Base Line Health Facility AuditBase Line Health Facility Audit

Presentation to the Select Committee on Social ServiceDate 19 March 2013

Introduction• Tender NDOH 20 / 2010-2011 (Nov 2010)• Feb 2011: Consortium of HST, ARUP, Exponant, HISP and

MRC appointed• Governance:

– National Steering Committee chaired NDoH– Provincial Steering Committees with Focal Person

• Provincial and District participation– Capacity development– Local ownership

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Audit Scope• To conduct an INDEPENDANT audit of all public health facilities:

– Facility Profile• Accessibility via - road• Operating hours• Number of inpatient beds• Ownership of land and buildings

– Infrastructure• Physical Infrastructure condition assessment

– Physical condition (walls, roofs, floors, windows, bathrooms, laundry, kitchens etc.)

• Facilities Management Maintenance of roads and buildings• Space - Meeting service and patient needs, waiting areas• Bulk Services – Electricity, water, sanitation and waste removal

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Audit Scope

– Equipment• Availability of essential equipment

– Human Resources• Post filled and vacant for different staff categories

– Finance management– Services provided

• Support services• Technical services e.g. IT• Clinical services

– Quality of care (sub-set of Core Standards)

Six Priority Areas of Quality

• Availability of medicine and supplies– Stock control and –management– Availability of tracer medicines– Prescribing practices– Storage– Patient and staff interviews

• Cleanliness– Patient Satisfaction results– Inspect records of daily inspections of cleanliness– Cleaning procedures– Toilets, Bathrooms, kitchens, laundry, grounds

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Six Priority Areas of Quality (cont)

• Improved patient safety– Physical safety measures– Emergency services response times– Packages of services– Management of adverse events, clinical audits

• Infection prevention and control– Surveillance and reporting systems – Health care associated infections– Waste management– Management of infectious diseases

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Six Priority Areas of Quality (cont)

• Positive and caring attitudes– Patient perceptions of service– Patient knowledge of their rights and responsibilities– Complaints management system– Observation of staff interactions with patients– Privacy– Staff satisfaction

• Waiting times– Management, monitoring, action– Patients with special needs– Physical layout of facility

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Facilities AuditedFacility classification Number of facilities

Satellite Clinic 125

Clinic 3 074

Specialised Clinic 4

Maternal Obstetrics Unit (MOU) 1

Community Day Centre (CDC) 44

Community Health Centre (CHC) 238

District Hospital 253

Regional Hospital 55

Tertiary Hospital 10

National Central Hospital 6

Rehabilitation Hospital 3

Children's Hospital 1

Chronic Hospital 4

Orthopaedic Hospital 1

Psychiatric Hospital 23

TB Hospital 35

TB and Psychiatric Hospital 2

Private Hospital 1

Total 3 880

COMPLIANCE SCORE FOR VITAL MEASURES ON 6 PRIORITY AREAS OF QUALITY

COMPLIANCE SCORE FOR VITAL MEASURES ON 6 PRIORITY AREAS OF QUALITY – Per Province

COMPLIANCE SCORE FOR VITAL MEASURES ON 6 PRIORITY AREAS

OF QUALITY – Per District

Functional Areas Functional Area Components

Clinical services Blood services, Laboratory, Health Technology, Pharmacy, Radiology

Infrastructure Integrated audit infrastructure, Integrated audit health technology

Management CEO/ hospital manager, Communications, Facility infrastructure, Financial management, HR management, Infection control, Procurement, Occupation health and safety, Clinical management group, Case management, Legal/insurance division

Patient care Accident and emergency unit, Outpatient department, Maternity ward incl. Maternity theatres, Medical ward, Surgical ward, Paediatric ward, Generic ward, Therapeutic support services, Speciality ward/ICU/HCU/Burn, Operating theatre, Psychiatric ward

Support services CSSD, Cleaning services, Food services, Laundry services, Maintenance services incl. garden, Record/archive department, Waste management, Transport services incl. Ambulance/patient transport, Security services, Entrance/reception/help desk, Patient administration, Mortuary services, Public areas

COMPLIANCE IN THE FUNCTIONAL AREAS ON VITAL MEASURES OF THE 6 PRIORITIES

Provision of Services

Proportion of support services , off sit or on-site

Supplies Clinics CHC+CDC Hospitals Total No water 56 1.7% 0 0.0% 0 0.0% 56 1.4%

No electricity 35 1.1% 1 0.4% 0 0.0% 36 0.9%

No domestic waste removal 449 14.0% 29 10.2% 26 6.6% 504 13.0%

No medical waste removal 113 3.5% 16 5.6% 7 1.8% 136 3.5%

No hazardous waste removal 139 4.3% 19 6.7% 16 4.1% 174 4.5%

No ash removal 4 0.1% 30 10.6% 33 8.4% 67 1.7%

Bulk Supplies – Facilities with no bulk services at the time of audit

Infrastructure Scores -Average overall infrastructure score

DISTRICT RANKING ON

INFRASTRUCTURE SCORES

Base Line Audit using the DHIS Core Standards Module

Base Line Audit using the DHIS Core Standards Module

DHIS Core Standards Module DHIS Core Standards Module as Data Collection Toolas Data Collection Tool

• The DHIS has a flexible relational database structure• The DHIS Core Standard Module was used to collect

and store data.• Ad hoc reporting per facility is available within the

Core Standards Module– This is used for immediate Facility feedback– Quality Improvement template generated on failed

measures– Facility Infrastructure overview report

• Pivot reports is used to aggregate and analyse further

Available Ad Hoc ReportsAvailable Ad Hoc Reports

• Geo Spatial use of the data

Thank youThank you

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