1

HEALTH MARKET INQURY

PRESENTATION BY THELIMPOPO DEPARTMENT OF

HEALTH18 MAY 2016

DURBAN

Introduction

• Approximately 80% of the population in

Limpopo is based in rural areas. This situation

greatly impacts on the population’s capacity to

acquire and access education, particularly

tertiary education, which in turn influences the

potential for gainful employment in the formal

economic sector.

• The South African Multidimensional Poverty

Index (SAMPI) using census data has shown

that Limpopo Province is having the third largest

poverty headcount of all provinces in 2001 and

2011 after Eastern Cape and KwaZulu-Natal.2

Cont…

• The department is faced with multi-

challenges of poverty that affects

indicators such as the incidence of severe

acute malnutrition, diarrhea, prevalence of

HIV and AIDS, etc. These multi-

dimensional factors of poverty further

constrain the resources of the department

in delivering health care services.

3

Cont….

• The province is a typical developing area,

exporting primary products and importing

manufactured goods and services.

• It has a high potential for development,

with resources such as tourism, rain-fed

agriculture, minerals and abundant labour

offering excellent investment

opportunities.

4

Cont….

•About 80% of SouthAfrica’s

hunting industry is found in

Limpopo.

• In addition to commercial

agriculture, subsistence farming

is the mainstay of a large section

of the rural population.

5

Cont….

• Limpopo is the gateway to the rest of

Africa, with its shared borders making it

favourably situated for economic

cooperation with other parts of Southern

Africa.

• The province borders the countries of

Botswana to the West, Zimbabwe to the

North and Mozambique to the East. In the

eastern region lies the northern half of the

magnificent Kruger National Park.6

Cont….

• In keeping with the NHI White Paper the

LPDoH is pursuing a number of strategies

to encourage greater cooperation

between the public and private health care

services.

7

DEMOGRAPHIC PROFILE OF LIMPOPO

• Limpopo is the fifth largest of South

Africa’s nine provinces covering an area

of 125 755 square kilometers, which is

10.3% of SouthAfrica’s total land area.

• It has a population of 5.6 million (2014

Mid-Year Population Estimates).

• The population of Limpopo is youthful

with 33% (1.86 million) being children

under the age of 15 years.

8

Cont.…

• Economically active population (15 -

64years) constitutes 61% or 3.4

million, while elderly people are in the

minority making up 5% of the

province’s population.

• Females constitute the majority,

making up 53.1% (2.98 million) of the

province’s population.

9

Cont.…

•Average total fertility rate is estimated

at 3.01 for the period 2011 – 2016,

• while the average life expectancy at

birth for males is estimated at 58.3

years

• and that for females at 62.5 years in

the same reference period.

10

Cont.…

• Migration is an important

demographic process in shaping the

age structure of the provincial

population.

• For the period 2011 – 2016, Limpopo

experienced an out-migration of

nearly 303 101 people (Stats SA,

2014).

11

Cont.…

• Table 1provides the age and sex

distribution of the population while

figure 1 depicts the age and sex

structure (Stats SA Mid-Year

Population Estimates, 2014 ).

12

AGE MALE FEMALE TOTAL

0-4 343943 336040 679983

5-9 302541 296251 598792

10-14 292885 290970 583855

15-19 315349 315383 630732

20-24 309034 307582 616616

25-29 264946 263728 528674

30-34 195662 207980 403642

35-39 144500 169732 314232

40-44 108106 150298 258404

45-49 88610 133734 222344

50-54 73872 117180 191052

55-59 61576 99094 160670

60-64 50762 83659 134421

65-69 36324 65198 101522

70-74 24839 50341 75180

75-79 18163 43320 61483

80+ 18003 50862 68865

Total 2649115 2981352 563046713

Demographic profile cont.…

Table 1. Population of Limpopo Province by age and sex, 2014

Cont.…

14

Cont.…

• The population pyramid above show

the distribution of males and females

across age groups in Limpopo.

• The population pyramid resembles a

developing country where there is

high birth rate and short life

expectancy.

15

Cont.…

• This is an indicative of future trends

which show that if not much is done

in improving the health outcomes of

the people, the life expectancy will

continue to drop.

16

DISTRIBUTION OF PUBLIC HEALTH

CARE FACILITIES IN THE PROVINCE

• Limpopo Province is divided, for

local government purposes, into

five district municipalities which

are in turn divided into twenty-five

local municipalities (see figure 2

below):

17

Figure 2

18

VhembeDistrict

Municipality

21349 1294722 60,6 02 01

(Psychiatric)

11

6

08 06 01 0

CapricornDistrict

Municipality

16988 261463 74,3 05 01

(Psychiatric)

96 04 06 0 02

MopaniDistrict

Municipality

24489 1092507 44,6 02 01

(Psychiatric)

95 08 06 01 0

Sekhukhune

District

Municipality

13426 1076840 80,2 01

ж

0

0 84 03 05 02 0

Waterberg

District

Municipality

49504 679336 13,7 05 0 61 02 07 01 0

SA

No..of

Dis

tric

tH

osp

itals

No

of

Pri

vate

Faci

liti

es

Sp

ecia

lise

dH

osp

itals

No..of

Fix

edC

lin

ics

Pop

ula

tion

Den

sity

(per

km

²)

Nam

eof

Dis

tric

t (Sta

ts

No.of

CH

C

Pop

ula

tion

2011)

No..of

Hosp

itals

Reg

ion

al

No..of

Hosp

itals

Ter

tiary

Table 2

19

District

Municipalitie

s

District

Beds

Regi

onal

Beds

Specia

lised

Beds

Tertiar

yBeds

Private

Beds

(Active)

Vhembe 1649 538 390 0 44

Capricorn 988 0 786 1210 493

Mopani 1216 400 400 0 197

Sekhukhune 853 938 0 0 *(14)*

Waterberg 962 273 0 0 191

TOTAL 5668 2149 1576 1210 925

Table 3

DISTRIBUTION OF DESIGNATED HOSPITAL BEDS IN LIMPOPO –

PUBLIC & PRIVATE

20

IN SUMMARY – PROVINCE

• Fixed Clinics : 452

• Community Health Centres: 25

•

•

•

•

•

District Hospitals

Regional Hospitals

Tertiary Hospitals

Specialised Hospitals

Private Health Facilities

:

:

:

:

:

30 (5668 beds)

05 (2149 beds)

02 (1210 beds)

03 (1576 beds)

14

(925 approved beds)

21

FUTURE PLANS

• Sefako Makgatho Academic Hospital: +-

800 Tertiary beds

22

ESTABLISHMENT OF PRIVATE

HOSPITALS IN THE PROVINCE

• The process start with the proprietor of the facility

submitting the application to the HOD.

• The application must contain the following

information:

-

-

-

-

Description of premises.

Particulars regarding their location.

The nature of the treatment to be rendered there.

Population groups of the staff attached to the private

hospital.

- Population group that will make use of the private hospital.

- Architectural plans of the buildings or proposed buildings

must accompany the application.

23

Cont…• Upon receipt of the application by the

HOD, it is forwarded to the Evaluation

Committee for processing, then to the

Adjudication Committee, which will then

recommend to the HOD for approval or

non approval.

• The HOD after consultation with the

committees, shall satisfy him or herself as

to the necessity or otherwise for such a

private hospital to be established before

granting or refusing permission.24

Cont…

• If permission is granted to proceed with the

establishment , the applicant shall complete

form 1 (Annexure B) attached in the R158 and

submit architectural plans for approval by the

HOD before construction can commence and/

or resume.

• In addition, the applicant shall furnish the HOD

with proof in writing, that neither the

Government Departments concerned nor the

Local Authority concerned have any objection

to the private hospital being constructed on

the premises concerned.25

Cont…

• The applicant must also provide written proof

that the plans have been approved by the Local

Authority concerned.

•

•

The applicant shall inform the HOD about the

completion of construction of the private

hospital, and the HOD shall dispatch a licensing

team to conduct an inspection before the facility

can be issued with a license to operate.

the operating license shall be valid for a period

of 12 months, subject to renewal after this

period.

26

Cont…

• The proprietor is supposed to

submit an application for the

renewal of the certificate of

registration at least 90 days

before the date of its expiry in

accordance with Regulation 11.

27

CRITERIA FOR LISENCING AND RENEWAL

OF CERTIFICATES OF REGISTRATION

• Before a license/ certificate of registration

is issued to a private facility, a licensing

team performs an inspection of the facility

for compliance before recommendation to

the HOD.

• The private hospital must comply with and

maintain compliance with the following:

- National building regulation (NBR) SABS

0400.

- Occupational Health and Safety Act, Act 85 of

1993.28

Cont…

- Regulation R158 of February 1980 as

regulation to the Health Act, Act no 63

of 1977.

- Basic Conditions of Employment Act.

- National Department of Health

Guidelines.

- IUSS guidelines.

29

Cont…• In addition, more emphasis is put on

National Core Standards:

- Patient’s Rights.

- Patient safety , Clinical Governance and Clinical

Care.

-

-

-

-

-

-

Clinical Support Services.

Operational Management.

Facilities and Infrastructure.

Leadership and Corporate Governance.

Medicine Supplies and Laboratory services.

Health Technology.30

Institution

Bedsoperational

TownNoof

Beds

RegistrationStatus

Mediclinic

Thabazimbi

Thabazimbi 21 Fullyregistered

MediclinicLephalale Lephalale 34of150 Fullyregistered

STVincent Bela-Bela 42of83

Fullyregistered

RPMUnionSwartklip Swartklip

Mine

46 Fullyregistered

RPMAmandelbult Amandelbult 48 Fullyregistered

•

Institutions which applied for certificate of

registration for 2016.

Waterberg District: total no of beds: 191 of 348

31

Institution

operational

Town NoofBeds Registrationstatus

Mediclinic

Limpopo

Polokwane 247of280 Fullyregistered

Netcare

Pholoso

Polokwane 200 Fullyregistered

MediclinicDay

ClinicLimpopo

Polokwane Dayclinic Fullyregistered

UnicareSub-

Acuteunit

Polokwane 38of40 Fullyregistered

CANSA

hospital

Polokwane 8 Fullyregistered

Cont…

• Capricorn: District no of Beds: 493 of 528

32

Institution

operational

Town Noofbeds Registration

status

Clinix

Phalaborwa

Phalaborwa 66 Fullyregistered

(PPP)

Mediclinic

Tzaneen

Tzaneen 131 Fullyregistered

Cont…

• Mopani: District no of beds: 197

33

Institution

operational

Town Noofbeds Registration

status

QualityCare Makhado 12of36 Fullyregistered

Zoutpansberg Makhado 32of40 Fullyregistered

Cont…

• Vhembe: District no of beds: 44 0f 76

34

Institution

operational

Town Noofbeds Registration

status

Ndhlovu

maternal

Dennilton 14 Certificate

suspendeddue

tonon-

compliance

Cont…

• Sekhukhune: District no of beds: 14 of 14

35

Nameofproject Town Noofbeds Comment

Mokgalakwena

private

Mokopane 45 Provisionalapproval

lapsed

Mokopane

private

Mokopane 100 Provisionalapproval

lapsed

Mokomedprivate Mokopane 30 Provisionalapproval

lapsed

Modimolle

private

Modimolle -

Applications not followed up by

proprietors• Waterberg: No of beds: 175

36

Nameofproject Town Noofbeds Comment

Boroloprivate Polokwane 200 Provisionalapprovallapsed

Polokwaneprivate Polokwane 200 Provisionalapprovallapsed

CureDayclinic Polokwane 30 Provisionalapprovallapsed

AcuteRehab

Centre

Polokwane - Provisionalapprovallapsed

EyeLaserunit Polokwane 20 Provisionalapprovallapsed

FloraDayClinic Polokwane 47 Provisionalapprovallapsed

Medlabprivate Lebowakgo

mo

50 Provisionalapprovallapsed

BophelongRehab

Centre

Polokwane 120 Architecturalplans

submitted

cont…

• Capricorn: no of beds: 667

37

Nameofproject Town Noofbeds Comment

Giyaniprivate Giyani 70 Provisionalapprovallapsed

Cont…

• Mopani: No of beds: 70

38

Nameofproject Town Noofbeds Comment

Burgersfortprivate Burgersfort 140 Provisional

approvallapsed

PlatinumHealth Burgersfort 14 Provisional

approvallapsed

Cont…

• Sekhukhune: No of beds: 154

39

Nameofproject Town Noofbeds Comment

Thohoyandou

private

Thohoyandou 85 Provisional

approvallapsed

Fundamed Thohoyandou - Provisional

approvallapsed

Cont…

• Vhembe: No of beds: 85

40

Activebeds Bedsnotactive

881 1163

Total number of bed s

• Number of beds Adjudicated: 2044

41

Categories

ABLEA9:HEA

DataSource:Pe

Number

employed

PERSONN

EL

rsal(oruselate

st

%of

total

employe

d

IN2014/1

5

informatio

nfrom

Numberper

100,000

people

SouthAfricanH

e

Number

per

100,000

uninsured2

people

althReview2

013

Vacan

cy5

rate

/14ifPer

sal

%of

total

person

nel

budget

dataisn

ot

Annualcostperstaffmember

available)

Medicalofficers 1082 3.1% 20 20 27.6% 9.5% 612377

Medicalspecialists 94 0.3% 2 2 49.5% 1.4% 1052140

Dentists 189 0.5% 3 3 4.1% 1.7% 638188

Dentalspecialists 5 0.0% 0 0 37.5% 0.1% 1187576

Professionalnurses 8993 25.5% 166 166 5.6% 34.7% 269627

EnrolledNurses 4245 12.1% 79 79 2.8% 7.8% 128885

EnrolledNursing3

Auxiliaries4998 14.2% 92 92 3.3% 7.3% 101366

Studentnurses 912 2.6% 17 17 NA 1.1% 87290

Pharmacists 462 1.3% 9 9 4.5% 3.1% 465571

Physiotherapists 192 0.5% 4 4 7.2% 0.6% 234563

3

Occupationaltherapists 158 0.4% 3 3 8.7% 0.6% 249480

Radiographers 209 0.6% 4 4 10.3% 0.8% 256612

Emergencymedicalstaff 1864 5.3% 34 34 0.9% 3.9% 147629

Nutritionists 44 0.1% 1 1 0.0% 0.2% 300495

Dieticians 293 0.8% 5 5 6.1% 1.0% 244855

HEALTH PERSONNEL : 2014 – 2015

42

BROAD ISSUES OF CONCERN FOR

LIMPOPO DEPT OF HEALTH

• There is an urgent need to review the

current Regulation 158 with the overall

objective of optimising the acquisition,

operation and management of the private

healthcare infrastructure through all

stages of infrastructure lifecycle.

43

Cont.…

•Access and affordability are the

key issues in the context of the

private health care sector in

Limpopo.

• Cost escalations are rendering

private health care increasingly

unaffordable to the majority of the

Limpopo population.44

Cont.…

• The public healthcare sector

continues to bleed significantly

from the health care personnel

that are trained by the

government and then join the

private healthcare sector

45

CONT…

• Non-compliance to the R158 regulations

also remains a critical challenge.

• Recently the department has had to

withdraw a certificate of registration /

license from one of the private healthcare

facility due to non-compliance.

• Quality and compliance are very critical

for certification of private health

establishments and we regard these

issues as non-negotiable.46

Challenges

• Lack of understanding of Department

of Health Policies and Guidelines

•

•

•

Applications vs Needs

Lack of applications for some districts

which really need private facilities

No follow up by proprietors

47

THANK YOU

48