usaid global health supply chain programme annual report

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USAID Global Health Supply Chain Programme

Annual Report

01 October 2017 to 30 September 2018

Contract No.: AID-OAA-I-15-00032

Task Order No.: AID-674-TO-16-00002

15 November 2018

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USAID Global Health Supply Chain

programme

Annual Report

01 October 2017 - 30 September 2018

Contract No.: AID-OAA-I-15-00032

Task Order No.: AID-674-TO-16-00002

Submitted to:

USAID/South Africa

Prepared by:

Global Health Supply Chain –Technical Assistance

Disclaimer:

This document is made possible by the generous support of the American people through the United States Agency for International

Development (USAID). The contents are the responsibility of Global Health Supply Chain Consortium and do not necessarily reflect the views

of USAID or the United States Government.

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TABLE OF CONTENTS

1. PROGRAMME OVERVIEW 6

2. ACRONYMS 7

3. EXECUTIVE SUMMARY 10

4. INTRODUCTION 12

4.1 BACKGROUND 12

4.2 SUMMARY OF ACCOMPLISHMENTS 13

5. PROGRAMME OBJECTIVES 16

5.1 RESULTS FRAMEWORK 16

5.2 PROGRAMME GOVERNANCE AND MANAGEMENT 17

6. FINANCIAL STATUS OF THE TASK ORDER 18

7. ACHIEVEMENTS AND MAJOR ACTIVITIES BY OBJECTIVE 20

7.1 OBJECTIVE 1: IMPROVE SELECTION AND USE OF MEDICINES 20

7.1.1 Sub-Objective 1.1: Assist with the Implementation of HTA 20

7.1.2 Sub-Objective 1.2: Improve Rational Medicine Use 20

7.2 OBJECTIVE 2: SUPPORT OPTIMISATION OF THE SUPPLY CHAIN 22

7.2.1 Sub-Objective 2.1: Improve contracting 22

7.2.2 Sub-Objective 2.2: Improve contract management 23

Workforce Management 23

Demand Forecasting 23

7.2.3 Sub-Objective 2.3: Design Supply Chain Operating Model 24

Demand Planning 24

Supply Planning (Informed Push) 24

Distribution Planning 25

7.2.4 Sub-Objective 2.4: Maintain and improve supply chain operations 25

Support to North West Province 26

Central Chronic Medicine Dispensing and Distribution (CCMDD) 27

7.3 OBJECTIVE 3 - STRENGTHEN GOVERNANCE 27

7.3.1 Sub-Objective 3.1: Contribute to Development of Policy and Legislation 27

7.3.2 Sub-Objective 3.2: Support the Implementation of Governance 28

7.3.3 Sub-Objective 3.3: Coordination and Oversight of Stakeholder Engagement and Communication Activities 30

7.4 OBJECTIVE 4 – WORKFORCE MANAGEMENT 31

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7.4.1 Sub-Objective 4.1: Support the Development of Standardised Structures, Roles, Competencies and Performance Management 31

7.4.2 Sub-Objective 4.2: Change Management Institutionalised 32

7.4.3 Sub-Objective 4.3: Upskilling and Mentoring and Staff 32

7.5 OBJECTIVE 5 – STRENGTHEN INFORMATION SYSTEMS AND INFORMATION MANAGEMENT 32

7.5.1 Sub-Objective 5.1: Design IT System Landscape 33

7.5.2 Sub-Objective 5.2: Provide Support to Strengthen Analytics and Oversight 34

7.5.3 Sub-Objective 5.3: Support the Implementation of Data Governance 35

7.5.4 Sub-Objective 5.4: Assist with Development and Implementation of IT Systems 36

RxSolution Maintenance and Consolidation 36

RxSolution: Application Development 36

SVS Phase I: Maintenance and Consolidation 37

SVS Phase II: Development and Enhancement 38

WMS (gCommerce) Implementation 38

PuLSe application development 39

7.6 OBJECTIVE 6 - IMPROVE FINANCIAL MANAGEMENT 40

7.6.1 Sub-Objective 6.1: Improve Forecasting and Budget Information 40

7.6.2 Sub-Objective 6.2: Assist to Strengthen Accounting Processes 41

7.6.3 Sub-Objective 6.3: Assist to Improve Financial Monitoring and Reporting 42

8. CRITICAL RISKS 43

9. LESSONS LEARNED 45

10. PERFORMANCE MONITORING 46

10.1 OBJECTIVE 1: IMPROVE THE SELECTION AND USE OF MEDICINE. 46

10.1.1 Sub-Objective 1.1: Assist with the Implementation of Health Technology Assessments. 46

10.1.2 Sub-Objective 1.2: Improve Rational Medicine Use. 47

10.2 OBJECTIVE 2: SUPPORT OPTIMISATION OF THE SUPPLY CHAIN. 49

10.2.1 Sub-Objective 2.1: Improve Contracting and 2.2 Improve Contract Management. 49

10.2.2 Sub-Objective 2.3 Design Supply Chain Operating Model and 2.4 Maintain and Improve Supply Chain Operations. 52

10.3 OBJECTIVE 3: STRENGTHEN GOVERNANCE. 52

10.3.1 Sub-Objective 3.1: Contribute to development of policy and legislation, Sub-Objective 3.2: Support the implementation of governance, and Sub-Objective 3.3: Coordination and oversight of stakeholder engagement and communication activities. 52

10.4 OBJECTIVE 4: IMPROVE WORKFORCE 53

10.4.1 Sub-Objective 4.1 – Support the development of standardized structures, roles and competencies & performance management, Sub-Objective 4.2 – Assist to institutionalize change management, and Sub-Objective 4.3 – Contribute to up-skilling and mentoring of AMD staff. 53

10.5 OBJECTIVE 5: STRENGTHEN INFORMATION SYSTEMS AND INFORMATION MANAGEMENT. 54

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10.5.1 Sub-Objective 5.1 Design an IT System Landscape and 5.2 Provide Support to Strengthen Analytics and Oversight. 54

10.5.2 Sub-Objective 5.3 Support the Implementation of Data Governance. 56

10.6 OBJECTIVE 6: IMPROVE FINANCIAL MANAGEMENT. 56

10.6.1 Sub-Objective 6.1 – Improve forecasting & budget information, Sub-Objective 6.2 - Assist to strengthen accounting processes, & Sub-Objective 6.3- Assist to improve financial monitoring & reporting 56

11. ANNEX 57

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1. PROGRAMME OVERVIEW

Name USAID Global Health Supply Chain Programme

Contract Number AID-OAA-I-15-00032; AID-674-TO-16-00002

Start Date September 27, 2016

End Date September 30, 2021

The USAID Global Health Supply Chain Programme (GHSC) in South Africa commenced in September

2016. The programme provides technical assistance to the South African government to strengthen public

health systems and supply chains in order to advance an AIDS-free generation and contribute toward the

achievement of universal health coverage.

The GHSC implementing team is led by Guidehouse (formerly PricewaterhouseCoopers Public Sector

LLP) and includes PwC South Africa, Imperial Health Sciences, and Priority Cost Effective Lessons for

Systems Strengthening South Africa (PRICELESS SA), Management Sciences for Health, and Banyan Global.

During this reporting period, PRICELESS SA elected to exit the consortium and ceased technical assistance

activities at the end of March 2018.

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2. ACRONYMS

AFT Administrative Function Testing

AMD Affordable Medicines Directorate

API Application Programming Interface

APP Annual Performance Plan

ARC Africa Resource Centre

ARV Antiretroviral

CCMDD Central Chronic Medicine Dispensing and Distribution

CDCS Country Development Cooperation Strategy

CMU Contract Management Unit

CPA Contract Price Adjustment

CSIR Council for Scientific and Industrial Research

DDV Direct Delivery

DO Development Objective

EC Eastern Cape

EDP Essential Drugs Programme

EMelA Essential Medicines Electronic Access tool

EML Essential Medicines List

ERC Expert Review Committee

FPD Foundation For Professional Development

FS Free State

GHSC Global Health Supply Chain

GTIN Global Trade Identification Number

HR Human Resources

HRD Human Resource Development

HRM Human Resource Management

HST Health Systems Trust

HTA Health Technology Assessment

ICT Information and Communications Technology

ISP Information Systems and Projects

IT Information Technology

ITSC IT Steering Committee

KPI Key Performance Indicator

LOE Level of Effort

LP Limpopo

M&E Monitoring and Evaluation

MEC Member of the Executive Council

MHPL Master Health Product List

MMDS Medicine Master Data System

MOU Memorandum of Understanding

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MPC Master Procurement Catalogue

NC Northern Cape

NDoH National Department of Health

NEMLC National Essential Medicine List Committee

NHC National Health Council

NHC-SC-

PS National Health Council – Sub-Committee – Pharmaceutical Services

NHI National Health Insurance

NSC National Surveillance Centre

NT National Treasury

NW North West

OD Organisational Design

ODC Other Direct Costs

OTIF On Time and In Full

PDU Pharmacy Dispensing Unit

PHC Primary Health Care

PIT Programme Implementation Team

PLDP Pharmacy Linked Distribution Points

PMDS Performance Monitoring and Development System

PMLO Provincial Medicine Liaison officer

PMPU Provincial Medicine Procurement Unit

POC Proof of Concept

PTC Pharmaceutical and Therapeutics Committee

PuP Pick Up Point

PwC PricewaterhouseCoopers

RACI Responsible, Accountable, Consulted, and Informed

RMU Rational Medicine Use

RSA Republic of South Africa

SAHPRA South African Health Products Regulatory Authority

SAPC South African Pharmacy Council

SAPICS South African Production and Inventory Control Society

SAVC South African Veterinary Council

SIAPS Systems for Improved Access to Pharmaceuticals and Services

SIMA Strategy to Improve Medicine Availability

SITA State Information Technology Agency

SLA Service Level Agreement

SOP Standard Operating Procedure

SQL Structured Query Language

STG Standard Treatment Guideline

SVS Stock Visibility System

SWP Sector Wide Procurement

TA Technical Assistance

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TB Tuberculosis

TL Truck Load

TLART Third Line Antiretroviral Treatment

TOR Terms of Reference

UAT User Acceptance Testing

URS User Requirements Specifications

USAID United States Agency for International Development

VAN Visibility and Analytics Network

WG Wave Governance

WMS Warehouse Management System

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3. EXECUTIVE SUMMARY The focus for Year 2 of the programme has been on implementing design work completed in Year 1, with

a focus on teams providing continued concentrated support to the Affordable Medicines Directorate

(AMD) within the National Department of Health (NDoH) and expanded technical assistance to provincial

departments of health in North West (NW), Eastern Cape (EC), Northern Cape (NC), and Limpopo (LP)

provinces. Key activities and accomplishments are summarised below:

Health Technology Assessments (HTA) and Rational Medicine Use (RMU)

Though focus on HTAs was reduced during Year 2, the team provided AMD with a cost effectiveness and

budget impact analysis for several medicines that supported National Essential Medicines List Committee

(NEMLC) decisions. GHSC TA also developed the National Formulary Guideline, a strategically important

document that guides the development, management, and use of formularies at all levels of the health care

system and supports the Medicine Master Data System (MMDS). In addition to these activities, the team

also drafted five memoranda of understanding (MOUs) that govern sharing antimicrobial resistance

surveillance data between public and private sector institutions.

Supply Chain

Year 2 saw the development and implementation of a new Demand Planning process supported by a

commercial forecasting tool and a guideline drafted by SCTA, both of which will significantly improve the

ability to model future medicine demand at national and provincial levels. This new approach to demand

planning will transform budgeting by providing a more analytically sound demand forecast. In addition,

outputs from the demand planning process are directly informing the contracting process. Importantly,

the process and tool were designed to be rolled out to provincial personnel with EC and NW demand

planners currently developing and submitting forecasts to AMD. Other notable supply chain activities

include developing a Proof of Concept (POC) for Supply Planning, which has the potential to ease the

burden of medicine ordering by clinic personnel, freeing them to focus on patient care.

Technology

Several technology activities continued in Year 2. GHSC personnel are developing the specifications for

the MMDS, a system that forms the basis for all medicine master data used across the entire public health

sector, a critical piece of work that improves system interoperability, promotes visibility and analytics, and

enables generation of formularies.

The team provided technical input to new receiving and ordering functions of the Stock Visibility System

(SVS) and supported the implementation of the gCommerce Warehouse Management System (WMS) in

LP. In addition, GHSC personnel supported completion of, and developed tools for, the implementation

of PuLSe, an online system that enables providers to apply for and manage dispensing licenses and permits

more quickly than the legacy paper process.

North West Province Intervention

During May 2018, NW experienced a period of labour unrest, which led to the closure of the Provincial

Medical Depot in Mahikeng. Facing a crisis, AMD asked GHSC TA personnel to establish and staff a

temporary PMPU at the NDoH, which during this period processed and managed more than 2,000

medicine and medical consumable orders from hospitals and Community Health Centres (CHCs) totalling

more than R 25 million. The team achieved AMD’s goal of rapidly shifting 100% of orders from depot to

supplier direct delivery—an achievement that fundamentally preserved medicine availability throughout

the province. Following our success operating the temporary PMPU, NDoH prioritised NW as the next

province to receive supply chain strengthening support once the labour unrest abated. GHSC TA also

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conducted rapid analyses of the workforce, supply chain planning, financial management, systems and

processes, and network and distribution operations. The AMD Intervention Lead and the Provincial

Administrator reviewed our findings and personally tasked GHSC to support the province in implementing

recommended improvements.

Performance Reporting, Supply Chain Analytics and Visibility

GHSC TA developed improved KPIs for AMD, which were approved and incorporated into the National

Surveillance Centre (NSC) dashboards. These KPIs span the entire medicine value chain, including

selection and use of medicines, contracting, contract management, and supply chain. They are

communicated to national and provincial stakeholders via eight dashboards with 135 views and 65 reports.

The team also improved performance monitoring and visibility by significantly increasing the number of

sites that report medicine availability to the NSC to 3,137 clinics, 443 hospitals, 8 provincial warehouses,

8 CCMDD stock storage sites and 8 GP Care Cells. To facilitate reporting on medicine availability, GHSC

developed an application that automates reporting processing from sites using RxSolution, which was

successfully tested and deployed in the Free State.

Workforce

AMD requested GHSC TA personnel to provide workforce strengthening services to the Contract

Management Unit (CMU) which is responsible for overseeing demander and supplier performance—

critical enablers of medicine availability. The team delivered a new organizational design, job descriptions,

and performance measures for CMU. In addition, the team reengineered existing processes, drafted SOPs

and provided training and coaching. The team replicated this approach during similar interventions for the

Information Systems and Projects (ISP) Unit within AMD and in the NW.

Way Forward

The aforementioned activities and accomplishments form a foundation for expansion of GHSC TA support

to provinces and the continued improvement in pharmaceutical supply chain performance across the

country. Our experience in NW, working daily and side-by-side with provincial, depot, district, hospital

and clinic personnel, has afforded us significant insight into the complexities and challenges associated with

driving improved pharmaceutical supply chain performance. We look to apply lessons learned as we

support additional provinces and foresee encountering and addressing many of the same challenges and

utilising opportunities encountered to date. In addition to provincial engagement, we look forward to

continuing our collaboration with AMD personnel responsible for selection and rational medicine use,

contracting and contract management, supply chain, information technology, and finance.

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4. INTRODUCTION

4.1 BACKGROUND

The USAID GHSC Programme in South Africa commenced in September 2016. The GHSC Programme

leverages 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. The programme provides technical assistance (TA) to build capacity of the

South African government, including the AMD within the NDoH and provincial pharmaceutical services

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, as well as the NDoH Strategy to Improve Medicine Availability (SIMA) (2016-2021)

and the NDoH Annual Performance Plan (APP).

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4.2 SUMMARY OF ACCOMPLISHMENTS

Key accomplishments in the past year are summarised in the table below:

OBJECTIVE 1: IMPROVE

SELECTION AND USE OF

MEDICINE

OBJECTIVE 2: SUPPORT OPTIMISATION OF THE

SUPPLY CHAIN

OBJECTIVE 3: STRENGTHEN

GOVERNANCE

Medicine Selection

● Developed a cost-effectiveness, budget

impact, and capacity-development

analysis for tretinoin, long-acting beta

antagonists and fondaparinux to inform

decisions on whether to include these

medicines on the national Essential

Medicines List (EML).

Rational Medicine Use (RMU)

● Provided technical assistance in

developing the National Formulary

Guideline including principles on

individual patient access to non-

formulary medicines.

● Developed easy-to-understand

presentations designed to increase

implementation of the revised Primary

Health care (PHC) Standard Treatment

Guidelines (STGs) and EML. The

presentations were tailored for

individual stakeholder groups with a

particular focus on nurses.

● Assisted development of five MOUs to

govern the sharing of Antimicrobial

Resistance Surveillance data between

the public and the private sectors.

● Assisted developing and incorporating

Contract Management

● Strengthened AMD’s CMU workforce via a new

organisational/workforce design, and improved processes and

governance, change management, training and coaching. This

activity featured quarterly impact assessments to support

continuous improvement and sustainability.

Provincial Medicine Procurement Units

● Conducted baseline assessments in eight provinces to assess the

maturity of warehouse and infrastructure, demand, supply, and

distribution planning, ordering, payment, and financial

management processes. The assessment also evaluated the state

of contract management, organisational design, and KPI

monitoring.

● Established an emergency PMPU at NDoH for the processing

and management of NW province orders and subsequent

deliveries during the May 2018 labour unrest. The GHSC TA

team processed over 2,000 orders for medicines and medical

consumables with a value of more than R 25 million and

achieved its goal of shifting 100% of hospital orders to supplier

direct delivery, which fundamentally preserved medicine

availability throughout the province.

Demand, Supply, & Distribution Planning

● Developed and piloted the future state demand planning process

in two provinces. Trained stakeholders on the process and

Legislation

● Assisted AMD in developing four

sets of regulations to be

published in terms of the

Pharmacy Act 53 of 1974

including:

o Regulations relating to

continuing professional

development of registered

persons as defined by the Act,

which were published for

public comment with

projected completion in the

first quarter of Year 3.

o Amendments to three sets of

regulations to introduce a new

category of pharmacy support

personnel were finalised,

comments provided by the

State Law Advisors and will be

ready for publication for public

comment in the first quarter

of Year 3.

Governance tools and

approaches

● The full set of 26 national KPIs to

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medicine related principles in the

National Referral Policy

forecasting tool (Forecast Pro), which more accurately models

future medicine demand at provincial and national levels. The

demand planning process informs the contracting process and

shapes Supply and Distribution planning decisions.

● Developed and currently piloting the future state Supply Planning

process in the NW. The new approach shifts ordering from

over-burdened healthcare providers to a centralised team able

to apply analytics to minimum/maximum levels and

replenishment decisions. This is a first step towards an Informed

Push model.

● Applied distribution planning principles to rapidly assess and

identify several potential improvements to NW medicine

distribution including improved routing and scheduling,

increasing Truck Load (TL) utilisation, and increasing supplier

direct delivery (DDV).

Supply Chain Segmentation

● Developed an initial segmentation approach for shaping demand,

supply, and distribution planning. The segmentation includes

considerations for and the ability to weight volume, cost, and

criticality—e.g. using the Vital, Essential, or Necessary

classification —and will be used to better align resources to

predicting the demand, supplying and distributing those

medicines with the highest volumes, cost, and patient impact.

monitor performance of the

supply chain in accordance with

the SIMA, were finalised following

incorporation of provincial input.

The document was submitted to

the National Health Council

Technical Committee of NDOH

and dashboards were revised to

reflect the revised KPIs.

● To improve the ability of AMD to

manage, coordinate, and

recognise efficiencies in work

performed by implementing

partners, GHSC developed the

terms of reference for the Wave

Governance project management

approach, as well as a set of KPIs

to monitor implementation and

usefulness of this planning and co-

ordination mechanism.


WORKFORCE MANAGEMENT

OBJECTIVE 5: STRENGTHEN INFORMATION SYSTEMS

AND INFORMATION MANAGEMENT


FINANCIAL MANAGEMENT

● Reviewed and designed new structures

for the CMU, ISP, and NW

Pharmaceutical Services.

● Reviewed and developed seventeen job

descriptions and performance

● Helped develop specifications for further development of the

SVS including enabling the application to support ordering and

receiving transactions at PHC facilities.

● Implemented the gCommerce Warehouse Management System

(WMS) in Limpopo.

● Designed Standard Operating

Procedures (SOPs) related to

budget management for Sector

Wide Procurement (SWP) and

conducted training with the

relevant Directorates.

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agreements for both CMU and ISP.

● Developed new dashboards to provide visibility across the

supply chain, including warehouses, Central Chronic Medicine

Dispensing and Distribution (CCMDD) service providers and

contracted general practitioners. The eight dashboards now

offer users multiple customisable views.

● Developed the IT Strategy and Roadmap, including IT operating

model and IT project methodology.

● Developed, tested and deployed the RxSolution middleware

Application Programming Interface (API) in Free State (FS),

enabling automated reporting of medicine availability data.

● Assisted developing master data requirements and design

specifications fa full-fledged online Master Health Product List

(MHPL) that will serve as the authoritative list of approved

medicines that all other databases reference.

● Increased the number of sites reporting medicine availability to

the National Surveillance Centre (NSC) to 3,604. This includes

3,137 clinics, 443 hospital facilities which are supported by the

GHSC programme, 8 provincial warehouses, 8 CCMDD stock

storage sites and 8 GP Care Cells.

● Assisted and provided guidance

with budget forecasting for the

2018/19 financial year for each

Directorate with SWP.

● Designed and implemented

Budget vs. Actual expenditure

monitoring dashboards for SWP.

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5. PROGRAMME OBJECTIVES

5.1 RESULTS FRAMEWORK

The project results framework captures overall long-term goals, desired impact, desired outcomes and

expected outputs related to each of the programme’s six objectives. Figure 1 shows the relationship

between goals, impact, outcomes, and outputs and serves as a guide for organising the annual report.

Figure 1 GHSC Programme Result Framework

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5.2 PROGRAMME GOVERNANCE AND MANAGEMENT

Since its inception, GHSC has successfully mobilised a diverse but complementary team to deliver on a

complex scope of work. During the early months of Year 1, the team spent a significant amount of time

and effort developing and refining its work plan and shaping associated interventions to more closely align

with the Department’s strategic priorities, as outlined in the SIMA. To achieve this, the team categorised

activities into eight different “projects,” each of which features an AMD liaison person. This collaborative

structure proved highly successful throughout Year 2 and will continue to be a featured component of

GHSC TA support in South Africa.

During Year 2, the project structure and organisation was further refined, with the eight projects grouped

according to work streams which are further aligned to the objectives and sub-objectives defined in the

Results Framework.

All activities reflected in the Year 2 work plan formed the basis for quarterly detailed Wave Governance

(WG) plans, which were presented to the AMD, USAID, other implementing partners and donors. GHSC

TA personnel regularly reviewed progress against the WG plans with AMD and USAID.

In response to the aforementioned AMD deprioritisation of Health Technology Assessment (HTA) related

activities, PRICELESS withdrew from the consortium and concluded their activities at the end of March

2018, with all HTA deliverables completed and handed over to AMD. As mentioned, AMD has recently

expressed an interest in reinitiating HTA related activities during Year 3 for which discussions are

currently ongoing.

At the end of Year 1, the team consisted of 39 professionals providing technical assistance. During Year

2, the team grew to 42 with the addition of the following personnel:

● An IT Strategist & Programme Manager responsible for managing the projects related to the IT

landscape and master data;

● A supply chain planning subject matter expert, responsible for developing the demand, supply, and

distribution planning along with developing a supply chain segmentation strategy;

● A monitoring, evaluation and continuous improvement team member to assist with developing new

national and provincial KPIs and developing a continuous improvement methodology.

Other changes during Year 2 include realigning provincial support personnel to report to a single provincial

support team lead. This restructuring has provided a higher degree of coordination and alignment across

personnel supporting prioritised interventions in the provinces.

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6. FINANCIAL STATUS OF THE TASK ORDER

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7. ACHIEVEMENTS AND MAJOR ACTIVITIES BY OBJECTIVE

7.1 OBJECTIVE 1: IMPROVE SELECTION AND USE OF MEDICINES

Objective 1 encompasses technical assistance provided to AMD in the areas of HTA and RMU.

Establishment of a coherent medicine value chain from evidence based medicine selection to the rational

and effective use of medicines is imperative for improved clinical practice and patient outcomes.

7.1.1 SUB-OBJECTIVE 1.1: ASSIST WITH THE IMPLEMENTATION OF HTA

Activities and Impact

Activities under Objective 1 included finalisation of support on the Essential Medicine Electronic Access

(EMelA) system, as well as developing policies, guidelines, processes, and interventions to establish

governance frameworks for evidence-based medicine selection and the rational use of medicines. During

Year 2, many planned HTA activities were suspended at the request of AMD. Towards the end of the

period, however, the Director of AMD requested GHSC to again provide technical assistance with HTA.

Major activities and accomplishments associated with sub-objective 1.1 in Year 2 are outlined below:

● Developed a revised Draft Conflict of Interest Policy for the NEMLC and associated change

management plan. The revised policy adopts a more generic approach to managing potential conflicts

of interest involving committee members.

● Developed a revised version of the Reviewer’s Manual based on observations from the NEMLC and

Expert Review Committees (ERC) processes.

● Delivered cost-effectiveness, budget impact, and capacity-development analyses for tretinoin, long-

acting beta antagonists and fondaparinux. Provided reports to assist the NEMLC in considering the

cost-effectiveness and budget impact of inclusion of the medicines in the National Essential Medicines

List (EML).

● Supported recruiting of potential members of the Paediatric ERC, including developing interview

questions and evaluating applicants. Resulted in appointment of committee members, convening of the

committee and the assumption of its duties.

● GHSC personnel served as core team members assisting AMD in developing a new HTA strategy.

Looking Forward

● Finalizing the Conflict of Interest Policy

● Revising the existing Reviewer’s Manual

● Continuing support of AMD’s efforts to develop a new HTA Strategy.

7.1.2 SUB-OBJECTIVE 1.2: IMPROVE RATIONAL MEDICINE USE


Year 2 activities focused on evaluation and handover of EMelA, a web-based application that digitises the

STGs and the EML. The focus then shifted to developing policies, guidelines and interventions to promote

rational medicine use. Specific activities that took place in Year 2 included:

● Delivered the EMelA Phase I Evaluation Report following completion of an analysis of system

functionality. Due to identified functional limitations, AMD decided to cease further development and

implementation. Team personnel then assisted with the handover of documentation and the source

code from developers to AMD.

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● Applied business rules and lessons learned from supporting the EMelA implementation to the

development of the AMD MMDS including the MHPL. Drafted a policy relating the management of

medicine master data that informs both system development and implementation, which is under

review.

● Provided input in the development of the content, graphics, and communication materials for

Pharmacy Month 2018’s theme, “Use Medicines Wisely.” The messaging launched in September with

the aim of enhancing communication between patients and pharmacists to improve rational and

appropriate medicine use.

● Working with the Essential Drugs Programme (EDP) to develop the National Formulary Guideline, a

strategically important document that guides the development, management, and use of formularies

at all levels of the health care system to promote improved RMU. Collected numerous stakeholder

inputs including principles on individual and special access to medicines by patients, which were aligned

with the national policy on patient referral and medicine master data.

● Provided support in quality control of data on EML Clinical Guide App, which serves as the primary

implementation mechanism of the STGs and EML, to improve the accuracy of information available to

healthcare professionals.

● Assisted the implementation and use of STGs by developing an explanation of major changes to the

STGs and their ramifications. This included summaries of significant decisions made by NEMLC related

to PHC during committee meetings from 2016 to 2018. The team tailored the messaging designed to

accelerate implementation of the revised PHC STGs and EML for target audiences, including simplifying the content for specific stakeholder groups with a particular focus on nurses.

● Developed multiple presentations designed to improve communication on EDP and STG/EML

processes for use by AMD at pharmaceutical conferences and other meetings.

● Drafted five MOUs that have been reviewed by NDoH’s Legal Unit and are awaiting sign off:

‒ NDoH and private laboratories,

‒ NDoH and the National Institute for Communicable Diseases,

‒ NDoH and the South African Society for Clinical Microbiology,

‒ NDoH and the Department of Agriculture, Forestry & Fisheries, and

‒ NDoH and National Health Laboratory Services.

Also developed an Antimicrobial Use Data Surveillance Framework in support of the MOUs.

● Developed a draft NEMLC Appeals Policy, which explains the procedure for lodging an appeal against

an NEMLC medicine related decision. The document is currently under review by the committee.

● Drafted an outline to shape the content of the future National Pharmaceutical and Therapeutics

Committee (PTC) Guideline, which was approved following incorporation of stakeholder comments.

Although delayed (at the request of AMD) due to other higher priority activities, the team has begun

developing new governance tools that will be included in the guideline. A major focus of Year 3 will

be refining and completing the guideline, which will serve as a critical tool in supporting PTC efficiency

and governance with the goal of improving RMU.

● Assisted drafting the National Referral Policy related to the medicine management principles. Created

scenarios to test alignment of the policy with the National Formulary Guideline principles. In addition,

the project provided inputs to the National Palliative Care Implementation Plan related to medicine

use.

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Looking Forward

GHSC will assist EDP with developing relevant policies, procedures, and interventions for the rational

selection and use of medicines. During Year 3, the GHSC team will perform the following activities in

support of Objective 1.2:

● Developing the PTC Guideline, soliciting input and prioritise PTCs for implementation of the guideline

● Developing an implementation plan for the Formulary Tool of the AMD MMDS

● Finalizing the National Formulary Guideline and Medicine Master Data Policy

● Finalizing the NEMLC Appeals Policy

● Reviewing NEMLC governance documents including the Terms of Reference (TOR)

● Developing and implementing of an EDP Communications and Awareness Plan

7.2 OBJECTIVE 2: SUPPORT OPTIMISATION OF THE SUPPLY CHAIN

Optimising the supply chain is critical to improving 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 institutionalisation of elements of the Visibility Analytic

Network (VAN) operating model as well as implementing select components of the Provincial Medicine

Procurement Unit (PMPU) concept. Activities included within this objective also include improving

contracting and contract management.

7.2.1 SUB-OBJECTIVE 2.1: IMPROVE CONTRACTING


In Year 2, the GHSC team worked with the tender forecasting team to transition long-term forecasting

responsibilities to NDoH. Long-term forecasting will provide NDoH with improved demand projections

that inform the tendering process for national contracts. Specific activities performed include the

following:

● Conducted training on the demand planning process and the statistical forecasting tool, Forecast Pro

with focus on data cleansing, generating a baseline forecast using the statistical demand planning tool,

forecast enrichment, communicating the initial forecast to provinces and consolidating feedback

received.

● Supported AMD by assisting National Treasury (NT) with the loading and updating of National

Transversal Contracts for medicines and medical related items. This was necessary to populate the

master table used for procurement in gCommerce that will assist in expediting future contracting

processes and activities related to Contractual Price Adjustments (CPA).

Looking Forward

● Assisting NDoH personnel in becoming self-sufficient in generating, communicating and finalising

tender forecasts.

● Completing the tender forecasting guideline that will describe the process and activities associated

with incorporating demand planning information into upcoming tender forecasts.

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7.2.2 SUB-OBJECTIVE 2.2: IMPROVE CONTRACT MANAGEMENT


Workforce Management

AMD requested GHSC TA personnel to provide workforce strengthening services for the CMU within

AMD. The subsequent intervention featured four areas of focus:

● People: Optimised the organisation design, job descriptions, performance measures, communications

and change management, and provided training, development and coaching.

● Governance and Processes: Established new, more efficient processes, frameworks and SOPs.

● Technology: Developed and optimised tools and reports to assist in monitoring and evaluating KPIs

for CMU staff and the whole unit.

● Monitoring and Evaluation: Performed quarterly assessments of the impact of the intervention to

measure improvement, tailor support, and promote continuous improvement and sustainability.

Developed and implemented recommendations to improve CMU operations including designing and

delivering the following:

● A strategy enabling capability map.

● A CMU organisational structure interaction model and performance management framework, with

revised job descriptions and individual performance management plans.

● Governance frameworks (decision making bodies and supporting terms of reference).

● Job impact assessments highlighting the change from the current to future jobs.

● Improved processes and procedures with accompanying SOPs.

Demand Forecasting

In-contract demand forecasting enables the NDoH to review the actual usage and future projected

demand of medicine against the original contracted volumes with suppliers, thus improving the NDoH’s

supplier management capabilities by providing greater insight into the projected requirements for a specific

medicine. GHSC TA support for demand forecasting included the following:

● Trained the national demand planning team on the new demand planning process.

● Provided detailed instruction on use of Forecast Pro, the demand planning forecasting tool, and enabling

activities like data analysis and cleansing and how those activities are used to support CMU’s contract

management responsibilities.

● Trained CMU personnel on developing in-contract forecasts and national level ad hoc forecasts in

response to emergent requests. Data from these forecasts provided CMU resources with greater

information and insight during their discussions with suppliers, allowing for more robust and

meaningful discussions/negotiations. Suppliers also benefitted from receiving a more highly refined

demand signal, which enabled them to better optimise their own operations.

Looking Forward

● Continuing to engage and strengthen contract management capabilities and further integrate demand

plans into contract oversight activities.

● Improving In-Contract demand planning by formally establishing a CMU team that reviews the forecast

against the original tender volumes and coordinates with suppliers to manage variances and adjust

rough-cut capacity plans.

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7.2.3 SUB-OBJECTIVE 2.3: DESIGN SUPPLY CHAIN OPERATING MODEL


Demand, supply, and distribution planning (together known as Planning Services) are critical to improving

medicine availability and reducing stock outs at the provincial, district, and healthcare facility levels.

Demand Planning

In Year 2, GHSC led the implementation of demand planning at National and Provincial level. The objective

of the demand planning implementation is to provide improved projections of medicine demand for short,

medium and long-term requirements. This activity will inform the following:

● Supply planning regarding what medicine should be supplied, at what point of time, to which location.

● Contracting processes (see above).

● Financial management including budget reviews, establishing budget projections, tracking consumption

versus plan, and understanding the financial consequences of demand fluctuations.

During this period, GHSC performed the following activities:

● Investigated and documented options relating to different demand planning statistical forecasting tools

and supported AMD in selecting a “fit for purpose” tool—Forecast Pro.

● Conducted a demand planning Proof of Concept (POC) in the EC which offered team members the

opportunity to:

‒ assess the current process,

‒ adapt the design of the new demand planning process,

‒ implement Forecast Pro,

‒ evaluate the effectiveness of training courses and change management activities on the ability

of provincial teams to conduct demand planning, and

‒ test new demand planning KPIs

● Following the POC, the team delivered a post POC report including lessons learned which were

incorporated in updates to the process that are being rolled out to other provinces.

● Developed guidelines detailing the standard demand planning process, approach and implementation

methodology.

● Together with AMD counterparts, conducted forecast reviews and forecast enrichments, and

received approval of these forecasts as part of finalising the demand plan.

● Subsequently generated initial forecasts for several medicine contracts.

● Rolled out demand planning to the NW, which benefited from insights gained during the EC POC

resulting in production of initial demand forecasts.

Supply Planning (Informed Push)

To improve product availability, realise efficiencies, and reduce the risk of stock-outs, the GHSC team

developed a framework for implementing an Informed Push Model and refined the approach to enable

automated replenishment of stock at the lowest facility level. This activity should positively impact health

outcomes at rural clinics where sole practitioners, often nurses, will no longer have to generate orders

and can then focus additional time on patients.

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● Proposed and began planning for a Supply Planning POC in NW to test automated replenishment

planning for two sites using RxSolution and two sites using the SVS during Year 3.

● Developed an inventory calculation tool to calculate minimum and maximum stock levels by facility,

which will also be tested as part of the POC.

● Developed an initial segmentation approach for assessing product volume, cost, and criticality—Vital,

Essential, or Non-Essential (VEN)—that will be used to focus planning activities on those medicines

with the greatest impact to health outcomes and the health supply chain.

Distribution Planning

Distribution planning did not formally commence in Year 2 though several GHSC TA personnel were

directly involved in optimising distribution operations in NW at AMD request. Contributions included the

following:

● Documenting the current state of primary (depot to hospital) and secondary (hospital to clinic)

transportation operations in the province including understanding volume and cost of transportation

● Identifying several opportunities to improve distribution operations including:

‒ Optimising routing and scheduling of outbound primary transportation from depot to

hospitals.

‒ Reducing the cost of outbound transportation by shifting from eight to four-ton trucks due

to a non-linear pricing model.

‒ Increasing the rate of depot deliveries from bi-weekly to weekly, which will reduce overall

inventory costs, largely covering commensurate increases in transportation spend while

improving velocity and medicine availability.

‒ Increasing the number of facilities receiving supplier Direct Deliveries (DDVs) which will

reduce the burden on depot staff, reduce transportation spend as many sites are closer to

supplier warehouses than the depot, improve responsiveness, and reduce losses due to

additional handling.

Looking Forward.

● Continuing to roll out demand planning in the provinces, providing training to provincial personnel on

the process and use of Forecast Pro.

● Institutionalising the roll of forecasting and demand planning in financial reporting and the budgeting

process.

● Reviewing a proposed centralisation of demand planning functions with AMD and if approved, agreeing

on an implementation approach.

● Completing the supply planning POC for NW, documenting lessons learned and updating the process

and min/max tool as required.

● Agreeing on an implementation plan for the roll out of supply planning to the rest of the provinces.

● Drafting a Supply Planning Guideline document similar to that produced for demand planning.

● Continuing to support NW’s efforts to improve distribution operations by implementing new routing

and scheduling, increasing supplier direct delivery, optimizing truck type, and increasing depot delivery

frequency.

7.2.4 SUB-OBJECTIVE 2.4: MAINTAIN AND IMPROVE SUPPLY CHAIN OPERATIONS

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In Year 1 GHSC developed the Provincial Medicine Procurement Unit (PMPU) Blueprint, which aimed to

describe how the supply chain could be improved by strengthening transactional processes at provincial

level. During Year 2, GHSC conducted baseline assessments in eight provinces.

● The assessments highlighted the maturity level of nine critical elements - warehouse and infrastructure,

demand, supply and distribution planning, ordering, payment and financial management, contract

management, organisational design, as well as monitoring against KPIs.

● Key opportunities to strengthen the supply chain identified by the assessment included the following:

‒ Strengthening governance and leadership structures to streamline decision making, escalation,

delegation and monitoring and evaluation processes;

‒ Aligning roles within Pharmaceutical Services to the required capabilities to eliminate

duplication of roles and improve decision making;

‒ Improving planning capability, reviewing planning processes and systems at an operational level

to support efficient stock management;

‒ Strengthening financial practices and processes to promote effective governance including

consistency in accounting reports and supplier performance management; and

‒ Refining logistics networks to reduce lead times improve routing and scheduling of deliveries,

optimise management of transport cost and optimise safety stock levels.

The findings of these assessments will inform planning of future interventions at provincial level.

Support to North West Province


During May 2018, NW experienced a period of labour unrest, which led to the closure of the Provincial

Medical Depot in Mahikeng. Facing a crisis, AMD asked GHSC TA to establish and staff a temporary PMPU

at the NDoH, which processed and managed orders from Hospitals and Community Health Centres

(CHCs) across the province. Team personnel processed over 2,000 orders representing more than R 25

million in contracted pharmaceutical items and achieved AMD’s goal of rapidly shifting 100% of orders

from depot to supplier direct delivery—an achievement that fundamentally preserved medicine availability

throughout the province.

Following our success operating the temporary PMPU, NDoH prioritised NW as the next province to

receive supply chain strengthening initiatives once the labour unrest abated. GHSC TA personnel

subsequently focuses on strengthening five specific areas:

● workforce and organisational design

● planning services (demand, supply and distribution)

● financial management (ordering and payment processes)

● depot systems and processes

● network optimisation

A cross-functional project team from GHSC TA was deployed to conduct deep-dive assessments in each

of the five areas culminating in an ‘As-Is’ report highlighting the findings and recommendations for each of

the focus areas. The report was presented to the AMD Intervention Lead and the Provincial Administrator

who then asked the team to support provincial leadership in implementing recommended improvements

to each of the five areas.

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Looking Forward

The supply chain strengthening team will continue to support implementation activities in the NW.

Lessons learned transforming supply chain operations and supporting activities will be applied to future

provincial interventions with anticipated continuing support of the following focus areas in NW subject to

provincial and AMD coordination:

● Optimising payment and financial management processes

● Implementing new Demand, Supply and Distribution planning services

● Continuing to refine and optimise distribution operations, reducing costs while preserving or

improving operational performance

Central Chronic Medicine Dispensing and Distribution (CCMDD)


The Central Chronic Medicine Dispensing and Distribution (CCMDD) programme, where repeat

prescriptions for chronic stable patients are dispensed centrally by contracted service providers and

delivered to a pick up point close to the patient’s home or work, is considered to be one of the flagship

programs of NDoH. Because of the nature of the programme, it is critical that CCMDD service providers

carry sufficient stock to enable prescriptions to be filled. Specific Year 2 CCMDD activities included:

● Worked with the CCMDD National Coordinator and AMD to develop and implement standardised

supply chain processes to support the programme. These processes aim at improving efficiency of the

CCMDD programme, provide guidance during review meetings, and facilitate escalation of process

inefficiencies.

● During the reporting period, NDoH contracted new service providers for the programme with GHSC

TA personnel playing a vital role in preparing for and supporting the transition of CCMDD services

to the new service providers.

Looking Forward

● Monitoring and supporting CCMDD supply chain performance across the provinces and identifying

opportunities to improve processes.

7.3 OBJECTIVE 3 - STRENGTHEN GOVERNANCE

One of the primary functions of AMD is to provide oversight and set policy for the provision of

pharmaceutical services in South Africa. GHSC TA activities in support of this objective include assisting

AMD in establishing relevant legislation and policies, developing appropriate governance structures to

improve accountability and oversight, and making data available for decision-making.

7.3.1 SUB-OBJECTIVE 3.1: CONTRIBUTE TO DEVELOPMENT OF POLICY AND LEGISLATION


Activities undertaken in this reporting period included the following:

● Worked with AMD on amendments proposed by the South African Pharmacy Council (SAPC) to

three sets of regulations published in terms of the Pharmacy Act 53 of 1974 (the Pharmacy Act) to

enable the education, registration, and practice of a new category of pharmacy support personnel -

pharmacy technicians. Following consultation and engagement with SAPC representatives and the

Legal Unit of NDoH, the regulations were submitted to the Office of the State Law Advisor for review.

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● Supported AMD with the revision of draft regulations to be published in terms of the Pharmacy Act

dealing with continuing professional development of persons registered in terms of that Act. After

consultation with the SAPC and the Legal Unit of NDOH, and the incorporation of amendments

proposed by the State Law Advisers, the regulations were signed by the Minister and published for

public comment on 13 July.

● Supported AMD in the revision of the draft guidance for the issuing of pharmacy licences. 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. Work is

underway with the task team to review public comment received.

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

Medicines and Related Substances Act 101 of 1965 (the Medicines Act) regarding the new requirement

that veterinarians must have a licence to dispense and compound medicines if they perform these

functions. After stakeholder engagement and consultation, the team prepared and submitted a

submission for exemption from this requirement to the Minister and the Director General. GHSC

TA personnel provided further assistance by preparing correspondence to the SAVC and suppliers of

medicine to veterinarians relating to a decision that the legislative requirement for vets to hold a

dispensing licence not be implemented at this time.

● Completed and submitted comment on two Board notices published by SAPC in terms of the

Pharmacy Act relating to Pharmacy Linked Distribution Points (PLDPs) and Competency Standards

for Pharmacists. GHSC provided technical assistance to AMD and participated in 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.

● Supported AMD in the processing and consolidation of public comment received for implementation

of Global Trade Identification Number - GTIN-14 and data matrix barcodes published in the

Government Gazette on 15 September 2017. GHSC TA also supported AMD with the presentation

of progress made regarding implementation of GTIN-14 and data matrix barcodes at the GS1 Africa

Healthcare Conference held in Ethiopia. Based on learnings from the conference, a meeting with the

South African Health Products Regulatory Authority (SAHPRA) took place to discuss implementation

of the requirement for barcoding as per amendments to the General Regulations published in terms

of the Medicines Act of 25 August 2017. It was agreed that a Technical Working Group (AMD and

SAHPRA) be set up to develop guidelines for implementation. A barcoding concept note was

developed and submitted to AMD.

● Prepared and submitted a prioritised list of supply chain policies required to AMD.

Looking Forward

● Reviewing and incorporating comment from the State Law Advisors on the regulations published in

terms of the Pharmacy Act to enable the education, registration and practice of pharmacy technicians.

● Reviewing comment received on regulations to be published in terms of the Pharmacy Act dealing

with continuing professional development of persons registered in terms of that Act.

● Continuing working with the task team to review the criteria for pharmacy licences.

● Developing guidelines for labelling and identification of medicines as per amendments to the General

Regulations published in terms of the Medicines Act to incorporate barcoding.

● Providing additional policy related support as directed.

7.3.2 SUB-OBJECTIVE 3.2: SUPPORT THE IMPLEMENTATION OF GOVERNANCE

29


● Provided support to AMD in the revision of the norms and standards for the Pharmaceutical Services

Dashboard, which was presented at the National Health Council – Sub-Committee – Pharmaceutical

Services (NHC-SC-PS). The revised norms and standards were finalised and approved by AMD.

● Revised and submitted the TORs for the NHC-SC-PS and the Pharmaceutical Bid Specification

Committee to AMD.

● Assisted AMD in presentations to the Primary Health Care ERC and NEMLC on the principles of the

nurse prescriber policy. Both engagements highlighted the need for speedy implementation of all facets

of the policy (viz. legislative changes, finalisation of the competencies of nurses, appropriate training

of nurses, and developing an IT system to assist in managing the process).

● Provided support to the Foundation for Professional Development (FPD) for review of the draft

service level agreement between that body and the Gauteng Provincial Department of Health relating

to the project where private medical practitioners and pharmacies provide services to patients using

medicines and medical consumables provided by the province – GP Care Cell.

● Worked with AMD and Health Systems Trust (HST) to develop a full set of the documents required

for awarding new contracts for CCMDD service providers.

● Developed a pilot framework and a transition framework for use by AMD and support partners.

● Completed the TOR for the Programme Implementation Team (PIT) and Wave Governance (WG)

meetings, and finalised a set of KPIs to monitor the functioning of the WG mechanism, both of which

were accepted.

● Reviewed the Special Conditions of Contract document and proposed amendments required to align

the document with amendments to the Medicines Act, and the establishment of SAHPRA.

● Prepared input on draft Good Pharmacy Practice rules prepared by the SAPC on the services that can

be provided from a pharmacy (e.g., unit dose dispensing), pharmacy linked distribution points, and

other innovative models of service delivery.

● Finalised the SOP for Ideal Clinics regarding the disposal of obsolete and expired stock and submitted

to the Ideal Clinic team. Supported updating the Ideal Clinic tracer lists with the revised lists being

finalised during this period.

● In collaboration with HST, supported AMD with finalising a document describing criteria and standards

for external pick up points for patients receiving medicine for chronic diseases. AMD subsequently

submitted the document to the SAPC.

● Following a direct request from AMD for support, GHSC assisted EDP with improving governance

and management of requests for initiation of Third Line Antiretroviral Treatment (TLART) and

provincial procurement activities for associated commodities. Activities included the following:

‒ Commenced TLART work after achieving agreement with EDP on a high-level work plan,

detailing governance and system development activities.

‒ Conducted a situation analysis to provide a clear, detailed understanding of the current state

of processes and risks. Identified numerous opportunities to improve efficiency.

‒ Developed and/or revised multiple governance documents including the committee TOR, the

SOP outlining TLART procurement procedure, and an application guide for clinicians.

‒ Supported AMD at a meeting of the TLART Peer Review Committee held in May 2018.

Following the meeting, updated and submitted a revised committee TOR to EDP.

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● Prepared a National KPI Dictionary describing the KPIs used by AMD to monitor progress toward

achieving the desired outcomes of the SIMA. AMD adopted the dictionary following consultation with

the provinces. The team then conducted assessments to gauge readiness to operationalise the KPIs

and developed continuous improvement plans to establish processes and procedures that align

operational plans to KPIs and APP targets. In cases where existing processes allow for required KPI

data to be retrieved and processed, the team developed new or updated existing dashboards.

● Developed new provincial KPIs in consultation with AMD, which were submitted to provinces for

comment. The provincial KPI Dictionary provides stakeholders with a standard set of common KPIs

used to measure the provincial progress in achieving SIMA outcomes.

● Developed a new governance framework that helps AMD apply a structured approach to developing

and shaping governance interventions and controls, as well as National Surveillance Centre (NSC)

roles and processes that drive use of dashboards and a culture of continuous improvement.

Looking Forward

● Finalising and implementing provincial KPIs.

● Supporting AMD in implementing and institutionalising the NSC roles and functions and the

implementation of continuous improvement plans.

7.3.3 SUB-OBJECTIVE 3.3: COORDINATION AND OVERSIGHT OF STAKEHOLDER ENGAGEMENT AND

COMMUNICATION ACTIVITIES


In Year 2, GHSC continued to support coordination and oversight of stakeholder engagement,

communication and change management activities related to programme interventions.

● Identified multiple stakeholder engagement and change management activities required to support

successful implementation of numerous interventions designed to improve supply chain performance

and patient outcomes. The team developed stakeholder maps, Responsible, Accountable, Consulted,

and Informed (RACI) analyses and communications plans for several initiatives including PuLSe,

Dashboards, IT System Landscape, Demand Planning, gCommerce, CMU and ISP units to inform

change management considerations and approaches.

● Held bi-weekly huddle sessions, quarterly pulse checks and regular engagement sessions with unit

personnel during the CMU intervention. The CMU team is currently in transition mode and have

assumed responsibility for the huddle sessions. GHSC personnel successfully applied a similar

engagement approach during the ISP intervention.

● Performed numerous change management and communications activities in support of the Provincial

RxSolution Transition Workshops including delivering presentations to Provincial IT practitioners,

super users, and Pharmaceutical Services representatives. Pre-transition and post-transition surveys

were distributed, collected, and reported on to improve future transition workshops.

● Established Provincial Steering Committees featuring key stakeholders to provide direction in supply

of pharmaceuticals and related products. These committees play a key role in governance and decision

making related to improving medicines availability.

Looking Forward

● Continuing numerous communications and change management activities in support of new policies,

processes, procedures, and system implementations.

● Applying lessons learned from past change management and stakeholder engagement activities to

future stakeholder interactions.

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7.4 OBJECTIVE 4 – WORKFORCE MANAGEMENT

Activities included within this objective address the management of human resources within the medicine

supply chain, including addressing challenges relating to the lack of staff with the required capabilities, high

vacancy rates, uneven distribution of human resources, and the need to improve staff management and

retention. Year 2 focused on strengthening interventions and activities to improve workforce alignment,

performance management, operational management components and organisational structure for specific

units within AMD

7.4.1 SUB-OBJECTIVE 4.1: SUPPORT THE DEVELOPMENT OF STANDARDISED STRUCTURES, ROLES,

COMPETENCIES AND PERFORMANCE MANAGEMENT


During Year 2, GHSC TA personnel assisted both AMD functional units as well as multiple stakeholders

and organisations in NW

● Conducted two organisational interventions including efforts for CMU (described above) and a similar

intervention for AMD’s ISP. Each intervention featured a three-phased strengthening approach based

on assessment, design and implementation.

● Completed the “As-Is” Workforce and Organisational Design (OD) Assessment for ISP including

review of structures, job descriptions, processes and PMDS documents.

● Assisted in aligning AMD strategy with operational plans for CMU, ISP and AMD Governance Units.

● Completed the “To-Be” design of the ISP unit including:

‒ Capability maps focusing on business analysis, project management and systems;

‒ Organisational structure options with supporting job descriptions and PMDS documents;

‒ Interaction models;

‒ A project management lifecycle methodology with a supporting toolkit; and

‒ A governance framework highlighting decision making bodies and terms of reference

● Activities addressed functional, behavioural and performance aspects of the units. The team conducted

ongoing monitoring and evaluation of these interventions to measure sustained impact. Personnel

introduced continuous improvement supported by ‘huddle sessions’ that promote improved change

management. The team conducts brief weekly stand-up sessions to check in with unit members to

monitor and drive performance against departmental KPIs.

● Led a broad workforce management intervention in NW and provided technical assistance to other

work streams including gCommerce, SVS, RxSolution, Demand Planning, and PULSE.

Successful execution of these interventions and strengthening activities played a key role in improving

workforce organisation and are expected to materially improve performance.

● Assessed and provided new organisational designs, structures and supporting artefacts for three

organisational structures (CMU, ISP and NW).

● Drafted or updated 17 job profiles and performance assessment documents that to strengthen AMD,

CMU, ISP and NW workforce organisation. All AMD documents were signed by incumbents and

submitted to Human Resource Management (HRM).

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Looking Forward

● Continue to monitor past workforce transformation activities and assess the degree to which change

is sustained. Personnel will maintain their high level of continued interaction with AMD, CMU, ISP,

and NW.

● Continue to provide work force transformation and organisational design services where required to

support rollout of new supply chain process and systems.

7.4.2 SUB-OBJECTIVE 4.2: CHANGE MANAGEMENT INSTITUTIONALISED


Year 2 featured greater emphasis on stakeholder engagement, communications, initial change

management, and training all of which form the cornerstones of effective and lasting change management.

Detail around this sub-objective is covered in other sections in the report where we explain our approach

to monitoring change and our periodic engagement with stakeholders and organisations to assess the

effectiveness and sustainability of previously implemented changes to people, processes, and systems.

7.4.3 SUB-OBJECTIVE 4.3: UPSKILLING AND MENTORING AND STAFF


In Year 2, the GHSC team focused on training, coaching upskilling and mentoring staff in order to affect

performance, impact and sustainability. Activities included:

● Designing and implementing the ‘To–Be’ training framework, curriculum, and pre-and post-knowledge

assessments for ISP.

● Aligning knowledge and skills requirements to operational plans, individual job descriptions, PMDS,

and departmental objectives of each unit.

● Training Provincial Medicine Liaison Officers (PMLOs) on workplace skills, enabling effective initiation

of roles and responsibilities as PMLOs form an important part of the contract management function

within the provinces.

● Engaging with and supporting Africa Resource Centre (ARC), South African Production and Inventory

Control Society (SAPICS), and the University of the Witwatersrand in the research and design of a

performance-based framework for a Heineken sponsored national training programme for national

and provincial supply chain managers and stakeholders.

● Conducted pre-and post-assessments of all training interventions.

Looking Forward

In Year 3, GHSC will continue to engage and strengthen AMD, focusing on the implementation of the To-

Be plan at ISP and the Master Data Project. Provincial strengthening and support will continue in NW, LP

and other provinces, as required by AMD. GHSC will continue to use the three-phased, continuous

improvement and sustainability approach, adapting to the needs of each strengthening intervention and

project.

7.5 OBJECTIVE 5 – STRENGTHEN INFORMATION SYSTEMS AND INFORMATION

MANAGEMENT

Technology and information systems are critical enablers of health supply chain performance and form a

cornerstone of the successful delivery of the SIMA. Key activities performed in support of this objective

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include drafting an information technology architecture roadmap, and developing and deploying

information systems.

7.5.1 SUB-OBJECTIVE 5.1: DESIGN IT SYSTEM LANDSCAPE


Given criticality of IT systems in achieving improved health supply chain performance, AMD sought to

better understand the complexities of managing IT systems in their environment along with potential

approaches to information system management. To this end, the team drafted an IT Strategy and Roadmap

with a focus on improving interoperability and reporting visibility. In addition, during this period, personnel

supporting strengthening of information systems and information management including:

● Documented the existing IT landscape by mapping information systems to SIMA-defined functional

areas and provided a gap analysis between the IT Landscape and critical functions.

● Delivered a new IT strategy comprised of:

‒ a proposed IT operating model,

‒ an approach for managing the IT environment,

‒ an IT project methodology including all required templates needed to successfully deliver IT

projects, and

‒ an IT architecture approach to be followed when building IT components.

● Led workshops for the AMD team and partner organisations focusing on implementing the IT project

methodology. The team then piloted the IT project methodology during the master data project to

test and collect lessons learnt.

● Continued developing and refining the IT roadmap, which illustrates IT initiatives required to address

identified functional gaps and dependencies along with alignment to the SIMA roadmap. The IT

roadmap consists of two sections: one dealing with master data (e.g. the Master Health Product List

(MHPL)); and the other focused on transactional systems that support stock management, planning,

and reporting.

● Led two “IT think tank” meetings that helped shape the IT Steering Committee (ITSC), an advisory

body that will make recommendations on IT strategy and roadmap.

● Drafted the Terms of Reference (TOR) for the ITSC, which will govern the committee’s involvement

in finalising the IT Strategy and Roadmap during Year 3.

Looking Forward

● Working with AMD to finalise the IT Strategy and Roadmap and transition its maintenance to the ISP

unit.

● Supporting cyclical reviews and revisions of the IT Strategy and Roadmap.

● Providing technical assistance to AMD on:

‒ Procuring and sourcing of IT services (as required/directed)

‒ Creating concept notes for key initiatives arising from the roadmap prior to them becoming

official projects

‒ Socializing the strategy and roadmap with relevant stakeholders

● Assisting AMD with helping implementing partners and contractors to adhere to the new IT project

methodology

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7.5.2 SUB-OBJECTIVE 5.2: PROVIDE SUPPORT TO STRENGTHEN ANALYTICS AND OVERSIGHT


Activities and impact on this sub-objective focus on improving surveillance and visibility across the end-

to-end supply chain in accordance with new national KPIs developed under Objective 3:

● Refined the PHC, Hospital and CCMDD dashboards to align with relevant supply chain management

KPIs.

● Developed a new Supplier Management Dashboard (consolidating the previous Supplier Performance

Dashboard, Age Analysis Dashboard & Pipeline Analysis Dashboard) to better convey information

related to contract management performance and associated KPIs.

● Conducted in-depth training sessions for CMU personnel on use of the PHC, Hospital and Supplier

Management Dashboards.

● Led training sessions for the Provincial Medicine Liaison Officers (PMLOs) on the PHC and Hospital

Dashboards.

● Developed several new dashboards specifically designed to support of the goal of hosting all

performance data in a single location and improve stakeholder access to information including:

‒ the Depot Dashboard,

‒ mobile versions of the PHC and Hospital Dashboards (which significantly improve access to

performance data in remote locations), and

‒ dashboards designed for remote Pharmacy Dispensing Units and the GP Care Cell project.

● The utility and popularity of the aforementioned and other dashboards created by GHSC TA

personnel have helped increase the number of facilities reporting performance data to the NSC to

3,604.

● Provided ongoing maintenance of existing dashboards and continued to pursue further automation

and harmonisation of data sources, processes, and visualisations.

● Current number of dashboards, views and reports are shown in Table 4.

Table 4 Dashboard Views and Reports

Dashboard # Views # Reports

PHC 42 17

Hospital 25 17

Supplier Management Dashboard 53 17

CCMDD 5 3

GP Care Cell 6 6

EML App Dashboard 5 5

Total 136 65

Looking Forward

GHSC will continue to provide technical assistance to AMD on several fronts:

● Supporting and maintaining existing dashboards

● Enhancing existing dashboards and developing new dashboards as required to support new KPIs

developed under Objective 3

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● Optimizing data sources and feeds for both new and existing dashboards

● Deploying dashboards to provinces and districts along with relevant training and coaching to help

institutionalise data centric management to improve medicine availability1

7.5.3 SUB-OBJECTIVE 5.3: SUPPORT THE IMPLEMENTATION OF DATA GOVERNANCE

Considered the most critical and foundational of IT initiatives within AMD, the Master Data project (SVS

phase III) will have a broad impact on other systems as well as AMD process capability. Aligning master

data across systems will form the basis for communication and passing of work across systems

(interoperability), and improve data aggregation and disaggregation for reporting (visibility). The master

data system will also support achieving the objectives described in the National Formulary Guideline and

AMD Medicine Master Data Policy.


GHSC team members have, and are currently supporting, the Master Data project as subject matter

specialists and have performed numerous activities in support of the effort:

● Conceptualised and developed a core data structure for AMD that draws on lessons learned from the

EMelA system development.

● Developed a prototype system to support the core data structure concept, which was then used to

demonstrate reporting across data entities.

● Used the prototype system to verify the suitability of the proposed data structure.

● Participated in review and testing of the first iteration of the online MHPL application and provision

of input to Mezzanine and AMD.

● Completed a detailed first draft of the medicines and repositories specifications (as an extension of

the overarching design specification) to achieve a full replacement of the current Medicine

Procurement Catalogue (MPC) which specifies the components from which medicines and other

system objects are built.

● Completed a first draft of the specifications for the “clinical setup” area of the MMDS, which, once

consultation with stakeholders is completed, will form the underlying system to support ePrescribing

and the revised Clinical Guideline application.

GHSC TA personnel also supported AMD’s efforts to build project management capacity within the ISP

unit through the following activities:

● Assisted the contracted service provider responsible for the master data project to adopt and apply

the new IT project methodology.

● Worked with stakeholders to develop and circulate the new Project Concept Note and Project

Initiation Document.

● Helped AMD expand the focus of the existing planning process from being more narrowly focused on

IT development to having a broader perspective that includes the impact of a project on master data.

Looking Forward

The GHSC team anticipates focusing Year 3 activities on several key areas:

1 This activity is dependent upon AMD’s pending procurement of Tableau user licenses.

36

● Drafting high-level master data requirements and design specifications for the overarching master data

design during sprint planning.

● Supporting the contracted service provider’s capturing requirements and design activities during each

master data sprint.

● Providing technical assistance on the approach for locating master data, developing a concept note for

the location master, and socialising the proposed approach with stakeholders.

● Providing technical inputs to concept notes and project initiation documents related to master data

integration for the RxSolution, RSA Pharma, and SVS systems.

● Supporting the contracted service provider’s master data design activities.

7.5.4 SUB-OBJECTIVE 5.4: ASSIST WITH DEVELOPMENT AND IMPLEMENTATION OF IT SYSTEMS

RxSolution Maintenance and Consolidation


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

dispensing. Support to the RxSolution implementation included:

● Assisted the transition of RxSolution support and maintenance to all provinces and, where applicable,

the relevant district support partners. Support calls are now routed directly to provincial call centres

where provincial support personnel are able to resolve calls/issues before escalating to NDoH.

● Helped develop a recommended provincial support structure featuring representatives from

Information and Communications Technology (ICT) and Pharmaceutical Services, to help provinces

better manage the RxSolution. Two provinces, North West and Gauteng, have subsequently

established RxSolution task teams, developed terms of reference, and have begun meeting quarterly

to address RxSolution-related topics.

● Collected and analysed data from the Rx databases for 176 Facilities in five provinces namely, EC, FS,

KwaZulu-Natal (KZN), NC and NW.

● Added 19 facilities to the hospital dashboard in two provinces namely, Eastern Cape and KZN as a

result of facility visits.

● Supported the successful pilot implementation of RxSolution in the Eden district in the Western Cape.

Looking Forward

● Developing an integrated helpdesk support plan for RxSolution that improves visibility into and

understanding of user challenges for both NDoH and the provinces.

RxSolution: Application Development


RxSolution is a legacy application running on a modern database (Microsoft Structured Query Language

(SQL) Server) with a Delphi frontend application. New technologies have been used by GHSC to create

a secondary application (middleware API) that bypasses the Delphi frontends and connects directly to the

SQL database. This application employs modern communication technologies to transmit reporting data

where communication networks exist. It is designed to automate reporting by facilities using RxSolution

to the hospital dashboard, thereby improving reporting compliance to the NSC and eliminating reliance

on provinces submitting manual reports. Activities and impact this period include:

37

● Completed the initial version of the “middleware API” and worked to optimise transmission of data

from remote sites to provincial servers and then to the NSC server (push model).

● Deployed the next iteration of the API to the FS provincial server with connects to remote sites. We

are now able to pull data to the provincial server without the need for software at the remote site

(pull model).

● Developed an improved push model installed remotely to manage sites that are not reachable through

the “pull model” by autonomously generating data files. The files are then automatically emailed to

the central server email address, where the central server monitors its email inbox and automatically

harvests the data from the incoming email attachment (push model that autonomously utilises email).

● Tested each of the applications described above to assess their ability to function while dealing with

“real world” issues typically experienced in field. Lessons learned are being applied to ongoing

improvements.

● Rolled out reporting middleware API (pull model) to collect data from 15 sites in the FS.

● Supported the Council for Scientific and Industrial Research (CSIR) in the redevelopment of the

RxSolution prescribing module, on to a modern technology stack. GHSC TA personnel provided

technical assistance in developing the concepts related to the prescribing module.

Looking Forward

● Developing a plan for refreshing the RxSolution store modules, including an architectural vision and

strategy for stock management with open architectural standards for integration and implementation.

● Providing technical assistance for efforts to refresh the RxSolution store modules.

● Automating hospital dashboard reporting for all sites.

SVS Phase I: Maintenance and Consolidation


The Stock Visibility System (SVS) is a mobile, internet-based application used to capture and view medicine

availability at PHC clinics on application enabled mobile devices. It is one of the flagship programmes of

NDoH, providing visibility of stock levels at 3,137 PHC clinics across the country. Initially only data relating

to ARV, anti-TB and vaccine commodities was captured. The item list has since been expanded to include

other commodities including contraceptives, psychiatric agents, anti-hypertensive and anti-diabetic agents

and is aligned with the tracer medicine list which forms part of the Ideal Clinic framework.

● Leveraged the implementation repository developed by GHSC personnel to guide provincial

engagement sessions with the various Heads of Health or their representatives. The repository

provided the framework and structure to be used to drive institutionalisation of SVS and improve

associated governance structures and processes.

● Developed a training pack used as the official guide during countrywide SVS refresher training provided

to national, provincial and district users. The revised training approach featured greater focus on

ensuring SVS users use the data and reports available to them to follow an evidence-based approach,

when carrying out routine activities linked to medicine availability monitoring. The training also

promoted sustainability and continuity by training-the-trainer, ensuring that provincial and district

champions are sufficiently trained and equipped to continue providing training across their provinces.

● Technical input was also provided to determine the necessary updates and implementation sequence

for planned changes to the existing SVS mobile application, which has not been altered since

implementation in 2014. These planned changes take into account end-user suggestions on how to

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improve the application functionality and are designed to address common challenges mobile users

experience when using the system. These changes are due to be implemented in early 2019.

● Developed a time bound transition plan to guide the process of handing over management of all SVS

maintenance related activities to AMD. The plan was approved and will be implemented in Year 3

supported by extensive mentorship and coaching of personnel.

SVS Phase II: Development and Enhancement


The SIMA includes implementation of the Visibility and Analytics Network (VAN) as the operating model

to facilitate improved management of the medicine supply chain. One of the key features of the VAN is

the use of technology to support visibility and analytics functions. To this end, the Department’s vision is

to develop SVS to enable other medicine supply management processes, namely placing orders and

receiving stock electronically on mobile devices at PHC clinics. During this period GHSC:

● Developed user requirement specifications (URS) and incorporated them in a living document, which

was routinely updated and used to inform the detailed technical specification (Scope of Work) and

process flows.

● Developed and tested the non-interfaced receiving functionality in the test environment. AMD and

NC provincial procurement team and facility staff the conducted testing in accordance with the SVS

User Acceptance Testing (UAT) plan. Input collected during these sessions helped shape adjustments

to the app in preparation for pilot testing.

● Held project scoping workshops with multiple stakeholder representatives for the third-party systems

with which SVS is required to interface to support planned VAN supply chain system reforms. Input

from these sessions was used to inform all functional and technical specification documents.

Looking Forward

● Continuing to transition SVS maintenance activities to AMD to support sustainability and continuity.

● Supporting implementation of system enhancements to SVS to enable the devices to be used for

ordering and confirming receipt of medicines at PHC clinics. Efforts will focus on creating both non-

interfaced and interfaced versions.

● Expanding UAT to include other provinces and obtain a broad representation of end-user input to

inform newly developed functionality

WMS (gCommerce) Implementation


The gCommerce platform (previously known as Intenda Solution Suite) 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. The warehouse management module will provide depots with

the necessary tools to perform procurement and replenishment activities, as well as real time data to

undertake the demand forecasting and planning and supply planning services anticipated under the VAN

operating model. While the State Information Technology Agency (SITA) is responsible for

implementation, training and change management, GHSC has provided technical assistance in the

customisation of the application and implementation. GHSC personnel further provided critical support

to updating NT contracts used by the system to verify all contract-related data upon receipt of goods into

the system. Specific activities performed under this work stream included the following:

● Supported gCommerce rollout to a second province—the system is now used to manage provincial

depots in the NC and LP provinces.

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● During this period, the SITA Cloud was developed, tested, and implemented to allow for Cloud

hosting and computing. This is a critical evolution allowing gCommerce to be hosted in a centrally

managed environment.

● Identified a number of system challenges during implementation, which GHSC personnel logged as

bugs and later monitored resolution thereof. System problems and bugs were documented and fixes

were prioritised in consultation with relevant stakeholders.

● Developed User Requirement Specifications (URS) for new system functionality to improve security,

productivity, and throughput.

● Supported the bi-annual stock take in the NC to assess functionalities of the upgraded version of

gCommerce implemented in the province during the course of the reporting period.

● Provided change management and communications support to SITA, with regard to implementation

of gCommerce in LP and Mpumalanga.

Looking Forward

● Supporting improvement of gCommerce functionality related to improving visibility into medicine

availability

● Finalising an approach to post pilot review to give guidance on improving the implementation of the

system in other provinces.

● Providing continued support to existing gCommerce sites

● Supporting the implementation of gCommerce in the other provinces as determined by the AMD

National gCommerce Steering Committee.

● Supporting the development and implementation of service level agreements between AMD, SITA and

NT, which has an impact on the roles and responsibilities between and across parties relating to

contracting and contract management.

PuLSe application development


The PuLSe system enables health care providers to apply for and manage dispensing licenses and permits

issued in terms of the Medicines Act, and yellow fever licences issued in terms of the International Health

Regulations online. The system is intended to replace an outdated and heavily paper based system, and

will enable efficiencies and promote good governance. During this period, personnel performed the

following:

● Supported completion of system set up and initial master data load including a legislative change, which

enables the issuing of permits to midwives allowing them to access highly scheduled medicines needed

in the provision of intrapartum care.

● Assisted AMD in negotiations with the South African Veterinary Council (SAVC) regarding

amendments to legislation, which would have required veterinarians to hold a dispensing license. The

inclusion of the management of dispensing licenses for veterinarians in the system was subsequently

halted as a result of a court decision.

● Collaborated with the EDP to revise lists of medicine which permit holders may use and supply, to

align them with the PHC (STGs/EML). Further consultation on these lists with key stakeholders is

ongoing.

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● Developed, finalised, and obtained sign off from the NDoH Corporate Communications Department

on PuLSe communication materials, including training videos that educate health care professionals on

using the system.

● Finalised the PuLSe System Administrator User Manual and provided training to Licensing Unit staff.

Refined SOPs and processes as needed based on staff feedback. Finalised the monitoring and evaluation

framework and reports to be generated from the system.

● Held discussions with the NDoH division responsible for NHI systems and the CSIR about the

purpose and functionality of the system, and possible linkages between PuLSe and the provider

enrolment application CSIR is developing. This opportunity will be further explored in Year 3.

● Conducted extensive internal UAT of the system and performed bug fixing as needed. After

completing testing, AMD decided that PuLSe should undergo further Administrative Function Testing

(AFT) prior to the outward facing (self-service) functionality going online. This decision resulted in the

need to develop various workarounds and the redesign of forms, SOPs, and guidelines, all of which

were completed.

● Presented the PuLSe system to NDoH’s ICT Steering Committee and obtained to continue

development.

● NDoH and SITA ultimately decided that PuLSe should be hosted by SITA in line with an existing

business agreement between both parties. The process of transitioning from NDoH to SITA proved

challenging, resulted in considerable delays, and is projected to be completed in Year 3.

Looking Forward

● Continuing to resolve hosting challenges followed by commencing additional AFT once PuLSe has

been transitioned to a secure host.

● Consulting with stakeholders on the medicine lists followed by submission of revised lists to NEMLC

for approval. Once approved, they will uploaded to the PuLSe application.

● External testing has been planned and all communication, SOPs, process flows, and other relevant

materials have been created and are ready for distribution. Once the AFT phase is completed, the

team will proceed with external testing.

● Following successful external testing, supporting application go live featuring a phased on-boarding of

healthcare professionals.

7.6 OBJECTIVE 6 - IMPROVE FINANCIAL MANAGEMENT

This objective aims to improve financial management processes including budgeting and forecasting,

financial monitoring, and reporting against the budget for both the Chief Directorate: SWP within NDOH

and in assisted provinces.

7.6.1 SUB-OBJECTIVE 6.1: IMPROVE FORECASTING AND BUDGET INFORMATION

AMD budgeting and reporting is performed at the directorate level. The objectives of this intervention

are to improve budgeting and forecasting, as well as monitoring and reporting.


● Conducted an ‘As-Is’ assessment of SWP’s budget processes to obtain a more detailed understanding

of current budget related processes and activities.

● Designed SOPs aimed at improving budget management within the directorates in SWP and provided

training on SOPs for personnel from multiple directorates.

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● Assisted with and provided guidance on the budget forecasting for the 2018/19 financial year for each

of the directorates within SWP.

● As part of the demand forecasting and planning activities in the EC POC, GHSC personnel

demonstrated how the demand forecast can be used to improve budgeting for medicines and other

health commodities. The team explained how to “cash-up” the demand forecast to arrive at a

recommended budget and how the “cash-up” value of future medicine demand can be incorporated

in both national and provincial budgeting activities.

Looking Forward

● Implementing newly developed budget related SOPs.

● Providing improved, demand informed inputs to budgeting and forecasting during the compilation of

the 2019/20 budget.

7.6.2 SUB-OBJECTIVE 6.2: ASSIST TO STRENGTHEN ACCOUNTING PROCESSES


As part of the NW intervention, GHSC TA personnel conducted an intensive analysis of current Accounts

Payable processes and activities related to or directly impacting health supply chain performance. Specific

activities included:

● Evaluated the state of finance/accounting structures, capturing, processing, monitoring and reporting,

as well as Supplier Relationship Management activities to determine their suitability in achieving

compliance with the Public Finance Management Act (PFMA).

● Traced invoice processing activities through the end-to-end payment process documenting touch

points with key stakeholders and organisations.

● Delivered comprehensive process maps detailing specific actions executed by members of Provincial

Treasury, Accounting and Purchasing Departments.

● Measured cycle times including delivery-to-documents-received, documents-receipt-to-payment-

pack-submission, payment-pack-processing at the provincial office, and billing-pack-data-submission to

Treasury for disbursement.

● Identified numerous inefficiencies in existing processes including parallel processes performed using

manual ledgers that hindered the use of the existing ORACLE system functionalities. Other

opportunities for improvement include:

‒ Redefining financial delegations for various sized procurements – both positions and

thresholds.

‒ Increasing the pool of signatories to expedite payment processes along with designating

alternates.

‒ Creating a shared payment service centre for medicines and surgical supplies at the Depot.

‒ Automatic routing of invoices for payment to the appropriate person required for processing

to reduce processing time and create an audit trail that enables visibility & control over the

entire process.

Looking Forward

● Continuing to support the NW province’s efforts to improve Accounts Payable performance and

drive down the Supplier Direct Delivery invoice backlog.

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● Conducting targeted interventions based on provincial ‘As-Is’ assessments to strengthen accounting

processes.

7.6.3 SUB-OBJECTIVE 6.3: ASSIST TO IMPROVE FINANCIAL MONITORING AND REPORTING


● Analysed SWP’s actual expenditures for the 2017/18 fiscal year to better allocate actual expenditure

per directorate.

● Compiled a Finance Dashboard based on the expenditure analysis to assist the directorates with

monthly monitoring and reporting their budget execution.

Looking Forward

● Reviewing the expenditure analysis for 2018/19 and updating the Finance Dashboard accordingly.

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8. CRITICAL RISKS Area Challenges Mitigation

PMPU Ideal

Blueprint

GHSC TA submitted the first draft of the Ideal

PMPU Blueprint to AMD in June 2017.

Finalisation and approval was delayed which

delayed our engagement with the provinces and

subsequent implementation of the proposed

solution. An abbreviated 20-page summary of the

PMPU Blueprint was later based on an agreed

conceptual framework was later delivered.

Altered the previous approach to

implementing PMPUs across the provinces.

GHSC TA personnel are now implementing

selected elements of envisioned PMPU

functions and services across multiple

provinces including EC, NC, LP and NW.

Stability of the

gCommerce

SITA completed implementing gCommerce in

two provinces, NC and LP. The initial

implementation experienced some growing pains

including stability issues and slower than

expected adoption by stakeholders resulting in

further delays in rolling out to other provinces.

In conjunction with AMD, decided to slow the

rollout of gCommerce until the system is

more stable and has added additional

functionality.

Created a priority list for tackling the

challenges—SITA has resolved to address the

problems with the system developers.

Continue to assist with the documentation of

known system issues, advise, and propose

corrective actions required.

SVS SITA sent official communication to the

Department that they will not be able to expand

their activities to support work aimed at

developing an interface between SVS and

gCommerce. This decision will allow SITA

resources to focus on the gCommerce

implementation in NC and LP. SITA provided no

timelines or estimates for when they will be able

to re-engage on the SVS to gCommerce

interface. As a result, development work on the

system interface is indefinitely delayed until SITA

can re-engage.

Submitted recommendations on how to

simplify the level of integration required

between SVS and gCommerce. The team will

work with AMD to try to raise the

prioritisation of the interface work.

PuLSe Transitioning PuLSe system to a suitable hosting

provider represents risk to AMD’s ability to

sustain and maintain the PuLSe application post

go-live.

Reviewing and providing comments and

recommendations to the draft SLA between

AMD and SITA for hosting PuLSe.

Will continue to provide technical assistance

to AMD as PuLSe transitions to the SITA

hosting environment and work with AMD to

develop an approach to sustain and maintain

PuLSe in the longer term.

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Area Challenges Mitigation

Workforce

management

Activities related to redesigning and

strengthening organisational structures have the

potential to impact workforce size, composition,

and work performed—all of which are highly

sensitive and have the potential to lead to labour

unrest.

Will continue to be conscious of the risks,

promote communication, collaboration, and

transparency during its work with both

provincial and national stakeholders to

implement corrective actions that minimise

impact on the work force.

Sustainability Several highly skilled, highly experienced senior

officials in some provinces and districts are

nearing retirement. Lack of clear succession plans

represent risk in terms of loss of institutional

knowledge, leadership, stakeholder relationships,

technical expertise, and continuity of operations.

Incorporate succession planning in the design

of the future organisational structures and

detail the required capacities and capabilities in

critical positions.

RxSolution

Middleware

Rollout of the middleware to additional

provinces faces several risks, including local IT

technical staff capability, physical hardware

challenges, internet connectivity issues and

network policy management issues.

RxSolution connectivity is critical to several

supply chain improvement initiatives. The team

has accepted the larger risks associated with

the rollout and is working to mitigate

individual challenges by adapting the system

and processes to reflect local conditions in

order to maintain reporting to the NSC.

Medicine

Master Data

System

Risk of misalignment between requirements and

data structure design exists due to the inherent

complexity of select requirements and lack of a

prior system to inform the current design.

Employ “agile” development processes with a

focus on frequent prototyping as a way of

verifying the design meets documented

requirements.

Training,

development

and change

management

Competing priorities and conflicts combine to

make scheduling training, coaching and change

management intervention sessions difficult

resulting in delayed adoption and implementation

of new processes and procedures.

Establish a more flexible programme for

training, coaching and mentoring including

holding individual sessions for staff to catch up

on new initiatives. In addition, ask AMD

management to include training attendance as

a staff performance management indicator and

escalate non-attendance at initial and make up

training sessions with AMD management.

Key

stakeholder

availability

Competing demands on senior manager time at

AMD can result in delays reviewing and

approving deliverables, which causes a cascade of

delays in associated project plans.

Continue to raise and escalate instances of

delayed deliverable reviews and decisions.

Where possible, seek approval from AMD to

proceed in parallel while final documents are

reviewed or decisions are pending. In addition,

project plans and Wave Governance

documents now incorporate time for potential

delays.

45

9. LESSONS LEARNED Category Lesson Learned Programme Response

Process / Policy Clear definition of processes and business rules

is critical to improving the development of IT

applications, reducing delays, and eliminating

wasted LOE.

Incorporated new processes, business rules and

user requirements included in the IT

Implementation Framework.

Process / Policy Retrofitting policies, processes and procedures

to match an existing a system has proven

difficult and often yields sub-optimal results.

Policy and process must inform the system

development as opposed to the system

informing the policy or process.

Added early development and implementation

of policy and processes as a critical component

of the IT framework and continuing to stress

their importance as a leading practice for

successfully delivering IT projects.

Master Data Master data is key to the success of the

applications being developed or deployed.

Management of master data is critical to

achieving system interoperability, performing

routine supply chain transactions, and

improving visibility.

Created a separate work stream within the

programme to lead and align all master data

related work activities.

Stakeholder

Engagement,

Change

Management &

Communication

Stakeholder engagement is crucial for

implementation especially with the introduction

of new policies/guidelines, which significantly

alter current practices. Including stakeholders

early in the development and design will

significantly aid change management and

adoption.

Incorporated stakeholder identification,

engagement, communication, change

management and training activities in project

rollout plans and have established doing so as a

standard practice within AMD.

Working closely with stakeholders in the PHC

directorate—Ideal Clinic to institutionalise SVS

reporting.

Institutionalizing early engagement with other

implementing partners at National, Provincial

and District levels.

Stakeholder

Engagement,

Change

Management &

Communication

Change management activities should be

executed in tandem with technical support.

Both are critical to supporting successful

implementations and institutionalising changes

that involve a technology solution. Programme

managers must understand what change

management is, appreciate how it fits together

with both communication and training, and

how those activities when combined with

technical support, significantly increase the

change of successful implementations.

Institutionalised the documentation of change

management, communication and training

responsibilities using responsibility matrices

(RACI) that are now incorporated in technical

implementation plans.

Working closely with ARC resource that will

be appointed to assist with overall change

management efforts.

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10. PERFORMANCE MONITORING During Year 2, the programme was able to collect and report on 15 of the programme’s 20 key

performance indicators (KPIs). These include 12 annual indicators and three of the endline indicators, on

which the programme was able to collect preliminary data. The following section highlights progress made

against these 15 indicators, with 86% of targets having been achieved, exceeded or on track. Of note is

the performance monitored by KPI 17 where the programme exceeded the target of 100% of APP facilities

reporting to the NSC with 3,604 facilities reporting by the end of the reporting period.

Due to unavailable data, the programme was not able to report on KPIs 1, 3 and 20 as well as

baseline/endline KPIs 2 and 6. Activities related to indicators 1, 2, 3, and 6 were suspended during Year 2

due to deprioritisation of HTA activities by AMD. The GHSC programme has, however, been asked to

again support these activities. In addition, the data source originally planned to inform KPI 20 does not

provide the level of detail necessary to track the submission of payment packs. The programme is working

to address this challenge through the design and launch of gCommerce. Each KPI is discussed in detail

below.

10.1 OBJECTIVE 1: IMPROVE THE SELECTION AND USE OF MEDICINE.

The GHSC programme’s theory of change posits that the establishment of a coherent medicine value

chain from evidence-based medicine selection to the rational and effective use of medicines is imperative

for improved clinical practice and patient outcomes. With this in mind, objective 1 focuses on the delivery

of technical assistance to AMD in the areas of HTA (sub-objective 1.1) and RMU (sub-objective 1.2) in

efforts to improve the selection and use of medicines.

10.1.1 SUB-OBJECTIVE 1.1: ASSIST WITH THE IMPLEMENTATION OF HEALTH TECHNOLOGY

ASSESSMENTS.

Under sub-objective 1.1, the programme seeks to measure the effects of the GHSC intervention of

assisting the implementation of HTAs at the outcome levels by examining the number of medicine reviews

conducted by the ERCs, the capacity of medicine selection staff and committee members to perform and

interpret medicine reviews, and the utilization of HTA outputs. Performance to date against the

programme’s outcome level KPIs under sub-objective 1.1 are described below.

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

Review Committees.

Key performance indicator (KPI) 1 examines the maturity of the medicine selection process utilised by

measuring the number of medicine reviews conducted by the ERCs, which provide recommendations to

the NEMLC. The ERCs support the selection of medicines by determining whether to add, remove, or

change a medicine on the national EML, by assessing and appraising evidence presented during medicine

reviews. Due to confidentiality concerns raised by AMD, it has not been possible to access the only

available data source for this KPI, namely the minutes of meetings of the ERCs to determine the number

of medicine reviews conducted.

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.

The GHSC programme seeks to build the capacity of ERCs to perform and interpret medicine reviews to

improve medicine selection. Informed by the programme’s customized Skills, Attitudes, and Knowledge

Questionnaire, KPI 2 seeks to measure improvements in the knowledge and skills of trained ERC members

to perform and interpret medicine reviews. Using this questionnaire to determine a baseline, the

47

programme found room for improvement in the skills and competencies of members of the two ERCs

surveyed. In response to these findings, the programme designed a series of workshops and mentoring

opportunities, to build capacity of ERC members to perform and interpret medicine reviews. The

programme delivered one training focusing on the foundational aspects of HTAs in March of Year 1 to 28

participants. Plans to conduct additional training, knowledge and skills assessments were put on hold due

to suspension of HTA activities by AMD in Q2.

Key Performance Indicator 3: Percentage of recommendations on medicine selection

made utilising HTA outputs.

Key performance indicator 3 measures the percentage of recommendations of ERCs to NEMLC, which

utilise HTA outputs. “Utilising HTA outputs” refers to the use of multiple analyses of HTAs including

budget impact analysis,

comprehensive international

pricing comparison, and cost

effectiveness analysis.

To date, the total number of

medicine selection

recommendations made

utilising HTA outputs remains

at three for the life of project.

Recommendations were made

regarding the use of tretinoin,

long-acting beta antagonists

and fondaparinux.

While the programme is able

to report on the number of recommendations made utilising HTA outputs, it is not possible to identify

the total number of medicine reviews conducted – refer KPI 1. It is thus not possible to report on the

percentage of recommendations made which utilise HTA outputs.

10.1.2 SUB-OBJECTIVE 1.2: IMPROVE RATIONAL MEDICINE USE.

Under sub-objective 1.2, GHSC is providing technical assistance to AMD in the development of the MMDS,

including a formulary tool. This tool will enable electronic generation of formularies and enable subsequent

visibility by AMD. In addition, the team is working closely with AMD in the development of the National

Formulary Guideline, which will mandate that all provinces, districts, and health establishments have an

updated formulary in place, enable standardization and support rational medicine use. In efforts to

understand the effects of these activities, the programme seeks to monitor the generation of formularies,

expenditure on non-EML items, and the capacity of PTCs to support the rational use of medicines.

Performance to date against the programme’s outcome level KPIs under sub-objective 1.2 are described

in detail below.

0

2

1

0

1

2

3

Baseline Year 1 Year 2 Year 3

Figure 3. Number of Medicine Selection Utilizing HTA

Outputs

48

Key Performance Indicator 4: Number of formularies generated.

Key performance indicator 4 measures the number of formularies generated and will monitor

implementation of the formulary tool once finalised and implemented. In the interim, the number of

provinces with a provincial

formulary, as reported to the

Pharmaceutical Services

Dashboard, the system on which

provinces report performance

against a defined set of standards,

is monitored.

During the last two quarters of

Year 2, the dashboard was not

accessible due to a change in the

hosting platform. During the

transition period, provinces were

unable to access the dashboard to

upload data. The Year 2 data is

informed by the most recent dashboard, as reported at the end of the second quarter of the year. As

demonstrated in Figure 4, five of nine provinces reported that a provincial formulary had been generated

and uploaded on the system.

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

items.

Key performance indicator 5

highlights implementation of the

STGs and EML, by measuring the

percentage of expenditure on

non-EML items by provinces. This

data is reported for provinces by

the Pharmaceutical Services

Dashboard.

As previously noted in relation to

KPI 4 above, the dashboard was

not available during the last two

quarters of the year and the data

is as reported at the end of the

second quarter. During the

period for which data is available, provinces reported 1.6% expenditure on non-EML items against a target

of less than 10%, demonstrating an improvement of 0.7 percentage as compared to Year 1 shown in Figure

5.

Key Performance Indicator 6: Percentage of assisted Pharmaceutical and Therapeutics

Committees with advanced or optimal capacity.

Key performance indicator 6 measures the operational capacity of PTCs by assessing governance, member

management, and performance of core PTC functions. Improvements to PTC operational capacity will

result in strengthened rational medicine use.

To date, the programme has not provided direct assistance to PTCs and does not anticipate doing so until

after Year 3, following the completion of the PTC Guideline, which will include a set of assessment criteria

4 5 5

9 9 9 9

0

2

4

6

8

10


Figure 4. Number of Provincial Formularies Generated

Performance

Target

1,9% 2,3%1,6%

10% 10% 10% 10%

0%

2%

4%

6%

8%

10%

12%


Figure 5. Percentage of Expenditures on Non-Essential

Medicine List Items

Performance

Target

49

to measure PTC performance. Completion of the PTC Guideline currently under development is

projected for September 2019. Thus, the endline or Year 3 target has been set at 0%.

10.2 OBJECTIVE 2: SUPPORT OPTIMISATION OF THE SUPPLY CHAIN.

The optimisation 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. To support this objective, the

GHSC team designed a set of activities to improve contracting (sub-objective 2.1), contract management

(sub-objective 2.2), design a supply chain model (sub-objective 2.3), and support the maintenance and

improvement of supply chain operations (sub-objective 2.4).

10.2.1 SUB-OBJECTIVE 2.1: IMPROVE CONTRACTING AND 2.2 IMPROVE CONTRACT MANAGEMENT.

Under sub-objectives 2.1 and 2.2, the programme is supporting the transition of long-term forecasting to

AMD, which will lead to improved demand projections to inform the tendering process and strengthen

contract management. The programme seeks to measure the effects of interventions designed to improve

contracting and contract management by monitoring the number of MPC items processed within contract

lead-time, the forecast accuracy on tenders, perfect order fulfilment, order fulfilment cycle time and the

availability of MPC items at healthcare facilities. Performance to date against the programme’s outcome

level KPIs under sub-objective 2.1 and 2.2 are described in detail below.

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

Procurement Units within contractual lead-time.

At the conclusion of Year 2, the programme found that 77% of ARVs were processed within contractual

lead time at the provincial level. While this falls below the Year 2 target of 85%, a notable improvement

of 13% from 68% in Year 1 to

77% in Year 2 was observed as

shown in Figure 6. In

comparing the percentage of

ARVs processed within

contractual lead-time at the

individual provincial level, all

provinces demonstrated

improvement from Year 1.

Key Performance

Indicator 8: Percentage of

MPC medicines excluding

ARVs processed through

79%68% 77%

0%

79% 80%85%

90%

0%

20%

40%

60%

80%

100%


Figure 6. Percentage of ARVs Processed through PMPUs

within Contractual Lead-time.

Performance

Target

50

Provincial Medicine Procurement Units within contractual lead-time.

The programme found that

77% of MPC medicines,

excluding ARVs, were

processed within contractual

lead time, which was slightly

above the Year 2 target of

76%. Additionally,

performance exceeded both

the baseline and Year 1

achievements as shown on

Figure 7.

At the provincial level, the

programme found that seven

of the assisted provinces

achieved the Year 2 target, with the majority posting gains throughout Year 2.

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

At the conclusion of Year 2, the programme observed a forecast accuracy on tender of 54%. This figure

reflects forecast accuracy prior to implementation of the new approach to demand forecasting. The impact

of work done in this area will only be measureable once the contracts, where the new approach was

applied, are in use.

Key Performance Indicator 10: Percentage of assisted provinces demonstrating

improvement in perfect order fulfilment.

At the conclusion of the

reporting period, 88% of

provinces demonstrated

improvements in perfect order

fulfilment since baseline as

shown in Figure 8, exceeding

the Year 2 target of 67%. In

addition, 50% of provinces

continued to build gains on

Year 1 performance.

Key Performance

Indicator 11: Percentage

of assisted provinces

75% 76% 77%

0%

75% 75% 76% 80%

0%

25%

50%

75%

100%


Figure 7. Percentage of MPC Medicine Excluding ARVs

Processed through PMPUs within Contractual Lead-Time

Performance

Target

88% 88%

78%

0%

20%

40%

60%

80%

100%

Year 1 Year 2 Year 3

Figure 8. Percentage of assisted provinces demonstrating

improvement in perfect order fulfilment

Performance

Target

51

demonstrating improvement in order fulfilment cycle time.

During the period under

review, 75% of provinces

demonstrated improvements

in perfect order cycle time

since baseline as shown in

Figure 9, exceeding the year 2

target of 67%.

Additionally, 75% of provinces

continued to build gains on

Year 1 performance. NC

showed the greatest

improvement from 32 days at

baseline to 12 days cycle time

by the end of year 2.

Key Performance Indicator 12: Percentage availability of MPC items at health care

facilities.

In this reporting period the availability of MPC items at both PHC and hospital level were reported at an

average of 89% and 85%

respectively. Both types of

health care facilities are below

the target of 90%. In

comparison to Year 1, PHC

has declined in performance

and hospitals improved.

By the end of Year 2, of all the

provinces observed, Gauteng

and KZN achieved the target

of 90%. NC reflected the least

improvement with regard to

hospitals followed by NW.

Additionally, Mpumalanga and

Gauteng exceeded the target

of 90% for hospitals.

Key Performance

Indicator 13: Percentage

of assisted PMPUs

demonstrating

improvements in

operational capacity.

To date, the GHSC programme has performed baseline assessments at all provinces to determine

operational capacity. Through these assessments, the programme found that on average, provinces were

functioning at a ‘basic’ level of operation capacity.

Among these provinces, the programme found that LP, NW, KZN, EC, FS and Mpumalanga demonstrated

“Basic” level of operational capacity maturity, receiving scores ranging from 16% to 24% as measured by

33%

75%

78%

0%

25%

50%

75%

100%


Figure 9. Percentage of provinces demonstrating

improvement in perfect order cycle time.

Performance

Target

92%89%

90% 93%

0%

20%

40%

60%

80%

100%


Figure 10. Percentage availability of MPC items, PHC

Performance

Target

81%85%

90% 93%

0%

20%

40%

60%

80%

100%


Figure 11. Percentage availability of MPC items, hospitals

Performance

Target

52

the maturity assessment tool. In comparison, Gauteng and NC were reported at an “emerging” level with

overall scores of 28% and 29%.

10.2.2 SUB-OBJECTIVE 2.3 DESIGN SUPPLY CHAIN OPERATING MODEL AND 2.4 MAINTAIN AND

IMPROVE SUPPLY CHAIN OPERATIONS.

Demand, supply, and distribution planning are critical to improving medicine availability and reducing stock

outs at the provincial, district, and facility levels. In efforts to understand the effects of the activities under

sub-objectives 2.3 and 2.4 as described above, the programme seeks to monitor the direct delivery of

MPC medicines to designated hospitals. Performance to date against the programme’s outcome level KPIs

under sub-objectives 2.3 and 2.4 are described in detail below.

Key Performance Indicator 14: Percentage of identified MPC medicines delivered to

designated hospitals via direct delivery.

In Year 2 the percentage of identified

MPC medicines delivered to

designated hospitals via direct delivery

was at a stable level of 45%, falling

below the target of 70%. See Figure 12.

Despite the overall performance of

45%, two provinces achieved or

exceeded the target of 70%--Free

State and Gauteng.

10.3 OBJECTIVE 3:

STRENGTHEN

GOVERNANCE.

One of the primary functions of AMD is to provide oversight and set policy for the provision of

pharmaceutical services in South Africa. In support of this objective, the GHSC programme is contributing

to the development of policy and legislation (sub-objective 3.1), supporting the implementation of

governance (sub-objective 3.2), and providing coordination and oversight of stakeholder engagement and

communication activities (sub-objective 3.3).

10.3.1 SUB-OBJECTIVE 3.1: CONTRIBUTE TO DEVELOPMENT OF POLICY AND LEGISLATION, SUB-

OBJECTIVE 3.2: SUPPORT THE IMPLEMENTATION OF GOVERNANCE, AND SUB-OBJECTIVE 3.3:

COORDINATION AND OVERSIGHT OF STAKEHOLDER ENGAGEMENT AND COMMUNICATION

ACTIVITIES.

Under sub-objectives 3.1 – 3.3, the GHSC programme is assisting AMD in establishing relevant legislation

and policies, developing appropriate governance structures to improve accountability and oversight, and

ensuring the availability of data for decision-making. The programme seeks to measure the effects of these

activities and their ability to strengthen governance by monitoring the governance maturity levels of

assisted organizations. Performance to date against the programme’s outcome level KPIs under sub-

objective 3.1 – 3.3 are described in detail below.

Key Performance Indicator 15: Percentage of assisted organizations demonstrating

improvement in governance maturity.

KPI 15 measures the governance maturity of assisted organizations. The data gathered to inform KPI 15

will assist the GHSC programme to identify areas for improvement and ultimately contribute to the

strengthening of the implementation of good governance.

45%

70% 70% 70% 70%

0%

25%

50%

75%

100%


Figure 12. Percentage of identified MPC medicines

delivered to designated hospitals via direct delivery.

Performance

Target

53

During Year 2, the GHSC programme supported and monitored the governance maturity level of the

national Contract CMU, following initial strengthening engagements, which commenced in Year 1. The

GHSC programme expanded these efforts by assisting two additional organizations, the Information

Systems and Projects Unit (ISP) within AMD and the North West (NW) province. The programme started

working with CMU in Year 2 and progressed to ISP in May 2018. Work in NW started in July 2018. The

following highlights the progress at the organizational level that has been demonstrated to date:

CMU

Based on the ongoing monitoring of the CMU governance maturity levels, the programme observed an

improvement from a ‘basic’ maturity level at baseline of 25% to an ‘optimal’ maturity level of 83.3% at the

end of Year 2. The CMU demonstrated significant improvement across all elements of governance from

baseline, with optimal maturity levels in policies and operational plan. In Q2, improvement was observed

in four key areas including: operational plan, decision-making authority processes, governance structures,

and standard operating procedures. In Q3, policies, operational plan, oversight, and accountability,

progressed to emerging and advanced levels. In Q4 the majority of elements improved to advanced levels

with the operational plan and policies at the optimal level.

ISP

With regards to ISP, the average baseline score measured in May 2018 was reported at a basic level, with

all elements of the governance maturity model being at a ‘basic’ level of 25%. Over the course of Q3 and

Q4 of Year 2, ISP demonstrated an average increase of 12.5%, from a ‘basic’ level of maturity at baseline

to an ‘emerging’ maturity level. By the end of Q4, oversight and accountability had improved to an

‘emerging’ maturity level, raising the overall ISP governance score to an ‘emerging’ maturity level.

NW

The NW baseline assessment was administered in July 2018 and found that in the area of governance NW

was performing at a ‘basic’ maturity level with an overall score of 25%. Notably most elements on the

assessment were on the lower end of the ‘basic’ scale except for oversight and accountability. The GHSC

programme conducted a follow up assessment in September 2018. While the NW remains at an overall

‘basic’ level of governance maturity, the showed slight improvement during the period under review.

Specifically, the programme found improvements in standard operating procedures, with scores in the

later stage of ‘basic’ maturity level.

10.4 OBJECTIVE 4: IMPROVE WORKFORCE

To address the management of human resources within the medicine supply chain, including challenges

relating to the lack of staff with the required capabilities, high vacancy rates, uneven distribution of human

resources, and the need to improve staff management and retention, the GHSC programme seeks to

improve workforce. Specifically, the GHSC programme seeks to support the standardization of structures,

roles and competencies (sub-objective 4.1), institutionalize change management (sub-objective 4.2) and

the up-skilling and mentoring of staff (sub-objective 4.3).

10.4.1 SUB-OBJECTIVE 4.1 – SUPPORT THE DEVELOPMENT OF STANDARDIZED STRUCTURES, ROLES

AND COMPETENCIES & PERFORMANCE MANAGEMENT, SUB-OBJECTIVE 4.2 – ASSIST TO

INSTITUTIONALIZE CHANGE MANAGEMENT, AND SUB-OBJECTIVE 4.3 – CONTRIBUTE TO UP-

SKILLING AND MENTORING OF AMD STAFF.

Under sub-objectives 4.1 – 4.3, the programme strengthened the interventions and activities to improve

workforce alignment, performance management, operational management components and organizational

structure for specific units. The programme seeks to measure the effects of these activities and their ability

to strengthen workforce by monitoring the workforce maturity levels of assisted organizations.

54

Performance to date against the programme’s outcome level KPIs under sub-objective 4.1 – 4.3 are

described in detail below.

Key Performance Indicator 16: Percentage of assisted organizations demonstrating

improvement in workforce maturity.

KPI 16 measures levels of workforce management maturity among assisted organizations. The GHSC

programme classifies an organization’s level of workforce as mature when the staff of an organization have

a clear delegation of authority and decision-making roles; they agree with the designation of roles and

responsibilities; and maintain clear, documented, and continually assessed workforce development

elements with clearly defined roles and job descriptions standardized across departments and aligned with

the job profiles of an optimised organizational structure.

As of Year 2, the GHSC programme has supported and monitored the workforce maturity of the CMU.

The GHSC programme also assisted two additional organizations the ISP unit and the NW

Depot/Pharmaceutical Services. The following highlights the progress demonstrated to date:

CMU

The programme observed CMU’s improvement in workforce maturity from a ‘basic’ maturity level of 25%

at baseline to an ‘advanced’ maturity level of 75% by the end of Year 2. Improvements were observed in

almost all of the elements with organizational structure, roles and job profiles operating at optimal levels.

On the quarterly analysis, the majority of the elements elevated performance in Q2 and then plateaued in

Q3 and Q4. Notably Succession planning and Retention were the least improved by the end of Year 2.

ISP

The GHSC programme conducted a baseline assessment for ISP workforce maturity in May 2018. As a

result, the programme found that the ISP was operating at a ‘basic’ maturity level of 25% across all five

components of workforce maturity. Ongoing monitoring shows initial improvement in the areas of roles,

job profiles and performance management. The ISP has demonstrated improvement in these areas from

‘basic’ to emerging’. This resulted in the maturity level of ISP increasing to an ‘emerging’ maturity level of

35%, showing a 10% growth from baseline. The quarterly analysis showed that ISP was at the emerging

level at the end of Q4.

NW

For NW, the baseline was conducted in July 2018 and the average baseline score reported at a ‘basic’

level. Ongoing assessments reflected that the maturity level remains at a basic level with a slight

improvement due to the design of the Organizational Structure. Further work is underway.

10.5 OBJECTIVE 5: STRENGTHEN INFORMATION SYSTEMS AND INFORMATION

MANAGEMENT.

Technology and information systems are critical enablers of health supply chain performance and form a

cornerstone of the successful delivery of the SIMA. The GHSC programme seeks to support the

strengthening of information systems and information management by designing an IT system landscape

(sub-objective 5.1) and providing support to strengthen analytics and oversight (sub-objectives 5.2 and

5.3).

10.5.1 SUB-OBJECTIVE 5.1 DESIGN AN IT SYSTEM LANDSCAPE AND 5.2 PROVIDE SUPPORT TO

STRENGTHEN ANALYTICS AND OVERSIGHT.

Under sub-objectives 5.1 and 5.2, the GHSC programme drafted an information technology architecture

roadmap and is deploying information systems. The programme seeks to measure the effects of GHSC

55

interventions under objective five by monitoring facilities who report on stock availability to the NSC and

the level of data quality across the sources that inform the programme’s KPIs. Performance to date against

the programme’s outcome level KPIs under sub-objective 5.1 – 5.2 are described in detail below.

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

availability to National Surveillance Centre.

The programme observed an achievement of 102% in the percentage of APP target facilities reporting

stock availability to the NSC by the end of the reporting period. The performance improved from Year 1

achievement of 101% and exceeded the target of 100% shown in Figure 13.

Notably the target

accrued on a quarterly

basis throughout the

year. In Q2 the

programme reported

against a target of

3,323 APP target

facilities and 3,418

APP target facilities

reported stock

availability. In Q3 the

programme reported

against a target of

3,500 and achieved

3,504, which included

clinics, hospitals, provincial warehouses, CCMD storage sites and GP Care Cells. In Q4 the target

increased to 3,550 and the programme achieved 3,604 or 102% by the end of the reporting period. This

includes 3,137 clinics, 443 hospital facilities that are supported by the GHSC programme, and 24 others

including 8 provincial warehouses, 8 CCMDD stock storage sites and 8 GP Care Cells.

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

passing score.

By the end of year 2, of the 11 DQAs conducted for the programme’s key performance indicators, 73%

or eight of the DQAs received a passing score of 80% or more. As a result, the programme exceeded the

Year 2 target of 70% of DQAs

receiving a passing score.

Of the 11 DQAs conducted,

the programme observed an

average score of 84% with the

highest scores in the quality

assurance areas of reliability

and timeliness. See Figure 14.

In Q3, the programme

conducted six DQAs of which

three received passing scores

of 80% or more. The data

sources reflecting these

passing DQA scores were informed by SVS and RxSolution and correspond to KPIs 12 and 17, with an

average score of 96%. The remaining three DQAs that did not receive a passing score include KPIs 4 and

101% 102%

100% 100% 100%

50%

60%

70%

80%

90%

100%

110%


Figure 13. Percentage of APP Target Facilities Reporting Stock

Availability

Performance

Target

73%

0%

70%

80%

0%

20%

40%

60%

80%

100%


Figure 14. Percentage of DQAs Receiving a Passing Score.

PerformanceTarget

56

5, informed by Pharmaceutical Services Dashboard, with an average score of 70% and KPI 12, informed

by RxSolution, with a score of 71%. In Q4 the DQA scores for the remaining 5 KPIs were completed and

consolidated making a total of eleven. The five additional KPIs were informed by the RSA Pharma database

and received a passing score of 85%.

10.5.2 SUB-OBJECTIVE 5.3 SUPPORT THE IMPLEMENTATION OF DATA GOVERNANCE.

Under sub-objective 5.3, the GHSC programme drafted an information technology architecture roadmap

and is deploying information systems. The programme seeks to monitor the utilization of information

systems and information management systems among assisted facilities to measure the effects of the

programme’s intervention. Performance to date against the programme’s outcome level KPIs under sub-

objective 5.3 are described in detail below.

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

and information management systems are utilized.

KPI 19 contributes to the strengthening of data governance, which is key to facilitating the consistent

application of data and fulfilling the prerequisite, improved interoperability of systems within the AMD IT

ecosystem. KPI 19 also accounts for the impact of the GHSC programme’s contributions supporting the

deployment of gCommerce.

By the end of the period under review, the GHSC programme was supporting the deployment of

gCommerce in two of the ten targeted provincial warehouses (Northern Cape and Limpopo).

10.6 OBJECTIVE 6: IMPROVE FINANCIAL MANAGEMENT.

This objective aims to improve financial management processes including budgeting and forecasting,

financial monitoring, and reporting against the budget for both the Chief Directorate: Sector Wide

Procurement (SWP) within NDOH and in assisted provinces. Under objective 6, the GHSC programme

seeks to improve forecasting and budget information (sub-objective 6.1), strengthen accounting processes

(sub-objective 6.2) and improve financial monitoring and reporting (sub-objective 6.3).

10.6.1 SUB-OBJECTIVE 6.1 – IMPROVE FORECASTING & BUDGET INFORMATION, SUB-OBJECTIVE 6.2

- ASSIST TO STRENGTHEN ACCOUNTING PROCESSES, & SUB-OBJECTIVE 6.3- ASSIST TO

IMPROVE FINANCIAL MONITORING & REPORTING

Under sub-objectives 6.1 – 6.3, the programme seeks to measure the effects of the activities designed to

improve budgeting and forecasting, as well as monitoring and reporting by measuring the on-time

submission of PMPU payment packs. Performance to date against the programme’s outcome level KPIs

under sub-objective 6.1 – 6.3 are described in detail below.

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

KPI 20 measures the percentage of PMPU payment packs submitted on time as compared to the total

number of payment packs submitted within a defined period of review.

There is no performance data to report at this time, as GHSC does not have access to data sources that

inform KPI 20. Originally, the programme sought to use the current systems MEDSAS/PDSX to inform

this indicator. These systems, however, do not provide the necessary data to track the submission of

payment packs. gCommerce will provide future data to inform this indicator.

57

11. ANNEX

Indicator Reporting

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date

% of Proposed Year 2

Achievement to Date

Objective 1 – Improve selection and use of medicine.

Desired Outcome – Selection and Use of Medicines Improved.

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

Key Performance Indicator 1:

Number of medicine reviews

conducted by the Expert Review

Committees.2

FY18 N/A 25 N/A N/A


Percentage of recommendations on

medicines selection utilizing HTA

outputs.3

FY18 0% 10% N/A N/A

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


Number of formularies generated

using Essential Medicines Electronic

Access.

FY18 0 9 5 56%

2 To address the lack of available data, GHSC staff developed a Medicine Review Survey, a tool to capture and document the number of medicine reviews completed

but was neither approved nor implemented by AMD. In Q2 Activities under Sub-Objective 1.1: Assist with the implementation of HTAs were suspended due a

decision by AMD to deprioritize HTA support. Towards the end Year 2, however, the Director of AMD requested GHSC to again support HTA activities. A

concept note is being developed to will inform HTA strategy and required support. A meeting will take place in November 2018 to discuss AMD’s desired HTA

activities, with GHSC personnel forming a key portion of the core team providing support.

3 Since the suspension of HTA activities in Q2, GHSC continued to engage with AMD on future plans for HTA. However, following discussion with the Director of

AMD towards the end of Year 2, it is planned that these activities will commence in Year 3. A concept note is currently under development that will inform an HTA

strategy and the exact support that will be required from GHSC. It is envisioned that HTA support will be commenced including HTA capacity building that will

contribute towards improvement in this indicator. A meeting is due to be held in November 2018 to discuss HTA activities going forward by AMD and GHSC will

form part of the core team assisting AMD with HTA.

58

Indicator Reporting

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date


Percentage of expenditures on non-

Essential Medicine List items.

FY18 N/A <10% 1.6% 100%

Objective 2- Support optimisation of the supply chain

Desired Outcome - Improve security of medicine supply through the establishment of function MPUs and strengthening of demand

planning.

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


Percentage of ARVs processed

through Provincial Medicine

Procurement Units within

contractual lead-time.

FY18 79% 85% 77% 91%


Percentage of Master Procurement

Catalogue medicines excluding ARVs

processed through PMPUs within

contractual lead-time.

FY18 75% 76% 77% 101%


Percentage of forecast accuracy on

tenders.

FY18 5% 54% 54% 100%


Percentage of assisted provinces

demonstrating improvements in

perfect order fulfilment.

FY18 0% 67% 88% 131%


Percentage of assisted provinces

demonstrating improvement in order

fulfilment cycle time.

FY18 0% 67% 75% 112%


Percentage availability of Master

PHC

FY18 78% 90% 89% 99%

59

Indicator Reporting

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date

Procurement Catalogue items at

healthcare facilities

Hospital

FY18 78% 90% 85% 94%

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


Percentage of identified Master

Procurement Catalogue medicines

delivered to the designated hospitals

via direct delivery.

FY18 N/A 70% 45% 64%

Objective 3 – Strengthen governance

Desired Outcome - Increase number of decisions made based on good governance principles embodied in policies, implementation

plans and standard operation procedures.

Sub-Objective 3.1 – Contribute to development of policy and legislation, Sub-Objective 3.2 – Support the implementation of

governance, and Sub-Objective 3.3 – Coordination and oversight of stakeholder engagement and communication activities

No KPIs schedule to be reported annually.

Objective 4 – Improve workforce management

Desired Outcome - An improved culture aligned with proactive patient centric decision making and enhanced leadership

management and technical skills.

Sub-Objective 4.1 – Support the development of standardised structures, roles and competencies & performance management, Sub-

Objective 4.2 – Assist to institutionalise change management, and Sub-Objective 4.3 – Contribute to up-skilling and mentoring of

AMD staff.

No KPIs schedule to be reported annually.

Objective 5 – Strengthen Information Systems and Information Management

Desired Outcome - Information systems that support the visibility and analytics network operating model, to improve evidence-

based decision-making leading to improved medicine availability and continuous improvement.

Sub-Objective 5.1 – Design IT System Landscape

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

60

Indicator Reporting

Year

Baseline

Value

Year 2 Proposed

Target

Year 2 Achievement

to Date


Achievement to Date


Percentage of APP target facilities

reporting stock availability to

National Surveillance Centre.

FY18 100% 100% 102% 102%


Percentage of Data Quality

Assessments that receives a passing

score.

FY17 N/A 70% 73% 104%

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

implementation of IT systems


Percentage of assisted facilities where

information systems and information

management systems are utilised.

FY18 0% 50% 20% 40%

Objective 6 – Improve Financial Management

Desired Outcome - Prudent financial management processes that underpin and support improved medicine availability.

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


Percentage of PMPU payment packs

submitted on time.4

FY18 N/A N/A N/A N/A

4 There is no performance data to report at this time as GHSC does not have access to data sources to inform KPI 20. Originally, the programme sought to use

the current systems MEDSAS/PDSX to inform this indicator, however, these systems do not provide the necessary data to track the submission of payment packs.

The programme has designed gCommerce to track the submission time of payment packs and this will be used to inform this indicator as gCommerce goes live

within each province.

usaid global health supply chain programme annual report

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