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REPORT ON A SERVICE DELIVERY
INSPECTION OF DISTRICT HOSPITALS AND
CLINICS REGARDING AVAILABILITY OF
MEDICINES AND MEDICAL EQUIPMENT AND
THE ROLE OF HEALTH DISTRICT OFFICES
DEPARTMENT OF HEALTH:
FREE STATE PROVINCE
APRIL 2014
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province i
TABLE OF CONTENTS
FOREWORD .......................................................................................................................... iii
LIST OF ACRONYMS ........................................................................................................... iv
1. INTRODUCTION .......................................................................................................... 1
2. OBJECTIVES OF THE INSPECTIONS ....................................................................... 2
3. SCOPE AND METHODOLOGY ................................................................................... 3
3.1 Scope ........................................................................................................................... 3
3.2 Methodology ............................................................................................................... 3
4. LIMITATIONS OF THE STUDY ................................................................................... 3
5. KEY FINDINGS ON ANNOUNCED INSPECTIONS .................................................... 4
5.1 Contextual background .............................................................................................. 4
5.2 Management of medicines ......................................................................................... 5
5.3 Management of medical equipment ........................................................................ 13
5.4 Governance of health facilities ................................................................................ 15
5.5 Challenges................................................................................................................. 16
6 KEY FINDINGS ON UNANNOUNCED INSPECTIONS ............................................. 18
7. IMPLEMENTATION OF PSC RECOMMENDATIONS .............................................. 25
8. READINESS OF THE INSPECTED FACILITIES FOR THE ROLL-OUT OF
NATIONAL HEALTH INSURANCE (NHI) .................................................................. 25
9. RECOMMENDATIONS: ............................................................................................. 26
9.1 Announced Inspections ........................................................................................... 26
9.2 Unannounced Inspections ....................................................................................... 26
10. CONCLUSION ............................................................................................................ 27
11. ACKNOWLEDGEMENT ............................................................................................. 27
ANNEXURE A: A LIST OF FACILITIES VISITED AND OFFICIALS THAT WERE
ENGAGED ............................................................................................................................ 28
UNANNOUNCED INSPECTIONS IN THE CLINICS ............................................................ 30
ANNEXURE B1: Availability of medical equipment at inspected clinics ....................... 30
ANNEXURE B2: Availability of medical equipment at the inspected hospitals ............ 32
ANNEXURE C1: Availability of medicines at inspected clinics ...................................... 33
ANNEXURE C2: Availability of medicines at inspected hospitals ................................. 35
ANNEXURE D: THE STATUS ON THE IMPLEMENTATION OF RECOMMENDATIONS
OF THE PSC’S INSPECTIONS CONDUCTED IN 2009 ...................................................... 36
Tables
Table 1: Objectives of inspections ......................................................................................................... 2
Table 2: Sites and dates of inspections ................................................................................................. 3
Figures
Figure 1: Medicine management cycle .................................................................................................. 6 Figure 2: Availability of tracer drugs at health facilities ......................................................................... 11
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province ii
Pictures
Picture 1: Pharmacies of Phuthaditjhaba and Bophelong clinics with burglar doors to ensure
controlled access and safety of medicines. ......................................................................... 8
Picture 2: Medicines and medical consumables packed neatly on the shelves at Tokollo District
Hospital ................................................................................................................................ 9
Picture 3: Medicines stored in a refrigerator with controlled temperature at Brentpark Clinic. ............ 9
Picture 4: (left) Medical waste bucket still in use at Brentpark clinic. (Right) Medical waste buckets
sealed and safely stored for safe removal by a medical waste management company. .. 10
Picture 5: (Left) Reception area at Tokollo Hospital. (Right). Neat bedding in a ward at Tokollo
Hospital. ............................................................................................................................. 18
Picture 6: The wall (left) and floor (right) at Bophelong clinic show a crack which poses a health and
safety risk. .......................................................................................................................... 19
Picture 7: The grounds of Brentpark clinic need proper gardening. .................................................. 19
Picture 8: Cluttered sluice room used to store wheelchairs and other essentials. ............................ 20
Picture 9: A store room for medicines is also used to keep food for staff. ........................................ 20
Picture 10: The water tank at Brentpark clinic which needs to be installed. ........................................ 21
Picture 11: Poster in Sesotho and depicting tips on how to wash hands to promote hygiene. ........... 22
Picture 12: Business hours displayed at Brentpark Clinic. .................................................................. 23
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province iii
FOREWORD
South Africa’s burden of disease, consisting amongst others of a high rate of HIV/AIDS is
consistent with health challenges affecting many developing countries which are
characterized by high levels of poverty. Thus, health care is one of the key government
priorities as well as an essential service which should be accessible to all the citizens of the
country.
Key to ensuring a long and healthy life for all is having sustainable health care infrastructure
that is responsive to the needs of the citizens. To this end, primary health care facilities have
been established to ensure that citizens receive health services at the local level.
Furthermore, the National Health Insurance (NHI) will ensure equal access to quality health
care for all citizens. Amongst others, it is important that health care facilities should at all
times have sufficient medicines as well as adequate medical equipment for timeous and
quality treatment, if government is to succeed in mitigating the burden of disease and
ensuring a long and healthy life for all citizens. Furthermore, health facilities should function
in a manner that is in line with the Batho Pele principles of service delivery.
It is against this background that the Public Service Commission (PSC) deemed it necessary
to conduct inspections to determine the availability of medicines and medical equipment.
The inspections also sought to determine the implementation of the PSC’s previous
recommendations in this area and readiness of the health care facilities for the imminent roll
out of the NHI. Generally, it was found that despite supply chain challenges, medicines and
medical equipment were largely available at the sites visited. Out of 17 PSC’s
recommendations, 16 (94%) were implemented. Based on the findings and observations, it
is the PSC’s view that the visited health facilities were ready for the roll out of the NHI.
However, they require urgent attention relating to shortages of health care professionals.
It is with pleasure to present the Report on Service Delivery Inspection of Hospitals and
Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health
District Offices in the Free State. We believe that the inspections remain a valuable
monitoring mechanism whose findings could contribute towards service delivery
improvement.
The PSC wishes to thank officials of the Free State Department of Health (FSDoH) for their
cooperation and willingness to share information. We trust that the findings will help the
FSDoH in its efforts to improve service delivery for sustainable and quality health care.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province iv
LIST OF ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
AO Accounting Officer
ARV Antiretroviral
BP Blood Pressure
CEO Chief Executive Officer
CHC Community Health Centre
CPU Central Processing Unit
DAP District Acquisition Plan
DDV Direct Delivery Voucher
DHP District Health Plan
DHS District Health System
EA Executive Authority
EDL Essential Drugs List
FEFO First In, First Out
FSDoH Free State Department of Health
HIV Human Immunodeficiency Virus
HoD Head of Department
MCC Medicine Control Council
MEC Member of the Executive Council
NEDLC National Essential Drugs List Committee
NEMLC National Essential Medicine List Committee
NDP National Development Plan
NDPSA National Drugs Policy of South Africa
NHA National Health Act
NHI National Health Insurance
PHC Primary Health Care
PMCC Provincial Medical Consumables Committee
PSC Public Service Commission
PTC Pharmaceutical and Therapeutic Committee
RDM Remote Demander Module
SCM Supply Chain Management
SLA Service Level Agreement
SOPs Standard Operating Procedures
STG Standard Treatment Guidelines
TB Tuberculosis
WHO Wealth Health Organisation
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 1
1. INTRODUCTION
South Africa (SA)’s burden of disease mainly consists of HIV/AIDs (i.e. Human
Immunodeficiency Virus/Acquired Immune Deficiency Syndrome), communicable diseases,
non-communicable diseases, and trauma emanating from violence and injuries with
consequent high levels of morbidity and mortality1. The impact of this burden of disease is a
shortened life expectancy. To address this burden of disease, government at its Cabinet
Lekgotla held from 20 to 22 January 2010 adopted as one of its twelve Outcomes: A long
and healthy life for all South Africans.
Health care is one of the key government priorities as well as an essential service which
should be accessible to all citizens of the country. The foregoing is predicated on a
sustainable quality health care infrastructure. However, unless sufficient medicines as well
as adequate medical equipment are available at health facilities, government will not
succeed in its key objective of ensuring a long and healthy life for South Africans.
The introduction of the National Drug Policy of South Africa (NDPSA), in line with the World
Health Organization (WHO) guidelines, by the National Department of Health in 1996 aimed
at ensuring equal access to medicines for all South Africans. It is the aim of the NDPSA
through the Essential Drugs Programme, which includes an Essential Drugs List (EDL) and
Standard Treatment Guidelines (STG) to ensure that medicines are available at all health
facilities. It is against this background that the citizens expect health facilities to always have
medicines in sufficient quantities as well as the necessary medical equipment.
Furthermore, our constitutional imperatives dictated that government should devolve certain
responsibilities for health services to the provincial and local government2. As a result, the
District Health System (DHS) was established in terms of section 29(1) of the National
Health Act, 2003 to ensure that communities at local level have access to the quality health
care that they are entitled to3. Accordingly, the Provincial Departments of Health created
District Health Offices to facilitate the delivery of health services by hospitals and clinics at
district level. District Offices are expected to play a critical supportive role of ensuring that
health facilities are adequately resourced at all times for the optimal provision of quality
health care to citizens.
The Public Service Commission (PSC) deemed it necessary to conduct service delivery
inspections on availability of medicines and medical equipment at selected health facilities,
as well as to determine the role of Health District Offices in this regard. Inspections are
meant to entrench a citizen and service-centred culture, and reinforce accountability across
the Public Service. Furthermore, they provide the PSC with a first-hand opportunity to
experience what is happening at service delivery sites, and thus strengthen the oversight
work of the PSC. The inspections at the selected health facilities also present an opportunity
of determining their readiness for the imminent roll out of National Health Insurance (NHI).
1 Republic of South Africa. National Department of Health. Strategic Plan for Nurse Education, Training and Practice
2012/13 – 2016/17. 2 Republic of South Africa. National Department of Health. White Paper for the transformation of the Health
System in South Africa . 1997. 3 Republic of South Africa. National Health Act. 2003.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 2
Conducting inspections is in line with the Public Service Commission Act, 1997, Section 9,
which provides that “the Commission may inspect Departments and other organizational
components in the Public Service and has access to such official documents or may obtain
such information from Heads of those Departments or organizational components as may be
necessary for the performance of the functions of the Commission under the Constitution or
the Public Service Act4.”
2. OBJECTIVES OF THE INSPECTIONS
According to the PSC’s protocol on announced and unannounced inspections, the broad aim
of inspections is to assess the quality of services rendered by departments, the state of
facilities and the conditions at service delivery sites, in order to ensure adherence to
stipulated regulations and other government frameworks 5 . Table 1 below provides the
specific objectives of an inspection as defined in the PSC Protocol as well as those
pertaining to this inspection on the availability of medicines and medical equipment.
Table 1: Objectives of inspections
Objectives of an inspection Objectives of inspections on the availability of
medicines and medical equipment
To afford a personal opportunity to
experience the level of service delivery
first-hand and to see what kind of service
delivery challenges are facing staff.
To determine the availability/adequacy of medicines
and equipment at clinics and district hospitals.
To engender a sense of urgency and
seriousness among officials regarding
service delivery.
To establish the role of district health offices in
ensuring the availability of adequate medicines and
equipment at clinics and district hospitals.
To introduce objective mechanisms to
identify both weaknesses and strengths
towards improving service delivery.
To establish whether provincial departments of
Health have developed guidelines and procedures to
manage the selection, procurement, distribution and
use of medicines.
To report serious concerns about the
quality of service delivery and compliance
with Batho Pele requirements.
To establish whether provincial departments of
Health have developed guidelines to manage the
procurement, distribution and maintenance of
medical equipment.
To carry out investigations of serious
failures as pointed out by inspections; and
To determine the plans of the provincial departments
of Health to resolve any identified problems
experienced in relation to the procurement,
distribution and use of medicines as well as
maintenance of medical equipment.
To improve service user care relations in
order to promote a user-oriented public
service.
To establish the specific institution’s compliance with
the implementation of the Batho Pele Framework in
relation to medicines and equipment.
To determine the challenges experienced by the
district offices of health in ensuring that medicines
and equipment are available at the health institutions.
4 Republic of South Africa. Public Service Commission. Public Service Commission Act. 1997. 5 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 3
3. SCOPE AND METHODOLOGY
3.1 Scope
The inspections sought to gather first-hand information regarding availability of medicines
and medical equipment at selected district hospitals and clinics. A representative sample of
both urban and rural health facilities, which included the sites previously inspected in 2009,
was therefore targeted for inspection to determine the availability of medicines and medical
equipment. In particular, the Thabo Mofutsanyana District was selected on the basis that it
has been identified for the pilot of the NHI.
All identified sites were preceded by a brief discussion with the officials of the provincial and
relevant district offices in order to obtain an overview of the situation in respect of the sites
visited. The table below shows the inspected sites.
Table 2: Sites and dates of inspections
Provincial/District Office Component/Institution Date of Inspection
Provincial Office Sub-Directorate: Pharmaceutical Services 19/09/2013
Medical Depot 29/10/2013
Fezile Dabi District Office 30/09/2013
Brentpark Clinic 30/09/2013
Bophelong Clinic 30/09/2013
Tokollo District Hospital 01/10/2013
Thabo Mofutsanyana District Office 07/10/2013
Elizabeth Ross District Hospital 08/10/2013
Phuthaditjhaba Clinic 08/10/2013
Bluegumbosch Clinic 09/10/2013
3.2 Methodology
The methodology for conducting the inspections followed both the announced and
unannounced inspections as prescribed in the PSC’s protocol for conducting inspections6.
The inspections sought to understand the challenges experienced by the citizens in
accessing quality health care especially regarding the availability of medicines and medical
equipment at the sites visited and the role of the health district offices in this regard.
To initiate the inspection process, letters were forwarded to the Executive Authorities (EAs)
and the Accounting Officers (AOs) of the National and Provincial Departments of Health,
informing them about the PSC’s intention to conduct inspections in the selected hospitals
and clinics. Furthermore, the inspection team held engagements with the Provincial
Departments to set the scene for the inspections.
4. LIMITATIONS OF THE STUDY
The inspections were conducted at selected district offices and health facilities and as such
the findings relate to views and observations made at the said sites. The following limitations
were identified:
6 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 4
The PSC inspection team comprised members who are not experts in the medical
field and relied on the officials of the department to identify the medicines and
medical equipment at the visited sites. It should, however, be mentioned that the
officials appreciated the importance of honesty in this regard as the availability of
these resources will enable them to function optimally.
The inspections did not evaluate the implementation of NHI. However, critical issues
to NHI such as the availability of medicines and medical equipment were inspected to
determine its readiness for roll-out.
5. KEY FINDINGS ON ANNOUNCED INSPECTIONS
The findings of the announced inspections are presented into key thematic areas, which are
the management of medicines and the management of medical equipment. This will be
preceded by a contextual background.
5.1 Contextual background
In order to set the scene of the inspections and understand the extent of the problem, the
inspection team held a meeting with the Manager: Pharmaceutical Services of the Free
State Department of Health (FSDoH) on 19 September 2013. The purpose of the meeting
was to obtain an overview of the province’s DHS as well as information regarding policies
relating to the Primary Health Care (PHC) services, especially with regard to the distribution
of medicines and the management of medical equipment.
It emerged during discussions that the procurement of pharmaceuticals, medical
consumables and medical stationery used by district hospitals and clinics in the Free State
province is handled by an appointed Medical Depot (who procures such from the medical
suppliers). The inspection team was provided with a copy of the Service Level Agreement
(SLA) between the Medical Depot and FSDoH, which was reviewed and signed on 01 July
2013 and 13 August 2013 respectively. Furthermore, it emerged that District Offices must
develop District Health Plans (DHPs) as required by section 33 (1) of the National Health
Act, 2003 (NHA). It was found that the DHPs, which include a situational analysis on the
burden of disease as well as mitigating strategies, were developed and presented to the
Member of the Executive Council (MEC) of Health in the province in line with the NHA.
Furthermore, it was found that District Offices would consolidate and forward their orders in
terms of pharmaceuticals, medical consumables and medical stationery directly to the
Depot. However, an arrangement has been made for direct procurement by district hospitals
from the suppliers, which is in line with the Minister’s announcement of direct procurement
from suppliers7. The details of this arrangement are contained in paragraph 5.2.2.
The inspection team was also informed that challenges were experienced with the delivery
of pharmaceuticals, medical consumables and medical stationery in the beginning of the
2013/2014 financial year due to unavailability of stock at the Medical Depot. This was as a
result of outstanding payments of ±R32 million from the department to the suppliers for the
7 Republic of South Africa. Department of Health. Strategies to improve Performance in South Africa to ensure Universal
Health Coverage, Quality Care, Hospital Effectiveness and Affordability of Health Care. 2013
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 5
previous financial year, 2012/2013, who subsequently withdrew their services to deliver
stock at the Medical Depot. Although the suppliers were later paid after funding was
obtained from Provincial Treasury, the delayed payment was in contravention of Treasury
Regulation 8.2.3 which provides that “… payments due to creditors must be settled within 30
days from receipt of invoice”. It also emerged that some of the suppliers were no longer
willing to do business with the Medical Depot following the crisis. As result, the Medical
Depot experienced shortage of stock which further delayed deliveries to the health facilities.
The inspection team was informed that the situation had since improved and at the time of
the inspection, there were very few cases of shortage of medicines.
With regard to medical equipment, the inspection team was informed that the Provincial
Head Office is responsible for the procurement of equipment from minor to major assets.
Health facilities within districts submit their needs to the District Offices which are
consolidated and submitted to the Provincial Head Office, whereas the provincial and tertiary
hospitals submit their needs directly to the Provincial Head Office for acquisition.
Furthermore, the inspection team met with senior officials of both the Fezile Dabi and Thabo
Mofutsanyana District Offices on 30 September 2013 and 07 October 2013 to determine
their role in ensuring that medicines and medical equipment are available at health facilities.
According to the Handbook for Clinic and Community Health Centre (CHC) Managers,
supervisors should visit these facilities monthly to oversee operations and offer support8. In
addition, the inspection team visited the selected health care facilities within these districts to
determine the availability of medicines, medical equipment and the maintenance thereof as
well as the support received from the District Offices.
5.2 Management of medicines
An analysis of the National Drug Policy of South Africa (NDPSA) indicates that the
management of medicines essentially involves five key functions namely, selection,
procurement, management support, distribution, and use. The diagram below maps the
critical steps of effective and efficient medicine management. (It should be noted that for the
purpose of this report, reference to medicines includes pharmaceuticals, medical
consumables and medical stationery). In this regard, the findings on the management of
medicines are structured according to this integrated process.
8 Republic of South Africa. Department of Health. Handbook for Clinic/Community Health Centres Managers. October
1999.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 6
Figure 1: Medicine management cycle
5.2.1 Product selection
National essential drug lists, together with standard treatment guidelines, serve as the basis
for formal education and in-service training for health professionals and for education about
medication use for the public9. Scrutiny of the NDPSA indicates that the National Essential
Medicines List Committee (NEMLC) or National Essential Drugs List Committee (NEDLC),
appointed by the Minister of Health, is responsible for the selection and revision of a national
list of essential medicines for three levels of care, i.e. PHC, secondary and tertiary hospitals.
The NEMLC/NEDLC is composed of experts in all spheres of medical and pharmaceutical
practice.
During interaction with senior officials at both Fezile Dabi and Thabo Mofutsanyana District
Offices, it emerged that Pharmaceutical and Therapeutic Committees (PTCs) were
established at Provincial, District and hospital levels. The main objective of the PTCs is to
“ensure the rational, efficient and cost-effective supply and use of drugs”10. To this end, the
PTC’s function includes the identification of new drugs for possible inclusion on the EDL
based on consideration of scientific evidence of efficacy, substantial safety, risk/benefit ratio
as well as best cost advantage of the identified drug. According to the district officials, any
identified new drug or list of recommended new drugs is then considered by the District PTC.
Once agreed, the drug or list of drugs is consolidated and submitted to the Provincial PTC
for support, and subsequently forwarded for final consideration by the NEDLC. PTCs at
provincial and district levels are expected to hold meetings quarterly, whereas the hospital
PTCs should meet monthly. Copies of the minutes of the relevant District PTCs were
produced, which confirmed the frequency of meetings. Furthermore, the minutes of the
9 Jane Hutchings et al. United States of America. The Role of Essential Medicine Lists in Reproductive Health. December
2010. Volume 36. 10 Republic of South Africa. Department of Health. National Drug Policy of South Africa. 1996.
Product
selection
Rational use,
monitoring and
evaluation
Distribution and
storage
Procurement
Management support:
Information system
Organisation/staffing
Budgeting
Training
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 7
provincial PTC dated 29 May 2013 confirmed the deliberations on possible addition of new
medicines on the EDL at this level. It is the view of the PSC that product selection is well
institutionalized and contributes effectively toward the availability of medicines at health care
facilities.
5.2.2 Procurement
In terms of the general principle of the SLA between the FSDoH and the Medical Depot all
pharmaceuticals, medical consumables and medical stationery used in facilities falling under
the control of the FSDoH must be procured from or through the Medical Depot unless
permission to buy out such items has been granted to the facility. It was confirmed by
officials at Fezile Dabi and Thabo Mofutsanyana that all clinics and CHCs place their orders
monthly which are consolidated at district level for submission to the Medical Depot. The
inspection team was also informed that facilities such as District hospitals may in addition to
ordering from the Medical Depot through the district offices, use the Direct Delivery Voucher
(DDV) and “buy-out” methods. In terms of the DDV method, the order is placed through the
Medical Depot by the District hospital, but the medicines are delivered directly to the
hospitals by the supplier and/or pharmaceutical company. The “buy-out” method means the
hospital orders directly from the suppliers or pharmaceutical companies on a quotation
basis. However, the “buy-out” method is only allowed in the case of an emergency and
subject to prior permission by the FSDoH. This was to ensure that items were ordered in
accordance with the SLA and also based on the EDL. Officials at district hospitals confirmed
that they took advantage of the DDV and “buy-out” methods when necessary to obtain
medicines. This level of flexibility allows for efficient acquisition of urgently needed medicines
at the health facilities, and thereby ensuring stock availability.
5.2.3 Distribution and storage
Distribution: According to the SLA the Medical Depot is responsible for the delivery of
stock to facilities within four (4) weeks of the receipt of orders from individual facilities.
During the visit to Fezile Dabi and Thabo Mofutsanyana, the inspection team learned that
delays were experienced with deliveries of orders in the beginning of the 2013/2014 financial
year. The longest delay experienced was eight weeks as reported by Thabo Mofutsanyana
and this was mainly due to the financial challenges raised by the Provincial Office.
Inspections at the Medical Depot also found that a serious shortage of stock was
experienced in the beginning of the 2013/2014 financial year due to the late payment of
suppliers by the FSDoH, which resulted in most of the suppliers no longer willing to do
business with the Department and deliver stock at the Depot. The inspection team also
learned that other challenges arose after the payment to suppliers was made. For instance,
the Medical Depot, which is servicing a total of 423 facilities in the province, battled to
arrange for deliveries of ordered stock within the set timeframes as per the SLA due to
insufficient staff capacity in dealing with the resulting backlog of deliveries. Although
remunerated overtime was instituted, this was only for a short period due to financial
constraints. The inspection team was, however, informed by officials at Fezile Dabi that
some of their staff were made available to assist the Depot with the sorting of ordered stock
according to specific facilities. This expedited the packaging process and made huge
improvement in addressing the backlog.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 8
Another challenge the Depot experienced in the beginning of the financial year was that the
newly appointed contractor for delivery of stock to all facilities in the province was unfamiliar
with some of the routes. This, therefore, resulted in further delays of deliveries to health
facilities.
The above challenges of late deliveries of ordered items were corroborated by all the visited
hospitals and clinics in both districts. For example, Tokollo District Hospital mentioned that it
had to arrange its own transport to fetch ordered stock at the Depot due to the reported
delays in deliveries.
Storage: Standard Operational Procedures (SOPs) were found to be in place to ensure
control of access to the facilities’ pharmacies, safety and appropriate labelling of medicines
and medical consumables. The inspection team observed at the clinics and hospitals visited
that the pharmacies were always locked and notices displayed prohibiting unauthorized
access, and as such, there was generally compliance with the SOPs.
Picture 1: Pharmacies of Phuthaditjhaba and Bophelong clinics with burglar doors to ensure controlled access and
safety of medicines.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 9
The inspection team also observed that all medicines and medical consumables were neatly
packed on the shelves with appropriate labelling for easier identification.
Picture 2: Medicines and medical consumables packed neatly on the shelves at Tokollo District Hospital.
Furthermore, the temperature in all pharmacies and refrigerators used for storing certain
medicines was appropriately controlled to sustain the quality of the medicines.
Picture 3: Medicines stored in a refrigerator with controlled temperature at Brentpark Clinic.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 10
Proper stock control measures should be put in place to ensure safety of medicines and
medical supplies as well as to minimise discrepancies. According to the NDPSA, all
unwanted and expired drugs, medical supplies and associated waste should be disposed of
promptly, efficiently and safely. It was observed that the inspected clinics and hospitals were
using stock cards which were regularly updated based on stock availability and to inform
future orders. The inspection team further observed that all health facilities were using the
“first expired, first out” (FEFO) principle in identifying outdated medicines on their shelves to
ensure quality of medicines in keeping with the provisions of the NDPSA.
Furthermore, the inspection observed that the necessary waste buckets were provided for
safekeeping of medical waste. It was also found that once the buckets were full they were
sealed and safely placed where they were later collected by a medical waste management
company for incineration.
Picture 4: (left) Medical waste bucket still in use at Brentpark clinic. (Right) Medical waste buckets sealed and safely
stored for safe removal by a medical waste management company.
5.2.4 Rational use, monitoring and evaluation
Rational use: The NDPSA recognizes the key educational role of pharmacists in instructing
patients in the correct use of medicines and to provide preventive health services. According
to the guidelines for the district pharmacist in the province, clinics must be visited monthly by
the supervisor and a written record of the supervisor’s visit should be left with the clinic. The
purpose of the visits is to oversee the operations and provide pharmaceutical support,
especially in ensuring that the Standard Treatment Guidelines (STGs) are strictly followed by
the nursing staff. Although officials at the District Offices informed the inspection team that
visits were being regularly conducted, evidence of such visits by pharmaceutical officials
could not be found during examination of the visitors books at inspected facilities. Even
though the nursing staff at Brentpark and Bophelong indicated that the clinics were receiving
regular pharmaceutical support, the lack of evidence of these visits points to a challenge in
this regard. It was not in keeping with the Handbook for Clinic and CHC Managers. It was,
however, heartening to observe that the nursing staff at the visited facilities was guided by
the STGs in ensuring that patients were informed of the correct use of medicines including
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 11
providing them with accurate information on any dietary considerations whilst taking the
prescribed treatment.
Monitoring and evaluation: District Offices should manage the availability and safe use of
medicines at health facilities. The inspection team observed that there was a system called
Tracer Drugs used in the province for monitoring the availability of medicines at health
facilities. In this regard, a checklist has been developed by which a sample of essential
medicines is selected and monitored for availability at the health facilities. Based on the
checklist, reports were produced indicating which medicines were out of stock. Such
reporting took place weekly, monthly and quarterly and was linked to reporting against the
DHPs in line with the National Health Act, 2003. According to the DHPs for Fezile Dabi and
Thabo Mofutsanyana, the target for availability of medicines and medical consumables was
95%. The inspection team’s analysis of the quarterly reports of the two districts indicated that
most clinics in Fezile Dabi had coverage of 98% and in particular, the Tokollo hospital
achieved 99%, while clinics in Thabo Mofutsanyana and Elizabeth Ross hospital had
coverage of 95% and 99% respectively.
Figure 2: Availability of tracer drugs at health facilities
The foregoing performance suggested that the District Offices maintained consistent
availability of medicines at the facilities despite the challenges experienced in the beginning
of the 2013/2014 financial year. Upon enquiry with officials at Fezile Dabi, it emerged that
this was not entirely as reported. The District held the view that the small sample of
essential medicines utilized for monitoring availability might have presented a skewed
picture. It was also indicated that health facilities which experienced a shortage of certain
medicines were able to borrow from other facilities which had sufficient reserves of such
medicines. This ensured uninterrupted services whilst the challenge at the Depot was being
attended to. Having buffer stock at facilities was in line with the NDPSA.
Furthermore, the inspection team was informed by the nursing staff at inspected facilities
that there was no serious shortage of medicines. For instance, at Bophelong clinic the
nursing staff indicated that only Ferrous Sulphate (to be administered in the case of iron
deficiency in pregnant women) and Pentaxim (immunization for babies between ages of 2 to
4 months) were in short supply. However, the inspected facilities indicated that the situation
had improved following the payment of suppliers by the FSDoH as earlier indicated.
95%
98%
99%
95%
99%
93%
94%
95%
96%
97%
98%
99%
100%
Target for tracerdrugs
Fezile Dabi Clinics Tokollo Hospital ThaboMofutsanyana
Clinics
Elizabeth Ross
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 12
One of the functions of the PTC is the regular monitoring of medication errors and adverse
drug events at health facilities. The inspection team was informed that medication errors
may arise in instances of misdiagnosis of an illness. Scrutiny of the minutes of the provincial
PTC dated 28 August 2013 showed that a case of an adverse drug event was dealt with and
subsequently reported to the Medicines Control Committee (MCC) for further attention. At
Tokollo hospital the PTC in May and July 2013 dealt with cases of medication errors.
5.2.5 Management support
On-going support in terms management systems and processes is crucial for the effective
functioning of facilities.
Information technology system: According to the NDPSA computerized inventory control
systems should be established in all hospital pharmacies and clinics, and be linked to
computerized inventory control systems at the depots. The objective is to ensure the prompt,
efficient, timely and equitable distribution of essential drugs and medical supplies to all
health care institutions 11 . During inspection at the Medical Depot the inspection team
observed that the Medical Depot uses the Medfas system.
Furthermore, the inspection team obtained a copy of the Health Notice No. 5 of 2009 in
which the FSDoH directed all health care facilities in the province to use a computerized RX
Solution as from 1 November 2009 to capture pharmaceutical stock. The system has other
key functions such as determining stock levels and expiry dates as well as forecasting of
needs for sufficient ordering purposes. It was, however, observed during inspection that not
all visited facilities were using the system. Only Bluegumsbosch clinic and Tokollo and
Elizabeth Ross hospitals were using the system and was linked with the Medfas system at
the Medical Depot. The linkage is through a Remote Demander Module (RDM) software
programme, which was mainly used for ordering stock. The inspection team was informed
that the roll out of the RX Solution in all facilities was impeded by budgetary constraints.
The staff at Tokollo hospital also informed the inspection team that the computer on which
the RX Solution is installed, was being used for administrative duties as well. This was due
to a shortage of computers and network points. Tokollo hospital provides a 24 hour service
and regularly requires uninterrupted access to the RX Solution for optimal utilisation of the
system in effectively managing availability of medicines, including distribution of medication
in the wards. The dual use of the computer at the hospital meant that critical pharmaceutical
functions could not be performed while the computer was being used for administrative
duties, which impacted negatively on effective and efficient service delivery.
Other inspected clinics were still using the manual stock card system for ordering purposes
and stock control. This system was time-consuming and impacted negatively on service
delivery as it took days before the clinics could establish the appropriate stock levels to
inform ordering of new items. Previous inspections of the PSC emphasized the need for the
11 Republic of South Africa. Department of Health. National Drug Policy of South Africa. 1996.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 13
FSDoH to provide health care facilities with the requisite information technology (IT)
equipment in order to ensure the improved quality of service12.
Training: Training is important to ensure that employees are knowledgeable about what is
expected of them and also to keep abreast of new developments in order to provide quality
services to their clients. Although no evidence of specific training support with regard to
issues of medicine management was found at the inspected facilities, the inspection team
was shown a copy of a compact disc on drug management at Fezile Dabi. It was, however,
observed that other training support was provided by the District Offices. For example,
evidence was found of training relating to mental health, HIV/TB management, foetal alcohol
syndrome, lung diseases, infection control, and health and safety issues at Tokollo,
Elizabeth Ross and Bluegumbosch hospitals. Road shows on substance abuse and an anti-
rape campaign were also conducted. These training interventions were proactive measures
as they were focused on prevention rather than cure. They were also in keeping with
government’s commitment to increase life expectancy, decrease maternal and child
mortality, combat HIV and AIDS and decrease the burden of disease from TB through
education to ensure informed choices by the citizens. The District Offices should be
commended in this regard.
Staffing: In terms of the NDPSA, pharmacists play the critical role of managing medicine
supply in both hospital pharmacies and clinics. The inspection team was informed by visited
facilities that there is a need for additional capacity considering that there are only two (2)
pharmacists responsible for overseeing 28 clinics in the province. Similar concerns of
capacity constraints at health facilities were previously highlighted by the PSC during its
inspections of health care facilities in 200913. It is the view of the PSC that staff shortages
often result in employees being overworked and thus leading to low staff morale, which may
impact negatively on the quality of service.
5.3 Management of medical equipment
Availability of sufficient medical equipment at health facilities is integral to providing quality
health care.
Procurement: The District Offices informed the inspection team that the procurement of
medical equipment is centralised at the Provincial Head Office. All health facilities were
expected at the beginning of the new financial year to submit their annual needs to the
relevant District Offices for consolidation into District Acquisition Plans (DAPs). The District
Offices were accordingly expected to make budget provisions based on the DAPs and
forward the plans to the Head of the Department (HoD) for approval. Once the plans were
approved and the budget allocated, the purchasing of equipment was dealt with in terms of
the applicable provincial Supply Chain Management (SCM) procedures. Upon receipt of an
order to purchase, the approved supplier may then deliver the consignment to the relevant
facilities. The inspection team observed that all the facilities adhered to the process. The
inspection team was, however, informed at Elizabeth Ross Hospital that delays in the
12 Republic of South Africa. Public Service Commission. Consolidated Report on Inspections of Primary Health Care
Delivery Sites: Department of Health. 2010. 13 Republic of South Africa. Public Service Commission. Consolidated Report on Inspections of Primary Health Care
Delivery Sites: Department of Health. 2010.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 14
ordering of medical equipment were experienced during the 2013/2014 financial year due to
the late approval of the acquisition plan by the HoD.
Quality of medical equipment: It emerged that a Provincial Medical Consumables
Committee (PMCC) has been established which held its meetings quarterly. The role of the
PMCC was to deliberate on complaints received from facilities relating to poor quality of
equipment from certain suppliers in order to inform future procurement processes. Facilities
were required to document these on a standard form for consideration by the PMCC.
However, Elizabeth Ross hospital indicated that in some instances the equipment received
was of poor quality. The hospital attributed the poor quality of equipment to the SCM process
of selecting the cheapest quotations. Similar concerns were also raised by the
Phuthaditjhaba and Bluegumbosch clinics. At Bophelong clinic the nursing staff complained
that the Vicidex haemoglobinometer provided unreliable readings even though it was still
new. In response, the Fezile Dabi District was surprised to learn that the clinic was still using
the said item which the District no longer procured. The foregoing points to weaknesses in
the Department’s monitoring and audit processes, especially the effectiveness of the PMCC,
to ensure that facilities report on poor quality items so that these were no longer procured
from affected suppliers in future.
Asset control: Medical equipment involves the use of state funds and must be safeguarded
to ensure accountability. At all facilities visited, the inspection team found that the function of
asset control is centralised at the District Offices. It was also found that the acquired
equipment is captured on the asset register which is updated following an asset audit on a
monthly basis.
Maintenance of equipment: During interaction with the Provincial Head Office, the
inspection team was informed that there are no provincial guidelines for maintenance of
equipment. The District Offices indicated that they were responsible for maintenance of
equipment such as baby incubators and autoclaves. Facilities were expected to make a
requisition for the maintenance of equipment by the contractors by completing a prescribed
Form H24. At Elizabeth Ross and Tokollo hospitals, the inspection team was provided with
copies of their medical equipment maintenance plans which showed that the last inspections
of equipment were conducted on 10 September 2013 and 20 September 2013 respectively.
Amongst others, the aforementioned plans reflected the following details:
Type of inspected equipment;
Model/make;
Serial number;
Life span of equipment;
Its condition;
Where it is located;
Frequency of service required; and
Recommendations.
The visited clinics and District Offices did not provide the inspection team with proof of
maintenance of their medical equipment. However, most of them indicated that they did not
have challenges with medical equipment. Only Bophelong clinic raised concerns that the
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 15
electronic Blood Pressure (BP) machine required maintenance as it often provided incorrect
readings especially after prolonged usage. As a result, the clinic would revert to the manually
operated BP equipment. Although no serious challenges of misdiagnosis have been
reported at the clinic, it was a concern to the nursing staff that they always have to confirm
the readings with the manually operated equipment. It also raised a concern of value for
money to have equipment which cannot be utilised.
Disposal of medical equipment: The inspection team was informed that the whole process
of disposal of equipment was handled by the District Offices. According to officials at the
District Offices the status of identified items was first verified by a team of technicians from
the Provincial Health Office before the certificates could be issued for the items to be
declared redundant or obsolete. Once the approval was granted the asset controllers from
the District Offices would take the process forward. All the visited facilities indicated that they
submitted lists of items identified for disposal to the District Offices for consolidation and
further handling. The inspection team did not find any obsolete equipment at the visited
facilities.
5.4 Governance of health facilities
Since public funds are used to provide public services, it is important that those charged with
the responsibility to provide such services are held to account to ensure, amongst others,
responsiveness and value for money. In this regard, section 41(6)(a) of the NHA requires of
the relevant MEC to appoint a representative board for each public health establishment
classified as a hospital and to prescribe its functions and procedures for meetings. In terms
of section 42(1) of the NHA, provincial legislation must at least provide for the establishment
of clinic committees.
Hospital boards: In line with the provisions of the NHA, one of the eight core management
standards of the DHS is that the community acts as a shareholder in hospital management
and should be represented on the hospital board 14 . During interaction with the District
Offices, the inspection team was informed that hospital boards have been established, and
were convening regular meetings.
At Tokollo hospital, the inspection team was welcomed by a member of the hospital board
who apparently had earlier held a meeting with the CEO of the hospital. The board member
expressed great appreciation for the support the board was receiving from the hospital in
discharging its function. The CEO of the Tokollo hospital also mentioned that the members
of the hospital board were sometimes summoned to the provincial Portfolio Committee of
Health and further reported to the MEC if they were not satisfied about certain issues. The
foregoing suggests that a positive relationship exists between the hospital and the board,
which engendered confidence amongst the community that the hospital was responsive to
its inputs in ensuring the quality of service at the hospital.
During discussion with management at Tokollo and Elizabeth Ross District Hospitals, the
inspection team was informed that the function of the hospital board is to relay the
14 Republic of South Africa. A District Hospital Service Package for South Africa. A set of norms and standards. May 2002.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 16
complaints of the community to the hospital management regarding issues such as
cleanliness, waiting time and availability of equipment and medicines. In addition, the
hospital board also informed the members of the community about new developments at the
hospital. Minutes of the Tokollo hospital board dated 22 August 2013 were scrutinized, and it
was found that the community provided inputs on issues relating to patient care, safety and
water amongst others.
The inspection team further analysed the minutes of the Elizabeth Ross hospital board held
on 04 July 2013. According to the minutes, the chairperson of the hospital board had a
meeting with traditional leaders and councillors to inform them about the stolen computer
Central Processing Unit (CPU) from the Radiology Department of the hospital. In addition,
three (3) board members attended a community meeting on 06 June 2013 at Paballong
Village to give feedback on developments and challenges at Elizabeth Ross hospital. This
implied that the Tokollo and Elizabeth Ross hospital boards were operational in keeping with
the constitutional principle of public participation.
Clinic Committees: Clinic committees are essential for consultation with the communities
on health improvement issues and also to act as a link with the Department. The inspection
team was informed by the District Offices that clinic committees have been established and
functioning as required. At the Phuthaditjhaba and Bluegumbosch clinics, the inspection
team interacted with some of the members of clinic committees. It emerged during
discussion with them that committees were operational and held their meetings monthly.
Furthermore, the committees convened meetings when there were issues raised via
suggestion boxes that needed urgent attention. For instance, the suggestion/complaint
boxes were opened once a week by two (2) clinic committee members and the Operational
Manager of the clinic.
Minutes of the committees were also examined. The inspection team observed that critical
issues dealt with by the committee for Bluegumbosch clinic related to the long waiting
periods, the need for extended hours, a relief system for lunch breaks and shortage of
nursing staff and security officers. The foregoing issues were apparently identified during
patient satisfaction surveys conducted by the clinics. A complaint lodged through the
complaints box against a doctor was also dealt with. According to the nursing staff the
aggrieved patient was invited to make a representation in the case and the matter was
resolved.
Furthermore, the inspection team observed that clinic committee members also assisted with
cleaning and queue marshalling. A register was examined at Phuthaditjhaba clinic wherein
committee members signed every day and recorded what they have done. This ranged from
opening of the windows when the clinic operations commenced to discussing the theme of
the day or week with patients. The foregoing is consistent with the developmental state
agenda as espoused in the National Development Plan (NDP) and was also in keeping with
government’s slogan which says “together we can do more”.
5.5 Challenges
The following challenges were identified as impacting negatively on effective and efficient
service delivery at the inspected facilities:
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 17
Staff shortage: It emerged that there was generally a staffing challenge of professionals at
most of the visited facilities. Considering that primary health care is primarily nurse driven,
shortage of nursing staff is likely to affect the quality of health care at the facilities if not
addressed. The inspection team was informed by the Manager: PHC at Fezile Dabi District
that most facilities were still operating on old post structures. It was, however, comforting to
learn that the MEC was in the process of reviewing the structures to align these with the
demands placed on the facilities arising from the general population increase in the province.
At Bophelong clinic, the inspection team was informed that there was a need for additional
professional nurses due to the high patient turn-out experienced by the clinic. The nursing
staff indicated that the clinic has six (6) professional nurses, who often attended to
approximately 200 patients per day. Although this number meant one (1) nurse attended to
33 patients per day and seemed sufficient based on the nationally approved nurse to patient
ratio of 1:40, the nursing staff found this to be inadequate. The inspection team was
informed that the staff was insufficient as some of the nurses have to take leave, attend
meetings or training. This results in the available nurses being inundated with work, and has
impact on the quality of services at the clinic.
According to the CEO of Tokollo hospital there was a high labour turnover especially of
young professionals as most felt that there was nothing attractive in and around Heilbron to
encourage their long-term stay. This was due to lack of amenities such as schools,
recreational facilities and accommodation in Heilbron, which is predominantly a farming
area. The CEO further mentioned that the hospital was forced to utilize some of the staff in
other functions in which they were not sufficiently trained. Utilization of staff in different
functions promotes learning of new skills, and was in keeping with good practices such as
job rotation or job enrichment. While this may serve as a short term solution to the hospital’s
capacity problems, it is the view of the PSC that the arrangement may cause burnout with
the potential to adversely affect the quality of the service offered by the staff in the long run.
Thus a long term solution should be sought. Concerns of shortage of staff are worrying
especially since the PSC’s previous inspections highlighted these challenges as well as the
need to fill vacancies, particularly in the professional and pharmaceutical fields15.
Infrastructure: One serious challenge that was raised at the Thabo Mofutsanyana District
Office and visited facilities was the intermittent power failures in the area, which is serviced
by the Maluti-A-Phofung Local Municipality. This has largely impacted on the functioning of
equipment and care of drugs and medical consumables that need to be stored in
refrigerators. Furthermore, the battery for the Blood Gas Machine, which requires electricity
for recharging was eventually damaged as a result of the recurrent power failures. The
inspection team was informed that the Elizabeth Ross Hospital management had raised the
challenge of weak power supply in the area with the Local Municipality, but there had not
been any improvement. It was also found that the Elizabeth Ross Hospital’s backup
generator was damaged in July 2013 and needed replacement. Although the matter was
raised with the provincial department, approval for the replacement had not been obtained at
the time of the PSC inspections.
15 Republic of South Africa. Public Service Commission. Consolidated Report on Inspections of Primary Health Care
Delivery Sites: Department of Health. 2010.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 18
Budget constraints: Lack of funds impacted on the roll out of the RX Solution information
system to all facilities in the province. At Tokollo hospital a concern was raised that the X-ray
machine had almost reached its lifespan, and needed to be replaced urgently. The cost of
replacing the equipment was estimated at one million rands, and the hospital was uncertain
as to when it will be replaced. This presents a serious challenge for the hospital in providing
quality health care. This also points to a lack of proper budget planning by the Department
as a similar challenge was experienced as indicated earlier with the non-payment of
suppliers to the Medical Depot for the 2012/2013 financial year.
6 KEY FINDINGS ON UNANNOUNCED INSPECTIONS
The findings from unannounced inspections are presented below. Batho Pele as a key
strategy for the transformation of Public Service delivery sets out specific principles that
should be adhered to at all times 16 . The purpose of unannounced inspections was to
determine the extent to which the visited health care facilities adhered to these.
6.1 Observing facilities
Condition of premises: Most visited facilities generally appeared clean and well
maintained.
Picture 5: (Left) Reception area at Tokollo Hospital. (Right). Neat bedding in a ward at Tokollo Hospital.
It was, however, observed that the Bophelong clinic’s building had a worrying crack which
further affected its floor. The crack poses a serious health and safety risk. The Department
needs to repair the observed crack urgently.
16 Republic of South Africa. Department of Public Service and Administration. The Batho Pele White Paper on the
Transformation of Public Service Delivery, 1997.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 19
Picture 6: The wall (left) and floor (right) at Bophelong clinic show a crack which poses a health and safety risk.
The inspection team also observed that the clinic’s grounds required attention. The
inspection team was informed that it does not have a groundsman. According to the nursing
staff, the grounds were only cleaned once by a service provider at the beginning of the 2013
year. However, the clinic was not provided any reasons why the service provider did to visit
the clinic.
Picture 7: The Brentpark clinic need proper gardening.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 20
Lack of space: Brentpark clinic does not have enough space. The inspection team
observed that the sluice room was being used to store wheelchairs and other essentials. A
concern of lack of confidentiality during consultation was also raised by the nursing staff. For
instance, it was indicated that the nurses often had to whisper to patients when dispensing
medication to protect their privacy due to the insufficient space.
Picture 8: Cluttered sluice room used to store wheelchairs and other essentials.
Furthermore, the staff did not have a proper kitchen and was using the store room for
medicines as kitchen.
Picture 9: A store room for medicines is also used to keep food for staff.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 21
Lack of water: Another challenge at Brentpark clinic related to poor water supply from the
Moqhaka Local Municipality. Although the inspection team was shown a water tank which
was donated to the clinic by the Municipality, it had not been installed. The lack of water
poses a serious hygiene challenge.
Picture 10: The water tank at Brentpark clinic which needs to be installed.
At Bophelong clinic the nursing staff complained about the quality of water which led to a
number of cases of diarrhoea.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 22
6.2 Access to information
The Batho Pele principle of access to information requires information to be readily available
to citizens in order to empower them and address their needs.
Service charters: The inspection team found that service charters and other key
information were displayed in all facilities visited, and these were displayed in English,
Afrikaans and Sesotho. Sesotho is one of the predominantly spoken languages in the areas
visited, which was empowering and restored the dignity of the previously disadvantaged
communities. It was also in line with the Batho Pele principle of Information.
Picture 11: Poster in Sesotho and depicting tips on how to wash hands to promote hygiene.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 23
Business hours: All the inspected facilities had clearly displayed their business hours as
required by Batho Pele principle of access.
Picture 12: Business hours displayed at Brentpark Clinic.
Redress: In order to elicit feedback from citizens on the services they received, all national
and provincial departments were expected to have complaint/suggestion boxes. The
inspection team found that there were complaint/suggestion boxes in all hospitals and clinics
visited. The complaint procedure was displayed next to the complaint/suggestion boxes and
it was written in English and Sesotho. It was also found at Tokollo hospital that there was a
quality assurance coordinator responsible for opening the box and ensuring that complaints
were resolved at the lowest possible level.
6.3 Talking to citizens
Citizens as consumers of the services provided by the institutions are in the best position to
give feedback on the state of service delivery. Their views and comments are important in
any effort meant to improve service delivery. Interviews were conducted with randomly
selected citizens on the quality of services rendered.
Availability of medicines and equipment: Most citizens at the visited hospitals and the
clinics indicated that they promptly received their medication after consultation. They also
stated that the facilities had sufficient equipment to provide quality services to them.
However, one citizen at Bophelong clinic informed the inspection team that there were
previously instances where patients were turned away and requested to return on specific
days due to unavailability of medication. The aforementioned concern was consistent with
the findings at the Provincial Office relating to non-payment of suppliers which affected the
supply to the Medical Depot at the beginning of the 2013/14 financial year. The inspection
team also observed that the clinic did not have carry bags for dispensing medication, which
exposed the patients’ medication to other people and, therefore, infringed on their
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 24
constitutional right to privacy. The views of the interviewed citizens corroborated the
responses of the nursing staff that there were few challenges with the availability of
medicines and quality of medical equipment.
Confidentiality: The inspection team was informed by citizens at Brentpark clinic that there
was lack of confidentiality with regard to patients’ medical files based on the filing system
used by the clinic. It was observed that the clinic has labelled files for HIV/AIDS with a blue
sticker. According to the interviewed citizens this information was known to other patients
and as such, infringed on the right to privacy of the affected patients who did not wish to
disclose their medical condition. The leaking of information about the health of patients is in
contravention of the provisions of the NHA which states that “all information concerning a
user, including information relating to his or her health status, treatment or stay in a health
establishment is confidential”17.
Waiting time: Interviewed patients in most of the facilities visited informed the inspection
team that they waited too long before they were attended to. Most citizens mentioned that
the waiting period was on average 3 hours, except for Tokollo hospital where citizens
indicated the waiting period as approximately 1 hour. It should, however, be mentioned that
the staff at the visited facilities informed the inspection team that waiting times varied on
average from 15 minutes to four (4) hours depending on the nature of the case being dealt
with.
Access: Although it was found that in most cases clinics were located within a radius of 5
kilometres (km) from residential areas as required by the norms and standards for health
clinics, there were instances such as in Phuthaditjhaba where citizens travelled between
10km to 20km to access a clinic. Citizens were concerned that the distances were too far to
the extent that they had to utilize public transport which was costly, especially to the poor
and vulnerable.
Consultation: During interaction with citizens in all visited clinics, the inspection team was
informed that there were clinic committees which provided them an opportunity to raise their
concerns with the clinic management to ensure improved quality of services. This finding is
in line with Batho Pele principle of consultation. It is also consistent with the observation
made by the inspection team with regard to redress above.
It is the view of the PSC that the concerns of the patients with regard to the waiting time
suggest that the standards were not consulted with them to ensure that they were clearly
understood and their buy-in obtained. The Batho Pele principles of consultation and
information require public institutions to adequately consult with citizens and provide them
with sufficient information in order to empower them in providing inputs on the quality of
services they receive.
17 Republic of South Africa. National Department of Health. The National Health Act. 2003.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 25
7. IMPLEMENTATION OF PSC RECOMMENDATIONS
The inspection team followed up on the PSC’s previous recommendations emanating from
the inspections of primary health care facilities conducted in 200918. Overall, the findings
have shown that 16 (94%) of the 17 recommendations were implemented by the FSDoH.
Only the recommendation relating to the erection of ramps at Thabo Mofutsanyana remained
to be implemented. The District Office indicated that the matter had been referred to the
provincial Department of Public Works as the responsible institution for the refurbishing of
state properties. The high percentage of implementation of the PSC’s recommendations by
the FSDoH is commendable and demonstrates the commitment of the Department in
supporting the PSC’s work in its oversight role as enshrined in the Constitution. Most
specifically, it is in keeping with section 196(3) which stipulates that “no person or organ of
state may interfere with the functioning of the Commission”. Detailed findings on the status
of implementation of the recommendations at the sampled facilities are attached as
ANNEXURE D.
8. READINESS OF THE INSPECTED FACILITIES FOR THE ROLL-OUT OF
NATIONAL HEALTH INSURANCE (NHI)
The NHI is a financing system which aims to ensure that all SA citizens, including non-
citizens who have attained permanent residence, are provided with essential healthcare,
regardless of their economic status. According to the NDoH, during the first five years of the
NHI pilot the focus will be on strengthening the following key priority areas:
Management of health facilities and health districts;
Quality improvement;
Infrastructure development;
Medical devices including equipment;
Human resource planning, development and management; and
Information management and systems support.
An ancillary aim of the inspections at the selected health facilities was to further provide the
PSC with an indication of the sites’ readiness for the roll-out of the NHI. In this regard, the
inspection team observed that the success of the NHI will largely depend on the commitment
by the FSDoH in addressing the identified staff shortage especially of professional nurses
and doctors. The RX Solution (information management system) plays a key role in the
management of availability of medicines, and its roll-out to all health facilities is paramount.
Apart from the few challenges that have been identified during the inspections, it can be
inferred that the facilities are ready for the implementation of the NHI.
18 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of
Health. 2010.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 26
9. RECOMMENDATIONS:
The recommendations contained in 9.1 and 9.2 below emanate from the inspections. These
recommendations should apply to all health facilities in the province that may be
experiencing similar challenges and not only those that were visited by the inspection team.
9.1 Announced Inspections
The FSDoH should collaborate with the Departments of Higher Education and
Training, Public Works and Human Settlements to devise a strategy for the
recruitment and retention of doctors, nursing professionals and pharmacists. It follows,
therefore, that the imminent review of the organisational structures of facilities by the
MEC should incorporate inputs relating to availability of accommodation and
amenities. (A plan of action should be put in place by June 2015).
The FSDoH should strengthen its monitoring system of suppliers of equipment to
ensure that suppliers of poor quality equipment were identified and blacklisted in order
to exclude them from future procurement processes. A plan of action to be in place by
June 2015.
The FSDoH should put a system in place which is linked to performance management
to ensure that that District Offices visit health facilities, especially clinics, monthly as
required by the Handbook for Clinic/CHC Managers. This should be implemented by
October 2014
The FSDoH should immediately ensure that suppliers are paid on time as required by
the Treasury regulations to ensure availability of medicines at the Medical Depot and
facilities. Feedback in this regard should be provided to the PSC by October 2014.
Training should be provided to the staff in the necessary protocols of dispensing
medication especially in the management of adverse drug events. A training
programme should be in place by October 2014.
Computers and network points should be provided at all facilities. Provision in the
budget should be made this regard. This should include the procurement of new X-
Ray equipment for Tokollo hospital as well as the roll out of the RX Solution to all
clinics. (In this regard, a plan of action should be put in place by December 2014).
The FSDoH should address the concerns of waiting time through consultation
processes in line with Batho Pele (In this regard, a plan of action to be in place by
December 2014).
9.2 Unannounced Inspections
The refurbishing of Brentpark and Bophelong clinics should be undertaken to address
the challenge of lack of space (at Brentpark) and the identified crack (at Bophelong).
(In this regard, a plan of action should be put in place by April 2015).
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical
Equipment and the Role of Health District Offices in the Department of Health: Free State Province 27
Elizabeth Ross hospital should be provided with an emergency generator to ensure
that the hospital’s functions are not disrupted when there is power failure. This should
be done immediately.
Brentpark clinic’s filing system needs should be reviewed to ensure confidentiality of
information on patients in line with the NHA. This should be done by 31 March 2015.
The FSDoH should engage the Moqhaka Local Municipality in order to address the
challenge of water supply experienced by Brentpark and Bophelong clinics. In
addition, the Department should approach the Maluti-A-Phofung Local Municipality to
find a solution to the frequent power disruptions affecting hospitals and clinics in the
area. This should be done immediately. Feedback in this regard should be provided to
the PSC by October 2014.
10. CONCLUSION
The findings of the inspections have shown that there are few challenges of availability of
medicines and medical equipment at the visited sites. Key challenges identified related to
budgetary constraints impeding the roll out of the RX Solution to all clinics, general staff
shortage of professionals, water supply in the Moqhaka Local Municipality where Brentpark
and Bophelong clinics are located, as well as frequent power failures affecting Elizabeth
Ross hospital. It is hoped that the recommendations will assist the FSDoH in ensuring that
quality health care is provided at the inspected health care facilities.
11. ACKNOWLEDGEMENT
The PSC would like to express its appreciation for the cooperation received from the officials
of the Department in all the visited sites. It is the view of the PSC that the officials were
appreciative of the importance of the inspections in supporting the work of government in its
key objective for a long and healthy life for all South Africans.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 28
ANNEXURE A: A LIST OF FACILITIES VISITED AND OFFICIALS THAT WERE ENGAGED
Name of Institution Date Names and designation of interviewed personnel Inspection Team Members
Fezile Dabi District Office 30.09.13 Ms M Mokotso; Acting Manager
Mr MSG Shuping: Deputy Manager
Mr VS Malatse; PHC Manager
Mr TE Taje: Assistant Director: SCM
Mr Matela Mohale
Mr Martin Chale
Ms Mmapeu De Jenga
Ms Ntshebo Adoro
Ms Lindi Qithi
Ms Tshiamo Mothibi
Brentpark Clinic 30.09.13 Sr RIB Bouwer: Operational Manager
PM Motete: Pharmacy Assistant
Bophelong Clinic 30.09.13 Sr MO Mosala: Operational Manager
KD Beukes: Pharmacy Assistant
Tokollo Hospital 01.10.13 MA Makhalema: Head Administration
JJ Fourie: Senior Artisan Foreman
SR Sithole: Senior Supply Chain Practitioner
R Motebele: Assistant Manager Nursing
PA Makoti: Senior Admin Officer
MP Jansen: Infection Control and OHP
PM Tshabalala: Quality Assurance Coordinator
MR Tlopo: Quality Assurance Coordinator
RS Mokoena: Chief Medical Officer
TD Tsotetsi: HR & Employment Relations Officer
PS Lesibo: Mafube/Tokollo Board Member
DS Letsele: OPM Maternity
MV Ratshitanga: Artisan
M Matseliso: Head Nursing
MJH Wilbach: Pharmacist Tokollo
S Mofumane: OPM: G/W, CAS, Theatre
SR Noge: Chief Executive Officer
Thabo Mofutsanyana
Health District
07.10.2013 L Schabort: District Pharmacist
DS Ntsutle: Senior Manager
FC Moloi: Chief Executive Officer
MC Ramokotjo: Manager - District Health Clinics
Mr Matela Mohale
Ms Ntshebo Adoro
Ms Lindi Qithi
Ms Tshiamo Mothibi
Elizabeth Ross District 08.10.2013 MB Moloi: Senior Admin Officer – Supply Chain Management
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 29
Name of Institution Date Names and designation of interviewed personnel Inspection Team Members
Hospital MS Mohale: Senior Admin Officer – Finance
M Mlangeni: HCTNX Coordinator
PP Tsatsa: Pharmacist
MC Lerole: Acting Chief Executive Officer
Phuthaditjhaba Clinic 08.10.2013 M Motloung: DOH
J Mahlasela: MAP Primary Health Care Coordinator
BM Kwahela: Operational Manager
Bluegumbosch Clinic 09.10.2013 L Matsaba: Operational Manager
M Motloung: DOH
J Mahlasela: MAP Primary Health Care Coordinator
Medical Depot 29.10.2013 Ms C Claasens: Assistant Manager: SCM
MS M Smits: Pharmacist – Procurement
Ms N Phitsane: Chief Director – SCM
Ms S Mthethwa: Assistant Manager – Finance
Mr K Kgomo: Manager – Pharmaceutical
Ms K Mosikare – Manager –Medpharm
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 30
ANNEXURE B1: ANNOUNCED INSPECTIONS IN THE CLINICS:
Availability of medical equipment at inspected clinics
√ Norms and standards adhered to
X Norms and standards not adhered to
Me
dic
al e
qu
ipm
en
t
Brent Park Clinic
Dia
gn
ostic s
et
Blo
od
pre
ssure
mach
ine
s
Ste
tho
sco
pe
Sca
les f
or
adu
lts &
yo
un
g
ch
ildre
n
Me
asu
rin
g tap
es
Sp
ecu
lum
s o
f d
iffe
ren
t
siz
es
Ha
em
og
lob
ino
me
ter
Glu
co
me
ter
Pre
gna
ncy test
str
ips
Em
erg
en
cy tro
lley
Oxyg
en
cylin
de
r a
nd
mask
Te
lep
ho
ne
/ tw
o w
ay r
ad
io
Tw
o w
ork
ing
re
frig
era
tors
Sh
arp
s d
isp
osa
l syste
m
Ste
riliz
ation
syste
m
Eq
uip
men
t &
co
nta
ine
rs
for
takin
g b
loo
d &
oth
er
sa
mp
les
Co
nd
om
dis
pe
nse
r p
lace
d
wh
ere
easily
accessib
le
√ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
Bophelong Clinic
√ x √ √ √ √ x x √ √ √ √ √ √ √ √ x
Blood pressure machines: Gets overheated after prolonged usage then produce incorrect readings.
Haemoglobinometer: Bophelong clinic had two Haemoglobinometers, one hand-held but deemed to be mostly unreliable by the nursing
staff, and the other which required glass plates for use and found to be in short supply.
Glucometer: Glucometer was in short supply in that the clinic had one such equipment used by all the nursing staff.
Furthermore, batteries for the equipment were in short supply to the extent that the nursing personnel were forced
to recharge the used batteries by placing them in the sun on the window sills.
Condom dispenser: Although the condom dispenser was available and appropriately placed where the citizens could easily access it,
there were, however, no condoms provided in the dispenser.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 31
ANNEXURE B1: Availability of medical equipment at inspected clinics
Me
dic
al e
qu
ipm
en
t Phuthaditjhaba Clinic
Dia
gn
ostic s
et
Blo
od
pre
ssure
mach
ine
s
Ste
tho
sco
pe
Sca
les f
or
adu
lts &
yo
un
g
ch
ildre
n
Me
asu
rin
g tap
es
Sp
ecu
lum
s o
f d
iffe
ren
t
siz
es
Ha
em
og
lob
ino
me
ter
Glu
co
me
ter
Pre
gna
ncy test
str
ips
Em
erg
en
cy tro
lley
Oxyg
en
cylin
de
r a
nd
mask
Te
lep
ho
ne
/ tw
o w
ay r
ad
io
Tw
o w
ork
ing
re
frig
era
tors
Sh
arp
s d
isp
osa
l syste
m
Ste
riliz
ation
syste
m
Eq
uip
men
t &
co
nta
ine
rs
for
takin
g b
loo
d &
oth
er
sa
mp
les
Co
nd
om
dis
pe
nse
r p
lace
d
wh
ere
easily
accessib
le
√ √ √ √ √ √ √ √ √ x √ √ √ √ √ √ √
The clinic has a landline telephone only. A two-way radio is required as indicated by the Head of clinic for usage as backup.
Bluegumbosch Clinic
√ √ √ √ √ √ √ √ √ x √ √ √ √ √ √ √
The clinic has a landline telephone only. A two-way radio is required as indicated by the Head of clinic for usage as backup.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 32
ANNEXURE B2: Availability of medical equipment at the inspected hospitals
Tokollo District Hospital
Me
dic
al e
qu
ipm
en
t
Ba
sic
eq
uip
me
nt fo
r
exa
min
atio
n o
f p
atie
nts
in
OP
D a
nd
wa
rds
Ad
ult a
nd
ch
ild e
lectr
on
ic
we
igh
ing
sca
les, m
easu
ring
rods a
nd
pe
dia
me
ters
Pro
cto
sco
pe
s
La
rynsco
pes
Pe
ak f
low
mete
rs
Glu
co
me
ters
Ha
em
og
lob
ino
me
ters
Lu
mb
ar
pun
ctu
re k
its
Ca
rdia
c m
on
ito
rin
g u
nit
Ge
ne
ral X
-ra
y r
oom
with
su
pin
e &
bu
cky u
nit w
ith
scre
en
ing
& ta
ble
ma
ttre
ss
Sn
elle
n c
hart
Ve
no
-pu
nctu
re s
et
Flu
id g
ivin
g s
et
A c
linic
al w
aste
sto
rag
e
Fix
ed
an
d/o
r m
ob
ile o
xyg
en
su
pp
ly
A p
riva
te a
rea
fo
r cou
nse
ling
(e.g
. H
IV/A
IDS
)
Ba
sic
eq
uip
me
nt to
co
ndu
ct
no
rma
l d
eliv
erie
s
EC
G
Em
erg
en
cy e
qu
ipm
en
t fo
r
tra
um
a a
nd
em
erg
ency
Tro
lleys w
ith
em
erg
ency
dru
gs &
re
suscita
tion
eq
uip
me
nt
√ √ √ √ √ √ √ √ √ x √ √ √ √ √ √ √ √ √ √
General X-ray room: Although the X-ray equipment was found to be working, the hospital was concerned that it had almost reached the end
of its lifespan and, therefore, needed to be replaced.
Elizabeth Ross District Hospital
√ √ √ √ √ √ √ √ √ x x x √ √ √ √ √ √ √ √
General X-ray room: X-ray machine was not functioning due to unavailability of a central processing unit (CPU) that was allegedly stolen on
25/09/13. The matter was still under investigation as informed by management during inspection. Patients were referred
to a nearby hospital, namely Manapo Regional Hospital.
Snellen chart: The hospital did not have an eye care professional.
Veno-Puncher set: Two (2) towel packs were used as an alternative.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 33
ANNEXURE C1: Availability of medicines at inspected clinics
√ Norms and standards adhered to
X Norms and standards not adhered to
Brent Park Clinic
Me
dic
ine
s
Me
dic
ine
ro
om
with
bu
rgla
r ba
rs
/lo
cka
ble
cu
pb
oa
rds
Me
dic
ines a
nd
su
pp
lies s
tock
Me
cha
nis
m f
or
em
erg
ency s
up
plie
s
Ba
tte
ry %
spa
re
glo
be
s fo
r
au
rosco
pe
s
Me
dic
ines a
s p
er
ED
L fo
r P
HC
√ √ √ √ √
Bophelong Clinic
√ √ √ √ x*
* Although most medicines were found to be available at the clinic, concerns of serious shortage of Pentaxim (i.e. vaccination for 2 to 4
months old babies) and Ferrous Sulphate (used for boosting the haemoglobin level in pregnant mothers) were raised by the nursing
staff. Seriously disconcerting were reports that Ferrous Sulphate was not available despite an order having been placed with the District
Office for over two months.
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 34
ANNEXURE C1: Availability of medicines at inspected clinics
Phuthaditjhaba Clinic
Me
dic
ine
s
Me
dic
ine
ro
om
with
bu
rgla
r ba
rs
/lo
cka
ble
cu
pb
oa
rds
Me
dic
ines a
nd
su
pp
lies s
tock
Me
cha
nis
m f
or
em
erg
ency s
up
plie
s
Ba
tte
ry %
spa
re
glo
be
s fo
r
au
rosco
pe
s*
Me
dic
ines a
s p
er
ED
L fo
r P
HC
√ √ √ √ √
* Spare globes were not available – the clinic was awaiting delivery of ordered stock, which included globes as informed during the
inspection
Bluegumbosch Clinic
√ √ √ √ √
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 35
ANNEXURE C2: Availability of medicines at inspected hospitals
√ Norms and standards adhered to
X Norms and standards not adhered to
Tokollo District Hospital
Me
dic
ine
s
Me
dic
ines s
up
ply
acco
rdin
g to
ST
G
an
d E
DL
: H
osp
ita
l le
ve
l
Me
dic
ines s
up
ply
acco
rdin
g to
ST
G
an
d D
L: P
rim
ary
Ca
re leve
l
Me
dic
ines a
nd
su
pp
lies a
lwa
ys in
sto
ck.
Tro
lleys w
ith
em
erg
ency d
rug
s a
nd
resu
scita
tio
n e
qu
ipm
en
t
Ph
arm
ace
utica
l T
he
rap
eu
tic
Co
mm
itte
e in p
lace
√ √ √ √ √
Elizabeth Ross District Hospital
√ √ √ √ √
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 36
ANNEXURE D: THE STATUS ON THE IMPLEMENTATION OF RECOMMENDATIONS OF THE PSC’S INSPECTIONS CONDUCTED IN
2009
Details of the clinic Recommendations Implemented Not implemented
Thabo
Mofutsanyana
District Office
Ramps for people with disabilities should be
erected. In this regard a plan of action should be
in place by April 2010.
No Not yet implemented
(District lack capacity; the
matter to be referred to the
Department of Public works)
Procurement processes should be improved as
this impact negatively on the functioning of clinics.
In this regard, a plan of action should be in place
by April 2010.
Yes
Should have vehicles available to visit clinics. In
this regard, a plan of action should be in place by
April 2010.
Yes
Phuthaditjhaba
Clinic
Should display outside and inside signage at their
buildings by April 2010.
Yes
Should renovate buildings. In this regard a plan
of action should be put in place by April 2010.
Partially
(Renovation of the clinic
was done partially, only the
waiting area and the
corridor were painted but
not the consulting rooms)
Clinics should be provided with medical
equipment and medication
Yes
Vacant posts are to be filled to address staff
shortage at the clinics. In this regard a plan of
action should be in place by April 2010. The clinic
manager should ensure that all service users who
Yes
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 37
Details of the clinic Recommendations Implemented Not implemented
are in the queues are attended to instead of being
sent home because it is knock off time. This
should be done immediately.
Service Charters should be translated into the
languages spoken within the jurisdiction of clinic
and not just English. In this regard a plan of
action should be put in place by April 2010.
Yes
Staff should be provided with name tags by April
2010 and must wear them.
Yes
Bluegumbosch
Clinic
Should display outside and inside signage at their
buildings by April 2010.
Yes
Clinics should be provided with medical
equipment and medication immediately
Yes
Vacant posts are to be filled to address staff
shortage at the clinics. In this regard a plan of
action should be in place by April 2010.
Queue Marshall appointed
and reallocation of nurses
done in line with workload.
Clinic manager should immediately ensure that all
service users who are in the queues are attended
to instead of being sent home because it was
knock-off time.
No patients are returned
unattended and there is a
Free State circular in this
regard against returning
patients unattended.
Reception area and help desk should be clearly
identified.
Yes
A staff member should be assigned to guide and
direct citizens upon arrival. In this regard a plan of
action should be put in place by April 2010.
Queue Marshalls
appointed.
Service Charters should be translated into the Yes
Report on Service Delivery Inspection of District Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the Role of Health District Offices in the Department of Health:
Free State Province 38
Details of the clinic Recommendations Implemented Not implemented
languages spoken within the jurisdiction of clinic
and not just English. In this regard a plan of action
should be put in place by April 2010.
Staff should be provided with name tags by April
2010 and must wear them.
Yes
Recommended