1. MISSION

We are committed to achieving our vision through a decentralized, accountable, accessible and constantly improving health care system within available resources. Our caring, multi-skilled, effective personnel will use evidence-based, informative health care and maturing partnerships for the benefit of our clients and patients.

2. KEY STRATEGIC PRIORITY AEAS

• Decreasing morbidity and mortality rates through integrated strategic interventions
• Mother, Child and Women’s Health
• HIV /AIDS / STD’s
• TB
• Revitalization of hospital services
• Improving Human Resource Development and Management
• Reorganization of certain support services
• Emergency Medical Services
• Information Management
• Forensic Services
• Pharmaceuticals
• Strengthening co-operation with partners internationally
• Legislative reform
• Speeding up delivery of an essential package of services through the District Health System
• Improving quality of care
• Improving resource mobilization and the management of resources without neglecting the attainment of equity in resource allocation
• Improving communication and consultation within the Health System and between the health system and the communities we serve

The total revenue collected by the department for 2001/2002 amounted R12,5 million, an increase of 39% as compared to the previous financial year (see table below). The introduction of the Uniform Patient Fee Schedule (UPFS) and the Nootroclin Billing System has largely contributed to the increases observed in revenue, however the impact of these administrative improvements will be short-lived and other initiatives are required to further increase revenue.

The Department will seek to improve the revenue generated in the following ways:

• Hospital Revitalization Programme – This programme aims at improving the public health care facilities as well as services. It will address both the upgrading of buildings and equipment.
• Private Preference Beds – These beds have improved hotel facilities at an increased cost to the patient. Currently three hospitals have this facility viz. Kimberley, Kuruman and Hartswater.
• Amendment of UPFS – The UPFS is currently being amended by the National Department of Health to include the billing of the transport of patients making use of ambulance services.
• Revenue Retention – An important requirement for the improvement of revenue is the implementation of revenue retention by departments and institutions. This is aimed at ensuring incentives for managers and other personnel in the collection of revenue.

Three conditional grants amounting to R61,635 million are directed strictly towards hospital services. They are:

• National Tertiary Services Grant (R24,062 million)
• To fund national tertiary services as identified and costed by National Department of Health
• To ensure equitable access by all South Africans to basic level tertiary care
• To ensure nationally coordinated planning for tertiary services
• Health Professions Training and Development Grant (27,573 million)
• Support the training of professionals
• Support provinces to fund service costs associated undergraduate and post-graduate remedial students training
• Development and recruitment of medical specialists in under-served specialists
• Enable shifting of some teaching activities from central hospitals to regional and district facilities.
• Hospital Revitalisation Grant (R10,000 million)
• To transform and modernise hospitals in line with the national planning framework and to achieve sustainability

1. PROVINCIAL INFRASTRUCTURE GRANT (R7,0 million)

The department is expected to use these funds mainly for the rehabilitation and construction of health facilities and to address infrastructure for rural development. During 2002/2003 these funds will be used for the building of a new Colesburg Hospital.

 

2. HIV/AIDS GRANT (R5,727 million)

These grants are to be used to develop an effective integrated response to the HIV/AIDS pandemic. The Department’s responsibility includes:

• Expanding access to voluntary HIV counselling and testing (VCT–R1,029 million)
• Funding 2 pilot sites of mother to child transmission prevention programme and the roll-out of this programme once National Department of Health is satisfied with performance (MTCT–R1,112 million)
• Implementation of home based care (HCBC–R2,604 million)
• Strengthening of provincial programme management (R745,000)
• Implementation of step-down care (R236,000)

1. HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT GRANT (R7,0 million)

The purpose of this grant is to improve management in hospitals including cost centre accounting systems, improved PFMA implementation and strengthened financial skills and capacity. It is also to be used to support quality of care interventions to substantially improve quality of hospital services.

With the implementation of the National Policy aiming to increase the capacity of hospitals, Kimberley Hospital has seen an improvement in the quality of care in all facets of service delivery. Two conditional grants namely Redistribution of Tertiary Services and HR&R were successfully utilized.

• Various measures have been put in place to reduce waiting times in emergency, Operating theatres and Specialized Clinics.
• The take-over of Harmony Home to serve as a rehabilitation centre has increased the bed capacity of Kimberley Hospital Complex by 100 beds.
• Kimberley Hospital Complex has achieved the highest number of doctors and specialists. The departments of Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics, Anaesthetics, Urology, Orthopaedics, Oncology and Neuro-surgery are run by and managed by full time specialists

1. PHYSICAL FACILITIES

 

0. SPECIALIST CLINICS

A need was identified to revamp the specialist clinics to ensure efficient and effective care. The revamped client-friendly clinics were opened to the public in January 2002. The booking system at the clinics is linked to the districts.

 

1. HOUSING

Official accommodation has been made available to scarce professional. A need arose to repair and revamp some of the houses. These repairs were done at a cost of R500’000.00. The department is currently in the process of drafting a housing policy.

 

2. PHARMACY

There has been a marked increase in patients accessing pharmaceutical services which led to overcrowding. The area was converted into a casualty ward and the new identified area was revamped. Another significant event occurring in 2001 was the moving of the pharmaceutical store, into a new venue in the yard. This was mainly due to restructuring and upgrading of the hospital front entrance.

 

2. EQUIPMENT

 

0. CLINICAL

The theatre output was a matter of concern, to increase theatre utilization new equipment was acquired:

• 3 automatic
• 4 Anaesthetic machines
• 1 Laparoscopic machine
• 1 Endoscopic machine.

Advanced equipment like monitors and ventilators were procured for the Intensive care Unit and this made it easier for staff to monitor effectively.

A neuro-surgical service was not previously provided at Kimberley Hospital complex, but since the appointment of a neuro-surgeon critical equipment has been procured for theatre to the value of R500’000.

The following equipment will be procured in the current financial year:

• Cat Scan
• Echocardiogram
• Complete Urology instruments and equipment
• Complete neuro surgery equipment.

1. LAUNDRY

This is the largest laundry in the province and serves institutions in the Frances Baard and Karoo districts (12 hospitals). The repair of outdated laundry machines proved to be cost inefficient and thus a major investment of R4.9 million for a new tunnel washer and ironer were made. On the 22 October 2001 the laundry equipment was replaced by modern equipment. Since the launch of the laundry equipment the problem of the backlog has decreased.

 

2. X-RAY MACHINES

X- ray machines to the value of R2.7 million have been procured for Kimberley Hospital Complex.

1. HUMAN RESOURCES

 

0. TWINNING AGREEMENT

A 6 month rotation nursing scholarship program is being introduced and an agreement has been signed between Oxford Radcliffe Hospital in England and Kimberley Hospital Complex. This is geared towards improving quality of care.

With the next phase of the EU funding the Department will prepare work plans, reviewing the twinning agreement and the intention is to include Gordonia Hospital.

 

1. ADMINISTRATION

• All job descriptions have been finalized.
• 169 employees services were terminated during 2001, due to death, retirements, resignations and discharge.
• 69 employees of the previous Harmony Nursing Home was absorbed on the establishment, this brings to the total of appointments at Kimberley Hospital Complex for 2001 to 222.

To complement the purchase of the equipment and improve the standard of care, specialist were appointed in the following departments:

• Neuro- surgery
• Orthopedics
• Obstetrics
• Urology
• Anaesthetics
• Cardiology
• Haemotology

Additional nursing staff were also appointed.

Kimberley Hospital Complex aims at:

• Implementation of Employee Assistance Programme
• Improving the recruitment process

• Patient information system in is place help desk at the entrance of the hospital to assist the public.
• The Hospital Information System (HIS), which is being installed, gave rise to the need for an Information Technology Unit.
• Training and skills development on Oasis, Nutroclin and E- mail is ongoing.
• Pharmaceutical management system has been installed as part of the HIS.
• A clinical Resource Centre has been established and this will allow access to the Internet and in turn encourage the practice of Evidence Based Medicine.
• Laboratory results are on a network, which allows for an efficient and effective service.

1. TERTIARY SERVICES

• MDR TB services are provided at West End Hospital.
• A tertiary expansion program saw the addition of the following services:
• Cardiology
• Haematology
• Due to the incidents of trauma and cardiac conditions in our province, the demands for extra beds in Intensive Care Unit was critical. Beds were increased from6 to 10.
• Advanced equipment like monitors and ventilators were procured.
• Training of personnel at the unit is a priority.

1. RE-ORGANIZATION

 

0. HARMONY HOME

• Harmony Home has been provincialized and forms part of Kimberley Hospital Complex. The type of services rendered at the centre will change from long- term chronic care to acute care and rehabilitation.
• This added an extra 100 beds to the bed capacity of Kimberley Hospital Complex.
• 69 employees of the previous Harmony Nursing Home was absorbed on the establishment.
• A budget allocation was done for this take over.

1. WEST END HOSPITAL

TB services have been decentralized to hospitals in the district and to Jan Kempdorp Hospital in the Frances Baard district. This will increase the efficiency of our district hospitals. West End Hospital will still provide MDR TB services.

 

2. CATERING SERVICES

• The principles of Public Private Partnership became a reality with the outsourcing of catering to a private company.
• Personnel employed at the kitchens are still public servants

1. PRIVATE WARDS

• To improve private patient access, 20 side rooms were converted to private wards. This will assist in generating income for the hospital. A further 15 wards will be commissioned this year.
• The wards were upgraded, fitted with bathroom and television set.
• There has been a marked increase in the admission of private patients to the wards

1. OTHER

In addition to the above, Kimberley Hospital Complex achieved the following:

• Hospital Radio established
• The demand for Occupational Health services sees income generated through services rendered to private mining companies.
• The Hospital is in the process of formulating a policy on property or asset abuse/ asset management.
• Help Desks established at strategic location.
• Personnel issued with magnetic strip identity cards
• New Patient attire was procured.

1. DISTRICT HOSPITALS

 

0. COLESBERG HOSPITAL

A site has been identified for the building of the new Colesberg Hospital. Construction is to commence by July 2002 and it is expected to be completed during the financial year2003- 2004.

The new hospital will improve the services on the N1 route. It will be fully equipped to deliver level one services.

A sod turning ceremony was held on 23 April 2002.

The cost for the new building will amount to R15 million while upgrading the old hospital would have cost R12 million. Cost comparisons therefore suggested that a new hospital is the more cost-effective option.

 

1. CALVINIA

The business case for the new hospital in Calvinia is to be developed. The construction of the hospital will commence during the 2003-2004 financial year. The funding for the new hospital will amount to R15 million. Cost comparisons therefore suggested that a new hospital is the more cost-effective option.

 

2. GORDONIA HOSPITAL

The intention is to develop Gordonia Hospital into a level II Hospital to serve the Western half of the province. This forms part of the Hospital Revitalization Programme.

 

0. PHYSICAL PLANNING

Planning for upgrading or building of a new hospital depending on the cost and functionality.

 

1. HUMAN RESOURCES

• An additional R1 million has been allocated in this financial year on top of the R1 million allocated last year.
• Human resources planning will determine a staff establishment necessary for the functions to be performed.

1. EQUIPMENT

New equipment required to allow the hospital to render level II services will be purchased commencing this financial year. These include

• X- ray machine
• Ventilators
• Laundry machine
• New dental equipment

1. INFORMATION SYSTEMS

The rolling out of the Hospital Information System (HIS) is a critical component of revitalization. The following systems will be implemented:

• HIS
• LOGIS (Inventory)
• TRANSAID (Transport management)

1. OTHER HOSPITALS

The Hospital Rehabilitation Programme in the Districts continue to provide improved facilities and Health Services to the under privileged and communities in remote areas.

• Hartswater

• Jan Kempdorp

1. HOSPITAL INDICATORS

Indicators for hospitals per district

The graph comprises the bed utilization rates for April –June2000 and the same period in 2001. The most significant differences are in Namaqua and Frances Baard. A reason for this could be that the new form stipulates that useable beds be recorded. Thus there is no room for confusion between approved beds and actual beds as was the case with the previous Business Status Reports used by hospitals.

All "Average Lengths of Stay" are similar except for Kimberley Hospital Complex which is much higher. As was previously mentioned. Kimberley Hospital Complex is the main referral centre for secondary and tertiary care.

This graph represents a comparison of the average length of stay per district for April – June 2000 and the same period in 2001. The figures are more or less consistent, except for Kimberley Hospital Complex and Namaqua. With the advent of the new form many of Kimberley Hospitals data collection methods had to be revised due to previous inaccurate data recording. The greater proportion of Namaqua’s reporting facilities (70%) are Community Health Centers. This results in Namaqua referring most of their cases in need of hospital care to Kimberley Hospital and Gordonia which would account for low Average Lengths of Stay.

The investigations into the devolution of primary care services to Local Authorities are still continuing. Five workgroups namely:

• Personnel
• Finance
• Legal
• Services
• Informatics

are in place and are preparing reports that will be resubmitted to the MEC’s for Health and Local Government & Housing by the end of May. An interim Provincial Health Authority has been launched and a follow-up meeting is being arranged.

1. HUMAN RESOURCES

 

0. HUMAN RESOURCE PLANNING

A system is being investigated which will allow for a more rational approach to determine staff establishments.

Recruitment has been targeted at changing the racial imbalances in the various occupations. The aim is to have targeted recruitment from the various districts to ensure an even spread of key skills to serve the various communities. Training of students in these professions is a Departmental responsibility. We are envisaging to recruit and training at least four (4) students per annum from disadvantaged backgrounds in scarce fields.

The department is in the process of:

• Developing a retention strategy which is linked to an incentive package that management has to design. We are forced to consider individual incentive plans
• We are also developing generic job descriptions which includes job competencies for all job categories (65) in the Department.

1. HUMAN RESOURCE DEVELOPMENT

Planning, monitoring and reporting poses significant challenges. An information system is required to adequately address these areas.

1. SKILLS DEVELOPMENT

In terms of the integrated strategy that is being pursued by the Northern Cape Government skills development has been identified as a priority theme.

The Department of Education is the lead Department and we therefore have to plan this theme under the leadership of this Department. This approach allows for greater efficiency, improved coordination and better monitoring.

A workplace skills plan has been completed for 2002 / 2003 and submitted to:

• HWSETA
• DPSA

The total budget allocation for skills development in the Department is R3 444 000.

Training Committees were established in the various districts in line with the workplace Skills Plan and the Employment Equity Plan.

The following were identified as examples of scarce skills within the province; Opthalmologist, Speech Therapists, Clinical Technologies, Medical Technologists, Radiologists, Forensic Medical Practitioners, Radiographers, Physiotherapists, Pharmacists and Medical Officers. The Province has been recruiting in these fields. We are experiencing a high turnover of staff in these occupations.

Some of these shortages will be addressed by the phasing in of Community Service for other professions.

1. VULINDELA

This is a front-end system that integrates financial and human resource data. It also presents the information in a more management friendly format. It is being implemented in the department.

 

2. LABOUR RELATIONS

In order to develop management competencies to handle discipline in capacity, grievances, complaints and workplace conflict as well as to cover the legislative framework, Training was conducted for line managers. The first phase has been completed and a second phase has started in April 2002. The unit is in the process of developing standard guidelines on Labour Relations matters.

One Labour Relations Officer was appointed to serve Namaqua and Siyanda and two other Labour Relations Officers need to be appointed to serve exclusively the, Karoo and Siyanda, Frances Baard and Kgalagadi will be served by the Provincial Office. These appointments will fast track and deal expeditiously with misconduct matters, grievances, complaints and workplace conflict.

A Dispute Resolution Structure needs to be established for each District / Institution in keeping with the Labour Relations Framework.

 

3. TEACHING AND TRAINING- HENRIETTA STOCKDALE NURSING COLLEGE

 

0. PERSONNEL

4 Lecturers were appointed in 2001 and 4 in 2002.

 

1. STUDENT NUMBERS IN TRAINING:

• 4 year Diploma Course: 132
• Bridging Course: 114

1. NEW ADMISSIONS

39 new admissions have been accepted. This is a significant increase compared to the 20 accepted in the previous year. This is an attempt to increase the number of nurses available to the province within our financial constraints. Future numbers will be determined by the outcome of our Human Resource planning exercise.

 

2. COMPLETED TRAINING:

• 4 year diploma 19
• Midwifery 17
• Bridging Course 39

1. DISTRIBUTION

An equitable number of students are selected from the districts. Students are also selected from the "Xu" and "KHWE" communities.

 

2. COURSES

Eleven Professional Nurses were strategically selected and completed a five-week Forensic Nursing Training course accredited by University of Orange Free State and South African Nursing Council. The Human Rights Commission and lecturers from University of Western Cape, Wits University assisted the Department. The course was completed in March 2002.

Training of two nurses in Occupational Health Nursing from Namaqua to allow for the establishing two Occupational Health Units in the District.

Auxiliary nurses training curriculum has been approved and training to started April 2002.

 

3. FAILURE RATE

Failure rates of students have been reduced from 10% to 3% in the first semester of 2000. This was achieved due to the implementation of compulsory remedial classes for students.

1. ACCREDITATION OF HOSPITALS

22 (Private and State) hospitals have been accredited by the South African Nursing Council for clinical exposure of students making possible the decentralization of training in the remote areas.

This has prevented the depletion of peripheral hospitals and service delivery is therefore not compromised.

 

2. NATIONAL INSTITUTE OF HIGHER LEARNING

An investigation by the Department of Education into the Institution of Higher Education for the Province is underway. It is envisaged that the college will be incorporated into this institution.

 

3. STUDENT CONTRACTS

The Department is in the process of revising the study contracts to ensure retention of students for the Province, to ensure service to the communities in remote areas in the province for at least two years after completion of training.

1. SUPPORT SERVICES

 

0. PHARMACEUTICAL SERVICES

The Department strives to attain 100% availability of Essential Drugs and steps are being taken to achieve this objective.

A major change has taken place with respect to medicines procurement and distribution.

• Sekunjalo Medical Logistics could not provide a guarantee as per the tender. As a result the contract with the company was terminated as of 31 March 2002. The Department is in the process of taking over the procurement, warehousing and distribution of Pharmaceuticals.
• Medicines will be stored at the Kim- Diamond building from where it will be distributed to the districts and Kimberley Hospital will cater for its own needs. Part of the building is being converted for this purpose.
• The number of Community Service Pharmacists have been increased from five (5) to eight (8). 23 persons have been registered in Pharmacy Support, this will result in improved Pharmaceutical services
• A large percentage of Nursing and Pharmacy Support personnel have been trained in Drug Supply management and the Essential Drugs Programme. Due to the high turnover of nursing personnel new staff will have to be trained on a regular basis.
• The continuous implementation of the National Drug Policy will improve conditions of Pharmaceutical Services in the province at operational level.

1. EMERGENCY MEDICAL SERVICES

During the previous financial year 63 new emergency medical vehicles were purchased, which allowed for 39 vehicles to be decommissioned and 24 Centres which did not have Emergency Medical Services vehicles stationed there, to be supplied with vehicles.

In pursuance of our 3- year replacement policy we will purchase another 20 Emergency Medical Services vehicles this year and 20 next year. In addition we will purchase 15 patient transport vehicles. Thirty (30) of the old Emergency Medical Services vehicles will be decommissioned.

The net effect of the above is that the emergency medical services fleet will be 123 of which 83 will be new (63 purchased 2001 and 20 purchased 2002) and 40 old. A patient transport fleet of 15 new vehicles will also be in place.

During the year records will be kept of the Emergency Medical Services / Patient Transport Vehicles (PTV) utilization which will inform our decision on the final fleet sizes for Emergency Medical Services and PTV.

Drivers will be appointed for the PTV’ s. These vehicles will transport ambulant patients presently being transported by the Emergency Medical Services.

The reduction in the EMS fleet and the reduction in the workload will contribute towards the introduction of 2 crew ambulances.

R2 million have been allocated this year for the employment of additional Emergency Care Practitioners for the roll-out of the 2 crew ambulance system. The Department intends to extended to all big towns namely De Aar, Springbok, Kuruman and Upington. In the Frances Baard it has been extended to Jan Kempdorp.

A tender procedure for the establishment of a central provincial control room (based in Kimberley) and a vehicle tracking system is in the process of being completed.

 

2. LABORATORY SERVICES

Laboratory services have been transferred from South African Institute of Medical Research (SAIMR) to National Health Laboratory Service (NHLS).

Additional laboratory site in Springbok has already been identified and alterations to the building are to start during this year.

 

3. FORENSIC SERVICES

The taking over of Medico-legal Mortuaries from SAPS by the Department of Health is in progress, auditing has been completed.

The appointment of a Forensic pathologist is in progress. The Department utilizes the services of a Medical Practitioner to assist with Post Mortems in Upington.

Victim Support Centres have been established in the following areas, Galeshewe, Upington, Calvinia, De Aar and Springbok. Plans are underway to establish a centre in Kuruman. The Department provides Forensic Nurses to the centres on an on- call system.

 

4. INFORMATION MANAGEMENT

Through an interactive process with district and programme managers the information priorities were composed into an Essential Data Set (EDS) for this department. The EDS pertains to primary health care issues. In addition we have the monthly Hospital form for hospital information priority areas.

These data fields are forwarded monthly on paper from the facilities to the respective district offices. In the district offices the data from paper instruments are captured onto the District Health Information Software (DHIS). This data is forwarded to the provincial office via email from where it is forwarded to the National health Information Systems of (NHIS) directorate. The provincial information management sub-directorate has the responsibility to convert the data into information that can be used for management decision-making and planning through report writing. Last year in February our first hospital report saw the light and this will be followed by a comprehensive report on hospital, TB and PHC data in may 2002. To make this report comprehensive and to respond to information needs that are not part of the EDS, the provincial information management sub-directorate also developed and maintains the following stand-alone databases:

• Termination of Pregnancy (TOP)
• Notifiable Medical Conditions (NMC)
• Maternal Deaths
• Deaths

TB indicators that can be reported on are:

• Incidence
• Smear conversion rate
• Treatment interruption rate
• Cure rate
• Percentage of patients supported by DOTS
• Percentage of Multi Drug Resistant (MDR) TB

1. TELEMEDICINE

The Telemedicine project, phase one (Ultrasound between Kuruman and Kimberley Hospitals) worked well for only a short while in 2000 (May to August 2000). The project was introduced to the Northern Cape in 1999 as a project of the National Health Information Systems (NHIS) directorate. The project was also funded by the NHIS directorate with requests to provincial departments to budget for recurring telephone line usage costs. Due to technical problems encountered with the connection, it officially started functioning in May 2000. The connection has been set between Kuruman and Kimberley hospitals, with the plan of extending it to other hospitals in the near future.

PROJECT OBJECTIVES: 1. Ultrasound scanning in high risk pregnant women.

The achievements during that period were:

• 12 cases have so far been consulted through telemedicine with only 4 high risk clients eventually transferred to Kimberley hospital. This has greatly reduced the transfers to Kimberley hospital. The other cases are assessed by the consultants when they visit Kuruman hospital with outreach team.
• Telemedicine has also provided an opportunity for community doctors in the district hospitals to learn the basic elements of ultrasonography.

In August 2000 the equipment stopped functioning. After a long process of trial and error fault finding, technicians finally resolved that the camera on the Kimberley side was broken and quoted a sum of R20’000 for repair costs. In January 2002, the NHIS directorate resolved to pay this, but to date the camera has not yet being fixed.

A phase two role-out plan has been drafted and Medical Director is attending to this. To ensure maintenance of phase one and role out of phase two a total of 22 health professionals (nurses and doctors) from Kuruman and Kimberley hospitals attended training in April 2002.

The following issues needs attention in terms of telemedicine in the Northern Cape:

• Future cost – equipment installation, maintenance and recurring costs.
• The poor quality of technical service from the equipment supplier
• Training at other sites in the province

1. HOSPITAL INFORMATION SYSTEM

The hospital information system has been implemented from December 1999 to May 2000 in a staggered fashion starting with KH and ending with Kuruman Hospital.This is a modular system and thus far only patient registration (patient admissions and discharges) and billing modules have been implemented in 6 hospitals in the province. At Kimberley Hospital (the 7th hospital), implementation has progressed into the surgical and pharmaceutical sections. This system also incorporates the software on which the UPFS functions. A review of the system’s functioning, achievements and problems has been conducted in February 2002 at De Aar, Calvinia, Springbok, Upington and Kuruman Hospitals. The Kimberley hospital review is to be done within the next two weeks, whereafter a review report that will guide future developments will be delivered.

 

2. GEOGRAPHIC INFORMATION SYSTEMS (GIS)

The NCDH is working on an electronic GIS that could assist the department in displaying its service coverage geographically. Such a system could also display geographic coverage in terms of some of the department’s special programmes for example VCT sites, DOTS coverage etc. Phase one of this project namely the establishment of the health facilities’ geographic coordinates have been completed.

 

3. HUMAN RESOURCE MANAGEMENT, DEVELOPMENT AND LABOUR RELATIONS MANAGEMENT SOFTWARE

The department plans to go on tender for software packages for the above. This software should determine rationalised an affordable staff establishments for all health services, that reflect the health priorities of Northern Cape Province and ensure appropriate, equitable and affordable distribution of human resources in all offices, services and facilities. The module should also enable GIS mapping of staff category distribution. Two separate software packages will be procured for HRD and labour relations management.

 

4. PHARMACEUTICAL MANAGEMENT

Following the termination of the Sekunjalo contract, the department is in the process of considering two software packages on offer to manage pharmaceutical ordering, warehousing and distribution. These two packages are being compared in terms of functionality, implementation cost, running cost and availability of after sales service.

 

5. GOALS OBJECTIVES AND INDICATORS PROJECT

The NCDH has listed its key health indicators based on national and provincial health goals and objectives for the 2001 to 2005 period. Sources of data as well as methods (routine or surveys) of data collection has been determined to measure these indicators. As part of the twinning agreement between the Northern Cape government and the New Brunswick province in Canada, discussions have been commenced around a performance management tool. It is envisaged that such a tool will enable the department to link inputs to outputs and outcomes.

 

6. TRAINING IN INFORMATICS

In 2001, staff from the provincial information management sub-directorate attended practical statistics courses to improve data analysis and data presentation skills. Provincial and district information officers also attended courses on the DHIS at the UWC during 2001.

Two network controllers successfully completed the A+ course with Damelin in 2001. To facilitate the development of the District Health Information System, "Using Information for Management", workshops were held during June, July and August 2001. The course consisted of three modules and were presented by the HISP team from UWC. 30 facility managers and 1 district Manager from Frances Baard as well as 3 facility managers and 1 district Manager from the Karoo were trained. Similar training for Kgalagadi, Siyanda and Namaqua facilities was commenced in September 2001. Two modules were completed. The third module is planned to be completed during the first quarter of 2002. Information officers from all districts and the provincial office had a three- day work shop in August 2001 to synchronize the DHIS software on all relevant computers.

• Data base development on provincial level
• Information use in districts.
• GIS development on provincial level.
• Telemedicine training among health professional working in the districts.
• Statistical methodology on provincial level.

1. URBAN/RURAL DEVELOPMENT

The Department of Health forms part of the Provincial Interdepartmental Task Team (IDTT) of the Integrated Sustainable Rural Development Program.

A seven- year plan has been submitted to the provincial IDTT and certain projects have been identified for the current financial year.

The objective of the project is to ensure that all people living in each municipality have easy access to a wide range of high quality PHC services and, through referral also to relevant secondary and tertiary services.

 

0. RURAL NODE

Continuous discussion and integrated planning takes place between Northern Cape Province and North West Province in relation to the cross border issues of Kgalagadi District (Moshaweng, Gamagara and Gasegonyane Villages).

A joint District Health Management Committee was established. This committee is tasked to plan and manage the day to day health services in the district and to report to the district municipality and respective provincial Departments.

 

0. PROJECT OUTPUTS:

• All elements of the defined PHC package delivered to defined standards at all health facilities in each municipality.
• There is integration with other priority programs e.g HIV/ AIDS.
• Planning of a new hospital is being undertaken jointly by us and the North West Department of Health.
• Implementation of the Primary Health Care core package as one of the 10 anchor projects in the node as well as ensuring functionality of the clinics.
• The Provincial Health Departments are expected to staff, equip and run provincial PHC services and in consultation with municipalities to upgrade services to meet required standards.
• Different Departments and agencies are to contribute to service delivery where appropriate.
• Additional support and resources from the EU funded project as well as the Equity Project is being provided.

1. URBAN NODE

This urban programme is a deliberate effort, led by the Provincial Government of the Northern Cape to pull together resources from the different departments and agencies, in order to fast track a multi- pronged and multi- sectored development of Galeshewe.

 

0. CAPITAL PROJECTS

Access to primary Health Care facilities is being improved through the building and upgrading of facilities. Establishment of a new Primary Health Care clinic-in a previously under served informal settlement in Galeshewe, is planned for this financial year.

We have pledged R4,74million over five years with R1 million earmarked for this year.

 

1. SERVICE DELIVERY

 

0. TERMINATION OF PREGNANCY

Applications have been submitted to the Minister of Health for accreditation to render Termination of Pregnancy services at Galeshewe Day Hospital.

 

1. GALESHEWE CRISIS CENTRE

Support and Empowerment of Sexual Assault victims is of vital importance. The center run by NGO`s is assisted by the Department of Health by providing a forensic nurse on call on a daily basis.

A total of R6,3 million over 7 years has been pledged by the Provincial Department of Health for the improvement of various services in the node.

 

2. LOCAL COMMUNITY PROJECTS

 

0. HOME AND COMMUNITY BASED CARE

The Home and Community Based Programme has been established in 2001. A 100 volunteers received comprehensive training through St John`s and are in close collaboration with a specific clinic in a particular catchment area. The care- givers are to receive a stipend of R500.00 per month and Health Care kits.

1. COMMUNICATIONS

• Communication Officer appointed in the office of Head of Department.
• Functions include the marketing of the activities and events of the department; establishment of good relations with the media; the promotion of social and health programmes through the rendering of support.
• A quarterly newsletter will be published addressing any new developments in the health sector, acts as an educational tool and focus on key issues within the department
• A Departmental Website is established with the following objectives:
• The internal website will deal with issues of concern to employees.
• The site is a opportunity for management to actively interact with employees and vice versa
• Serve as a notice board
• On Line discussion groups for employees

1. GENDER

• A Gender Unit has been established and a Gender Focal Person appointed.
• Functions include:
• Review policy areas impacting on Gender and assess Gender sensitivity e.g MCWH
• The Unit envisages to sensitize the Department about gender issues.
• Propagate the mainstreaming of Gender
• Co- ordinate training and education of all personnel within the Department to ensure that transformation issues are integrated in all aspects of the Department.
• Emancipation of women i.e Programs of economic empowerment of women focussing on poverty alleviation.
• Ensure that programs aimed at addressing violence against women are incooperated into the Crime Prevention Strategy.
• Monitor the progress of HIV/ AIDS projects

1. KEY HEALTH AREAS

 

1. HIV/ AIDS

The Provincial Government has identified HIV/ AIDS as one of the themes which will be managed in an integrated manner. All provincial Departments, Regional offices of National Departments and Local Government is expected to function within a broad strategy. The Health Department has been identified as the lead Department for this theme. Budgets for HIV/ AIDS within provincial Departments will remain but decisions on action and activities will be collectively taken.

Strategic direction and oversight will be provided by the Provincial and District AIDS Councils with the Department of Health as the lead Department taking responsibility for co- ordination and implementation.

 

1. STRUCTURE

• Provincial Aids Council is functioning
• All Districts AIDS Councils have been launched.
• An Interdepartmental Committee (IDC) is functioning.

1. AWARENESS AND PREVENTION

 

0. AWARENESS CAMPAIGN

 

0. WORLD AIDS DAY

World Aids Day is celebrated annual. This year’s celebration was taken to Colesberg, in the Karoo district. The theme for last year was "I care, do you."

The Interdepartmental Committee demonstrates the transversal nature of the epidemic and ensures participation of all departments in the anti-HIV/AIDS campaign. The committee plays a central role in the organisation of activities, campaigns, including World Aids Day .

 

1. TALK SHOWS

Talk shows on HIV/ AIDS are held throughout the radio stations n the province, these are pre- planned slots.

 

2. BILL BOARDS

The Department of Roads and transport erected bill boards next to various main roads. Living Positive Program in Namaqua and mural paintings done by young adults is visible in the province.

 

2. LIFE SKILLS PROGRAM

The programme is primarily implemented by the Department of Education. The Department has a life-skills coordinator who works hand in hand with the Department of Education, Youth Commission and Department of Sports, Arts and Culture.

The objective of the department is to build capacity in out of school youth on HIV/ AIDS and school youth outside school hours.

Assessment of whether the youth center in Kimberley and Upington are on track in responding to the reproductive and sexual health needs of youth and adolescents

Participatory Learning for Action (PLA) workshop for learners from previously disadvantaged community schools was held.

Training in life-skills are also taking place. To this end Health care workers were trained on attitude changes in order to ensure youth friendly services

• Train 40% of master trainers in life skills
• Train schools to combat HIV/ AIDS through life skill education. This training is to be done in phases and 100% coverage is envisaged.
• The youth in and outside school should have access to youth friendly health services.
• Incorporation of HIV/ AIDS education in the curriculum of the Departments training centre.

1. VOLUNTARY COUNSELING AND TESTING (VCT)

• To date, there are 42 operational Voluntary Counselling and Testing sites of which 3 are non-medical sites.
• There are 2 counsellors per site. The department envisaged to have at least two sites per district and this has been exceeded as each district has on average a minimum of 8 sites.
• 159 Health workers have been trained in rapid testing. All VCT sites have health workers trained in rapid testing.

1. FUTURE PLANS

• Rolling out of the Voluntary Counselling and Testing sites that will see an increase from 42 sites to 100 sites by March 2003.
• Procure 160 rapid test kits for all the active sites.
• Train 5 laboratory technicians in the 2 districts, where there are laboratories, in quality control.

1. IMPLEMENTATION STRATEGY

• Identification of testing sites
• Provision of resources
• Identify suitable NGO for implementation of various training on VCT.
• Marketing of VCT sites
• Train mentors
• Assessment of VCT sites
• Identify existing youth centres for the introduction of Voluntary Counselling and Testing.

1. CONDOM DISTRIBUTION

• There is marked increase in condom distribution
• 5 employees were trained in condom logistic management in the province, one from province, one De Aar, one Upington, one Namaqua and one Kgalagadi.
• Male condoms - from May 2001 to March 2002, 2,573,732 male condoms were distributed.
• Female condoms (Femidomes) - Female condoms are only available in the six sites selected in the Frances Baard district for the purpose of a research conducted by Reproductive health Research Unit(RHRU) for DOH: From August 2001- March 2002, 12 973 Female condoms were distributed

In addition to the sites at Frances Baard, the Department intends to have at least one site per district.

• The infected and affected will receive a comprehensive continuum of services at their homes and communities.
• Referral pathways from home to hospital and vice versa have been identified.
• Pharmaceuticals played an important role in provision and identification of stock to care givers in Kimberley.
• Department of Social Services takes primary responsibility for this programme under the auspices of Health as the lead department.

The department envisages to integrate of poverty alleviation projects with the existing HCBC programmes.

1. IMPLEMENTATION STRATEGY

• Training of DOTS supporters in Home Based Care
• Training of additional 400 members of the community and personnel
• Avail medical supplies and equipment to the care- givers
• A stipend of R500.00 to be paid by Department of Social Services through the Geriatric Association of South Africa
• Allocate R1 Million for Home and Community Based Care

1. INTEGRATED STRATEGY ON CHILDREN AFFECTED AND INFECTED

The three lead sectors Social Services, Public Works, De Beers and Kimberley Child Care has embarked on a project that will provide temporary shelter to orphans whilst placement in the form of foster care and/or adoption is been sought by the organization. The venue has been donated by Education Department at Vuyolwethu School, renovation of the school to the value of R600’000 will be done by Education Department.

Health has committed R282’000, which will cover the running costs, auditing and clinic equipment. Department of Social Services and Population Development will pay salaries of personnel.

A further R1,029 million for the current financial year has been allocated to support the integrated strategy of Community Based and Support models.

De Beers will cover the fencing of the school and other contingency costs while Public Works has provided officials to do the plan, and also the renovations. The launch is envisaged by mid 2002.

 

2. MULTI PURPOSE CENTRE

We are investigating the relocation of the multi- purpose centre to new premises that still needs to be identified. This has been necessitated by the need for office space at Head Office of the Department of Social Services.

1. TREATMENT

 

0. SEXUALLY TRANSMITTED INFECTIONS

• All Primary Health Care facilities have implemented the syndromic management of Sexually Transmitted Diseases
• 10 Master trainers were trained in Frances Baard district on the syndromic management approach through the Health Systems Trust (HST).
• 62 professional nurses were trained by HST in Frances Baard on Management of STI and opportunistic infections.

• The Department of Health envisages to train 20% of the private sector on syndromic management of Sexually Transmitted Infection.
• Establishment of district care groups for the management of STI`s

1. OPPORTUNISTIC INFECTIONS

International Association of Physicians in Aids Care (IAPAC) Health Systems Trust (HST) trained 27 doctors on management of STI and opportunistic infections. These infections include TB, Pneumonia and certain fungal infections.

 

2. DIFLUCAN PROGRAM

302 health care workers were trained by IAPAC on the Diflucan programme, palliative care and treatment of other opportunistic infections. This programme makes this medicine available to HIV / AIDS patients with serious fungal infections.

 

3. SEXUAL ASSAULT PROPHYLAXIS

In terms of the recent cabinet policy decision, anti-retrovirals may be offered to victims of sexual assault. A protocol is being prepared. which will form part of a total package of care which will include counselling.

1. PARTNERSHIPS

• Extended efforts have been undertaken aimed at those NGO’s receiving financial support. Support is also rendered to those not receiving funds.
• 94 Traditional healers were trained in Sexually Transmitted Infections
• 10 NGO `s assisting in the fight against HIV/ AIDS received funding from the Department amounting to R1,6 million.
• In order to increase access to services, the Department of Health and other departments formed a partnership with NGO`s, CBO`s and FBO`s to address overall basic needs by linking various programmes.
• The Department ensures the integration of PWA programmes into the treatment and care strategies, with the provision of continuous support.

1. TUBERCULOSIS

The overall goal of the TB programme is to establish a viable, sustained TB control programme by:

• Ensuring 100% availability of drugs in all our clinics
• To achieve a cure rate of 80- 85% among sputum smear positive tuberculosis cases
• To detect 70% of the estimated new smear positive tuberculosis.

Lower Orange, Kalahari and Upper Karoo have been declared Demonstration and Training Districts (DTD). The ultimate goal is to have all districts as DTD.

1. TB/HIV PILOT DISTRICT

This is a new approach and De Aar has been identified as the TB/HIV pilot site. We hope to learn from the interventions that will take place in this district and roll out to the other districts. This project recognizes the relationship between HIV / AIDS and TB and attempts to deal with it jointly.

Belgian Funding is available for this project and the Province together with the Karoo district submitted business plans to national DOH, and we are awaiting a response. R500’000 for Province and R200’000 for the district.

The Provincial training of the Frances Baard district nurses was conducted in May by national DOH and 45 professional nurses received certificates.

Tuberculosis Alliance DOTS Support Association (TADSA) conducted training for 20 professional nurses in De Aar on TB/HIV/AIDS management in September 2001, in support of the pilot district. Capacity building training for the TB/HIV pilot district was also conducted in Gauteng.

 

2. SMEAR CONVERSION RATES

New Smear Conversion rates for 2001

Retreatment Smear Positive Conversion

1. MENTAL HEALTH

With the enactment of the Mental Health Bill, provincial Government has to adequately prepare for the implementation of the Act. The following preparations are being made:

• Allocation of acute care beds at district Hospitals.
• Extensive training of psychiatric nurses, medical practitioners.
• Identification of staffing needs and the filling of posts as will be determined by the needs.

Integrated mental health services are rendered at Primary Health Care level and Community Health Centres. Previously it was delivered as a vertical programme with resultant problems of access.

The department envisages that all health facilities would render integrated Mental Health Services. To realize this Wits University was commissioned to train 3 trainers on the Mental Health training manual for Primary Health Care Personnel.

West End Hospital will be converted into a dedicated Psychiatric Hospital except for the MDR TB unit.

1. NON-COMMUNICABLE DISEASES

The table below illustrates the disability prevalence of the Northern Cape, the two sources of data were Census 1996 and the CASE Disability Survey of 10 000 households.

In comparison with the national norm the Northern Cape has a comparatively low prevalence of disabilities.

All health Care facilities have been rendered accessible to the Physically Disabled after renovations have been carried out at the facilities.

Applications for assistive devices double on a yearly basis.

• Health facilities to be accessible to persons with hearing impairment.
• Availability of assistive devices to all requiring them.
• Implementation of the National Rehabilitation Policy.
• Effectively manage and control eye conditions at Primary Health Care Level and through the outreach system.

The wheelchair maintenance and repair workshop managed by the Association of the Physically Disabled was opened on 8 January 2001 in Upington. It was initially funded through a Flemish Grant but is now funded by the Department of Health.

Three disabled men who received training through Clinical Emergencies in Gauteng are employed at the workshop.

The project saw these services brought to the Western half of the Province.

Funding to ensure sustainability of the project is considered on an annual basis.

1. PHYSIOTHERAPY SERVICES

Physiotherapists based at Kimberley Hospital Complex render services to the districts/ Primary Health Care facilities through the outreach program.

Community Service Physiotherapists to commence during 2003, this will be of great assistance to the province.

1. NUTRITION

 

0. FOOD SECURITY

To celebrate the Health Month of volunteerism during April, the events for the month kick started with the issue of food gardens which is critical in our efforts to achieve food security. The Health Month was launched in Barkly West and National Minister Ms Thoko Didiza as the guest of honour.

The theme for the month was "Health in Action" and the point of Departure for the launch was "working together as communities and feed our families". This is a joint venture between the Departments of Health and Agriculture.

Department of Education participated in the Essay Competition Project, which is earmarked for learners. Continuous assessment of the projects is undertaken to ensure sustainability.

 

1. PRIMARY SCHOOL NUTRITION PROGRAMME

The Department through this programme contributes to household food security

• 314 schools are funded and 111,362 learners.
• Feeding Committees at all participating schools were trained in Financial Control Measures.
• Schools are monitored and motivated to start with vegetable gardens.
• This project is funded from conditional grants and sometimes takes up to 98% of the funds.
• The programme encourages the participation of women groups.
• Poverty Relief Projects

The following projects were funded during the previous financial year:

• Kharkams Food Gardening,
• Kimberley Hospital Breastfeeding Lodge
• Kalahari Creche feeding scheme
• Sandrift food garden.

1. NUTRITION AND HIV/ AIDS

The Red Cross society is assigned the responsibility to provide food parcels to 100 destitute families per month during this financial year.

A package which will be provided to families has been developed through the assistance of the nutrition unit and caters for all stages of infection. In addition, the infected and malnourished receive food supplements through Primary Health Care Services.

We are conducting workshops and training of the PWA’s on nutrition and HIV/ AIDS

2. NUTRITION AND TB

The programme is geared to assist TB patients to take their medication and improve their nutritional status. Supplements to feed these patients are covered under the Protein Energy Malnutrition Scheme. The nutrition division funds the programme.

1. ENVIRONMENTAL HEALTH

 

0. ACHIEVEMENTS

• Environmental Health Officers are involved in the fight against HIV/Aids
• Cholera education programmes started in two of the five districts namely Frances Baard and Siyanda.
• EHO’s in all the districts became involved in MDR – TB contact tracing
• Health and safety representatives were put in place in the Frances Baard District only. Plans are under way to establishment these structures in the other districts
• Risk assessment conducted at Kimberley Hospital Complex (KHC) main kitchen resulted in improving efficiencies.
• Walkthrough survey conducted at KHC laundry
• Risk assessment conducted at Hartswater Hospital’s radiography department. Resulted in a Northern Cape Occupational Health inspection and recommendations were made to the district manager to improve the conditions.

1. OCCUPATIONAL HEALTH

Occupational Health Services will be launched on 16 May 2002

 

0. TRAINING

• Incorporation of occupational hygiene into the nursing curriculum
• Occupational hygiene co-ordinator(OHC) on MPH programme at Pretoria University 1st year completed
• Health care workers of 30 health care institutions in Namaqua were trained on health care waste management.
• Eight Occupational Health Units in the four district excluding Namaqua to be established in the Northern Cape managed by qualified Occupational Health Practitioners.

1. SURVEYS

The Department of Health has the following ongoing surveys in progress:

• Benefit examination for ex-miners
• Pre-employment screening for new employees.
• Periodical survey health review status of employees.
• Medical exits – for retrenched and retired miners.
• Workplace inspection and audits.

1. PRIESKA PROJECT

• A Community Forum namely Concerned People Against Asbestosis assists to identify and refer the affected to hospitals for benefit examination.
• Assist in the processing of documents that are In turn submitted to Medical Bureau for Occupational Diseases.

1. POSTMANSBURG PROJECT

• During April 2002 the Postmansburg Research Project commenced led by University of Cape Town.

1. HEALTH PROMOTION

The goal of this unit is to promote health and improve lifestyles of the communities.

The Tobacco Act was passed. To sensitize and popularize the new tobacco legislation to public, business, government departments etc, a series of workshops were conducted. Health Promotion programmes have the responsibility of ensuring that effective, comprehensive and integrated Health Promotion activities are performed.

In collaboration with the Education department the legislation will be introduced at schools in the form of debates.

 

2. MATERNAL, CHILD AND WOMEN’S HEALTH

 

0. MATERNAL HEALTH
0. MATERNAL MORTALITY

A high maternal mortality rate has posed particular challenges to the Department

The province recorded 20 maternal deaths for 2000 and 19 in 2001. The mortality rates translated as follows:

To assist with the investigation of deaths and provide support to midwives throughout the Province the following committees have been formed:

• Investigating committee
• Steering committee

These committees are responsible for investigating each death and to ensure that protocols are applied.

With respect to training, 19 midwives are registered with the University of Free State in the advanced midwifery courses. 3 midwives received training as maternal death assessors with 2 allocated to the Districts and 1 at Kimberley Hospital Complex. The department envisages having at least one death assessor per District.

Advanced Midwives oversee policy implementation.

We are reviewing our policies with respect to which Institutions should be resourced for maternity services. A significant contributing factor to our maternal deaths seems to be the distances that must be covered when complications arise during delivery. We are considering only performing deliveries in Institutions where interventions such as caesarean sections are possible.

1. REPRODUCTIVE HEALTH

 

0. TERMINATION OF PREGNANCY (TOP)

In an effort to increase access to TOP services we have trained 2 midwives in Manual Vacuum Extractions and pre and post counselling per District. We also intend increasing TOP services to at least one facility per District. To this end the Department has applied to the Minister of Health to have the following hospitals accredited to render TOP services:

• Galeshewe Day Hospital
• Postmansburg Hospital
• Springbok Hospital and
• De Aar Hospital

Thus the total of 2379 termination of pregnancies since the inception of the programme to the end of 2001

This is a quality improvement programme for PHC services. NAFCI has developed standards and criteria for adolescent friendly clinics. The organization assesses clinics and a number of clinics in the Province take part in the programme. To assist with the implementation of life-skills, a three day training workshop for teachers on life-skills and HIV was conducted. This was done in collaboration with Department of Education.

Complaint Officer appointed at Kimberley Hospital.

Complaints procedure in place.

1. LEGISLATIVE REFORM

• Provincial Health Bill not yet accented by the Premier.
• Establishment of the Provincial and District AIDS Councils
• Provincial workplace policy on HIV/ AIDS to be formulated
• Implementation of the Tobacco Law.
• Occupational Health and Safety Act.
• Employee Assistance Program in draft form