DEPARTMENT OF HEALTH
GAUTENG HEALTH TURNAROUND STRATEGY: TOWARDS
EFFECTIVE SERVICE DELIVERY, STRENGTHENING PRIMARY
HEALTHCARE AND A CLEAN AUDIT IN 2014.
BRIEFING TO THE PORTFOLIO COMMITTEE ON HEALTH
05 SEPTEMBER 2012
OUTLlNE
■ Background
■ Current Context
■ Identifying Key Challenges
■ Objectives
■ Gauteng Health Turnaround Strategy in Detail
■ Summary
■ Way Forward
■ Recommendations
2
MANAGEMENT SUMMARY
The challenges and plans described in this presentation reflect the
inputs of GPG, the MoA with National Government, and the contribution
of the Department of Health’s employees and stakeholders in the
Turnaround Strategy Workshop.
■ The department is facing a serious situation, particularly regarding financial
management.
■ A lot of progress has been made recently
– However, we now need a systematic approach to sustain and build on this progress
■ This Turnaround Strategy sets out the interventions required to achieve this with
concrete activities and timelines.
■ Indications are that it will take a number of years to completely turn the Department
around
■ The on-going support of the Gauteng Provincial Government in this process is
acknowledged.
■ The Executive Authority through the Accounting Officer takes responsibility for the
successful implementation of this turnaround strategy.
3
RECENT CONTEXT
Gauteng POA Analysis 2011/2012: Health
 Achieved: 61%
Good progress: 29%
 Some progress: 10% No progress / No report: 0%
80%
70%
% ACHIEVED
60%
50%
40%
30%
20%
10%
0%
Achieved
Good Progress
Some progress
No Progress/Report
Grey
Q1
67%
29%
2%
2%
0%
Q2
72%
13%
13%
0%
2%
Q3
67%
21%
12%
0%
0%
Q4
61%
29%
10%
0%
0%
Annual
61%
29%
10%
0%
0%
IDENTIFYING THE KEY CHALLENGES
The Auditor General (AG)’s findings and the Premier’s Budget Council (PBC)
helped to identify the key challenges facing the Department:
The Auditor General’s audit opinions 2009-11 focussed on financial
management and information:
■ Tangible assets (Qualified 10/11)
■ Revenue and receivables (Qualified 10/11)
■ Employee benefits (Qualified 10/11)
■ Information deficiency (Disclaimer - predetermined objectives 10/11)
■ Evidence for major variances (Disclaimer - predetermined objectives 10/11)
The Premier’s Budget Council Oct 2011 highlighted:
■ Delegation to hospital CEOs - especially the four central hospitals - to improve
efficiency in infrastructure maintenance
■ Procurement and management concerns at the MSD
■ The management and outcomes of the EMS
■ Medico-legal and litigation issues; and corruption
■ The provincialisation process
■ Human Resources issues , including rationalisation and controls on overtime.
5
The negative cycle that stops us reaching our objectives
Crisis in
leadership
and
management
Budget deficit
and inefficient
budget
management
systems
Demoralised
health workers
Under
resourcing
and
under/over
spending
Crisis in public
confidence
6
THE KEY CHALLENGES TACKLED IN THIS STRATEGY
Through the Auditor General (AG)’s findings and the Premier’s Budget Council (PBC)
we have identified eight key problem areas:
■ Finance and financial management
■ Human resources
■ District health services for Primary health care
■ Hospital management
■ Medico-legal services and litigation
■ Health info management and health info systems (HIS)
■ Communication and social mobilisation
■ Health infrastructure development
We then held a 2-day workshop on 1 and 2 March in order to draw on the
experience and expertise of colleagues and stakeholders from throughout the
health system to understand these problem areas in more detail.
7
THE OBJECTIVES OF THE TURNAROUND STRATEGY
As well as responding to the obligations of the MoA and implementing the decisions
of the PBC and the Provincial Finance Lekgotla, the interventions outlined in this
turnaround strategy should lead to:
■ More effective utilization of available resources by the department;
■ The clearing of debt and accruals;
■ Delivery within allocated budgets;
■ Improvement of health outcomes;
■ Entrenchment of the desired organizational culture and enhanced internal
discipline throughout the organization; and
■ Improved public and partner confidence
8
The positive cycle we need
Effective leadership
and management
management of
people and money
Public confidence in
the health system
Improved quality of
health services
Well resourced
maintained & well
built facilities
Effective
communication and
social mobilisation
High staff morale and
commitment
9
WORK THAT IS ALREADY UNDERWAY (1 of 4)
There is already work underway to begin to address some of these
challenges on a number of fronts. The turnaround plan incorporates this work
and builds on it.
The National-Provincial MoA highlighted the need for work on:
■ Gauteng Provincial Government: adhering to the PFMA; recovering all debts
owed to the Department within FY12/13 and developing a sustainable
reimbursement mechanism.
■ National Government: supporting efficient administration of central hospitals;
Health Information Systems (HIS); strengthening PHC services; National Treasury
assistance in supply chain
Provincial Extended Finance Lekgotla – November 2011.
■ Top-slicing of the Gauteng Provincial Budget; reallocation of surrendered spending
to Health; quick-win infrastructure projects fast tracked;
■ GDF to develop a process to tackle accruals; allocation of infrastructure budget only
to projects that are ready
10
WORK THAT IS ALREADY UNDERWAY (2 of 4)
There is already work underway to begin to address some of these
challenges on a number of fronts. The turnaround plan incorporates this work
and builds on it (continued)
■ 5% top slice health personnel budget 2012/13
■ GDF and Health to collaborate the ensure that the central hospitals are functional
■ 3% top slice (hair –cut) in provincial Equitable Share budget to finance, and set
aside the Provincial Revenue Fund for paying accruals
■ GDF and Health to manage debt and collect about R800 million owed
■ GDF and Health to formulate an action plan for clearing accruals
■ Engage service providers with regards to their payments and negotiating
uninterrupted supply of goods and services
■ Stringent conditions to be put in place to ensure that no further accruals are
incurred after the intervention
■ Clearing of accruals will be managed with Treasury.
11
WORK THAT IS ALREADY UNDERWAY (3 of 4)
There is already work underway to begin to address some of these
challenges on a number of fronts. The turnaround plan incorporates this work
and builds on it (continued)
•
Accruals have been reduced as follows:
– Accruals as at 31 March 2012: R3.6 billion
– Accruals as at 10 April 2012: R1.8 billion
– Accruals as at 13 June 2012: R374 million
– Accruals as at 28 June 2012: R21 million
 Medical Supplies Depot
• R 874m paid in April 2012
•
The total paid from 1 April to 28 June 2012: R4.2 billion
•
•
The above includes current year and prior year invoices.
About R190M waiting to be cleared before declaration
12
WORK THAT IS ALREADY UNDERWAY (4 of 4)
There is already work underway to begin to address some of these
challenges on a number of fronts. The turnaround plan incorporates this work
and builds on it (continued)
KPMG have been engaged to undertake a diagnostic project which will:
■ Support the Department in developing a detailed understanding of the root causes of
the Department’s challenges;
■ Support the move from short-tem crisis management to longer-term development
and provide a solid base for improvement, including skills transfer; and
■ Support the implementation of the Turnaround Strategy
13
THE TURNAROUND STRATEGY IN MORE DETAIL
14
1. Finance and Financial Management
15
Finance and Financial Management
Challenges
Solutions
Maximisation of ■ Establish a Finance Management
outputs and
Committee and demand individual
deliverables with
accountability through internal audits.
the limited inputs
and available
■ Introduce and implement the National
resources.
monitoring template for budget
management.
■ All contracts to be reviewed for currency,
performance, cost effectiveness against
market rates, etc and a report produced.
Time frame Progress
■ June 2012 ■ FMC is established
and is operational
■ Monthly monitoring
template for
conditional grants in
place.
■ June 2012 ■ Audit of all contracts
conducted and a
database compiled
■ Some savings realised
from price negotiations
■ Effective implementation of Cost
containment measures especially with
pharmaceuticals and laboratory services,
and medical equipment procurement and G
Fleet.
■ Head Office to conduct monthly reviews of
vehicle use.
■ MSD business model
re-engineering to
realise savings.
■ 185 GG cars
withdrawn. Fuel and
repairs closely
16
monitored.
Finance and Financial Management
Challenges
Solutions
Maximisation of ■ Work closely with the NHLS to introduce
outputs and
Electronic Gate-Keeping (EGK).
deliverables with
the limited inputs
and available
resources.
■ Review of the MSD business model as
suggested by the AG; in order to increase
patient access to medicine, capacity building
and skills transfer for staff at the MSD,
improve warehousing, development and
implement SOPs, establish a ICT system at
Regional pharmacies, and central hospitals.
Time frame
Progress
■ March 2014 ■ EGK live in 20
biggest spending
hospitals.
■ Saving realised to
date is 0.53% out of
targeted 5% of the bill
(3% realised in the
WC from 5 hospitals)
■ May 2012
■ MSD business model
re-engineering to
realise savings.
17
Finance and Financial Management
Challenges
Solutions
Time frame
Maximisation of
outputs and
deliverables with
the limited inputs
and available
resources.
■ Establish functional Provincial Pharmaceutical
■ May 2012
and Therapeutic Committee (PPTC) to monitor
the use of medicines, ensure rational use of
medicines, interrogate scientific evidence for
protocols, assist with stock management for
availability of EDL and other essential medicines,
and to advise the province on all related matters
Progress
■ PPTC established –
two meetings held.
■ Forensic investigation to be instituted at the MSD ■ June 2012 ■ Investigation
and institute appropriate corrective measures
carried out,
where indicated
preliminary report
with the
Department
■ Appointment of CFO
■ Offer made, to
assume duty in
September.
18
Overview of cost containment plan
•
•
An analysis was conducted and it identified the following Top 14 cost drivers of the
budget over the MTEF period.
The top 14 cost drivers of the department account for R6.5b of the R6.8b goods and
services budget for FY 2012/13
19
Budget 2012/13: Top 14 cost drivers
2011/12
2012/13
2013/14
2014/15
Inventory: Medicine
1,983,967
1,794,393
2,797,365
2,928,772
Inventory: Medical Supplies
1,254,659
1,447,887
896,536
899,303
Property Payments
944,256
1,129,775
1,267,362
1,286,776
Cons/Prof: Laboratory Services
1,328,991
1,003,881
1,239,401
1,145,314
Inventory: Food & Food Supplies
195,927
401,365
226,812
229,593
Contractors
112,692
209,096
148,945
150,551
Inventory: Other Consumables
167,693
134,957
173,800
189,532
Travel And Subsistence
153,633
92,798
92,099
95,231
Inventory: Fuel, Oil And Gas
113,557
80,012
133,725
145,227
Inventory: Stationery & Printing
80,917
68,019
74,307
78,140
Cons/Prof: Business & Advisory Serv
4,024
51,952
3,190
3,390
Communication
123,089
51,199
86,578
92,284
Agency & Suprt / Outsourced Services
202,170
45,680
192,766
197,002
Cons/Prof: Legal Cost
89,569
10,000
51,904
43,779
TOTAL
6,755,144
6,521,014
7,384,790
7,484,894
20
Finance and Financial Management
Challenges
Solutions
Time frame
Progress
Avoiding
accruals and
debt during the
2012/13 MTEF
■ Demand Plans that to be informed by cost
centres for all Health institutions.
■ June 2012
■ Vetting
Committees
established
at all
Institutions.
21
Expenditure analysis
•
•
•
The department has spent R7.156 billion as at 30 June 2012.
This amount is 29% of the overall original budget (R24.5b).
The reason for the over expenditure is the payment of accruals carried over from the previous financial
years.
22
Comparison of expenditure as at June 2011 and June 2012 (2)
FIRST QUARTER EXPENDITURE REPORT ( 30 JUNE 2012 )
Source: Final BAS Reports for June 2012
Economic classification
Current payments
Compensation of employees
Goods and services
Interest and rent on land
Current transfers and subsidies
Provinces and municipalities
Departmental agencies and accounts
Universities and technikons
Public Corporations & Priv Ent.
Non profit institutions
Households
Payments for capital assets
Buildings and other fixed structures
Machinery and equipment
Software and other intangible assets
Heritage Assets
Payments for financial assets
Grand Total
Main
Appropriation
2011/2012
R'000
20,086,491
13,182,665
6,903,826
1,260,665
563,060
13,182
1,162
641,293
41,968
1,490,421
828,229
662,192
22,837,577
Adjusted
Appropriation
2011/2012
R'000
Main
Appropriation
2012/2013
R'000
20,376,456
13,425,885
6,950,571
1,378,487
663,060
13,182
1,162
659,369
41,714
1,631,890
809,388
822,502
23,386,833
Adjusted
% Spent as
Available as
Appropriation Total Actual Total Actual
at 30 Available as at 30 June
2012/2013
June 2011 30 June 2012 % Spent June June - at June 2011
2012
R'000
R'000
R'000
2011
2012
R'000
R'000
21,896,112
15,055,213
6,840,899
1,362,493
602,353
15,103
1,500
692,785
50,752
1,260,731
443,149
817,067
515
-
24,519,336
-
5,187,329
3,263,857
1,923,472
266,758
112,517
3
6,124,842
3,578,340
2,546,138
364
806,341
459,067
13,187
62
313,752
20,273
224,966
71,732
152,396
-
-
-
143,733
10,505
212,934
97,561
115,373
-
-
-
838
-
5,667,021
7,156,149
-
25.8%
24.8%
27.9%
*
21.2%
20.0%
0.0%
0.0%
28.0%
23.8%
37.2%
*
59.2%
76.2%
87.3%
0.0%
14,899,162
9,918,808
4,980,354
993,907
450,543
13,179
1,162
22.4%
25.0%
14.3%
11.8%
17.4%
*
*
24.8%
15,771,270
11,476,873
4,294,761
-364
556,152
143,286
1,916
1,500
45.3%
39.9%
17.8%
16.2%
18.7%
0.0%
*
*
29.2%
497,560
31,463
1,277,487
730,668
546,819
17,170,556
379,033
30,479
1,035,765
371,417
664,671
515
17,363,187
23
Finance and Financial Management
Challenges
Solutions
Time frame
Ensure adequate ■ Commission a study on Gauteng funding for ■ Aug 2012
Budget for Health
Health in order to answer the question: “Is the
Services and
Gauteng Health Department adequately
Grants in 2013/14
funded to meet its constitutional imperatives,
statutory mandates and strategic objectives?”
The outcomes of the study should inform
budget processes for 2013/14 MTEF
process.
Progress
■ Proposal to be
submitted to the
Gauteng Planning
Commission
24
Finance and Financial Management
Challenges
Solutions
Time frame
Ensure adequate ■ Establish the necessary controls for
■ Sep 2012
Budget for Health
implementation of the legislative
Services and
prescripts, policies, procedures and SOPs
Grants in 2013/14
Progress
■ Supply Chain Policy
developed
■ Bid Adjudication
Committee (BAC) revised
■ Rotation of SCM
practitioners implemented
■ Training of CEO’s on
SCM rolled out
■ Migration of procurement
Officials from GDF to
Institutions in Districts
■ Prohibition of Ex Post
Facto
■ Withdrawal of manual
purchase order books
25
Finance and Financial Management
Challenges
Solutions
Time frame
To manage
revenue and
debt.
■ Efficient recovery of R1.1b of outstanding debt ■ Sept 2012
amounting to R1.9b
Progress
■ Joint teams
established with
RAF, Alexander
Forbes, National
Treasury, National
Health, GDF for
reconciliation and
clearing of debt
■ R20M accessed
from NHI Pilot
Grant for revenue
management at
the 4 central
hospitals
■ 48 interns
deployed at central
hospitals through
World bank funded
NDOH programme
26
Finance and Financial Management
Challenges
Solutions
Time frame
To manage
revenue and
debt.
■ Establish strategic partnerships; e.g. with
■ Aug 2012
medical schemes, private hospital groups,
SARS, Department of Home Affairs (DoHA) etc.
Progress
■ Commission the evaluation of the Folateng
Programme.
■ Roll out Biometrics to the 20 top spending
hospitals as part of the solution
■ March 2013
■ Full scale
implementation at
CHBAH and SBAH
27
Finance and Financial Management
Challenges
Solutions
Time frame
Progress
Ensuring that
controls are in
place for the
safeguarding of
assets
■ Develop and implement a comprehensive Asset
Management Plan for the 2012/13 MTEF
■ June 2012
■ Partnership with
NDoH for I-Chain
implementation
■ Train all custodians and managers in the correct
procedures relating to assets and monitor
training outcomes through performance
management and the asset register
■ March 2013
Compliance to
■ A twelve (12) -point plan with indicators and a
the PFMA’s
monitoring framework to be developed and
requirements for
implemented
risk management
■ July 2012
28
2. Human Resources
29
Human Resources
Challenges
Solutions
Time frame
Rationalisation
■ Persal Cleanup (verification of employees)
of staff
establishment to ■ Ensure adequate budgeting for warm bodies
and funded vacant posts.
manage
expenditure on
■ Implement the NSDA-aligned organisational
employees and
structure.
provide good
quality health
services
■ Sept 2012
Accelerate filling ■ Develop and implement a comprehensive
of vacant funded
HRH Plan
posts in key
■ Monitor by Institution, Chief Directorate and
health
District CoE expenditure through monthly
professional
reporting, to align it to the allocated budget
categories e.g.
professional
nurses, doctors,
pharmacists and
pharmacists
assistants
■ Aug 2012
Progress
 Shortfall of about
R800M identified
• Recommended
structure awaiting
DPSA approval
30
Human Resources
Challenges
Solutions
Develop norms
■ Commission a work study for a report in
and standards for
September 2012.
Human
Resources for
Health
Tighten
management of
overtime and
RWOPS for best
value for the
organisation
■ Review and implement policies on overtime
and RWOPS.
Time frame
Progress
■ June 2012 ■ Norms and standards
are in place
■ National process is
underway
■ Sep 2012
■ Policy on overtime
reviewed with capping
of option E
■ Abuse of overtime
identified with
disciplinary action and
potential recovery of
losses
■ All CEO’s sign off and
account for overtime
based on need and
budget availability
31
Human Resources
Challenges
Solutions
Time frame
Progress
Tighten
management of
overtime and
RWOPS for best
value for the
organisation
■ Clinical Heads to also be held accountable for
abuse of Overtime and RWOPS by their staff.
■ Nov 2012
■ Two high profile
cases of RWOPS
abuse ( One case
charged with fraud
and corruption and
another dismissed)
Increase
productivity and
accountability
through effective
performance
management
■ Strengthen the implementation of the PMDS in
the Department.
■ March 2013
■ Ensure comprehensive Induction
■ Communicate the Departmental Code of
Conduct clearly
■ Act decisively on cases of poor performance
■ Establish an Ethics Office within Department
32
Human Resources
Challenges
Solutions
Time frame
Progress
Align Human
resource
Development
plans with the
Strategic
Direction of the
Department
■ HRD Plan for Pharmacy Assistants and
advanced Midwives to be developed for
implementation September 2012.
■ July 2012
■ Training
programme
underway place for
600 Pharmacy
Assistants
■ Policy and budget support for midlevel workers
and community health workers.
■ Dec 2012
■ Revive, revise actively implement the MOU with
the Three Academic Health faculties in the
Province.
■ Sep 2012
33
3. District Health Services For Primary Health Care
34
District Health Services
Challenges
Solutions
Time frame
Accelerate
development of
District Health
Systems
■ Re-organise the three regions and six health ■ Sept 2012
districts office (staff and budgets) into Five
Health Districts
■ Three Regions
dissolved and staff
absorbed in 5 Health
Districts
■ Appoint District Managers for the Five
Provincial Health Districts
■ July 2012
■ 4 Districts have full
time managers
■ Appoint a DHS manager at Central Office
■ Aug 2012
■ Recommendations
for appointment
made
■ Develop and implement Health District
Referral Policies
■ Social mobilization for each Health District
Progress
■ Mar 2013
■ GSSC migration to follow a District-based
model.
35
District Health Services
Challenges
Solutions
Time frame
Progress
Streamline the
provision of
Primary Health
Care across all
spheres of
government
■ Develop and implement a provincial PHC
reorganisational plan
■ April 2013 ■ Task team appointed
36
District Health Services
Challenges
Solutions
Align budget and ■ Budget 2012/13 to increase allocation to
human resources
the Districts
to support
District Health
■ Development and implement of a costed
Services and
Provincial Single PHC package
implement the
Primary
■ Five year Provincial Business and
Healthcare
Operational plan for the implementation
Reengineering.
of the Primary Health Care reengineering programme as part of the
NHI
Time frame
Progress
■ April 2012
■ Highest budget increase in
the current financial year
(18%)
■ April 2013
■ Driven by NDOH
■ July 2012
■ Primary Healthcare teams
in place in most wards
■ Primary Healthcare
Specialist Teams
appointed in all districts
■ School Health Programme
initiated
Implement
National Facility
Improvement
Programme
■ Develop and implement a business plan ■ April 2012
and operational plan for the Tshwane NHI
Pilot and the related conditional grant
■ Business plan developed
and funded
■ Conduct an assessment of compliance
■ Sep 2012
with all the National quality indicators and
develop quality improvement plans for all
institutions and facilities in all health
districts
■ 60% of facilities assessed,
improvement plans
developed and
implemented in
collaboration with the 37
NDOH
District Health Services
Challenges
Solutions
Time frame
Ensure
■ Develop and implement an EMS and PPT ■ Sept 2012
responsive
improvement plan
Emergency
■ Appoint EMS – CEO
Medical Services
and infrastructure
systems
including for
Planned Patient
Transportation
Mobilise and
support
leadership
structures of
society and
communities
■ Ensure that all Hospital Boards and Clinic ■ March 2013
Committees are in place and fully
functional
Progress
■ Two consecutive
selection interviews
unsuccessful
■ Partnerships with the
private sector
established
■ Induction completed for
all hospital board
members.
38
4. Hospital Management
39
Hospital Management
Challenges
Solutions
Time frame
Strengthen
governance and
environmental
control systems
in hospital.
■ Ensure adherence to and compliance with
National Essential Equipment List, National
Essential Drug List, National Essential
Laboratory Services List
■ Mar 2014
■ Medical supplies norms and standards to be
developed and implemented for all hospitals
■ Mar 2013
Build facilitative ■ Establish management/clinical heads to
relationships
provide a platform for participatory
among all cadres
governance and information sharing at all
of Health Service
hospitals
Providers.
Pay special
attention to
challenges
confronted by
nurses.
Progress
■ June 2012
■ Nurse Manager (Chief Director) to be
appointed at Central Office
■ Oct 2012
■ Nursing management strategy to be
developed and implemented
■ Nov 2012
40
Hospital Management
Challenges
Solutions
Time frame
■ HIV and AIDS, TB and general wellness
services to be provided at the workplace
■ April 2013
■ Targeted in-services training and skills
development and implemented
■ Sep 2012
Progress
■ Training programme
underway
Intensify public
■ Social mobilisation and communication.
■ Sep 2012
education for
■ Development of distribution and utilization
appropriate
plans for and with Family Medicine Specialists
utilisation of
health services
and
establishment of
effective district
– based referral
systems
41
5. Medico-legal services and litigation
42
Medico-legal services and litigation
Challenges
Solutions
Time frame
Reduce rates of
adverse events
and medical
negligence,
especially in
Obstetrics and
Gynaecology,
Surgery,
emergency unit
and
Orthopaedics.

■ March 2013
Reduce work environment related risksource constraints e.g. Breakdown in
equipment.
 Unavailability of commodities
 Increased patient volume and
disease burden
 Utilisation of junior staff with poor
supervision and support.
Progress
43
Medico-legal services and litigation
Challenges
Solutions
Build capacity on 
effective
management of
medico-legal
cases





Time frame
Enter into appropriate settlement
■ April 2013
negotiations and institute disciplinary
measures immediately on confirmation
of medico-legal negligence by
employees.
Report cases of proven medical
negligence to the HPCSA.
Establish a multidisciplinary Case
Review Committee of experts.
Conduct a skills audit and implement an
appropriate organisational structure for
legal services.
Develop and implement a proposal on
the use of an ombudsman.
Address challenges with State Attorney
Services.
Progress
■ Appointment of Chief of
Legal services in
progress
■ Working closely with the
office of the Premier and
NDOH on case review
and court representation
44
6. Health Information Management and Health
Information Systems
45
Health Information Management and Systems
Challenges
Solutions
Time frame
Provide
Strategic
direction for
Health
Information
Systems.
■ Develop and implement a
comprehensive , long term ICT
strategy for health.
■ Sept 2012
Ensure
availability of
adequate ICT
skills (HR)
■ Perform ICT Skills Audit
■ April 2013
■ Recruit Appropriate Staff
■ Develop and implement an
evidence-based and targeted skills
development plan
Progress
■ Chief of ICT to assume duty in
September 2012
■ March 2014
46
Health Information Management and Systems
Challenges
Solutions
Time frame
Update a full
technology
equipment and
LAN, and
provide
support and
maintenance
on equipment.
■ Conduct a full ICT audit
■ Sept 2012
■ Develop and implement an ICT
upgrade plan
■ October
2012
■ NDOH to assist with the migration
plan for HIS
■ March 2013
■ Overhaul MEDSAS to improve
efficiency of Pharmaceutical
Services throughout the system.
■ March 2013
Streamline
systems for
unified Health
Information
System.
■ Through GDF, enforce Telkom to
meet contractual obligations
■ June 2012
■ Through the NDOH, develop a
business proposal for VPN (Virtual
private network) (or alternative)
■ Sept 2012
Progress
■ MSD reengineering program
underway
■ Driven by NDOH
47
Health Information Management and Systems
Challenges
Solutions
Mainstream
■ Develop and implement a costed plan to
Information
unify systems based on National e-Health
Management and
strategy
Accountability
■ Initiate single HIS
Time frame
Progress
■ Sept 2012
■ Driven by NDOH
■ March 2015
■ Benchmark on good practice and phase in
the roll out of effective automated systems
■ Establish a Provincial Health Information
■ Sept 2012
Systems Committee as required by NIHSSA
■ Introduce Information management into
PMDS.
■ Adopt, adapt and implement national
DHMIS policy to rationalise registers
■ March 2014
■ Provide preservation of files.
■ Provide well structured records classification
system.
■ Data elements to be regulated by the
accounting officer
■ Development of systematic disposal
programme
■ March 2014
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7. Communication and Social Mobilisation
49
Communication and Social Mobilisation
Challenges
Solutions
Time Frame
Develop and
articulate a
communication
strategy
■ Gauteng Health Communication strategy is
approved and shared with communicators in
regions and facilities
■ April-Jun 2012 ■ Communication
strategy is in
place
Mainstream of
communication
management
throughout the
organisation
■ Training of all district and facility managers in
key health issues and media management.
■ May’12Mar’13
Develop a service
provider
identification
mechanism
■ Photo, name and contact details of CEOs must ■ Sep 2012
be prominently displayed to facilitate filling of
complaints
■ Appoint communicators for all four central
hospitals
Progress
■ All four central
hospitals have
communicators
■ Complaints line must be popularised
■ Apr’12-Mar’13 ■ Queue
marshals are in
■ Queue marshals at all facilities to help patients
place
with complaints
■ Written complaints must be responded to
within seven days (monitoring and reporting)
■ Commission annual service perception survey
■ Mar 2013
50
Communication and Social Mobilisation
Challenges
Solutions
Time frame
Progress
Streamline
responses to
complaints from
the public for
positive media
publicity.
■ Media tours to showcase centres of excellence
and new developments in facilities
■ March
2013
■ Programme of the
Executive
Authority
51
8. Health Infrastructure Management and
Development
52
Health Infrastructure
Challenges
Solutions
Time frame
Health
■ All institutions to develop and implement
infrastructure
costed infrastructure, maintenance and
refurbishment
rehabilitation plans
and rehabilitation
■ Accounting Officer to conduct Quarterly
reviews of infrastructure maintenance and
rehabilitation plans
■ Sept 2012
■ Establish strategic partnerships to improve
infrastructure management
■ Sep 2012
■ Establish a departmental infrastructure
regulatory committee for proper prioritisation,
planning, implementation and maintenance
■ Aug 2012
Ensure
■ Develop and begin to implement a 5-year
accountability for
Health Infrastructure Plan
infrastructure
project planning
to produce the
risk of delays and
scope and budget
increases
Progress
■ March 2013
■ DBSA and NDOH
MOA is in place for
seven major funded
projects
■ Sept 2012
53
Health Infrastructure
Challenges
Solutions
Time frame
Improve capacity ■ Conduct a skills audit and capacity
for effective
improvement plan for the Health
project
Infrastructure Unit at Central Office and in
management.
the Districts
■ July 2012
■ Senior Manager
appointed for
Infrastructure
projects
Prioritise local
■ Infrastructure projects to comply with the
procurement and
new Provincial Procurement Policies
economic
participation in
health
infrastructure
maintenance and
building projects
■ October 2012 ■ Discussion document
on “localization” for
maintenance
compiled with DID
54
In summary …
55
The Big 3 Key Activities
Leadership
capacity at head
office
• CFO and five CDs
• DDG to manage HR, Districts,
• CDs : Communications, Litigation Management, Project managers
for infrastructure
Get an
unqualified audit
in 2012/13
• Engage services of one of big 5 as appropriate
• Incentivisation contract
• In house development as CFO etc come on board
Reputation
management
•
•
•
•
Put together the crack interventions team
Rapid deployment to crisis situations
Proactive media and public updates
Daily response to media queries
56
Follow the Money
Ensure a steady
revenue stream
Frequent payment
of suppliers and
clearing of accruals
Budget Reform
•Engage consultancy to bring in existing debts on percentage basis
•Regular billing and cost recovery
•Get a full understanding of the scale of the debt
•Active involvement of hospitals, district offices and the medical supplies depot.
•Schedule regular payments and communicate
•Schedule payment of accruals and communicate
•Standardise inputs for different types of health facilities
•Understand what is going on with personnel budget
•Standard drug and equipment lists
•Bias to the district health system
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The big 3 to give the system hope
Resource
health facilities
Fill critical
vacant posts
Communicate
the changes
• Standard drug list and supply
• Standard equipment list, regular
maintenance and supply
• Fast and dirty on staff to patient load
• Fast and dirty on critical posts in
each facility
• Start at with the budget speech
• Meet all staff and stake holders
58
Way forward
•
•
•
•
•
•
The Gauteng Health Turnaround Strategy will be available on the intranet to all
employees.
Road shows will be conducted to all districts and central hospitals,
Managers will develop performance agreements and operational plans for the
implementation of the Turn Around Strategy
Institutions and Districts will develop operational plans in line with the interventions
outlined in the Turnaround Strategy.
A Performance Monitoring and Evaluation Framework is being developed in consultation
with the Gauteng Planning Commission.
Quarterly reports will be provided to the Gauteng Provincial Government EXCO.
59
Recommendations
■ It is recommended that the Health Portfolio Committee notes the Gauteng Health
Turnaround Strategy.
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Thank you
61