re governance structures)

Planned

activities for

the next

Quarter

• Finalise the Terms of Reference for TLART committee

• Submit a strategy document and options analysis for TLART access programme

Lessons

Learned &

Collaboration

with other

Partners

• This work is being done in collaboration with Right to Care who will be responsible for the development of the software

required to support the TLART application process



27

Activities and

impact in the

past quarter

Activity: Results Framework and Key Performance Indicators

Work on the Results Framework has moved forward this quarter with the development, submission and approval of the

Medicines Availability KPIs and subsequent changes to the Hospital, PHC and Security of Supply dashboards. This change in

focus to complete the KPIs relating to Medicines availability KPIs was driven by the need to complete these in preparation for

the SVS project rollout. During the quarter:

• Gained AMD approval for revised KPI dictionary format

• Completed revision of medicines availability KPIs which were presented to AMD at the National Health Council

Subcommittee on Pharmaceutical Services. Consulted with took place with representatives of PHC at the NDOH.

• Completed a review of the Hospital, PHC, Pipeline, Age Analysis, RSA Pharma and Security of Supply dashboards; findings

and recommendations to be be submitted to AMD in the next quarter.

• Finalised and presented a proposed KPI prioritization tool to AMD for review and comment.

• Drafted and submitted to AMD for discussion a scoping document for continuous improvement that describes the scope

of potential improvement projects.

• Finalised drafting the Legal Framework document.

Planned

activities for

the next

Quarter

• Finalise National KPIs for presentation to AMD and NHC sub-committee on Pharmaceutical Services

• Complete National KPIs and National KPI dictionary

• Provide input into dashboards to enable visibility of new KPIs – link to design of dashboards

• Submit review of Security of Supply, PHC, Hospital, Pipeline, Age Analysis and RSA Pharma dashboards.

• Identify key challenges and determine root causes to inform development of loss tree for management of continuous

improvement in the supply chain

• Contribute to the development of supporting policies and procedures

Lessons

Learned &

Collaboration

with other

Partners

• Worked closely with other project streams in understanding the proposed process developments and measurement

needs to better align the KPI needs



28

Activities and

impact in the

past quarter

Stakeholder engagement activities are critical to securing inputs and buy-in on design and implementation of new concepts, streamlining

implementation, and facilitating change management across all work streams.

• Conducted regular feedback and engagement sessions with NDOH, AMD and CMU; as well as with partners such as CHAI to

collect feedback on multiple new initiatives.

• Institutionalized development of Activation Packs, Transition Packs, and Induction Packs for all streams and emphasized benefits of

their use in the provinces to ensure standardization and effective communication of new initiatives and activities.

• The team provided EDP with the following stakeholder communication support:

• Developed RMU Communications and Awareness Plan to improve communications EDP and stakeholder communications

and increase awareness of Standard Treatment Guidelines and Essential Medicines List.

• Prepared a draft options analysis for possible RMU interventions

• Created a presentation for the University of the Witwatersrand’s Teaching and Learning Committee which provides

information on the EDP medicine selection, use processes, and EMelA. The University is considering including the

information in courses within its health curriculum.

• Developed and presented suggested EDP Logo and Branding to the EDP. Conducted four advanced Excel Training sessions

for the EDP with the goal of teaching EDP staff to use Microsoft Excel for the purposes of managing EDP data (including that

relating to stakeholders).

• Held meetings with District Support Partners (DSPs) to detail the GHSC work plan and understand their activities, with specific

reference to the National Surveillance Centre (NSC) dashboards, SVS and RxSolution support. Meetings were held with Aurum

Institute, ANOVA and MATCH.

Planned

activities for

the next

Quarter

• Finalise stakeholder matrix documents for each work stream.

• Finalise communications and change management plans and implementation strategies per stream.

• Finalise TA/EE Critical Path document and framework for all streams; in order to correctly sequence EE activities and ensure

optimal stakeholder engagement and communications functions.

• Finalise all implementation activity calendars for communications activities.

• Identify participants and conduct focus groups to inform the EDP: RMU Communications and Awareness Plan

Lessons

Learned &

Collaboration

with other

Partners

• The focus is on optimal engagement and the use of frameworks with partners; to ensure best practice, QC and alignment of

activities.

• Regular engagement with all technical, training and communication partners to ensure optimal project alignment and feedback.

Sub-Objective 3.3 – Coordination and Oversight of Stakeholder Engagement and Communication Activities


29

Activities

and impact

in the past

quarter

• Completed baseline assessment for the CMU strengthening project and presented to CMU.

• Developed “to-be” design including organizational structure, job descriptions, training policy and curriculum, processes and

procedures, legal framework, communication and change plans, revised performance management plans and stakeholder

engagement. Awaiting confirmation from NDOH for presentation.

• Provided work force planning technical assistance to gCommerce, SVS, RxSolution, PMPU, and Demand Planning projects.

Planned

activities

for the

next

Quarter

• Implement monitoring and evaluation plan of the success of the CMU project

• Undertake regular evaluation and impact assessments

• Deliver training and provide orientation on new functions for employees

• Implement revised workflows

• Implement stakeholder engagement plan

• Implement stakeholders communication plan

• Continue to review stakeholder feedback

• Continue to revise the induction pack based on feedback and lessons learned

Lessons

Learned &

Collaborati

on with

other

Partners

• The successful planning of GHSC projects within provinces, needs to include the correct sequencing of all workforce planning,

organizational design, communications, change management and training activities; prior to the launch and implementation of the

projects within the provinces.

• Continuous engagement and integration of workforce development activities materially improves deliverable acceptance and

successful implementation of new processes and activities.

• The successful implementation of training across work streams, needs to be preceded by stakeholder engagement,

communications and change management.

• All District Support Partners (DSPs) need to be included in planning; in order to avoid duplication of effort.

Sub-Objective 4.1 – Support the Development of Standardized Structures, Roles, Competencies and Performance Management

Objective 4 – Workforce Management

Activities included within this objective are intended to address the management of human resources within the medicine supply chain, including

addressing issues relating to the lack of qualified staff, high vacancy rates, uneven distribution of human resources, uneven implementation of

education, and defining staff management and retention strategies.

30

Activities and

impact in the

past quarter

Stakeholder engagement, communications, change management, and training form the cornerstones of effective change

management.

• CMU change readiness surveys completed, as part of the baselining of the CMU department.

• Completed change management and stakeholder engagement report for CMU, presented to Chief Director of Sector Wide

Procurement.

• Completed analysis of external stakeholders for CMU.

• Various stakeholder engagements were initiated with AMD and CMU, including a Meet and Greet Activity to consolidate

work done on CMU; and to plan the next quarter’s activities and deliverables.

• Completed communications, change, and training strategies for CMU—awaiting approval and sign-off.

• Communications, change, and training frameworks being standardized across technical work streams including, SVS,

gCommerce, PuLSe, PMPU and RxSolution.

• Conducted an engagement session with GHSC Provincial Managers on 13 December 2017, to inform them of coming project

activities and future changes to current state operations. The session leveraged our integrated communications, change and

stakeholder management messaging.

Planned

activities for

the next

Quarter

• Change engagement workshop with CMU in January 2018

• Implement stakeholder engagement, communications and change management plans for CMU, gCommerce, and RxSolution.

Lessons

Learned &

Collaboration

with other

Partners

• Effective collaboration between GHSC communications and change management teams and SITA is critical to the success of

gCommerce.

• Lessons learned during the gCommerce implementation in Northern Cape include the need to more carefully apply effective

communications and change management activities

• Each deliverable in each work stream can benefit from more effective, focused stakeholder engagement, communications and

change management support.

• Effective stakeholder engagement and communication; needs to precede all change management efforts; these activities to be

carried out in order to elicit effective change management.

Sub-Objective 4.2 – Change Management Institutionalized


31

Activities and

impact in the

past quarter

• Completed the assessment and baselining of existing training in AMD and CMU, the finding of which were presented to the

Chief Director: Sector Wide Procurement, with recommendations from GHSC.

• Apply feedback received while drafting the internal AMD Training Policy and developing training curricula to producing

training materials.

• Conducted training engagements with internal Provincial Managers to promote alignment and acceptance of provincial

training.

• Provided an introduction of pre-and post-testing of training using the Kirkpatrick Model.

• Provided training for various EDP and PuLSe staff members on MS Excel and data management dashboards.

Planned

activities for

the next

Quarter

• Receive approval of CMU training policy and curriculum

• Complete the DSP’s and training partner framework for training and development across streams.

• Commence Induction Training at CMU and initiate other training activities as per the Training Curriculum.

• Provide training and coaching on critical reporting frameworks used by CMU.

• Deliver mentoring sessions for CMU staff to introduce them to all new SOP’s and processes.

• Monitoring and evaluate provincial training on gCommerce, SVS, RxSolution, PMPU and demand planning.

• All training will be evaluated using the Kirkpatrick Model to assess the effectiveness of the training and allow for relevant

adjustments to training material and approaches if required.

Lessons

Learned &

Collaboration

with other

Partners

• All training provided across the GHSC program, needs to adhere to a training framework designed by the Training Team in

order to determine training standards, plan and execute training logistics, conduct pre-and post-assessments of training

effectiveness; as well as coaching and mentoring as required.

• The regular engagement between all training teams affiliated with the program; needs to be coordinated by the Training

Team.

• The CMU and AMD department need to adhere to an internal Training Policy that is aligned to workforce planning, KPA’s

and KPI’s.

• Training within AMD, should focus on continuous improvement, succession planning, and career path planning. It should

constantly be aligned to departmental strategies of NDOH, AMD and CMU.

• This concept needs to be used within provinces.

Sub-Objective 4.3 – Upskilling and Mentoring and Staff


32

Activities and

impact in the

past quarter

Many GHSC projects are enabled by IT. GHSC is developing a refined vision of the AMD IT landscape to detail all existing systems and

identify gaps with appropriate recommendations to address the gap. Linked to the landscape document will be a IT roadmap which is

intended to detail the steps needed to achieve improved interoperability between systems and supply chain visibility.

• The IT landscape documentation is currently being amended to:

− Discuss current best practice with regard to IT operations management, to contextualise IT development as a space where

the receiving environment partially informs the development requirements and standards, and also where IT landscape

planning finds context in IT operations and associated enforcement of standards

− Broaden the discussion to contrast the ‘Master Data Layer’ concept previously developed, against ‘Service Orientated

Architecture’, ‘Enterprise Service Bus’ and ‘Micro Services’ architecture concepts. These concepts provide better linkage

between process and the required IT components to enable this process

• The revised documentation acknowledges that providing detail of the planned (‘to be’) environment will require detailed analysis

that can only follow formal acceptance of the suggested approach, and so will initially provide an ‘approach document’.

• Completed several revision cycles to the draft Terms of Reference for the IT Steering Committee

Planned

activities for

the next

Quarter

• Present and gain approval on IT Landscape Approach document, begin work on detailed ‘to be’ IT landscape

• Recruit business analyst resource to assist with detailed work for the ‘to be’ process

• Finalise the Terms of Reference for the IT Steering Committee

• GHSC will assist AMD with the development of tender requirements for the procurement of identified applications and systems.

Lessons Learned & Collaboration with other Partners

• None

Sub-Objective 5.1 – Design IT System Landscape

Objective 5 – Strengthen Information Systems and Information Management

Technology and information systems are critical enablers of the processes and people within AMD and form the cornerstone of the successful

delivery of the AMD Strategy. Thus, this objective involves developing an information technology architecture roadmap together with developing

and deploying supporting systems..

33

Activities and

impact in the

past quarter

The National Surveillance Centre (NSC) was established by AMD to assess the overall health of the medicine supply value chain and

includes dashboards that have been developed by GHSC. These dashboards use data from different systems to provide visibility

relating to medicine availability and other agreed KPIs.

• Redevelopment of the PHC and Hospital Dashboard with new Medicine Availability KPI’s incorporated. The structures have been

changed to differentiate between KPI’s and Reports to ensure the purpose of each dashboard/report is clear.

• Harmonization of the PHC & Hospital Dashboard has been achieved. This is to ensure that the basic principles of using/navigating

the dashboards are transferable to a large degree and minimizes the complexity.

• Have improved coordination and collaboration between dashboard developers and KPI work streams resulting in improved

alignment and less rework.

• Developed a virtual server specifically for the National Surveillance Centre dashboards. This will mitigate the risk of the server

being compromised as there are now limited users with access and thus much easier to monitor.

• Deployed the automated PHC Report. This means that the updating of the PHC Dashboard on a weekly basis will require little

manual intervention. This will increase capacity once the transition is made to the new dashboards (awaiting approval from AMD to

move to the new KPI’s).

• Completed the Tableau Navigation Training Video. Presented to AMD and received verbal confirmation of sign-off (awaiting signed

document).

• 313 Hospitals reporting to the Hospital Dashboard through the various ESMS.

• Maintenance of existing dashboards has continued with minimal interruption despite the server having been compromised by

ransomware in December 2017. Lessons learnt from the previous incident assisted to rapidly recover from the intrusion

Planned

activities for

the next

Quarter

• Develop Training Materials for the Hospital & PHC Dashboards; Train Contract Management Unit on Hospital & PHC Dashboard

and Train SCTA team Provincial Managers on Hospital & PHC Dashboards so they can provide onsite support

• Refine Security of Supply Dashboard with updated Medicine Availability KPI’s

• Develop Depot/Provincial View Dashboard with updated KPI’s

Lessons

Learned &

Collaboration

with other

Partners

• Collaborate with the Ideal Clinic work stream in 2018 to improve end user compliance and to ensure SVS begins to benefit other

work streams in the Department.

Sub-Objective 5.2 – Provide Support to Strengthen Analytics and Oversight


34

Activities and

impact in the

past quarter

Master Health Product List (MHPL), formerly “Master Data”

• Mezzanine were appointed to create a Master Health Procurement List (formerly “Master Data”) management system

under project “SVS Phase 3”, where GHSC will participate as subject matter experts

• Developed and submitted the first draft of the formulary guideline which will define and standardize the hierarchical

method of development, maintenance, and use of a formulary across all levels of care at all types of facilities offering public

health services as mandated by the Pharmaceutical and Therapeutics Committee (PTC). The draft scoping brief for the

PTC guideline was prepared and shared with EDP. (also contributes to Objective 1)

Planned

activities for

the next

Quarter

• Hold MHPL requirements and scoping sessions and develop a prototype for core list management to facilitate further

engagement

• Develop formulary guidelines based on input from relevant stakeholders and finish draft version by the end of the quarter.

• Finalise the PTC Guideline Brief, outlining the structure and content of the more detailed PTC Guideline that will be

developed in the following quarter

Lessons

Learned &

Collaboration

with other

Partners

• Stakeholder engagement will be crucial for implementation of any activity, especially with the introduction of a new

guideline for formulary development which may result in altering current practices in some provinces.

Sub-Objective 5.3 – Support the implementation of data governance


35

Activities

and

impact in

the past

quarter

RxSolution is a legacy application used in health care facility pharmacies for stock management and/or dispensing.

• 121/144 new calls were resolved through helpdesk support activities which included sites visits.

• A total of 313 hospitals are reporting into the hospital dashboard. Hospital dashboard data collection has been semi-automated in some

provinces to improve compliance to the National Surveillance Centre.

• Successfully commenced RxSolution implementation in the Northern Cape with 6 new sites commissioned.

• Analysed helpdesk calls and to identify opportunities to adjust training and communications content.

• LP and MP facility stock master files completed and shared with the provinces to update and align to MPC in preparation for gCommerce

implementation.

• Integrated RxSolution and SVS implementation/transition plans to improve provincial engagements.

• Initiated DSP engagement in support of transition of RxSolution support activities.

• Completed RxSolution training YouTube video.

RxSolution Re-platforming

• Assisted with inputs to tender processes for the procurement of development services

• Developed user requirement documents for RxSolution detailing current and new functionality as described in the briefing and business

requirements documents.

Stock Visibility System (SVS)

• Collaborated with the Ideal Clinic work stream to better align activities and promote better adherence to the SVS operating procedures

including:

• Alignment of facility lists

• Alignment and enforcement of minimum reporting requirements

• Engaged the Departments’ top seven suppliers and distributors, who supply and distribute approximately 80 % of the stock purchased by

the state, to formally document consensus among the group to adhere to the Department’s minimum data requirements for invoicing to

the State.

• Helped facilitating the delivery of the ‘Proof of Delivery’ module enhancement to the SVS system which will allow facility staff to

electronically receive orders. This will reduce reliance on paper-based systems to capture transactional data as well as reducing the time

taken to transmit this information between locations. The functionality which will be available to pilot in the next quarter and will enable

AMD to measure supplier & depot performance.

Sub-Objective 5.4 – Assist with Development and Implementation of IT Systems


36

Activities and

impact in the

past quarter

WMS (gCommerce) Implementation

The gCommerce platform is a scalable, web-based, centrally hosted suite of applications that includes a variety of modules, such as

bid management, contract management and warehouse management (WMS). gCommerce will provide the PMPUs with the necessary

tools to perform procurement and replenishment activities, as well as the data to undertake the demand forecasting and planning and

supply planning services anticipated under the Visual Analytics Network. GHSC has provided technical assistance in the

customization of the application and implementation of the gCommerce WMS.

• The team helped respond to system challenges experienced post go-live in the Northern Cape by:

• Drawing up new specifications to streamline processes and enhance functionality

• Working closely with Depot management and SITA developers to test functionality, train users, and deploy new releases

Planned

activities for

the next

Quarter

• Finalise user requirements, and confirm timelines for the Re-platform of RxSolution

• Develop an integrated transition plan for RxSolution support to help to establish sustainability.

• Prepare for the implementation and go-live of gCommerce in Limpopo and Mpumalanga

• Assist AMD in developing an SLA for gCommerce

• Develop the requirement for an Interface to accept RxSolution requisitions directly into gCommerce

• Begin design and planning to interface SVS, requisitions and goods receipts

• Begin interface design and planning for new Master Health Product List and gCommerce, RxSolution & SVS.

• Assist with the SVS enhancement project focussing on testing the functionality as it becomes available;

• Work closely with other partners; particularly DSPs to facilitate testing of the new functionality;

• Support interfacing of SVS with other systems as required to implement the VAN operating model; and

• Support the institutionalisation of SVS in the provinces through provincial and district level engagements .

Lessons

Learned &

Collaboration

with other

Partners

• RxSolution: Some DSPs have dedicated resources to assist provinces to improve data quality issues. They are also instrumental in

facilitating activities and making additional tools available to improve reporting. Reference case is NW province being supported

by Aurum Institute

• The gCommerce solution relies on a host of Government departments like National Treasury to manage the tender process and

maintain pricing for contract amendments, CSD for maintaining the Supplier Master and BAS for Supplier payments. Without a

robust relationship regulated by a SLA between the parties the success of gCommerce is at risk.

• Collaboration with the Ideal Clinic work stream in 2018 will be a key step towards driving improve end user compliance and also

ensuring SVS begins to benefit other work streams in the NDOH.

Sub-Objective 5.4 – Assist with Development and Implementation of IT Systems


37

Activities and

impact in the

past quarter

• Performed an ‘as-is’ assessment of the budget and financial processes of AMD and at a cluster level.

• Provided recommendations on the budget split across various directorates.

• Designed basic financial SOP’s and dashboards and submitted them to AMD for approval.

• Provided assistance to Demand and Supply Planning efforts related to baselining processes and competencies at provincial

level; and the ultimate impact on forecasting and budgeting.

Planned

activities for

the next

Quarter

• Assistance with the rollout of the financial SOP’s and dashboards within AMD and relevant clusters.

• Provide training content for financial management and budgeting which will be included in the AMD training curriculum.

• Support integration of demand planning strengthening activities at AMD and Provinces.

Lessons

Learned &

Collaboration

with other

Partners

• SOPs and controls relating to financial management can be improved for AMD

• The is potential to improve the financial management forecasting and budgeting capabilities and processes between

NDOH and the provinces.

Sub-Objective 6.1 – Improve Forecasting and Budget Information

Objective 6 – Improve Financial Management

This objective aims to improve the financial management processes employed in the medicine supply value chain. This will include improving

budgeting and forecasting while strengthening the accounting processes related to medicine procurement and supply. This will be supported by

improved financial monitoring and reporting. Under this objective, the program team will develop a thorough and tailor-made cross-task training

program aligning and balancing it with the operational work requirements of the AMD personnel. Digital training tools, eLearning sites, and other

electronic platforms will be designed and tailor-made to address the specific needs of the Directorate.

Sub-Objective 6.2 – Assist to Strengthen Accounting Processes

Sub-Objective 6.3 – Assist to Improve Financial Monitoring and Reporting

38

IMPLEMENTATION

CHALLENGES, RISKS, AND

MITIGATION MEASURES

39

IMPLEMENTATION CHALLENGES, RISKS, AND MITIGATION

MEASURESArea Risks and Challenges Mitigation

EMelA As a result of business, user and policy requirements not being

well defined, understood and agreed upfront by all parties during

initial development, final functionality of EMelA (Phase I) was

misaligned with actual needs. This has resulted in extensive LOE

being expended to reach consensus.

The GHSC team developed an Options Analysis

articulating the different options for final functionality and

the corresponding costs / effort in developing those.

NDOH agreed on an option, and the project team

performed an evaluation to assess functionality.

Final decision and signoff is needed on re-platforming or

implementation following the EMelA Evaluation Report

presentation on 5 February.

Results

framework

Potential for misalignment between proposed KPIs and work

underway in various project streams and provinces.

The team is collaborating across projects to facilitate

alignment and consistency. KPIs developed have been

presented to the provinces for comment and input.

Master Data Data integrity and availability challenges may impact accuracy of

information in reporting dashboards

To address this, GHSC will undertake a new activity to

improve master data management within AMD. This will be

done together with Mezzanine ware, who will be

responsible for the development.

Master Health

Product List

(formerly

“master data”)

Effective management of the MHPL is, by necessity, core to the

structuring of the AMD systems architecture. Improving the

management, availability, and accuracy of master data is an

essential aspect of implementing the VAN operating model. Work

that had begun under the EMelA project has been restarted as part

of the extended SVS scope (SVS Part III). However, in addition to

the technological issues, a substantial contributor to MHPL

challenges is a lack of policy, procedure and business rules that

drive data quality.

The SVS III project is at an early stage, but GHSC will

support plans to focus on stakeholder engagement and

policy development assistance in order to drive better

process outcomes.

40


MEASURES

Area Risks and Challenges Mitigation

PuLSe Because PuLSe is an outward facing system, which will be used by

multiple users, and contains personal information about health care

professionals and facilities, the hosting environment is of critical

importance. The current hosting arrangement ended at the end of

December and NDOH indicated that they are unable to host the

system at present.

The GHSC team is supporting negotiations on extending

Negotiating an extension of the current hosting

arrangement with the developer, whilst UAT is underway.

The team will also work with AMD to make arrangements

for hosting of the system at CSIR or SITA in the future

SVS The signed Participation Agreement and letters to HoDs

recommending that HoDs sign the Provincial SLAs for SVS are a

critical requirements for institutionalizing SVS. They are particularly

important for the HoD engagements and refresher training

planned in 2018. Without the signed documents, these two events

will not be able to proceed.

The roll-out of the SVS to gCommerce interface is dependent on

the gCommerce project timelines relating to the specification

development, costing and final approval from SITA. Until this is

agreed on, further work on the interface between SVS and

gCommerce for both the receiving and ordering functionality will

not proceed.

Continue to escalate the urgency of the matter to the

NDOH.

Continue to manage dependencies across the projects and

engage with the developers or custodians of the other

third party applications.

Stability of

gCommerce

gCommerce first went live in Northern Cape (NC) in June 2017.

The team encountered a number of challenges relating to the

system functionality and master data. AS such, roll out to other

provinces has been delayed until some of the critical issues in NC

are resolved.

The GHSC team created a priority list for tackling

challenges encountered; SITA has resolved to address the

problems with the system developers.

GHSC will continue to assist with the documentation of

known system issues and advise and propose corrective

actions required.

41


MEASURES


Strengthening

the Supply Chain

Data availability and accuracy may impact supply chain

decision making

Limited skills and capabilities of demand planning team

Demand planning tool complexity too high for

handover

Resource availability to implement demand planning at

Provincial level

Current data cleansing exercise (~2 days) is done for every

Province on initiation of demand planning. Further systems

development and Master data establishment in progress

(gCommerce, SVS, RxSolution)

Training material being developed to address capability

assessment and gap closing initiatives

Simplifying the tool and limiting the user interface

CMU redesign in progress flagging additional resource and skill

requirements

RxSolution Hospital dashboard reports are still being collected

manually for some facilities

National Helpdesk is managed through a different unit

within NDOH.

Provincial readiness to take over RxSolution activities

Enable provinces/DSPs to assist in the collection of reporting.

Develop middleware to assist with data acquisition.

NDOH-AMD to assist with helpdesk activations

NDOH to issue a notice which mandates province (IT and

Pharmaceutical) to take over RxSolution activities

PMPU Ideal

Blueprint

The first draft of the Ideal PMPU Blueprint was

submitted to AMD in June 2017. There have been

delays in the finalization and approval of the Ideal PMPU

Blueprint, this has had an impact on the engagement

with the provinces and subsequent implementation of

the proposed solution.

A 20-page summary of the PMPU Blueprint, based on an agreed

conceptual framework, was developed and submitted. This

summary will be presented and reviewed with the Chief

Director: Sector Wide Procurement to gain buy-in. GHSC will

assist in drafting engagement plans for provinces in order to

communicate progress on the Ideal PMPU Blueprint to avoid

stakeholder disengagement.

42


MEASURES


Deliverable

review process

Difficulty moving from design to implementation, while

awaiting sign off from NDOH.

GHSC will work closely with resources from AMD to

streamline the engagement model and approval process to

alleviate bottlenecks. GHSC will facilitate regular reviews

during the creation of deliverables in an attempt to reduce the

need for lengthy reviews once the deliverable is completed.

National

Surveillance

Centre

Server that hosts the data for the NSC has proven to be

susceptible to hacking.

A second server has been created with the single purpose of

hosting the NSC dashboards. This mitigates the risk by

limiting the number of users who have access to the NSC

server.

National

Surveillance

Centre

AMD roll-out plan for dashboards is not clear. Enabling Environment team is engaging with the Project

Managers from AMD to develop clear roll-out plans for each

dashboard and define success criteria.

National

Surveillance

Centre

It is unclear if the NDOH will procure Tableau Enterprise

License. This has an affect on the type of dashboards being

developed, as their future state needs to be considered to

ensure they have maximum impact

Discuss with provinces and build business case for Enterprise

License– if there are sensitivity issues related to data an

Enterprise License is key to be able to provide individual

levels of access with controlled views

43

KEY PERFORMANCE

INDICATORS

44

Performance

trends

• A key function of the Expert Review Committees (ERC) is to conduct Medicine Reviews, which are an assessment and

appraisal of the evidence for a medicine to assist NEMLC in determining whether to add the medicine to the National

Essential Medicines List. This key performance indicator is a measure of the throughput of Medicine Reviews by ERCs.

The GHSC team can have a positive impact on this indicator in multiple ways, including introducing HTA planning and

analysis-management processes to improve committee operations by introducing procedure and governance

enhancements.

Root cause

analysis

• To date, the GHSC team has been unable to access the data related to number of Medicine Reviews conducted by all

ERCs annually, due to confidentiality concerns raised by the AMD staff. The figures in the table are currently estimates,

but GHSC staff will develop a plan including and define avenues for potential escalation, to gain access to the relevant

data this quarter.

Corrective

actions

• A current key limitation of this indicator is uncertainty of the baseline. GHSC staff will implement an Action Plan to

obtain the baseline figures.

• GHSC staff are in the process of finalizing two major outputs that will have a positive impact of number of Medicine

Reviews conducted. The revision of the “Reviewer’s Manual”—the guide for those conducting Medicine Reviews—will

streamline the analytical component and enable more Medicine Reviews to be conducted per ERC member. The

“Recommendations to Strengthen the Medicines Review Process” will provide a series of recommendations and

planning approaches to increase Medicine Review output. In theory, as review productivity increases, so should

willingness to share applicable data.

Key Performance Indicator 1: Number of medicine reviews conducted by the Expert Review

Committees.

Reporting

year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date

% of Proposed Year 2

Achievement to Date

FY18 20* 25 0% 0%


Sub-Objective 1.1 – Assist with implementation of Health Technology Assessments (HTAs)

* estimate, see explanation

45

Performance

trends

Initial assessment of two of the Expert Review Committees in Year 1 demonstrated significant potential for improvement

in the skills and competencies of ERC members to perform and interpret medicine reviews. This indicator measures

improvement from baseline following targeted training, and will be a key indicator should the HTA mentorship program be

re-stated in subsequent quarters.

Due to competing priorities, AMD advised that priority of HTA activities should focus on process and governance reform

related to HTA in the short term, therefore training activities have not taken place in Year 1 Q4. It is possible that training

activities could take place in Quarters 3 and 4 in Year 2, however current achievement as of Quarter 4, Year 1 is 0%.

Root cause

analysis

The limited opportunity for structured HTA training and mentorship has resulted in no formal measured progress on this

indicator in the short term.

Corrective

actions

Following successful completion, key process and governance documents such as the Reviewer’s Manual, Conflict of

Interest policy, and the co-development of further costing analysis support with ERC members, GHSC staff will be able to

demonstrate the case for an established HTA training program for ERC members.

Key Performance Indicator 2: Percentage of medicine selection staff and committee members

trained that demonstrate an increased level of self assessed skills and knowledge to perform

and interpret medicine reviews

Reporting

year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY18 0% 75% 0%* 0%




46

Performance

trends

This indicator measures percentage of recommendations on Medicines Selection utilizing HTA outputs, focusing on the

functions of the National Essential Medicines List Committee in conjunction with the Expert Review Committees. “Utilizing

HTA outputs” refers to the use of analysis of HTA – from budget impact analysis to comprehensive international pricing

comparison, to cost effectiveness analysis.

To date achievement stands at 5% and key activities completed include GHSC staff supporting two recommendations

utilizing HTA outputs:

• medicines Tretinoin and long-acting beta antagonists

• Initiation of plans for a full analysis of the medicine Fondaparinux

As with KPI 1, the baseline for this indicator is currently an estimate due to confidentiality concerns raised by AMD

regarding the release of information on the number of Medicine Reviews conducted.

Root cause

analysis

Improved access to ERC meetings have enabled the GHSC team to develop tailored, efficient analytic approaches that are

inline with HTA best practice but also meet the specific needs of the ERC committees and NEMLC. This has improved our

ability to perform analysis with EDP staff and is likely to allow GHSC to meet the requirements of this indicator.

Corrective

actions

HTA outputs are currently being utilized, no corrective actions are required to address the numerator. However, as with

KPI 1, an Action Plan is in development to obtain a more accurate baseline for number of Medicine Reviews (denominator).

Key Performance Indicator 3: Percentage of recommendations on medicines selection utilizing

HTA outputs.

Reporting

year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY18 0% 10% 5%* 15%




47

Performance

trends

Per the Options Analysis meeting on the 15th September 2017, no formularies will be created using the EMelA application.

Root cause

analysis

Although this indicator was initially created to based on the vision that formularies would be created using the EMelA

application, this has now changed and formularies will be created on a different Master Data platform outside the control of

SCTA.

Corrective

actions

We recommend amending this indicator. A decision is pending on the implementation and use of EMelA, is expected to be

made following the EMelA Evaluation Report presentation to the National Department of Health on 5February 2018.

Potential replacements include “Percentage of Expert Review Committee meetings conducted on EMelA” with a Year 2

Target of 50%.

Key Performance Indicator 4: Number of formularies generated using Essential Medicines

Electronic Access.

Reporting

year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY18 0 N/A N/A N/A


Sub-Objective 1.2 – Improve Rational Medicine Use (RMU)

48

Performance

trends

KPI 5 provides outcome measures on the percentage of expenditures on non-EML items purchased as compared to the

total expenditures at hospitals. The percentage of expenditures on non-EML items measures the transparency in the

development, review and implementation of STGs and EML, and facilitates access to and management of master data.

Provincial Non-EML expenditure as per the NDOH Pharmaceutical Dashboard is relatively stable, although this relies on

self-reporting of the provincial departments of health.

Root cause

analysis

In FY2017 performance was at 3.94%, Year 2 Q1 data could not be attained as the department is still collecting data from

provinces for this indicator.

There are no GHSC activities currently under way to directly affect Non-EML expenditure.

However, formulary guideline and PTC guidelines under development may indirectly positively influence this indicator.

Corrective

actions

A formulary guideline is being developed to define and standardize the hierarchical method of developing, maintaining, and

using a formulary across all levels of care and all types of facilities offering public health services, through a mandated

Pharmaceutical and Therapeutics Committee (PTC).

This will enable improved RMU and lower percentage expenditure on Non-EML medicines.

Key Performance Indicator 5: Percentage of expenditures on non-Essential Medicine List

items.

Reporting

year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY18 NA 10% 0% 0%



49

Performance

trends

This indicator stands at 0% as the PTC Guidelines are needed in order to provide the assessment criteria against which

PTCs will be accredited.

Root cause

analysis

• The larger NDOH workplan does not prioritize the indicator as it tracks a single milestone targeted for the duration of

the entire GHSC program (3 years). That milestone is the development of the PTC Guidelines which has a targeted

deadline of October 2019. Unfortunately completing the PTC Guidelines are critical path to being able to measure and report

KPI 6.

• Based on previous experience, we assess that the PTC Guidelines are likely to be completed no sooner than the

targeted October 2019 deadline due to the number of reviews involving large numbers of stakeholders.

• The only other related activities in the NDoH work plan include “completing a baseline assessment of interventions based on

the PTC guideline” and “baseline assessment of evaluations of assisted PTCs” both of which have no timelines. This implies

that these activities are both likely to take place in year 4 and 5 which is beyond the 3 years period of the GHSC project.

Corrective

actions

We recommend this indicator be reviewed and updated to better reflect work and outcomes that are achievable during

the first three years of the GHSC project.

Key Performance Indicator 6: Percentage of assisted PTCs with advanced or optimal

operational capacity

Reporting

year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY18 0 0 0 N/A



50

Performance

trends

NOTES:

• % of Proposed Year 2 Achievement to Date is calculated as: Year 2 Achievement to Date / Year 2 Proposed Target.

• The current data source is RSA-Pharma which relies on frequency and quality of supplier provided information. In the

future we will use tools such as gCommerce for this KPI.

OBSERVATIONS:

• Four of the nine depots have improved on baseline values led by Mpumalanga with a 27% increase.

Root cause

analysis

• In this period three FDC suppliers experienced short-term challenges relating to their ability to meet contractual lead

times. (Source: Pipeline Analysis Tool) These issues were resolved by December,

• Deliveries of FDC for the period were 38% within the contractual lead time.

• The Q3 period includes December which is known for diminished performance as both depot and supplier activity is

affected by the holiday season. This seasonal trend affects both processing of orders by suppliers and the receiving of

deliveries at the depot.

Corrective

actions• Provincial operational baseline assessments are being conducted in all provinces to identify and address specific gaps,

especially with regards to supplier performance tracking and relationship management.

• Greater alignment of supplier performance management to the Contract Management Unit (CMU) within AMD will be

achieved by implementing the supplier performance management framework at a provincial level with clear escalation

processes.

• Implementation of improved demand planning processes and the development of supply planning processes will mitigate

the risks and effects of planned shutdowns (e.g. holidays, stock takes, etc.) during the year.

Key Performance Indicator 7: Percentage of ARVs processed through Provincial Medicine

Procurement Units within contractual lead-time.

Baseline

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement to

Date


Achievement to Date

FY 2017 79% 85% 61% 72%

Objective 2 – Support optimization of the supply chainSub-Objective 2.1 – Improve contracting & Sub-Objective 2.2 – Improve contract management

51

Performance

trends

NOTES:

• % of Proposed Year 2 Achievement to date is calculated as: Year 2 Achievement to Date / Year 2 Proposed Target

• The current data source is RSA-Pharma which relies on frequency and quality of supplier provided information. In the future

we will use tools such as gCommerce for this KPI.

OBSERVATIONS:

• KwaZulu-Natal and Northern Cape depots have improved on baseline values while the other six provinces declined.

• The two worst performing provinces were Mpumalanga and North West.

Root cause

analysis

• The Q3 period includes December which is known for diminished performance as both depot and supplier activity is affected

by the holiday season. This seasonal trend affects both processing of orders by suppliers and the receiving of deliveries at the

depot.

• Delays in the award of some of the contracts by National Treasury has resulted in orders being placed, but not delivered on

time, as suppliers have a longer lead time for new orders at the beginning of a new contract.

Corrective

actions• Provincial operational baseline assessments are being conducted in the all provinces to identify and address specific gaps,

especially with regards to supplier performance tracking and relationship management.

• Greater alignment of supplier performance management to the Contract Management Unit (CMU) at the NDoH by

implementing the supplier performance management framework at a provincial level with clear escalation processes.

• Implementation of improved demand planning processes and the development of supply planning processes should mitigate the

risks and effects of planned shutdowns (e.g. holidays, stock takes, etc.) during the year.

Key Performance Indicator 8: Percentage of Master Procurement Catalogue medicines excluding ARVs

processed through PMPUs within contractual lead-time.

Baseline

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY 2017 75% 76% 72% 95%


52

Performance

trends

NOTES:

• % of Proposed Year 2 Achievement to Date is calculated as: Year 2 Achievement to Date / Year 2 Proposed Target



• Forecast accuracy cannot be calculated at provincial level due to unavailability of data.

• This KPI is greatly influenced by when the calculation is made for each contract in relationship to how far the contract

is from expiration, with accuracy improving on contracts that have been running for a longer period.

• The Baseline Value was calculated using the preceding 6 months to when the project started: April 2016 – September

2016.

OBSERVATIONS:

• Forecast Accuracy has improved compared to FY 2017 (72%.) The forecast accuracy did however not improve in

relation to the baseline value.

Root cause

analysis

• Undetermined – Analysis of current data sources could not provide significant insights.

Corrective

actions• gCommerce is being implemented which will greatly improve data access and quality.

• Demand planning processes have been developed and are being implemented for the Contract Management Unit

(CMU) within AMD.

• Demand planning process pilots are being planned and implemented in the Eastern Cape and Northern Cape

provinces.

• KPI to be calculated on a more frequent basis (monthly) to achieve a more accurate view of actual performance to

identify potential challenges and manage related process inefficiencies.

Key Performance Indicator 9: Percentage of forecast accuracy on tenders.

Baseline

Year

Baseline

Value

Year 2 Proposed

Target


Date


Achievement to Date

FY 2017 95% 96% 78% 81%


53

Performance

trends

NOTE:

• % of Proposed Year 2 Achievement to Date is calculated as: Year 2 Achievement to Date / Year 2 Proposed Target.

• The current data source is RSA-Pharma which relies on frequency and quality of supplier provided information. In the future we

will use tools such as gCommerce for this KPI.

OBSERVATIONS:

• In FY 2017, five of the nine depots showed improvement in order fulfilment.

• In Q1 of FY 2018, two of the nine depots improved, and one remained unchanged. The two provinces showing improvement are

KwaZulu-Natal and Northern Cape.

• Overall, perfect order fulfilment decreased from the baseline of 73% to 70% in Q1.

• gCommerce was implemented in FY 2017 Q3 and is now fully operational with improved functionalities. This is a major

contributing factor of the 4% improvement it showed from 68% to 72%, in the Northern Cape .

• Perfect order fulfilment includes delivery within contractual lead times, so the results of indicators 7 & 8 have an influence.

Mpumalanga and North West have thus performed poorly in this indicator.

Root cause

analysis

• Mainly attributed to the poor performance related to delivery on time in indicators 7 and 8.

• Delays in the award of some of the contracts by National Treasury has resulted in orders being placed, but not delivered on time,

as suppliers have a longer lead time for new orders at the beginning of a new contract.

Corrective

actions• Provincial operational baseline assessments are being conducted in the all provinces to identify and address specific gaps. Especially

with regards to supplier performance tracking and relationship management.

• Greater alignment of supplier performance management to the Contract Management Unit (CMU) at the NDoH by implementing

the supplier performance management framework at a provincial level with clear escalation processes.

• Improved demand planning processes and the introduction of supply planning processes will mitigate the risks and effects of

planned shutdowns (e.g. holidays, stock takes, etc.) during the year.

Key Performance Indicator 10: Percentage of assisted provinces demonstrating improvements in

perfect order fulfilment.

Baseline

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY 2017 0% 65% 22% 34%


54

Performance

trends

NOTE:




OBSERVATIONS:

• Eight of the nine depots showed improvement with only Eastern Cape (Mthatha) declining. This depot experienced

numerous challenges in the latter half of 2017 which impacted operations.

• This metric significantly exceeded the Year 2 Target of 65%.

• gCommerce was implemented in the Northern Cape in FY 2017 Q3 and is now fully operational. This is a major

contributing factor of the 41% improvement in order fulfilment cycle time, with a decrease 24.8 days to 14.6 days.

Root cause

analysis

• Operational issues in the Eastern Cape (Mthatha) resulted in it being the only depot to not achieve an improvement in

order fulfilment cycle times.

Corrective

actions• The implementation of gCommerce in the other provinces will continue in FY18 and should result in improved order

fulfilment cycle times due to the integrated and automated procurement processes.

Key Performance Indicator 11: Percentage of assisted provinces demonstrating improvement in

order fulfilment cycle time.

Baseline

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY 2017 0% 65% 89% 137%


55

Performance

trends

NOTE:


OBSERVATIONS:

• The indicator is performing fairly well at 87% which shows a slight increase from last year (86%).

• Primary Health Care Facility medicine availability improved consistently over the quarter starting at 90% in October and

increasing to 91% in December.

• Hospital medicine availability improved consistently over the quarter starting at 83% in October and increasing to 85% in

December.

Root cause

analysis

• Reporting on medicine availability in some provinces is complicated by connectivity constraints, resulting in incomplete data

submission.

• Configuration of the Electronic Stock Management System (ESMS) has an impact on reporting as the denominator may be

inflated resulting in a lower availability percentage.

• Inconsistent product identifiers and master data have an impact.

Corrective

actions• SCTA is developing code to improve the data acquisition process from RxSolution sites, this will partially address

connectivity challenges mentioned above.

• DSPs and Provinces will be trained on the ideal configuration of RxSolution to including how to address setup issues which

result in reduced medicine availability.

• A Master Data Management project has been initiated to align all product identifiers across all healthcare facility

applications.

Key Performance Indicator 12: Percentage availability of Master Procurement Catalogue items at

healthcare facilities

Baseline

Year

Baseline

Value

Year 2 Proposed

Target


Date


Achievement to Date

FY 2017 78% 90% 87% 97%


56

Performance

trends

NOTE:

• New functions described by the Ideal PMPU Blueprint already exist in many provinces at varying stages of development

and maturity. However, no ‘official’ PMPUs have been formally established under GHSC due to the delay in obtaining

NDoH approval on the PMPU Blueprint document.

• Provincial project managers are engaging with the stakeholders in the various provinces to conduct operational baseline

assessments which inform implementation of new, optimized processes.

Root cause

analysis

• No ‘official’ PMPUs have been established to date under GHSC due to the delay in receiving approval on the PMPU

Blueprint.

Corrective

actions• Provincial operational baseline assessments are being conducted in the all provinces to identify and address specific gaps.

The assessment reviews four areas:

− Facility & Infrastructure

− PMPU processes

− Organisational design

− Results and KPI framework

findings from which will be incorporated into rollout of new processes and activities.

Key Performance Indicator 13: Percentage of assisted PMPUs demonstrating improvements in

operational capacity.

Baseline

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY 2017 0% TBC 0% 0%

Objective 2 – Support optimization of the supply chain

Sub-Objective 2.1 – Improve contracting & Sub-Objective 2.2 – Improve contract management

57

Performance

trends

NOTE:




• The directive from the NDoH is 70%

• Not all provinces make use of the DD model (i.e. Northern Cape) or have this information available (i.e. Mpumalanga)

OBSERVATIONS:

• Target achieved

Root cause

analysis

• None

Corrective

actions• Monitoring and evaluation to continue

Key Performance Indicator 14: Percentage of identified Master Procurement Catalogue medicines

delivered to the designated hospitals via direct delivery.

Baseline

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY 2017 15% 70% 70% 100%

Objective 2 – Support optimization of the supply chain

Sub-Objective 2.3 – Design supply chain operating model & Sub-Objective 2.4 – Maintain and improve supply chain operations

58

Performance

trends

This KPI will be used to measure governance maturity demonstrated by assisted organizations. This is a baseline and

endline indicator therefore achievement to date is not applicable.

The team recently completed a baseline assessment of CMU governance including strategy reforms, policies, SOP’s, and

governance structures which collectively were assessed at level two (emerging) of a four point maturity model.

Root cause

analysis

Planning and design of the recommended strengthening interventions was developed and is pending presentation to CMU

and NDOH.

The implementation phase, change management and monitoring and evaluation phases commenced on 8 January 2018.

Corrective

actions

The planning and design of the recommended strengthening interventions; which was schedule to be presented to CMU an

NDOH on 13 December 2017. NDOH postponed this presentation. It has been re-scheduled for 2 February 2018.

Key Performance Indicator 15: Percentage of assisted organizations demonstrating improvement

in governance maturity.

Reporting

year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY 2018 0% 25% NA NA

Objective 3 – Strengthen governance

Sub-Objective 3.2 – Support the implementation of governance

59

Performance

trends

• This indicator measures the total number of assisted organizations demonstrating improvements in workforce management

maturity as compared to the total number of assisted organizations.

• The team has begun assisting CMU, a second organization will be designated for assistance in April 2018.

• The team recently completed a baseline assessment of CMU work force maturity including decision making authority,

compliance processes/timeframes, oversight/accountability, organizational structure, strategic culture/objectives, roles/ job

profiles, training and learning, talent metrics, performance management, retention, and succession planning which collectively

were assessed at level one (basic) of a four point maturity model.

Root cause

analysis

• The CMU Strengthening Project is running according to planned deliverables; except for the planning and design of the

recommended strengthening interventions; which was scheduled to be presented to CMU and NDOH on 13 December

2017. NDOH postponed the presentation which has been rescheduled for 2 February 2018.

• Some discussion of potential overlap with KPIs 13 and 15.

Corrective

actions• CMU strengthening activities such as communications, training and development, process design and change management

that are able to be done in the interim, commenced in January 2018.

• The team will conduct a re-assessment of CMU in March 2018 to assess the level of improvement on the maturity scale.

• Meetings to assess degree of overlap with KPIs are being scheduled.

Key Performance Indicator 16: Percentage of assisted organizations demonstrating improvement

in workforce maturity.

Reporting yearBaseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY 2018 0% 25% NA NA

Objective 4 – Improve workforce managementSub-Objective 4.3 – Contribute to up-skilling and mentoring of AMD staff.

60

Performance

trends

NOTES

This indicator measures the visibility of the National Surveillance Centre dashboard and reporting rates for stock availability at primary

health care facilities and hospitals. Targeted facilities include clinics and hospitals at the central, tertiary, district and regional levels

throughout the eight provinces excluding the Western Cape.

Root cause

analysis

Hospitals: Success in the reporting for hospitals was attributed to that most targeted facilities had software installed. Some facilities

required either system or software upgrades or refresher training. Others required the installation of an additional tool to extract the

dashboard reports. Data quality, however, remains a concern and requires local intervention by pharmaceutical services and/or DSPs

rendering such services. The quality issues relate to the denominator used as this varies from facility to facility and depends on how the

ESMS is configured to reflect stocked and non-stocked items.

Due to connectivity challenges dashboard reporting became very resource intensive to maintain.

Clinics: The high-level interest in the project of the AG and the Minister as well as efficient project management has contributed to the

success of the implementation and reporting of SVS.

However, because of the accelerated deployment of the system, key processes such as change management were compromised, which

affected administration of the system

Moreover Data quality issues were identified on reporting. About 5% of the clinics utilizing the system do not adhere to reporting

criteria stipulated by NDOH

Corrective

actions

Hospitals: Provincial resources and DSPs have been enlisted to manage the connectivity problem. These resources should also assist in

improving the data quality of the reports.

The next level of targeted facilities, including specialized hospitals and community health centres, are expected to receive the SCTA

toolkit, which should enable reporting and improved visibility.

Clinics: Finalise legal framework and support institutionalization of SVS in the provinces and districts

Key Performance Indicator 17: Percentage of APP target facilities reporting stock availability to

National Surveillance Centre.

Reporting

yearType of

facility

Year 2 number

of app target

facilities

Year 2 APP %

Target

Year 2 Number of

APP target facilities

reporting

Year 2 Achievement

to Date

FY 2018 Clinics 3100 100% 3100 100%

FY 2018 Hospitals 230 100% 250 109%

Objective 5 – Strengthen information systems and information management


61

Performance

trends

• KPI 18 measures the quality of data generated through the program monitoring system against a set of data quality

standards.

• Data will be scored according to the criteria of validity, precision, reliability, timeliness and integrity.

• Data quality scores in the different criteria are then summed to develop a total data quality score.

• The data quality tool has been developed and will be reviewed by AMD.

Root cause

analysis

• Review of the tool by an STTA consultant is ongoing

• Following STTA consultant review, it will be presented to and reviewed by stakeholders prior to implementation.

Corrective

actions

• The STTA consultant will be contracted to perform the assessment by the end of the second quarter of FY2018

Key Performance Indicator 18: Percentage of Data Quality Assessments that receives a passing

score.

Reporting

year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

FY 2018 0% TBD TBD TBD



62

Performance

trends

The gCommerce WMS went live in the Northern Cape on 1 June 2017. The focus this year was addressing the challenges

experienced post go live. Performance since the start of the GHSC program stands at 10%.

Root cause

analysis

Challenges include

• Retention of the project manager position from SITA

• Master data not locked down causing disruption to the warehouse and procurement processes

• Issues between the central supplier database and gCommerce resulted in supplier updates not reaching gCommerce

• Bids and price update discrepancies,

• WAN connectivity compounded by LAN performance hindered system refresh of multiple screens and functions

Corrective

actions

For the Master Data, AMD launched an initiative to bring the management of Master Data from Treasury back under

NDOH control which should enhance WMS functionality.

Established a Steering Committee to manage problem escalation and provide governance.

A new testing environment was created on the National Treasury Server to enable formal UAT and regression testing

outside of the production environment.

Contract price maintenance will be performed through Treasury to ensure updated contract prices.

A new Cloud based platform for gCommerce should address some of the WAN/LAN performance challenges. When

combined with the new SITA VPN, should result in users observing significantly improved systems performance.

With the gCommerce WMS now stabilized, the system will deploy next to Limpopo (3 April 2018) and Mpumalanga (16

April 2018).

Key Performance Indicator 19: Percentage of assisted facilities where information systems and

information management systems are utilized.

Reporting

year

Baseline

Value

Year 2 Proposed

Target


Date


Achievement to Date

FY 2018 0% 50% 10% 20%


Sub-Objective 5.3 – Support the implementation of data governance and Sub-Objective 5.4 – Assist with development and

implementation of IT systems

63

Performance

trends

NOTE:


Root cause

analysis

• No data sources currently available.

Corrective

actions• gCommerce is being implemented which will greatly improve data access and quality.

• Provincial operational baseline assessments are being conducted in the all provinces to identify and address specific gaps.

The assessment reviews four areas:

− Facility & Infrastructure

− PMPU processes

− Organisational design

− Results and KPI framework

findings from which will be incorporated into rollout of new processes and activities and will inform development of new

tools.

Key Performance Indicator 20: Percentage of PMPU payment packs submitted on time.

Baseline

Year

Baseline

Value

Year 2 Proposed

Target


Date


Achievement to Date

FY 2018 TBC 50% 0% 0%

Objective 6 – Improve financial management

Sub-Objective 6.1 – Improve forecasting and budget information, Sub-Objective 6.2 – Assist to strengthen accounting processes, and Sub-

Objective 6.3 – Assist to improve financial monitoring and reporting

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