CLUSTER: NATIONAL HEALTH INFORMATION SYSTEM

PORTFOLIO COMMITTEE HEARINGS: 7 MARCH 2000.

POLICY ISSUES: GENERAL

PERFORMANCE TARGETS (OPERATIONAL PLANS) AND ACHIEVEMENTS FOR 1999/00

PERFORMANCE TARGET	PRIORITY	ACHIEVED (WITH EXPLANATION)	NOT ACHIEVED (STATE REASONS
1.Vital Registration Implement Birth Notification form Maintain Death Notification system to ensure feedback	High	Birth Registration forms promulgated and implemented. Preliminary evaluation data available from 15 000 forms.	CAPTURING OF BIRTH DATA: R 2 000 000 was allocated for the printing of Birth and Death forms as agreed with Department of Home Affairs. However to date the Department of Home Affairs have managed to print the forms from their own budget. The volume of birth data required an automation of the data capture process. We have investigated the procurement of a 'form capture' system with StatsSA, to specifically capture the health data from the birth form. The procurement process was not completed in time to make the commitment for the required hardware. StatsSA would acquire the software for the birth data from Sweden. POPULATION REGISTER: Due to the Y2K problem we did not attempt modify the data fields on the population register, this will now be done in the new financial year. The Cabinet decision to adopt a multipurpose smart card will allow us an opportunity to contribute to Home Affairs when they modify the population register and deliver the HANIS project
2. Telemedicine 2.1 Tender preparation, evaluation and awarding to successful bidders. 2.3 Establish implementation team and adopt project plan 2.4 Deliver 28 sites in six Provincial Pilot	Very High	Telemedicine tender awarded and phase one of the project implemented. 28 sites equiped and commissioned.	INTERNATIONAL TELEMEDICINE CONFERENCE: Telemedicine Conference is shifted to the 2000/01 financial year. R720 000 surplus on Professional and Special Services occurred due to the fact that the Telemedicine Conference was shifted to the year 2000/01 financial year The delay in the tender process and in obtaining the ISDN infrastructure from Telkom added to the total project plan schedule being moved forward. This increased our current budget by five million Rand. In addition we spent a further four million Rand from the CD: Hospital services, on the Telemedicine project
3. Web site development 3.1 Finalise contractors for site and system implementation 3.2 Deliver functional site with provincial links 3.3 Ensure (Web technology to support functions of NHIS/SA)	Medium	We have a pilot web page hosted by GCIS. Static pages available on DoH site.	The delay in establishing a dynamic web site was due to the appointment of Consultants which was delayed by DFID. This resulted in a delay in the procurement of the required development environment and the GIS Web technology delivery.
4. NHIS/SA Committee Co-ordination 4.1 Co-ordinate four quarterly meetings for the year 4.2 Support standards adoption and NHC/MIS implementation 4.3 Primary Health Care form 4.4 Hospital form	Very High	N. Cape, W Cape, N Province and Gauteng implemented the NHC/MIS. Patient Administration and Billing (PAAB) implemented in four provinces. The PAAB development team is looking at incorporating the Uniform Patient Fee Structure (UPFS) tariff. Support standards adoption and National Health Care Management Information System (NHC/MIS) implementation . Hospital form has been agreed and finalized by NHIS/SA and implementation will start in April 2000. The hospital form has been agreed and finalised by NHIS/SA and implementation in all provinces will start in April 2000. The PHC form has also been accepted as the vehicle to facilitate data capturing of primary health care services at various levels.
5. District Health Information System Development 5.1 Implement and support DHS 5.2 Update Geographic Information System 5.3 Collate Nationally all District data	High	District Health Information System software was adopted by all provinces. We would want to request permission to buy PC’s for provinces to use for collecting data for District Health Information System (DHIS). By June 2000 all provinces will have 80% district data. Training manual was developed last year. The HISPP training is being done in provinces. Report of GIS in all facilities was completed.	We delayed in the appointment of GIS consultants in the light of the new demarcation of Districts, Council boundaries.
6. Develop Health Information Standards	Medium	ICD-10 has been adopted as the diagnostic coding system for the public sector. It has been implemented as part of the NHC/MIS system in N Province, Gauteng, Free State, Kwazulu Natal, N Cape and W Cape.	CPT coding system is being reviewed by a task team formed by NHIS/SA to determine the most appropriate coding system for the public sector.

2. PERFORMANCE TARGETS (OPERATIONAL PLANS) FOR THE 2000/01 FISCAL YEAR

TARGET	OBJECTIVE	PRIORITY	TIME FRAME	LEGISLATION	CONSTRAINTS	SOLUTIONS
Registration of all births and deaths in the country within one month	Improve Vital Registration System	High	On going	Birth and death registration Act No 51 of 1992	No staff to capture data	Build an existing system and await development in the revision of the population register in implementing "forms capture"
Implement Telemedicine application in 73 sites Implementation of National Telemedicine Strategy (phase two). Tender awarded Conference 2000	Implementation of National Telemedicine Strategy (phase two). Tender awarded Conference 2000	Very high	June 2001		Availability of infrastructure	Telkom rollout of telephones in collaboration with Doh
Have a functional web site for the Doh	Development and maintenance of the department of health web site which is dynamic and interactive	Medium	October 2000		Need for GCIS Compatible system and Dynamic GIS	Appointment of consultancy
Provincial NHIS/SA Committees	Co-ordinate and facilitate the activities of the NHIS/SA committee	High	On going	New Health Bill	Lack of cooperation from provinces	Request from provincial heads
Provincial data by Health Districts	Implementation and support to the District Health Information System	High	All provinces by June 2000		Provincial budget constraints for PC’s and training	Commitment from provincial heads to fund IT for District offices
All staff appointed	Functional Directorate Delegation taken for human resource and finance	Medium

DIRECTORATE HEALTH SYSTEMS RESEARCH, RESEARCH CORDINATION AND EPIDEMIOLOGY

1. ACHIEVEMENTS

1.1. PUBLIC HEALTH SURVEILLANCE AND EPIDEMIOLOGY (ALL TARGETS HAVE BEEN ACHIEVED)

1.1. 1 EPIDEMIOLOGY TRAINING ( HIGH PRIORIRTY)

Achieved
National training course to be held from 6-10 March 2000
Provincial course to be held in Pietersburg 15-16 March 2000

1.1.2. TOP MONITORING ( VERY HIGH PRIORITY)

On going monitoring
Review workshop to strengthened current reporting structures and mechanisms scheduled for 23 March 2000

1.1.3 MATERNAL MORTALITY REPORTING ( VERY HIGH PRIORITY)

On going
First annual report launched by the Minister in 1999
Full report and executive summary available

1.1.4 MAINTAIN AND REVIEW NOTIFICATION SYSTEM (VERY HIGH PRIORITY)

On going reporting
Review process started in 1999
To culminate with workshop this year (15-16 March 2000)

1.1.5 INFORMATION DISSEMINATION (HIGH PRIORITY): a Number of publications are being disseminated on an on-going basis by the directorate .

During the course of this financial year :

The 1998 HIV survey report was widely disseminated
Four quarterly editions of Epidemiological Comments have been disseminated
Report on confidential enquiries into maternal deaths are being disseminated
Statistical Notes disseminated on a regular basis

1.1.6 Epidemiology conference to be held on strengthening surveillance activities and the early warning system for epidemic control and outbreak response (15- 16 March 1999): This has very high priority.

1.1.7 NATIONAL AND PROVINCIAL WORKSHOPS (HIGH PRIORITY)

Preparatory workshop held for the 1999 HIV survey in August 1999
Debriefing workshop held for the 1999 HIV survey in November 1999
Laboratory workshop held for the 1999 HIV prevalence and incidence surveys in September 1999
District Health Information System workshop held in February 2000

1.1.8 COMPREHENSIVE HIV/AIDS SURVEILLANCE AND STRATEGY ( VERY HIGH PRIORITY)

Annual HIV prevalence survey conducted
HIV incidence implemented
Cost assessment study completed : report available
Proposal for STD Surveillance forwarded by the SAIMR
Annual survey of TB in HIV patient : protocol prepared fieldwork to start later this year

1.1.9 ESTABLISH NEW SURVEILLANCE SYSTEMS (VERY HIGH PRIORITY)

New routine immunisation : data collection tools and mechanisms devised. System successfully launched in the Eastern Cape and Western Cape. To be rolled out to the rest of the country this year.
AIDS Notification : data collection tools devised. Forms printed. Awaiting policy decision.
New TB register: System devised (with forms, data collection mechanisms and structures) and currently being piloted in the North West and Mpumalanga.

1.2 RESEARCH

1.2.1. ESTABLISHMENT OF PROVINCIAL RESEARCH COMMITTEES: HIGH

4 Provincial Research committees are functional and 5 are not well established because of financial constraints at Provincial level.
A workshop was held with 9 Provincial Research Committee Representatives at the National Department to facilitate and support these committees.

1.2.2. IDENTIFY HEALTH SYSTEMS RESEARCH PRIORITIES: HIGH

A Research Audit was done and the process of prioritising is ongoing
The Unit has allocated R5 million rands to the Health Systems Trust for priority research areas in health systems, which is conducting and commissioning out Health Systems Research for the Department of Health
The Unit has also identified Project to be commissioned out. The process of tendering is ongoing.

1.2.3 DISSEMINATION AND FEEDBACK: HIGH

The Directorate produces and disseminates the Research Update is quarterly document produced by the unit, which focuses on research issues.
The South African Demographic and Health Survey was conducted in 1998, and a preliminary report is available. This survey will be conducted every five years and provides a broader picture of the health status of South Africans.
A Research Forum is held every month to update policy makers about health, and health related issues. Policymakers, researchers are invited from inside and outside the Department to present their findings to this forum.

1.2.4. HEALTH SYSTEMS RESEARCH CONFERENCE: HIGH

The unit holds a yearly Research conference to get researchers, policymakers and civil society together. In this Conference practical issues relating to the link between research and policy are discussed.

1.2.5. HEALTH SYSTEMS RESEARCH TRAINING: HIGH

The unit collaborates with the Health Systems Trust in capacity building for health systems research
The planned Basic and Applied Epidemiology Training has a component of health systems Research.

1.2.6. ESTABLISHMENT OF ENHR COMMITTEE: VERY HIGH

The Minister has approved the appointment of the committee.
A draft health research policy document has been produced, and this policy depends on the partnerships and collaboration between major research stakeholders. The draft has still to be discussed with the Essential National Health Research Committee and other stakeholders.

1.2.7. ESTABLISHMENT OF THE ETHICS COUNCIL: VERY HIGH

Draft Discussion document is available and was discussed in consultative workshop held in at the National Department with major stakeholders.

1.2.8. DEVELOPMENT OF RESEARCH DATABASE : VERY HIGH

This has not been fully developed yet, but we have started with a component on clinical trial going on in the South Africa. This is still in the stages of co-ordination with all the other stakeholders who have health research databases.

1.2.9. ESTABLISHMENT OF CLINICAL TRIALS WORKING GROUP: VERY HIGH

The Clinical Trials working group is functional and a draft on good clinical practice has been produced. This is still to be discussed with major stakeholders.

1.3. MONITORING AND EVALUATION

1.3.1. YEAR 2000 HEALTH GOALS AND OBJECTIVES: VERY HIGH

A final report on the progress and status of health goals and indicators is in process.
A workshop on health goals, objectives and indicators has been scheduled.

1.3.2. DEMOGRAPHIC AND HEALTH SURVEY: VERY HIGH

The South African Demographic and Health Survey preliminary report is available.
The compilation of the final report is in process.

1.3.3. COMMISSION OUT RELEVANT RESEARCH:VERY HIGH

A facility Survey was conducted by the HST to look into issues of quality care in the 9 Provinces. The findings of the Survey were discussed in a workshop held by the unit.
There is a plan to conduct another facility survey to provide more information on indicators not covered in the previous survey.
The Unit has commissioned the Reproductive and Health Research Unit, to undertake a study that looks into the Impact of the Termination of Pregnancy (TOP) Policy. This project has been allocated R79 000.

1.3.4. CONTRACT WORKER: VERY HIGH

A submission to higher a contract to deal with health goals, objectives and indicators is still to be approved.

2. EXPLANATIONS ON UNDER EXPENDITURE ON THE BUDGET OF THE

DIRECTORATE: HEALTH SYSTEMS RESEARCH, RESEARCH CO- ORDINATION & EPIDEMIOLOGY

Expenditure at 31/01/2000: R2'965'708

Under expenditure at 31/01/2000(balance): R2'816'292

Total budget: R5'782'000

2.1 .Activity: Payment of an once-off amount to the SAIMR for the maintenance of the Cancer Registry.

Amount: R588'000

Status: Department of State Expenditure’s approval is obtained. Invoice is requested from SAIMR. Awaiting revised agreement from State Attorney.

2.2.Activity: Payment to the MRC for a report on "The benefits/risks of interventions to reduce vertical HIV transmission".

Amount: R24'000

Status: Department of State Expenditure’s approval is obtained and an invoice is requested from the MRC.

2.3. Activity: Write-up of the final report on "Health Goals, Objectives & Indicators".

Amount: R22'000

Status: Quotation is approved. Awaiting completion of work and the final invoice for work rendered.

2.4. Activity: TOP Tender

Amount: R79'000

Status: Committed. Awaiting report and invoice from tenderer for payment.

2.5. Activity: Personnel vacancies:

* 2 Medical Natural Scientist posts: R200'000

* 1 Assistant-Director: Administration post: R150'000

* 1 Deputy-Director: Demographer post: R180'000

Amount: R530'000

Status: Approved vacant posts on the post establishment.

2.6. Activity: HIV Incidence testing

Amount: R150'000

Status: Proposal is received. Contract is in process of being drafted.

2.7.Activity: Workshops, meetings & training not yet paid:

* Epi Training: 6/3/2000 - 10/3/2000

* TOP Workshop: 23/3/2000

* Ethics consultative meeting: 28/3/2000

* Health Goals Workshop: 30/3 - 31/3/2000

* ENHR meeting: 3/2000

Amount: R400'000

Status: All expenditure on above-mentioned must be paid in the current book year.

2.8. Activity: The write-up of the SADHS report.

Amount: R20'000

Status: In process of obtaining FMC approval.

2.9. Activity: Projected operational cost for February & March 2000.

Amount: R500'000

Status: Operational expenditure for the remainder of the financial year.

TOTAL AMOUNT OF LISTED ACTIVITIES: R2'313'000