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CONSOLIDATED REPORT ON SERVICE DELIVERY
INSPECTIONS OF DISTRICT HOSPITALS AND
CLINICS REGARDING AVAILABILITY OF MEDICINES
AND MEDICAL EQUIPMENT AND THE ROLE OF
HEALTH DISTRICT OFFICES
DEPARTMENTS OF HEALTH:
FREE STATE, LIMPOPO, NORTH WEST AND
WESTERN CAPE PROVINCES
MARCH 2015
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page i
FOREWORD
The Public Service Commission (PSC) derives its mandate from Chapter 10 (Section 196) of
the Constitution to, amongst others, promote the values and principles set out in Section
195, and to propose measures in ensuring effective and efficient performance within the
Public Service1. Furthermore, Section 9 of the PSC Act, 1997 (Act 46 of 1997), provides that
“the Commission may inspect departments and other organizational components in the
Public Service and has access to 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 Public Service
Act”2.
Health care is one of the key government priorities which should be accessible to all the
citizens of the country in order to achieve its delivery outcome: a long and healthy life for
all. This outcome is predicated on a sustainable health care infrastructure that is responsive
to the needs of the citizens. For this reason, the PSC has during the 2013/2014 financial
year conducted the inspections at selected service delivery sites of the Department of Health
in the Free State, Limpopo, North West and Western Cape Provinces. The purpose of the
inspections was to determine the availability of medicines and medical equipment at these
sites as well as the role of health district offices in this regard. The inspections also sought to
follow up on the implementation of its previous recommendations in this area at the health
facilities3.
Overall, it was found that the sampled provinces were experiencing various challenges such
as supply chain management issues, poor quality of medical equipment, unavailability of
certain critical medicines and lack of space for storage thereof. Of the 38 recommendations
the PSC issued in all the visited provinces in 2010, 29 (76%) were implemented. These
findings could be used as a basis for further work in assessing the readiness of health
facilities in rolling out the National Health Insurance (NHI) system.
It is a pleasure to present the Consolidated report on Service Delivery Inspection of
Hospitals and Clinics regarding Availability of Medicines and Medical Equipment and the
Role of Health District Offices. Inspections remain a valuable monitoring mechanism whose
findings and recommendations could contribute towards service delivery improvement. The
PSC wishes to thank officials of the Free State, Limpopo, North West and Western Cape
Provincial Departments of Health for their cooperation and willingness to share information.
RK SIZANI
DEPUTY CHAIRPERSON: PUBLIC SERVICE COMMISSION
1 Republic of South Africa. Constitution of the Republic of South Africa, 1996. 2 Republic of South Africa. Public Service Commission Act, 1997. 3 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of
Health. 2010.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page ii
FOREWORD ......................................................................................................................... i
LIST OF ACRONYMS ......................................................................................................... iv
EXECUTIVE SUMMARY ...................................................................................................... v
CHAPTER ONE: INTRODUCTION ....................................................................................... 1
1.1 INTRODUCTION AND BACKGROUND ................................................................... 2
1.2 OBJECTIVES OF THE INSPECTIONS ..................................................................... 2
1.3 SCOPE AND METHODOLOGY ................................................................................ 3
1.3.1 Scope ........................................................................................................................ 3
1.3.2 Methodology .............................................................................................................. 4
1.4 LIMITATIONS OF THE STUDY................................................................................. 5
CHAPTER TWO: OVERVIEW OF THE FINDINGS .............................................................. 6
2.1 KEY FINDINGS ON ANNOUNCED INSPECTIONS .................................................. 7
2.1.1 Contextual Background ............................................................................................. 7
2.1.2 Management of Medicines ......................................................................................... 7
2.1.3 Management of Medical Equipment ........................................................................ 12
2.1.4 Governance of Health Facilities ............................................................................... 13
2.1.5 Challenges .............................................................................................................. 13
2.2 KEY FINDINGS ON UNANNOUNCED INSPECTIONS ........................................... 14
2.2.1 Observing facilities .................................................................................................. 14
2.2.2 Observing access to information.............................................................................. 14
2.2.3 General observations .............................................................................................. 15
2.2.4 Talking to citizens .................................................................................................... 15
2.3 IMPLEMENTATION OF PSC RECOMMENDATIONS ............................................ 15
CHAPTER THREE: CONCLUSION AND RECOMMENDATIONS ..................................... 17
3.1 INTRODUCTION ..................................................................................................... 18
3.2 CONCLUSION ........................................................................................................ 18
3.3 RECOMMENDATIONS ........................................................................................... 18
3.3.1 Announced inspections ........................................................................................... 18
3.3.2 Unannounced inspections ....................................................................................... 19
3.4 ACKNOWLEDGEMENT.......................................................................................... 20
ANNEXURES
ANNEXURE A: FINDINGS FROM FREE STATE PROVINCE ............................................ 21
ANNEXURE B: FINDINGS FROM LIMPOPO PROVINCE .................................................. 27
ANNEXURE C: FINDINGS FROM NORTH WEST PROVINCE .......................................... 32
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page iii
ANNEXURE D: FINDINGS FROM WESTERN CAPE PROVINCE ...................................... 37
ANNEXURE E: STATUS ON THE IMPLEMENTATION OF RECOMMENDATIONS OF THE
PSC’S INSPECTIONS CONDUCTED IN 2009 .......................................... 45
ANNEXURE F: FEEDBACK ON IMPLEMENTATION OF THE PSC’S RECOMMEN-
DATIONS CONTAINED IN THE REPORTS ON INSPECTIONS OF
DISTRICT HOSPITALS AND CLINICS REGARDING AVAILABILTY OF
MEDICINES AND MEDICAL EQUIPMENT AND THE ROLE OF HEALTH
DISTRICT OFFICES IN THE DEPARTMENTS OF HEALTH IN THE FREE
STATE, LIMPOPO, NORTHWEST AND WESTERN CAPE PROVINCES . 50
TABLES
Table 1: Objectives of inspections .................................................................................................... 3
Table 2: List of provinces, inspected sites and dates of inspections .......................................... 3
FIGURES
Figure 1: Medicine management cycle ............................................................................................ 8
Figure 2: Statistical analysis of medicine availability based on reporting against the DHPs .. 11
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page iv
LIST OF ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
AO Accounting Officer
ARV Antiretroviral
BP Blood Pressure
CCTV Closed Circuit Television
CDC Community Day Centre
CEO Chief Executive Officer
CHC Community Health Centre
DAP District Acquisition Plan
DDV Direct Delivery Voucher
DHP District Health Plan
DHS District Health System
DoE Department of Education
EA Executive Authority
EDL Essential Drugs List
EMS Emergency Medical Services
FSDoH Free State Department of Health
GDoH Gauteng Department of Health
HIV Human Immunodeficiency Virus
HoD Head of Department
HPCSA Health Professional Council of South Africa
LPDoH Limpopo Province Department of Health
MoA Memorandum of Agreement
MSD Medical Supply Depot
NDoH National Department of Health
NDPSA National Drugs Policy of South Africa
MEC Member of the Executive Council
NEDLC National Essential Drugs List Committee
NEMLC National Essential Medicine List Committee
NHA National Health Act
NHI National Health Insurance
NWDoH North West Department of Health
PHC Primary Health Care
PSC Public Service Commission
PTC Pharmaceutical and Therapeutic Committee
RDM Remote Demander Module
SAPC South African Pharmacy Council
SCM Supply Chain Management
SLA Service Level Agreement
SOPs Standard Operating Procedures
STGs Standard Treatment Guidelines
TB Tuberculosis
WHO Wealth Health Organisation
WCDoH Western Cape Department of Health
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page v
EXECUTIVE SUMMARY
INTRODUCTION
Since 1994 the provision of equitable and quality health care services to all citizens has
been paramount in the government’s health programme in order to adequately mitigate the
burden of disease. Hence, the adoption of “A long and healthy life for all South Africans”
during the Cabinet Lekgotla of 2010 as one of government’s key priorities. By devolving
certain responsibilities for health services to the provincial and local government levels
through the District Health System (DHS)4, government aimed to improve access to quality
health care to communities at the local level. For this reason, Health District Offices are
expected to play a critical supportive role of ensuring that health care facilities are
adequately resourced at all times for the optimal provision of quality health care to citizens.
In line with its oversight role, the Public Service Commission (PSC) has over the years been
conducting inspections to assess Public Service performance and provide advice on
pertinent steps to be taken to ensure the required improvement. During 2013/14 the PSC
conducted inspections in the Departments of Health in four provinces, viz. Free State,
Limpopo, North West and Western Cape, to assess the availability of medicines and medical
equipment at selected health facilities, as well as to determine the role of the relevant Health
District Offices in this regard. The inspections at the selected health facilities also aimed to
follow up on the implementation of the PSC’s previous recommendations in this regard5.
Reports with recommendations have been forwarded to the Executive and Accounting
Authorities of the said departments in the four provinces for implementation, and they are
also available on the PSC website (www.psc.gov.za). Following engagements with the
respective departments on implementation of the recommendations, feedback has been
received and is attached as ANNEXURE F.
METHODOLOGY
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, engagements were held with officials of the National and Provincial
Departments to set the scene for the inspections.
Both the announced and unannounced inspections were conducted in line with the
protocol for conducting inspections 6 . The inspections sought to understand 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. These inspections took place at selected Health District Offices,
District Hospitals and clinics in the four provinces. In the Western Cape selected Regional
4 Republic of South Africa. National Department of Health. White Paper for the transformation of the Health
System in South Africa . 1997. 5 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of
Health. 2000. 6 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page vi
hospitals and Community Day Centres (CDCs) were also inspected for their role in providing
primary health care services.
KEY FINDINGS ON ANNOUNCED INSPECTIONS
Findings of the announced inspections are presented into two thematic areas, which are the
management of medicines and the management of medical equipment. Detailed findings on
these inspections are attached as ANNEXUREs A1, B1, C1 and D1.
Management of Medicines
The management of medicines is categorised into five key functions namely, product
selection, procurement, distribution and rational use, and management support.
Product selection
Officials of the visited provincial Departments of Health (i.e. FSDoH, LDoH, NDoW and
WCDoH) indicated that the selection of medicines or drugs was a national competence. The
function was handled by the National Essential Drugs List Committee (NEDLC) or National
Essential Medicines List Committee (NEMLC) appointed by the Minister of Health and
determines which medicines were essential to be included in the Essential Drugs List (EDL).
Pharmaceutical and Therapeutic Committees (PTCs) were further established at Provincial,
District and hospital levels and made recommendations of new drugs based on their
scientific efficacy and safety. The PSC found the process to be well institutionalized and
contributed effectively towards the availability of medicines at health care facilities.
Procurement
In all provinces the primary supply of medicines to the visited health care facilities was done
through Medical Depots. However, district hospitals were allowed, subject to permission and
based on the urgency of cases, to use either the “buy out” or Direct Delivery Voucher (DDV)
methods. The “buy-out” method is a process whereby orders were made directly to the
suppliers or pharmaceutical companies on a quotation basis. The DDV method involved
hospitals ordering through the depots, however, the ordered stock was then delivered
directly to the facilities. District hospitals often took advantage of this flexibility in the process,
which allowed for efficient acquisition of urgently needed medicines, and thereby ensuring
stock availability.
Distribution and storage
Distribution: It was observed in all provinces that medical depots were responsible for the
distribution of medicines to the health care facilities as advocated in the National Drug Policy
of South Africa (NDPSA). However, provinces such as the Free State and North West, at
some stage experienced challenges with the timely delivery of ordered stock to the health
care facilities resulting in the facilities being forced to use own transport to fetch their orders
from the depots. In the case of Free State the issue was due to the non-payment of service
providers.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page vii
Storage: There was general compliance with the NDPSA and the applicable Standard
Operating Procedures (SOPs) in all the visited health facilities as the pharmacies were
always locked and thus prohibiting unauthorized access. In the Western Cape these security
measures were augmented with Closed Circuit Television (CCTV) systems and alarm
systems as observed at Kwanokuthula Community Development Centre (CDC) to enhance
the safety of medicines. Refrigerators were also sufficiently available for storing medicines
requiring constant cool temperature such as vaccines and insulin and their temperatures
monitored regularly. In addition, waste buckets were provided for safekeeping of medical
waste, which were collected by a medical waste management company once full for
incineration.
Rational use, monitoring and evaluation
Rational use: In the Free State, North West and Western Cape provinces, guidelines for the
district pharmacists were developed for purposes of visits to the health facilities on monthly
basis, while in the Limpopo, district offices relied on the Handbook for Clinic and Community
Health Centre (CHC) Managers7. The purpose of the visits is to oversee the operations and
provide pharmaceutical support, especially in ensuring that the dispensing of medicines is in
accordance with the Standard Treatment Guidelines (STGs). However, only the Western
Cape was found to adhere to its guidelines with district pharmacists conducting regular
workshops and comprehensive analysis of the stock levels, which empowered the facilities
to maintain quality service delivery in line with the NDPSA. No evidence of such visits could
be found in the case of the Free State, Limpopo and North West provinces despite the
district officials and nursing staff indicating that they were taking place.
Monitoring and evaluation: Various systems were used to monitor and evaluate the
availability of medicines in the visited provinces. The stock cards system relied upon by the
North West and Limpopo provinces was regarded as highly ineffective. In the case of
Limpopo the finding was corroborated during scrutiny of the Waterberg District’s progress
reports against its DHP, which showed that the district failed to meet the 95% target of
availability of medicines. Officials in the Free State questioned the reliability of the findings of
the province’s Tracer Drugs system, which indicated that both the inspected districts
achieved the 95% target of availability of essential medicines, due to the small sample
selected by the system.
Management support
Information technology (IT) system: Although medical depots in all the visited provinces
were found to have electronic system for capturing orders, not all the inspected health care
facilities had similar systems. In Limpopo all the visited health care facilities were using a
particular form for ordering medicines, while in the Free State and North West provinces only
district hospitals were using the RX solution (i.e. an electronic ordering system), and the
systems were linked to the respective medical depot via the Remote Demander Module
(RDM). In the Western Cape all its health facilities were using the WINRDM electronic
7 Republic of South Africa. Department of Health. Handbook for Clinic/Community Health Centres Managers. October
1999.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page viii
system for ordering and managing availability of stock, and it was linked to the Cape Medical
Supply Depot (MSD). These IT systems were found to be effective in expediting requisitions
by health facilities, as opposed to the cumbersome manual system used by the facilities in
Limpopo.
Training: Generally, some form of training for staff had taken place in all the provinces.
However, evidence of focused training on dispensing of medicines or for pharmacists was
only found in the North West and Western Cape provinces.
Staffing: Shortage of health professionals was a common concern at all the visited facilities,
especially of doctors and nursing staff, which impacted negatively on the delivery of quality
health care services.
Management of Medical Equipment
Procurement: Officials of the LDoH, FSDoH and NWDoH indicated that this function was
centralized at the Provincial Head Office and undertaken in terms of the Preferential
Procurement Policy Framework Act, 2000 (PPPFA)8. However, officials at all the visited
health facilities in the above-mentioned provinces were concerned about the delays of
procuring new or replacing broken equipment. On the contrary, District Offices in the
WCDoH informed the inspection team that the procurement of medical equipment in the
province had been decentralized to ensure that needed items were timeously procured for
the facilities.
Asset control: This function was the responsibility of District Offices in the Free State,
Limpopo and North West provinces. In the Western Cape it had been devolved to the heads
of administration or operational managers of the health facilities with the appropriate
delegations in place. Generally, there was proper asset management control at the sites
visited except at Unit 9 clinic (North West) where the inspection team found broken
equipment lying around the clinic yard.
Maintenance of equipment: Only the Western Cape was found to have an effective
arrangement in that sufficient capacity in this regard had been established at District,
Regional and Tertiary hospitals to assist all other facilities. In the Free State, Limpopo and
North West provinces, staff raised concerns about the turnaround times for maintenance of
equipment.
Disposal of medical equipment: It was found in the Free State, North West and Western
Cape that the function rests with District Offices, whereas in Limpopo it was located in the
Provincial Head Office. The broken equipment found lying around at Unit 9 Clinic in the
North West raised questions of the process in place being adhered to. Some of the items
posed serious risks of injury to staff and the citizens.
Governance of health facilities
8 Republic of South Africa. National Treasury. Preferential Procurement Policy Framework Act, 2000 (PPPFMA).
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page ix
Hospital boards: In all the visited provinces the inspected hospitals had hospital boards as
required by the National Health Act (NHA), with those of the Free State and Western Cape
functioning effectively. In Limpopo and North West the staff at the inspected hospitals raised
concerns of interference in administration matters by the hospital boards.
Clinic Committees: Only the clinic committees in the Free State were found to be
functioning effectively. The lack of functioning of these structures in Limpopo, North West
and Western Cape not only contravened section 42(1) of the NHA, but also deprived the
community of the constitutional avenue to contribute to improved service delivery at the
clinics.
Challenges
Infrastructure: There was a general lack of space at most of the inspected facilities.
Messina District Hospital in Limpopo was worst affected as some infants and their mothers
were found sleeping on the floor due to the insufficient wards and beds. In the Free State the
inspected facilities within Thabo Mofutsanyana District, which is serviced by the Maluti-A-
Phofung Local Municipality, experienced intermittent power failures and mostly did not have
back-up generators.
Emergency Medical Services: Emergency medical services (EMS) were found to be poor
in the visited districts in the North West, with concerns of response times being inordinately
long and in some instances ambulances failing to arrive, and thus putting the lives of
patients at risk. The PSC in its report on EMS found that generally there was a shortage of
resources ranging from emergency care practitioners to vehicles, which impacted on the
delivery of quality EMS services9.
KEY FINDINGS ON UNANNOUNCED INSPECTIONS
The unannounced inspections were based on Batho Pele framework as a key strategy for
the transformation of Public Service delivery10. These inspections sought to determine the
extent to which the visited health care facilities adhered to the principles of Batho Pele.
Detailed findings of these inspections are attached as ANNEXUREs A2, B2, C2 and D2.
Observing facilities
Condition of buildings: The buildings of Bophelong Clinic (Free State), Messina District
Hospital (Limpopo) and Unit 9 and Tlapeng clinics (North West) required urgent refurbishing.
In Limpopo the Bela-Bela Clinic is a makeshift structure of containers, which was not
conducive for providing quality health care.
Records management system: The filing system at Ellisras Hospital in Limpopo was
cluttered and raised serious questions of easier location of patients’ files. It also posed a
9 Republic of South Africa. Report on the Assessment of the Quality of Support provided by the Department of Health to
Emergency Medical Service Practitioners. 2009. 10 Republic of South Africa. Department of Public Service and Administration. The Batho Pele White Paper on the
Transformation of Public Service Delivery, 1997.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page x
serious safety risk in case of fire breaking out, which was further exacerbated by the lack of
servicing of the hospital’s fire extinguishing equipment.
Observing access to information
Information: In all the visited provinces the inspected facilities had displayed key
information on health issues, business hours and service charters in line with the Batho Pele
principle of Information.
Suggestion/complaint boxes: These boxes were found to be available and strategically
placed in all the inspected facilities in all the selected provinces, which facilitated the process
of lodging complaints or suggestions in line with the Batho Pele principle of Redress.
Complaint procedures were also found to be in place to enable citizens to lodge complaints.
General observations
Water and sanitation: Generally, there was no challenge of water and sanitation in most
inspected facilities in visited provinces. However, in the Free State province the Brentpark
Clinic experienced a poor supply of water from the Moqhaka Local Municipality, while
Bophelong Clinic’s quality of water led to a number of cases of diarrhoea. The toilets
facilities at Unit 9 Clinic in the North West required urgent refurbishing since sanitation pipes
were damaged such that an unbearable smell filled the waiting area, and thus posing a
health risk.
Conducive working environment: Air conditioning systems were not adequate in all the
inspected facilities in Limpopo, mostly because they needed maintenance.
Parking facilities and security: Parking facilities were not adequate at Bela-Bela and
Namakgale clinics in Limpopo. The fencing at the Namakgale Clinic in Limpopo appeared
worn-out and needed to be repaired in some areas.
Talking to citizens
Availability of medicines and medical equipment: Interviewed citizens in the visited
facilities were generally satisfied with the availability of medicines and medical equipment.
However, key observations were made regarding challenges involving lack of maintenance
of equipment as well as the procurement of poor quality equipment such as in Limpopo
where Messina District Hospital’s X-ray machine was broken and in the North West several
broken equipment items were found lying around at Unit 9 Clinic.
Waiting time: There was a general concern with the waiting time of two (2) to four (4) hours
before consultation as being unreasonably long. However, in the Western Cape the citizens
were satisfied with the time taken to collect their medicines, which ranged from 10 to 45
minutes.
Access: Challenges of accessing the health care facilities were raised at Phuthaditjhaba
Clinic (Free State), Marishane Clinic (Limpopo) and Sedgefield Clinic (Western Cape), with
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page xi
interviewed citizens at Phuthaditjaba Clinic indicating that they travelled between 10km to
20km to access a clinic.
IMPLEMENTATION OF PSC RECOMMENDATIONS
In line with its oversight role the PSC followed up on the implementation of its previous
recommendations emanating from the inspections of primary health care facilities conducted
in 200911. Of the 38 recommendations, 29 (76%) were implemented with Limpopo and
Western Cape achieving 100%. The implementation rate in the Free State was 94%, while
the North West was trailing at 58%. Specific details of the status on implementation of these
recommendations are attached as ANNEXURE E.
RECOMMENDATIONS
The following recommendations should apply to all health facilities that may be experiencing
similar challenges and not only those that were visited: Specific recommendations as
contained in the relevant reports have been forwarded to the Departments concerned.
Announced Inspections
Electronic information systems, which are linked to the medical depots’ ordering
systems, should be established in all the health care facilities. Computers and
network points should be provided as well.
The FSDoH, LDoH and NWDoH should collaborate with the provincial Departments
of Education (DoE), DPW and Human Settlements to devise strategies for the
recruitment and retention of medical professionals, especially in view of the challenge
of shortage of accommodation in these areas.
The FSDoH, LDoH and NWDoH should ensure that District Offices regularly visit
health facilities. In this regard, the visits should be linked to the applicable
performance management system.
The FSDoH and NWDoH should strengthen their SCM processes for procurement of
medical equipment and ensure that systems of blacklisting suppliers of poor quality
of medical equipment were implemented.
In addition, an audit of equipment should be conducted at all the facilities in all the
visited provinces to determine their needs, especially the procurement of new X-ray
equipment for Tokollo and Ellisras hospitals.
The FSDoH should ensure that suppliers are paid on time as required by the
Treasury regulations to ensure availability of medicines at the Medical Depot and
facilities.
Security measures should be improved at the health facilities, which should include
CCTV systems and/or alarm systems.
11 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of
Health. 2010.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page xii
The LDoH should urgently investigate the veracity of the allegations of malpractices
relating to conduct of the Nurse-in-Charge reported at Messina Hospital.
Training should be provided to the staff in the necessary protocols of dispensing
medication especially in the management of adverse drug events.
The LDoH should engage the provincial Department of Public Works to address the
poor condition of buildings and lack of space experienced by health care facilities
especially at Ellisras and Messina hospitals as well as at Bela-Bela and Namakgale
clinics.
The LDoH should also immediately ensure that the pharmaceutical license of the
MSD is renewed as required by the SAPC to ensure that the operations of the depot
are legal and in line with section 22 of the Pharmacy Act, 1974.
The LDoH should ensure that DHPs are in place, especially in the Capricorn,
Mopani, Sekhukhune and Vhembe districts, in line with the provisions of the NHA..
The NWDoH should immediately ensure that asset management unit of the Ngaka
Modiri Molema District Office attend to the broken equipment found at Unit 9 Clinic in
terms of the relevant SCM prescripts.
Back-up generators should be provided to the Taung Station, Tlapeng and Unit 9
clinics in order to prevent disruption of services in case of power failure.
Unannounced Inspections
An audit of the state of buildings of health facilities should be conducted in order to
ensure proper maintenance, eradication of dilapidated buildings and to address the
challenge of space. Most importantly, provision should be urgently made for
additional maternity wards and beds at Messina District Hospital in Limpopo.
Improved outside signage that is visible from the main roads should be provided, in
collaboration with the provincial Departments of Roads and Transport, especially for
Helene Franz Gateway Clinic.
Training on the necessary protocols of patient care and customer care should be
provided to the staff, especially on Batho Pele.
The general challenge of waiting time should be addressed through consultation
processes in line with Batho Pele with the citizens.
All facilities should be equipped with air-conditioning systems.
The records management system at Brentpark Clinic (Free State) and Ellisras District
Hospital (Limpopo) should be overhauled to align these with the applicable prescripts
and best practices.
A system of feedback or action taken following receipt of any complaint or suggestion
lodged should immediately be in place to ensure at all facilities, especially inspect of
Namakgale Clinic in Limpopo.
Parking facilities should be provided for members of the public, especially at
Namakgale and Bela-Bela clinics in Limpopo.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page xiii
Back-up generators should be provided to the facilities, especially at Ellizabeth Ross
Hospital (Free State), to ensure that services were not disrupted during power failure.
The FSDoH should engage the Maluti-A-Phofung and Moqhaka Local Municipalities
to address the identified challenges of power disruptions and water supply.
The Department should urgently ensure the general maintenance of Great Brak River
Clinic and Alma CDC, including painting of the external walls, to address their
unattractive appearance.
The general challenge of maintenance, disposal and replacement of medical
equipment should be addressed. In the case of Unit 9 Clinic, the NWDoH should
urgently take measures to address the identified obsolete equipment found lying
around the premises.
CONCLUSION
The PSC’s inspections mechanism aims to entrench accountability in the Public Service
through observing first-hand service delivery and involving key stakeholders. It is hoped that
the findings and recommendations will assist the provincial Departments of Health in
improving the delivery of services and contribute towards a long and healthy life for the
citizenry.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 1
CHAPTER ONE: INTRODUCTION
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 2
1.1 INTRODUCTION AND BACKGROUND
Health care is one of government’s key priorities as well as an essential service which
should be accessible to all citizens of the country. Hence, government adopted as one its
outcomes “A long and healthy life for all South Africans”. The foregoing is predicated on a
sustainable quality health care infrastructure. The National Department of Health (NDoH)
developed various policies and guidelines to ensure the availability of key resources for the
delivery of quality health care services. Amongst these policies is the National Drug Policy of
South Africa (NDPSA) of 1996, formulated in line with the World Health Organization (WHO)
guidelines. The NDPSA, through the Essential Drugs List (EDL) and Standard Treatment
Guidelines (STG), ensures that medicines are available at health facilities.
Furthermore, our constitutional imperatives dictated that government should devolve certain
responsibilities for health services to the provincial and local government levels12. As a
consequence, 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 to13. Accordingly, the Provincial Departments of
Health created District Health Offices to facilitate the delivery of health services by hospitals
and clinics at district level. In this regard, 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. It follows, therefore, that the citizens
expect health facilities to always have medicines in sufficient quantities as well as necessary
medical equipment to ensure that quality health care is accessible to them.
It is against this background that during 2013/14 the PSC decided to conduct inspections in
in selected health care facilities of the Free State, Limpopo, North West and Western Cape
Provincial Departments of Health focusing on availability of medicines and medical
equipment. These inspections further aimed to determine the role of Health District Offices
with regard to ensuring the necessary support. The inspections also aimed to establish the
extent to which the provincial departments of Health have implemented the PSC
recommendations emanating from the inspections of primary health care facilities conducted
in 200914. Reports with findings and recommendations emanating from the inspections in the
four provinces have been forwarded to the relevant Executive Authorities and Accounting
Officers for implementation of the recommendations. The reports are available on the PSC
website www.psc.gov.za. Subsequently, the PSC engaged the respective authorities of the
departments on progress regarding implementation of its recommendations. Feedback in
this regard has been received and is attached as ANNEXURE F.
1.2 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
12 Republic of South Africa. National Department of Health. White Paper for the transformation of the Health
System in South Africa . 1997. 13 Republic of South Africa. National Health Act. 2003. 14 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of
Health. 2000.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 3
stipulated regulations and other government frameworks15 . Table 1 below provides the
specific objectives of an inspection as defined in the PSC Protocol as well as those
pertaining to these inspections 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.
To establish whether the provincial departments of Health have implemented the PSC recommendations emanating from the inspections of primary health care facilities conducted in 200916.
1.3 SCOPE AND METHODOLOGY
1.3.1 Scope
The inspections were conducted in 11 District Offices, 2 Regional hospitals, 7 District
hospitals, 21 clinics and 6 Community Day Centres (CDCs). The table below represents the
sites visited as well as the dates of inspections.
Table 2: List of provinces, inspected sites and dates of inspections
Provincial/District Office Component/Institution Date of Inspection
FREE STATE
Provincial Office Sub-Directorate: Pharmaceutical Services 19/09/2013 Fezile Dabi District Office 30/09/2013 Brentpark Clinic 30/09/2013
15 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007. 16 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of
Health. 2000.
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Provincial/District Office Component/Institution Date of Inspection
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 Medical Depot 29/10/2013
LIMPOPO
Sekhukhune District Marishane Clinic 14/10/2013 Waterberg District Bela-Bela Clinic 15/10/2013 Ellisras District Hospital 15/10/2013
Mopani District Namakgale Clinic (Zone A) 16/10/2013 Vhembe District Messina District Hospital 17/10/2013 Capricorn District Helene Franz Gateway Clinic 18/10/2013 Provincial Office/District Offices Polokwane Provincial Office and five (5) District
Offices 30/10/2013
Medical Supply Depot 30/10/2013 NORTH WEST
Mmabatho Provincial Office 21/10/2013 Tlapeng Clinic 21/10/2013 Unit 9 Clinic 21/10/2013 Bojanala District Office 22/10/2013
Brits District Hospital 22/10/2013 Dr Kenneth Kaunda District Office 28/10/2013 Klerksdorp District Hospital 28/10/2013 Taung Clinic 29/10/2013
Dryhartz Clinic 29/10/2013 WESTERN CAPE
Provincial Office Directorate: Communications 11/10/2013 Eden District District Office 17/10/2013 Sedgefield Clinic, Sedgefield 16/10/2013 Knysna District Hospital, Knysna 16/10/2013 Kwanokuthula CDC, Plettenberg Bay 16/10/2013 George Regional Hospital, George 17/10/2013 Alma CDC, Mossel Bay 17/10/2013 Great Brak River Clinic, Mossel Bay 17/10/2013 Thembalethu CDC, George 17/10/2013 George CDC, George 17/10/2013 Cape/Winelands District District Office 08/11/2013 Nduli Clinic, Ceres 07/11/2013 Tulbagh Clinic, Tulbagh 07/11/2013 Touws River Clinic, Touwsriver 07/11/2013 Montague CDC, Montague 07/11/2013 Bergsig Clinic, Robertson 07/11/2013 Worcester Regional Hospital, Worcester 07/11/2013 Phola Park Clinic, Wellington 08/11/2013 Rawsonville Clinic, Rawsonville 08/11/2013 Kayamandi Clinic, Stellenbosch 08/11/2013 Cloetesville CDC, Stellenbosch 08/11/2013
1.3.2 Methodology
The methodology for conducting the inspections followed both the announced and
unannounced inspections as prescribed in the PSC’s protocol for conducting inspections17.
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.
17 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 5
To initiate the inspection process, letters were forwarded to the Executive Authorities (EAs)
and Accounting Officers (AOs) of the National and selected Provincial Departments of
Health, informing them about the PSC’s intention to conduct inspections in the sampled
hospitals and clinics, as well as CDCs in the case of the Western Cape. Furthermore, the
inspection teams held engagements with the respective Provincial Departments to set the
scene for the inspections.
1.4 LIMITATIONS OF THE STUDY
The inspections were conducted at selected district offices and health care facilities and
therefore, the findings relate to views and observations made at the said sites. In this regard,
the key limitation was that the PSC inspection teams comprised members who are not
experts in the medical field and relied on the officials of the departments 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.
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CHAPTER TWO: OVERVIEW OF THE
FINDINGS
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2.1 KEY FINDINGS ON ANNOUNCED INSPECTIONS
The findings of the announced inspections are presented into key thematic areas, which are
contextual background, the management of medicines and the management of medical
equipment. Detailed findings on availability of medicines and medical equipment are
attached as ANNEXUREs A1, B1, C1 and D1.
2.1.1 Contextual Background
It emerged during discussions with senior officials of the Departments in the visited
provinces that procurement of medicines by health care facilities was mainly undertaken
through the relevant provincial medical depots. Whilst the process was mainly deemed
effective in all the visited provinces, it was observed that some provinces experienced
challenges. For instance, it was noted in the Free State that challenges were experienced
with the delivery of medical supplies in the beginning of the 2013/2014 financial year. This
was mainly due to the FSDoH delaying to pay suppliers during the 2012/2013 financial year.
Consequently, most suppliers withdrew their services to deliver stock to the Free State
medical depot leading to a shortage of stock and thus affecting deliveries to the health
facilities. The PSC noted that the situation had since improved and at the time of the
inspection, there were very few cases of shortage of medicines.
Similarly, there were challenges with regard to obtaining medical supplies in Limpopo. The
decision to place the LDoH under administration in terms of Section 100 of the Constitution
of South Africa18 coincided with the expiry of Department’s contract with medical suppliers.
As a result, the Department was no longer able to undertake large procurement bids, which
led to the medical depot relying heavily on the quotation system. With the quotation system’s
threshold of R500 000,00 as set in Paragraph 3.3 of the National Treasury Practice No 8 of
2007/200819, the funds were acutely insufficient and resulting in a shortage of medicines.
The Department was, however, creative in partnering with the Gauteng Department of
Health (GDoH) to purchase bulk medical supplies on its behalf, which improved availability
of medicines at health facilities.
2.1.2 Management of Medicines
The management of medicines is categorised into five key functions namely, product
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.
18 Republic of South Africa. Constitution of the Republic of South Africa, 1996. 19 Republic of South Africa. National Treasury. National Treasury Practice No. 8 of 2007/2008.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 8
Figure 1: Medicine management cycle
(a) Product Selection
It was found during interaction with officials of the visited Departments of Health, i.e. FSDoH.
LDoH, NWDoH and WCDoH, that the selection of medicines or drugs is a national
competence. The National Essential Drugs List Committee (NEDLC) or National Essential
Medicines List Committee (NEMLC) appointed by the Minister of Health has the
responsibility to determine which medicines are regarded as essential to be included in the
Essential Drugs List (EDL). It also emerged that Pharmaceutical and Therapeutic
Committees (PTCs) were established at Provincial, District and hospital levels. The functions
of the PTCs include identifying new drugs for possible inclusion on the EDL based on
consideration of scientific evidence of efficacy, substantial safety, and risk/benefit ratio as
well as best cost advantage of the identified drug. The PSC found product selection to be
well institutionalized and contributing effectively towards the availability of medicines at
health care facilities.
(b) Procurement
In all provinces visited, the primary supply of medicines to the visited health care facilities
was done through Medical Depots. However, district hospitals were allowed in the case of
urgently needed medicines to use either the “buy out” or Direct Delivery Voucher (DDV)
methods. In terms of the buy-out method orders were made directly with the suppliers or
pharmaceutical companies on a quotation basis. The DDV method requires hospitals to
order through the depots, however, the ordered stock was then delivered directly to the
facilities. It was observed that district hospitals took advantage of these methods when
necessary to obtain medicines. This level of flexibility allowed for efficient acquisition of
urgently needed medicines at the health facilities, and thereby ensuring stock availability.
Product
selection
Rational use,
monitoring and
evaluation
Distribution
and storage
Procurement
Management support:
Information system
Organisation/staffing
Budgeting
Training
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(c) Distribution and storage
Distribution: As stated in the NDPSA provincial departments were required to make own
distribution arrangements to ensure prompt, efficient, timely and equitable distribution of
essential drugs and medical supplies to all institutions. It was found that in all provinces
visited, Medical Depots were responsible for the distribution of medicines to the health care
facilities. Service level agreements (SLAs) or Memorandums of Agreement (MoAs) were in
place in this regard. Challenges were, however, experienced with the timely delivery of
ordered stock to the health care facilities, especially in the Free State and North West
provinces. These resulted in the facilities having to use own transport to fetch their orders
from the depots. In the Free State the depot failed to meet the four weeks delivery timeframe
during the 2013/2014 financial year, such that the longest delay was 8 weeks as indicated by
officials at Thabo Mofutsanyana. The distribution lapses not only contravened the applicable
SLAs or MoAs, but were also not in keeping with the NDPSA and thus impacting negatively
on service delivery, with potential serious health consequences. Of concern in the Free State
was that a serious shortage of stock was experienced by the depot in the beginning of
2013/14 due to late payment of suppliers by the FSDH. This was demoralising to the
affected suppliers especially since most of them decided to withdraw their services to the
FSDH. The late 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”.
Storage: According to the NDPSA measures should be in place for the proper storage and
safeguarding of drugs and medical supplies to ensure the maintenance of quality and
security from the time of receipt into stock up to the time of issue to the patient. It was found
that there was general compliance with the applicable Standard Operating Procedures
(SOPs) in all the visited health facilities with their pharmacies always locked and notices
displayed prohibiting unauthorized access. These security measures were augmented with
additional measures such as Closed Circuit Television (CCTV) systems and alarm systems
at some of the inspected facilities as observed at Kwanokuthula Community Day Centre
(CDC) in the Western Cape province. These additional measures were critical, in particular
dedicated security manning the entrances especially at Messina District Hospital in the
Limpopo Province where the inspection team noted reports of theft of medicines. The
inspected building of the Brits District Hospital appeared old with very little storage space.
However, it was heartening to be informed that the hospital was in the process of moving to
a newly built facility.
The majority of the facilities had sufficient refrigerators for storing medicines requiring
constant cool temperature such as vaccines and insulin and their temperatures monitored
regularly. At Tlapeng Clinic in the North West province one of the refrigerators was not used
despite being new apparently due to its inherent electrical fault that kept tripping up power
whenever it was connected. Waste buckets were also provided for safekeeping of medical
waste, which were sealed once full and safely placed where they were later collected by a
medical waste management company for incineration.
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(d) Rational use, monitoring and evaluation
Rational use: The NDPSA has recognized the key educational role of pharmacists in
instructing patients in the correct use of medicines and to provide preventive health services.
It was observed that guidelines for the district pharmacists have been developed in the Free
State, North West and Western Cape provinces for clinic supervisors to visit these facilities
monthly and the clinics to keep written record in this regard. In the Limpopo province, district
offices were guided by the Handbook for Clinic and Community Health Centre (CHC)
Managers, which states that supervisors should visit these health facilities monthly20. 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. Only the Western Cape was found to adhere to its guidelines with district
pharmacists conducting regular workshops and comprehensive analysis of the stock levels.
This intervention empowered the facilities to maintain quality service delivery in line with the
NDPSA. In the case of the Free State, Limpopo and North West no evidence of such visits
could be found despite the district officials and nursing staff indicating that they were taking
place. The lack of supervision in the aforementioned provinces was not in keeping with the
developed guidelines and Handbook for Clinic and CHC Managers. In addition, the shirking
of this key responsibility by district officials in Limpopo contributed to the reported misguided
practices by some personnel at Messina District Hospital of stealing certain essential
medicines.
Monitoring and evaluation: District Offices should manage the availability and safe use of
medicines at health facilities as required by the NDPSA. The inspection team observed that
the visited provinces used varied systems to monitor and evaluate the availability of
medicines. However, systems such as the stock cards relied upon by the North West and
Limpopo were regarded as highly ineffective with District officials in Limpopo describing the
system as inaccurate, cumbersome and time-consuming.
In the Western Cape Province, the Cape/Winelands District conducted regular surveys with
citizens on their experiences on medicine availability and usage as well as operations of the
facilities. However, the Eden District relied on the PTC to assess stock levels and trends of
expired medicines. In the case of the Free State, a system called Tracer Drugs was used
which entailed a selection of a sample of essential medicines across all the facilities. Figure
2 below illustrates analysis of statistical information provided by Fezile Dabi District (Free
State), Thabo Mofutsanyana District (Free State) and Waterberg District (Limpopo) in line
with their District Health Plans (DHPs).
20 Republic of South Africa. Department of Health. Handbook for Clinic/Community Health Centres Managers. October
1999.
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medicines and medical equipment and the role of Health District offices. Page 11
Figure 2: Statistical analysis of medicine availability based on reporting against the DHPs
Figure 2 above shows that analysis of the quarterly reports against the DHPs for Fezile Dabi
and Thabo Mofutsanyana districts indicated that most facilities either achieved or exceeded
the 95% set target. However, district officials questioned the validity of the results. They cited
the small sample selected by the Tracer Drugs system as presenting a skewed picture.
With regard to Limpopo, the Waterberg District failed to meet its DHP target of 95% for
availability of essential drugs with coverage of 85%, 93% and 90% in the first, second and
third quarters respectively. Capricorn, Mopani, Sekhukhune and Vhembe districts did not
provide the inspection team with their DHPs and relevant reports. However, the reported
challenges of unavailability of medicines at the inspected facilities within these districts
suggested that they were also not meeting their targets.
(e) Management support
Information technology (IT) system: In Limpopo the inspected health care facilities
ordered their stock from the Medical Supply Depot (MSD) on a particular form despite the
NDPSA requiring health institutions to have computerized inventory control systems that are
linked to similar systems in the depots. The staff at the inspected health facilities found this
mode of ordering medicines cumbersome and led to delays in the delivery of orders.
85% 85%
98% 99%
95%
99%
95%
93% 93%
98%99%
95%
99%
90% 90%
98%99%
95%
99%
75%
80%
85%
90%
95%
100%
105%
1st Quarter
2nd Quarter
3rd Quarter
Waterberg District Thabo Mofutsanyana DistrictFezile Dabi District
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However, the MSD has an electronic system for capturing orders although officials were
concerned that it was slow and contributed towards delays in finalising the orders, which was
further exacerbated by insufficient personnel for capturing orders. In the North West and
Free State district hospitals were using the RX solution (i.e. an electronic ordering system),
which was linked to the Medical Depot via the Remote Demander Module (RDM), to record
and monitor stock levels, whilst clinics used the manual system of stock cards. All visited
health facilities in the Western Cape were using the WINRDM electronic system, which was
also linked in the same manner to the Cape MSD, for ordering and managing availability of
stock. These IT systems were found to be effective in expediting requisitions by health
facilities.
Training: Training plays a central role in empowering employees about what was expected
of them and also to keep them abreast of new developments in order to provide quality
services. It was observed in the North West that training on dispensing of medicines and
Batho Pele principles was provided to staff, while district pharmacists in the Western Cape
regularly conducted workshops and meetings with pharmaceutical staff within their districts.
In the Free State the training offered focused mainly on health prevention programmes.
Staffing: It was found that there was in general a shortage of health professionals at the
visited facilities in Limpopo, North West, Free State and Western Cape, which impacted
negatively on the delivery of quality health care services.
2.1.3 Management of Medical Equipment
Procurement: It was established during interviews with officials of the LDoH, FSDoH and
NWDoH that the procurement of medical equipment was centralized at the Provincial Head
Office and undertaken in terms of the Preferential Procurement Policy Framework Act, 2000
(PPPFA) 21 . However, all the visited health facilities raised concerns with the aforesaid
approach especially since it resulted in delays of procuring new or replacing broken
equipment that can no longer be repaired. On the contrary, District Offices in the WCDoH
informed the inspection team that the procurement of medical equipment in the province has
been decentralized to ensure that needed items were timeously procured for the facilities.
Concerns were also raised in the North West province about the procurement of poor quality
equipment such as blood pressure (BP) machines, which required frequent repairs or
replacement. Some of the BP machines often provided incorrect readings and resulted in
poor service delivery. The staff attributed the poor quality of equipment to the Supply Chain
Management (SCM) process of selecting the cheapest quotations.
Asset control: In the Free State, Limpopo and North West provinces, the function of asset
control was the responsibility of District Offices. On the contrary, this function in the Western
Cape had been devolved to the heads of administration or operational managers of the
health facilities with the appropriate delegations in place.
Maintenance of equipment: The Western Cape province was found to have the most
effective arrangement in that sufficient capacity in this regard had been established at
21 Republic of South Africa. National Treasury. Preferential Procurement Policy Framework Act, 2000 (PPPFA).
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 13
District, Regional and Tertiary hospitals to assist all other facilities. In the Free State and
North West provinces, the function had been entrusted to the District Offices although there
were concerns of delays in the turnaround times for maintenance of equipment. Limpopo
had centralized the function and staff at inspected facilities raised serious concerns of lack of
maintenance of equipment due to delays from the Provincial Head Office. Ellisras District
hospital was worst affected with its X-ray machine not functional.
Disposal of medical equipment: It was found that the process of disposal of equipment in
the Free State, North West and Western Cape provinces rests with District Offices, whereas
in Limpopo the function was located in the Provincial Head Office. In the case of the North
West the process in place was not being adhered to in that broken equipment was found
lying around at the Unit 9 Clinic with some items posing serious risks of injury to the citizens.
2.1.4 Governance of Health Facilities
Hospital boards: In all the visited provinces the inspected hospitals had hospital boards
with those of Free State and Western Cape functioning effectively. However, staff at the
inspected hospitals in Limpopo and North West raised concerns of instances of interference
by the hospital boards in administration matters. The foregoing points to the possibility of
lack of clear governance rules which leads to the boards overstepping their mandate.
Clinic Committees: Although these structures were established in all the provinces visited,
not all of them were found to be functioning as required. In fact, it was only in the Free State
province where the inspected clinics’ committees were found to be functioning effectively. In
Limpopo the committee members for Marishane Clinic failed to regularly attend meetings
citing transport costs and lamented the lack of a stipend to offset such costs. The lack of
functioning of these structures is not in keeping with section 42(1) of the NHA and most
importantly, deprives the community of a constitutionally enshrined avenue to contribute to
improved service delivery at these clinics.
2.1.5 Challenges
Infrastructure: In all the visited provinces there was a challenge of space at most inspected
facilities. Messina District Hospital was worst affected due to insufficient maternity wards and
beds such that some infants and their mothers were forced to sleep on the floor. In the Free
State province the inspected facilities within Thabo Mofutsanyana District, which is serviced
by the Maluti-A-Phofung Local Municipality, experienced intermittent power failures.
Unavailability of back-up generators to mitigate power failure was a concern at Taung
Station, Tlapeng, and Unit 9 clinics in the North West province.
Shortage of staff: There was generally a staffing challenge of health professionals at most
of the visited facilities in all the provinces. In the Free State, Limpopo and North West
provinces the challenge was further exacerbated by lack of accommodation and other key
amenities to attract professionals in the areas serviced by the inspected facilities.
Emergency Medical Services: It was found that the emergency medical services (EMS) in
all the districts in the North West were generally poor due to insufficient ambulances.
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Response times to calls often varied from an hour to four hours and in some instances the
vehicles failed to arrive putting the lives of patients at risk. The PSC report on the EMS
raised similar challenges of lack of emergency care practitioners and insufficient vehicles
impacting negatively on service delivery in this area22.
2.2 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 23 . The purpose of unannounced inspections was to
determine the extent to which the visited health care facilities adhered to these. Detailed
findings on adherence to Batho Pele requirements are attached as ANNEXUREs A2, B2,
C2 and D2.
2.2.1 Observing facilities
Condition of buildings: In all the provinces some of the inspected facilities required
maintenance. However, buildings of Bophelong Clinic (Free State), Messina District Hospital
(Limpopo) and Unit 9 and Tlapeng clinics (North West) required urgent refurbishing. In the
Limpopo province, the Bela-Bela Clinic was found to be a makeshift structure of containers,
which was not conducive for providing quality health care.
Records management system: The filing system at Ellisras Hospital in Limpopo needed to
be overhauled due to its cluttered nature, and thus making it difficult to locate patients’ files.
The system also posed a serious safety risk in case of fire breaking out, which was further
exacerbated by the fact that its fire extinguishing equipment had passed its service date.
2.2.2 Observing access to information
Information: The Batho Pele principle of Information determines that information should be
readily provided to the public to empower them in making informed decisions. In all the
visited provinces the inspected facilities had key information on health issues, business
hours and service charters visibly displayed. Some of the information was also made
available in languages predominantly spoken in their respective areas to enhance access in
line with Batho Pele.
Suggestion/complaint boxes: These boxes were found to be available and strategically
placed in all the facilities visited in all the selected provinces to enable citizens to raise their
concerns and also to provide input on the desired quality of services in line with the Batho
Pele principle of Redress.
22 Republic of South Africa. Report on the Assessment of the Quality of Support provided by the Department of Health to
Emergency Medical Service Practitioners. 2009. 23 Republic of South Africa. Department of Public Service and Administration. The Batho Pele White Paper on the
Transformation of Public Service Delivery, 1997.
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2.2.3 General observations
Water and sanitation: Generally, there was no challenge of water and sanitation in most
inspected facilities in visited provinces. However, in the Free State the Brentpark Clinic
experienced a poor supply of water from the Moqhaka Local Municipality, while Bophelong
Clinic’s quality of water led to a number of cases of diarrhoea. Furthermore, at Unit 9 Clinic,
also in the North West, the toilet facilities required urgent refurbishing since sanitation pipes
were damaged such that an unbearable smell filled the waiting area, and thus posing a
health risk.
Conducive working environment: Air conditioning systems were not adequate in all the
inspected facilities in Limpopo, mostly because they needed maintenance.
Parking facilities and security: Parking facilities were not adequate at Bela-Bela and
Namakgale clinics in Limpopo. While security measures were provided at all the inspected
facilities in all the selected provinces, the fencing at the Namakgale Clinic in Limpopo
appeared worn-out and needed to be repaired in some areas.
2.2.4 Talking to citizens
Availability of medicines and medical equipment: The majority of the interviewed citizens
in the visited facilities were satisfied that medicines and medical equipment were sufficiently
available. However, in the case of Limpopo the foregoing was not consistent with the
observations made while interviewing the nursing staff at Messina District Hospital and
Marishane Clinic. For instance, the scrutiny of the progress reports based on the DHP for
Waterberg District on availability of medicines suggested challenges in this regard as stated
in paragraph 2.1.2. Furthermore, key observations were made regarding challenges
involving lack of maintenance of equipment as well as the procurement of poor quality
equipment. For example, in Limpopo the Messina District Hospital’s X-ray machine was not
functional whilst several broken equipment items were found lying around at Unit 9 Clinic in
the North West.
Waiting time: Most citizens at the visited facilities in the selected provinces were highly
concerned that the waiting time before consultation which ranged from two (2) to four (4)
hours was too long. In the Western Cape province, interviewed citizens were satisfied with
the time waiting to collect their medicines of 10 to 45 minutes.
Access: There were challenges raised with accessing the health care facilities at
Phuthaditjhaba Clinic (Free State), Marishane Clinic (Limpopo) and Sedgefield Clinic
(Western Cape). Interviewed citizens at Phuthaditjaba Clinic indicated that they travelled
between 10km to 20km to access a clinic, which was extremely in excess of the set 5 km
radius in terms of the applicable norms and standards.
2.3 IMPLEMENTATION OF PSC RECOMMENDATIONS
During the inspections in all the selected provinces the PSC followed up on the
implementation of its previous recommendations emanating from the inspections of primary
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 16
health care facilities conducted in 200924. Overall, the findings have shown that 29 (76%) of
the 38 recommendations were implemented by the FSDoH, LPDoH, NWDoH and WCDoH,
with Limpopo and Western Cape achieving 100% and Free State implementing 94%. The
North West was trailing with 58% of the recommendations implemented. However, the
overwhelming rate of implementation of the recommendations was indicative of the
recognition of the value-add of the PSC’s work by these provincial departments. Specific
details of the status on implementation of these recommendations are attached as
ANNEXURE E.
24 Republic of South Africa. Consolidated Report on Inspections of Primary Health Care Delivery Sites: Department of
Health. 2010.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 17
CHAPTER THREE: CONCLUSION AND
RECOMMENDATIONS
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 18
3.1 INTRODUCTION
This Chapter presents the recommendations and overall conclusion of the inspections of the
service delivery sites that were visited in the Departments of Health in the Free State,
Limpopo, North West and Western Cape provinces. The recommendations contained in
3.3.1 and 3.3.2 below should apply to all health facilities that may be experiencing similar
challenges and not only those that were visited. According to the PSC’s protocol on
inspections, the key success factors of the inspections include the timely communication of
their outcomes to the line Departments and other implementing agencies, as well as the
reciprocal commitment of these institutions in implementing the suggested remedial action25.
In this regard, the PSC has already disseminated the reports emanating from these
inspections to the Executive Authorities and Accounting Officers of the Departments of
Health in the Free State, Limpopo, North West and Western Cape provinces.
3.2 CONCLUSION
The findings of the inspections have shown that there are challenges related to availability of
medicines and medical equipment at some visited sites. Poor maintenance of medical
equipment and general shortage of professionals especially at rural areas was noticed by
the inspection team. Whilst the Handbook for Clinic/CHC Managers requires the District
Offices to conduct monthly visits, the inspections proved that this is lacking. The PSC trusts
that the recommendations will assist the visited provinces in ensuring that quality health care
is provided at the inspected health care facilities.
3.3 RECOMMENDATIONS
The following recommendations emanate from the inspections:
3.3.1 Announced inspections
Electronic information systems, which are linked to the medical depots’ ordering
systems, should be established in all the health care facilities. Computers and
network points should be provided as well.
The FSDoH, LDoH and NWDoH should collaborate with the provincial Departments
of Education (DoE), DPW and Human Settlements to devise strategies for the
recruitment and retention of medical professionals, especially in view of the challenge
of shortage of accommodation in these areas.
The FSDoH, LDoH and NWDoH should ensure that District Offices regularly visit
health facilities. In this regard, the visits should be linked to the applicable
performance management system.
25 Republic of South Africa. Public Service Commission. Protocol on Announced and Unannounced Inspections. 2007.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 19
The FSDoH and NWDoH should strengthen their SCM processes for procurement of
medical equipment and ensure that systems of blacklisting suppliers of poor quality
of medical equipment were implemented.
In addition, an audit of equipment should be conducted at all the facilities in all the
visited provinces to determine their needs, especially the procurement of new X-ray
equipment for Tokollo and Ellisras hospitals.
The FSDoH should ensure that suppliers are paid on time as required by the
Treasury regulations to ensure availability of medicines at the Medical Depot and
facilities.
Security measures should be improved at the health facilities, which should include
CCTV systems and/or alarm systems.
The LDoH should urgently investigate the veracity of the allegations of malpractices
relating to conduct of the Nurse-in-Charge reported at Messina Hospital.
Training should be provided to the staff in the necessary protocols of dispensing
medication especially in the management of adverse drug events.
The LDoH should engage the provincial Department of Public Works to address the
poor condition of buildings and lack of space experienced by health care facilities
especially at Ellisras and Messina hospitals as well as at Bela-Bela and Namakgale
clinics.
The LDoH should also immediately ensure that the pharmaceutical license of the
MSD is renewed as required by the SAPC to ensure that the operations of the depot
are legal and in line with section 22 of the Pharmacy Act, 1974.
The LDoH should ensure that DHPs are in place, especially in the Capricorn,
Mopani, Sekhukhune and Vhembe districts, in line with the provisions of the NHA.
The NWDoH should immediately ensure that asset management unit of the Ngaka
Modiri Molema District Office attend to the broken equipment found at Unit 9 Clinic in
terms of the relevant SCM prescripts.
Back-up generators should be provided to the Taung Station, Tlapeng and Unit 9
clinics in order to prevent disruption of services in case of power failure.
3.3.2 Unannounced inspections
An audit of the state of buildings of health facilities should be conducted in order to
ensure proper maintenance, eradication of dilapidated buildings and to address the
challenge of space. Most importantly, provision should be urgently made for
additional maternity wards and beds at Messina District Hospital in Limpopo.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of
medicines and medical equipment and the role of Health District offices. Page 20
Improved outside signage that is visible from the main roads should be provided, in
collaboration with the provincial Departments of Roads and Transport, especially for
Helene Franz Gateway Clinic.
Training on the necessary protocols of patient care and customer care should be
provided to the staff, especially on Batho Pele.
The general challenge of waiting time should be addressed through consultation
processes in line with Batho Pele with the citizens.
All facilities should be equipped with air-conditioning systems.
The records management system at Brentpark Clinic (Free State) and Ellisras District
Hospital (Limpopo) should be overhauled to align these with the applicable prescripts
and best practices.
A system of feedback or action taken following receipt of any complaint or suggestion
lodged should immediately be in place to ensure at all facilities, especially inspect of
Namakgale Clinic in Limpopo.
Parking facilities should be provided for members of the public, especially at
Namakgale and Bela-Bela clinics in Limpopo.
Back-up generators should be provided to the facilities, especially at Ellizabeth Ross
Hospital (Free State), to ensure that services were not disrupted during power failure.
The FSDoH should engage the Maluti-A-Phofung and Moqhaka Local Municipalities
to address the identified challenges of power disruptions and water supply.
The Department should urgently ensure the general maintenance of Great Brak River
Clinic and Alma CDC, including painting of the external walls, to address their
unattractive appearance.
The general challenge of maintenance, disposal and replacement of medical
equipment should be addressed. In the case of Unit 9 Clinic, the NWDoH should
urgently take measures to address the identified obsolete equipment found lying
around the premises.
3.4 ACKNOWLEDGEMENT
The PSC would like to express its appreciation for the cooperation received from the officials
of the Departments 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.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 21
ANNEXURE A: FINDINGS FROM FREE STATE PROVINCE
ANNEXURE A1: ANNOUNCED INSPECTIONS ON AVAILABILITY OF MEDICINES AND MEDICAL EQUIPMENT
Availability of medicines at inspected clinics
X Norms and standards adhered to
0 Norms and standards not adhered to
Brent Park Clinic
Med
icin
es
Med
icin
e r
oo
m w
ith
burg
lar
bars
/lockab
le c
up
board
s
Med
icin
es a
nd
supplie
s s
tock
Mechan
ism
for
em
erg
ency s
upp
lies
Batt
ery
% s
pare
glo
bes for
auro
scopes
Med
icin
es a
s p
er
ED
L f
or
PH
C
X X X X X
Bophelong Clinic
X X X X 0
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.
Phuthaditjhaba Clinic
X X X X X
Spare globes were not available – the clinic was awaiting delivery of ordered stock, which included globes as informed during the
inspection
Bluegumbosch Clinic
X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 22
Availability of medicines at inspected hospitals
X Norms and standards adhered to
0 Norms and standards not adhered to
Tokollo District Hospital
Med
icin
es
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and E
DL:
Hosp
ita
l le
vel
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and D
L:
Prim
ary
Care
level
Med
icin
es a
nd
supp
lies a
lways in
sto
ck.
Tro
lleys w
ith e
merg
ency d
rugs a
nd
resuscitation e
qu
ipm
ent
Pharm
aceutical T
hera
peutic
Com
mitte
e in p
lace
X X X X X
Elizabeth Ross District Hospital
X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 23
Availability of medical equipment at inspected clinics
0 Norms and standards adhered to
X Norms and standards not adhered to
Brent Park Clinic
Med
ical eq
uip
men
t
Dia
gnostic s
et
Blo
od p
ressure
mach
ines
Ste
thoscope
Scale
s f
or
ad
ults &
you
ng
child
ren
Measuri
ng t
apes
Specu
lum
s o
f d
iffe
rent
siz
es
Haem
og
lob
ino
mete
r
Glu
com
ete
r
Pre
gn
ancy test str
ips
Em
erg
ency tro
lley
Oxygen c
ylin
der
an
d m
ask
Tele
pho
ne/ tw
o w
ay r
adio
Tw
o w
ork
ing r
efr
igera
tors
Sharp
s d
isposa
l syste
m
Ste
riliz
atio
n s
yste
m
Equ
ipm
ent
& c
onta
iners
for
takin
g b
lood &
oth
er
sam
ple
s
Cond
om
dis
pe
nser
pla
ced
where
easily
accessib
le
X X X X X X X X X X X X X X X X X
Bophelong Clinic
X 0 X X X X 0 0 X X X X X X X X 0
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.
Phuthaditjhaba Clinic
X X X X X X X X X 0 X X X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 24
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 X X X X X X X X 0 X X X X X X 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.
Availability of medical equipment at the inspected hospitals
X Norms and standards adhered to
0 Norms and standards not adhered to
Tokollo District Hospital
Med
ical eq
uip
men
t
Basic
equ
ipm
ent fo
r
exam
ination
of
patients
in
OP
D a
nd w
ard
s
Adu
lt a
nd c
hild
ele
ctr
on
ic
weig
hin
g s
cale
s, m
easurin
g
rods a
nd p
edia
mete
rs
Pro
cto
scopes
Lary
nscopes
Peak f
low
mete
rs
Glu
com
ete
rs
Heam
og
lob
ino
mete
rs
Lum
bar
pu
nctu
re k
its
Card
iac m
on
itori
ng
un
it
Genera
l X
-ray r
oo
m w
ith
supin
e &
bucky u
nit w
ith
scre
enin
g &
tab
le m
attre
ss
Sne
llen c
hart
Ven
o-p
unctu
re s
et
Flu
id g
ivin
g s
et
A c
linic
al w
aste
sto
rag
e
Fix
ed a
nd/o
r m
obile
oxyge
n
supply
A p
riva
te a
rea for
co
unse
ling
(e.g
. H
IV/A
IDS
)
Basic
equ
ipm
ent to
con
duct
norm
al d
eliv
eries
EC
G
Em
erg
ency e
quip
me
nt fo
r
traum
a a
nd e
merg
ency
Tro
lleys w
ith e
merg
ency d
rugs
& r
esuscitatio
n e
quip
me
nt
X X X X X X X X X 0 X X X X X X X X X 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 X X X X X X 0 0 0 X X X X X 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
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 25
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.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 26
ANNEXURE A2: UNANNOUNCED INSPECTIONS ON ADHERENCE TO BATHO PELE REQUIREMENTS
X Batho Pele requirement adhered to
0 Batho Pele requirement not adhered to
Bath
o P
ele
req
uir
em
en
ts
Reception
Outs
ide s
ign
Insid
e s
ign
Busin
ess h
ours
Prior
requir
em
ents
Cost of serv
ices
Build
ing in g
ood c
onditio
n
Ram
ps
Cle
anlin
ess
Sta
ff to g
uid
e p
eo
ple
Serv
ice c
hart
er
Serv
ice c
hart
er
in loca
l
lan
gua
ge
vis
ibili
ty o
f serv
ice c
hart
er
Info
rmation d
esk
Desk w
ith m
ate
ria
l
Desk s
taffed
Sug
gestion b
ox
Com
pla
int
pro
ced
ure
Nam
e b
adges
Nam
e b
adges o
f back
offic
e s
taff
frie
nd
liness
Pro
fessio
na
lism
Air-c
ond
itio
nin
g s
yste
ms
Park
ing
Brentpark Clinic X X X X X X 0 X X X X X X X X X X X X X X X X X
Bophelong Clinic X X X X X X 0 X X X X X X X X X X X X X X X X X
Phuthaditjhaba Clinic
X X X X X X X X X X X X X X X X X X X X X X X X
Bluegumbosch Clinic
X X X X X X X X X X X X X X X X X X X X X X X X
Tokollo District Hospital
X X X X X X X X X X X X X X X X X X X X X X X X
Elizabeth Ross District Hospital
X X X X X X X X X X X X X X X X X X X X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 27
ANNEXURE B: FINDINGS FROM LIMPOPO PROVINCE
ANNEXURE B1: ANNOUNCED INSPECTIONS ON AVAILABILITY OF MEDICINES AND MEDICAL EQUIPMENT
Availability of medicines at inspected clinics
X Norms and standards adhered to
0 Norms and standards not adhered to
Marishane Clinic
Med
icin
es
Med
icin
e r
oo
m w
ith
burg
lar
bars
/lockab
le c
up
board
s
Med
icin
es a
nd
supplie
s s
tock
Mechan
ism
for
em
erg
ency s
upp
lies
Batt
ery
% s
pare
glo
bes for
auro
scopes
Med
icin
es a
s p
er
ED
L f
or
PH
C
X X X X X
Bela-Bela Clinic
X X X X X
Namakgale Clinic
X X X X 0
Helene Franz Gateway Clinic
X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 28
Availability of medicines at inspected hospitals
X Norms and standards adhered to
0 Norms and standards not adhered to
Ellisras District Hospital
Med
icin
es
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and E
DL:
Hosp
ita
l le
vel
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and D
L:
Prim
ary
Care
level
Med
icin
es a
nd
supp
lies a
lways in
sto
ck.
Tro
lleys w
ith e
merg
ency d
rugs a
nd
resuscitation e
qu
ipm
ent
Pharm
aceutical T
hera
peutic
Com
mitte
e in p
lace
X X X X X
Messina District Hospital
X X X X 0
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 29
Availability of medical equipment at inspected clinics
X Norms and standards adhered to
0 Norms and standards not adhered to
Marishane Clinic
Med
ical eq
uip
men
t
Dia
gnostic s
et
Blo
od p
ressure
mach
ines
Ste
thoscope
Scale
s f
or
ad
ults &
you
ng
child
ren
Measuri
ng t
apes
Specu
lum
s o
f d
iffe
rent
siz
es
Haem
og
lob
ino
mete
r
Glu
com
ete
r
Pre
gn
ancy test str
ips
Em
erg
ency tro
lley
Oxygen c
ylin
der
an
d m
ask
Tele
pho
ne/ tw
o w
ay r
adio
Tw
o w
ork
ing r
efr
igera
tors
Sharp
s d
isposa
l syste
m
Ste
riliz
atio
n s
yste
m
Equ
ipm
ent
& c
onta
iners
for
takin
g b
lood &
oth
er
sam
ple
s
Cond
om
dis
pe
nser
pla
ced
where
easily
accessib
le
X X X X X X X X X X X X X X X X X
Bela-Bela Clinic
X X X X X X 0 0 X X X X X X X X 0
Namakgale Clinic
0 X X X X X X X X X 0 X X X X X X
Helene Franz Gateway Clinic
X X X X X X 0 0 X X X X X 0 X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 30
Availability of medical equipment at the inspected hospitals
X Norms and standards adhered to
0 Norms and standards not adhered to
Ellisras District Hospital
Med
ical eq
uip
men
t
Basic
equ
ipm
ent fo
r
exam
ination
of
patients
in
OP
D a
nd w
ard
s
Adu
lt a
nd c
hild
ele
ctr
on
ic
weig
hin
g s
cale
s, m
easurin
g
rods a
nd p
edia
mete
rs
Pro
cto
scopes
Lary
nscopes
Peak f
low
mete
rs
Glu
com
ete
rs
Heam
og
lob
ino
mete
rs
Lum
bar
pu
nctu
re k
its
Card
iac m
on
itori
ng
un
it
Genera
l X
-ray r
oo
m w
ith
supin
e &
bucky u
nit w
ith
scre
enin
g &
tab
le m
attre
ss
Sne
llen c
hart
Ven
o-p
unctu
re s
et
Flu
id g
ivin
g s
et
A c
linic
al w
aste
sto
rag
e
Fix
ed a
nd/o
r m
obile
oxyge
n
supply
A p
riva
te a
rea for
co
unse
ling
(e.g
. H
IV/A
IDS
)
Basic
equ
ipm
ent to
con
duct
norm
al d
eliv
eries
EC
G
Em
erg
ency e
quip
me
nt fo
r
traum
a a
nd e
merg
ency
Tro
lleys w
ith e
merg
ency d
rugs
& r
esuscitatio
n e
quip
me
nt
0 X 0 X 0 X X 0 X 0 X X X X X 0 X X X X
Messina District Hospital
0 0 0 X 0 X X 0 X 0 0 0 0 0 X 0 0 0 0 0
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 31
ANNEXURE B2: UNANNOUNCED INSPECTIONS ON ADHERENCE TO BATHO PELE REQUIREMENTS
X Batho Pele requirement adhered to
0 Batho Pele requirement not adhered to
Bath
o P
ele
req
uir
em
en
ts
Reception
Outs
ide s
ign
Insid
e s
ign
Busin
ess h
ours
Prior
requir
em
ents
Cost of serv
ices
Build
ing in g
ood c
onditio
n
Ram
ps
Cle
anlin
ess
Sta
ff to g
uid
e p
eo
ple
Serv
ice c
hart
er
Serv
ice c
hart
er
in loca
l
lan
gua
ge
vis
ibili
ty o
f serv
ice c
hart
er
Info
rmation d
esk
Desk w
ith m
ate
ria
l
Desk s
taffed
Sug
gestion b
ox
Com
pla
int
pro
ced
ure
Nam
e b
adges
Nam
e b
adges o
f back
offic
e s
taff
frie
nd
liness
Pro
fessio
na
lism
Air-c
ond
itio
nin
g s
yste
ms
Park
ing
Marishane Clinic X X X X X X X X X X X X X X X X X X X X X X 0 X
Bela Bela Clinic X X X X X X 0 0 X X X X X X X 0 X X X X X X 0 0
Namakgale Clinic X X X X X X X X X X X X X X X X X 0 X X X X 0 0
Helene Franz Gateway Clinic
0 X X X X X X X X X X X X X X X X X X X X X 0 X
Ellisras District Hospital
X X X X X X 0 X X X X X X X X 0 X X X X X X 0 X
Messina District Hospital
X X X X X X 0 X X X X 0 X X X 0 X X X X X X 0 X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 32
ANNEXURE C: FINDINGS FROM NORTH WEST PROVINCE
ANNEXURE C1: ANNOUNCED INSPECTIONS ON AVAILABILITIY OF MEDICINES AND MEDICAL EQUIPMENT
Availability of medicines at inspected clinics
Tlapeng Clinic
Med
icin
es
Med
icin
e r
oo
m w
ith
burg
lar
bars
/lockab
le
cupboard
s
Med
icin
es a
nd
supplie
s s
tock
Mechan
ism
for
em
erg
ency
supplie
s
Batt
ery
% s
pare
glo
bes for
auro
scopes
Med
icin
es a
s p
er
ED
L f
or
PH
C
X X X X X
Unit 9 Clinic
X X X X X
Taung Station Clinic
X X X X X
Dryharts Clinic
X X X X X
X Norms and standards adhered to
0 Norms and standards not adhered to
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 33
Availability of medicines at inspected hospitals
X Norms and standards adhered to
0 Norms and standards not adhered to
Brits District Hospital
Med
icin
es
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and E
DL:
Hosp
ita
l le
vel
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and D
L:
Prim
ary
Care
level
Med
icin
es a
nd
supp
lies a
lways in
sto
ck.
Tro
lleys w
ith e
merg
ency d
rugs a
nd
resuscitation e
qu
ipm
ent
Pharm
aceutical T
hera
peutic
Com
mitte
e in p
lace
X X X X X
Klerksdorp Hospital
X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 34
Availability of medical equipment at the inspected hospitals
X Norms and standards adhered to
0 Norms and standards not adhered to
Brits District Hospital*
Med
ical eq
uip
men
t
Basic
equ
ipm
ent fo
r
exam
ination
of
patients
in
OP
D a
nd w
ard
s
Adu
lt a
nd c
hild
ele
ctr
on
ic
weig
hin
g s
cale
s, m
easurin
g
rods a
nd p
edia
mete
rs
Pro
cto
scopes
Lary
nscopes
Peak f
low
mete
rs
Glu
com
ete
rs
Heam
og
lob
ino
mete
rs
Lum
bar
pu
nctu
re k
its
Card
iac m
on
itori
ng
un
it
Genera
l X
-ray r
oo
m w
ith
supin
e &
bucky u
nit w
ith
scre
enin
g &
tab
le m
attre
ss
Sne
llen c
hart
Ven
o-p
unctu
re s
et
Flu
id g
ivin
g s
et
A c
linic
al w
aste
sto
rag
e
Fix
ed a
nd/o
r m
obile
oxyge
n
supply
A p
riva
te a
rea for
co
unse
ling
(e.g
. H
IV/A
IDS
)
Basic
equ
ipm
ent to
con
duct
norm
al d
eliv
eries
EC
G
Em
erg
ency e
quip
me
nt fo
r
traum
a a
nd e
merg
ency
Tro
lleys w
ith e
merg
ency
dru
gs &
resuscitation
equ
ipm
ent
X X X X X X X X X 0 X X X X X X X X X 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.
Klerksdorp Hospital
X X X X X X X X X X X X X X X X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 35
Availability of medical equipment at inspected clinics
X Norms and standards adhered to
0 Norms and standards not adhered to
Tlapeng Clinic
Med
ical eq
uip
men
t
Dia
gnostic s
et
Blo
od p
ressure
mach
ines
Ste
thoscope
Scale
s f
or
ad
ults &
you
ng
child
ren
Measuri
ng t
apes
Specu
lum
s o
f d
iffe
rent
siz
es
Heam
og
lob
ino
mete
r
Glu
com
ete
r
Pre
gn
ancy test str
ips
Em
erg
ency tro
lley
Oxygen c
ylin
der
an
d m
ask
Tele
pho
ne/ tw
o w
ay r
adio
Tw
o w
ork
ing r
efr
igera
tors
Sharp
s d
isposa
l syste
m
Ste
riliz
atio
n s
yste
m
Equ
ipm
ent
& c
onta
iners
for
takin
g b
lood &
oth
er
sam
ple
s
Cond
om
dis
pe
nser
pla
ced
where
easily
accessib
le
X X X X X X X X X X X X X X X X X
Unit 9 Clinic X 0 X X X X X X X X X X X X X X X
Blood pressure machines: Gets overheated after prolonged usage then produce incorrect readings.
Taung Station Clinic
X X X X X X X X X X X X X X X X X
Dryharts Clinic
X X X X X X X X X X X X X X X X X
There is a telephone; however, a two-way radio is required as indicated by the Head of clinic for usage as backup.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 36
ANNEXURE C2: UNANNOUNCED INSPECTIONS ON ADHERENCE TO BATHO PELE REQUIREMENTS
X Batho Pele requirement adhered to
0 Batho Pele requirement not adhered to
* No fees payable at clinics.
Bath
o P
ele
req
uir
em
en
ts
Reception
Outs
ide s
ign
Insid
e s
ign
Busin
ess h
ours
Prior
requir
em
ents
Cost of serv
ices
Build
ing in g
ood c
onditio
n
Ram
ps
Cle
anlin
ess
Sta
ff to g
uid
e p
eo
ple
Serv
ice c
hart
er
Serv
ice c
hart
er
in loca
l
lan
gua
ge
vis
ibili
ty o
f serv
ice c
hart
er
Info
rmation d
esk
Desk w
ith m
ate
ria
l
Desk s
taffed
Sug
gestion b
ox
Com
pla
int
pro
ced
ure
Nam
e b
adges
Nam
e b
adges o
f back
offic
e s
taff
frie
nd
liness
Pro
fessio
na
lism
Air-c
ond
itio
nin
g s
yste
ms
Park
ing
Dryharts Clinic 0 X X X X -* X X X X X X X X X 0 X X X X X X X X
Taung Clinic 0 X X X X X X X X X X X X X 0 X X X X X X X X
Brits District Hospital
X X X X X X 0 X X X X X X X X 0 X X X X X X X X
Klerksdorp District Hospital
X X X X X X 0 X X X X 0 X X X 0 X X X X X X X X
Tlapeng Clinic X X X X X - 0 0 X 0 X X X 0 0 0 X X X X X X X X
Unit 9 Clinic X X X X X - 0 0 X 0 X X X 0 0 0 X X X X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 37
ANNEXURE D: FINDINGS FROM WESTERN CAPE PROVINCE
ANNEXURE D1: ANNOUNCED INSPECTIONS ON AVAILABILITY OF MEDICINES AND MEDICAL EQUIPMENT
Availability of medicines at inspected clinics and Community Day Centres (CDCs)
X Norms and standards adhered to
0 Norms and standards not adhered to
Cloetesville CDC
Med
icin
es
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and E
DL:
Hosp
ita
l le
vel
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and D
L:
Prim
ary
Care
level
Med
icin
es a
nd
supp
lies a
lways in
sto
ck.
Tro
lleys w
ith e
merg
ency d
rugs a
nd
resuscitation e
qu
ipm
ent
Pharm
aceutical T
hera
peutic
Com
mitte
e in p
lace
X X X X X
Sedgefield Clinic
X X X X X
Phola Park Clinic
X X X X X
Kayamandi Clinic
X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 38
Kwanokuthula CDC
X X X X X
Alma CDC
X X X X X
Great Brak River Clinic
X X X X X
Rawsonville Clinic
X X X X X
Montague CDC
X X X X X
Nduli Clinic
X X X X X
Bergsig Clinic
X X X X X
Thembalethu CDC
X X X X X
George CDC
X X X X X
Tulbagh Clinic
X X X X X
Touwsriver Clinic
X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 39
Availability of medicines at inspected hospitals
X Norms and standards adhered to
0 Norms and standards not adhered to
Knysna District Hospital
Med
icin
es
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and E
DL:
Hosp
ita
l le
vel
Med
icin
es s
upp
ly a
ccord
ing to S
TG
and D
L:
Prim
ary
Care
level
Med
icin
es a
nd
supp
lies a
lways in
sto
ck.
Tro
lleys w
ith e
merg
ency d
rugs a
nd
resuscitation e
qu
ipm
ent
Pharm
aceutical T
hera
peutic
Com
mitte
e in p
lace
X X X X X
Worcester Regional Hospital
X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 40
Availability of medical equipment at inspected clinics and CDCs
X Norms and standards adhered to
0 Norms and standards not adhered to
Med
ical E
qu
ipm
en
t
Dia
gnostic s
et
Blo
od p
ressure
mach
ines
Ste
thoscope
Scale
s f
or
ad
ults &
you
ng
child
ren
Measuri
ng t
apes
Specu
lum
s o
f d
iffe
rent
siz
es
Heam
og
lob
ino
mete
r
Glu
com
ete
r
Pre
gn
ancy test str
ips
Em
erg
ency tro
lley
Oxygen c
ylin
der
an
d m
ask
Tele
pho
ne/ tw
o w
ay r
adio
Tw
o w
ork
ing r
efr
igera
tors
Sharp
s d
isposa
l syste
m
Ste
riliz
atio
n s
yste
m
Equ
ipm
ent
& c
onta
iners
for
takin
g b
lood
& o
ther
sam
ple
s
Cond
om
dis
pe
nser
pla
ced
where
easily
accessib
le
Cloetesville CDC
X X X X X X X X X X X X X X X X X
Sedgefield Clinic
X X X X X X X X X X X X X X X X X
Phola Park Clinic
X X X X X X X X X X X X X X X X X
Kayamandi Clinic
X X X X X X X X X X X X X X X X X
Kwanokuthula CDC
X X X X X X X X X X X X X X X X X
Alma CDC
X X X X X X X X X X X X X X X X X
Great Brak River
X X X X X X X X X X X X X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 41
Rawsonville Clinic
X X X X X X X X X X X X X X X X X
Montague CDC
X X X X X X X X X X X X X X X X X
Nduli Clinic
X X X X X X X X X X X X X X X X X
Bergsig Clinic
X X X X X X X X X X X X X X X X X
Thembalethu CDC
X X X X X X X X X X X X X X X X X
George CDC
X X X X X X X X X 0 X 0 X X X X X
Tulbagh Clinic
X X X X X X X X X X X X X X X X X
Touwsriver Clinic
X X X X X X X X X X X X X X X X X
Comments
Khayamandi Clinic – Only large and Medium size speculums, Call log for emergency transport, only one way radio.
Thembalethu Day Centre - Emergency service takes 10-20 minutes, only one electronic oxygen cylinder, no two way radio,
refrigerator used for immunization and for medication, no burglar bars in rooms, Pharmacist attend weekly meetings. No spare
autoscopes available, generators available.
George Central Day Clinic – Ambulance takes 10-15 minutes, only a telephone no two way radio, no burglar bars and no
cupboards, Generator shared with municipality.
Great Brak River Clinic – no transport stationed at clinic for emergencies, transport takes 20 minutes depending on diagnosis,
telephone and no radio. Primary care childline for adults (For all types of diagnosis for medication).
Nduli Clinic – No extra batteries available, Ambulance and GG Vehicles stationed at hospital, one two way telephone, only sharp
containers, sterilization based at hospital.
Alma Clinic – No ambulance stationed at the clinic, 10-15 minute waiting time for ambulance from Mossel Bay Hospital.
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 42
Availability of medical equipment at the inspected hospitals
X Norms and standards adhered to
0 Norms and standards not adhered to
Med
ical eq
uip
men
t
Basic
equ
ipm
ent fo
r
exam
ination
of
patients
in O
PD
and w
ard
s
Adu
lt a
nd c
hild
ele
ctr
on
ic
weig
hin
g s
cale
s, m
easurin
g
rods a
nd p
edia
mete
rs
Pro
cto
scopes
Lary
nscopes
Peak f
low
mete
rs
Glu
com
ete
rs
Heam
og
lob
ino
mete
rs
Lum
bar
pu
nctu
re k
its
Card
iac m
on
itori
ng
un
it
Genera
l X
-ray r
oo
m w
ith s
upin
e
& b
ucky u
nit w
ith s
cre
enin
g &
table
mattre
ss
Sne
llen c
hart
Ven
o-p
unctu
re s
et
Flu
id g
ivin
g s
et
A c
linic
al w
aste
sto
rag
e
Fix
ed a
nd/o
r m
obile
oxyge
n
supply
A p
riva
te a
rea for
co
unse
ling
(e.g
. H
IV/A
IDS
)
Basic
equ
ipm
ent to
con
duct
norm
al d
eliv
eries
EC
G
Em
erg
ency e
quip
me
nt fo
r
traum
a a
nd e
merg
ency
Tro
lleys w
ith e
merg
ency d
rugs
& r
esuscitatio
n e
quip
me
nt
Knysna District Hospital
X X X X X X X X X X X X X X X X X X X X
George Regional Hospital
X X X X X X X X X X X X X X X X X X X X
Worcester Regional Hospital
X X X X X X X X X X X X X X X X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 43
ANNEXURE D2: UNANNOUNCED INSPECTIONS ON ADHERENCE TO BATHO PELE REQUIREMENTS
X Batho Pele requirement adhered to
0 Batho Pele requirement not adhered to
Bath
o P
ele
req
uir
em
en
ts
Reception
Outs
ide s
ign
Insid
e s
ign
Busin
ess h
ours
Prior
requir
em
ents
Cost of serv
ices
Build
ing in g
ood c
onditio
n
Ram
ps
Cle
anlin
ess
Sta
ff to g
uid
e p
eo
ple
Serv
ice c
hart
er
Serv
ice c
hart
er
in loca
l la
nguag
e
vis
ibili
ty o
f serv
ice c
hart
er
Info
rmation d
esk
Desk w
ith m
ate
ria
l
Desk s
taffed
Sug
gestion b
ox
Com
pla
int
pro
ced
ure
Nam
e b
adges
Nam
e b
adges o
f back o
ffic
e s
taff
frie
nd
liness
Pro
fessio
na
lism
Air c
on
ditio
nin
g s
yste
ms
Park
ing
Sedgefield Clinic
X X X X X 0 X X X X X X X X X X X X X X X X X X
Knysna District Hospital
X X X X X X X X X X X X X X X X X X X X X X X X
Kwanokuthula CDC
X X X X X X X X X X X X X X X X X X X X X X X X
George Regional Hospital
X X X X X X 0 X X X X X X X X X X X X X X X X X
Alma CDC X X X X X X X X X X X X X X X X X X X X X X X X
Great Brak River
X X X X X X X X X X X X X X X X X X X X X X X X
Thembalethu CDC
X X X X X X X X X X X X X X X X X X X X X X X X
George X X X X X X X X X X X X X X X X X X X X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 44
CDC Nduli Clinic X X X X X X X X X X X X X X X X X X X X X X X X
Tulbagh Clinic
X X X X X X X X X X X X X X X X X X X X X X X X
Touws River Clinic
X X X X X X X X X X X X X X X X X X X X X X X X
Montague CDC
X X X X X X X X X X X X X X X X X X X X X X X X
Bergsig Clinic
X X X X X 0 X X X X X X X X X X X X X X X X X X
Worcester Regional Hospital
X X X X X X X X X X X X X X X X X X X X X X X X
Phola Park Clinic
X X X X X X X X X X X X X X X X X X X X X X X X
Rawsonville Clinic
X X X X X X X X X X X X X X X X X X X X X X X X
Kayamandi Clinic
X X X X X X X X X X X X X X X X X X X X X X X X
Cloetesville CDC
X x X X X X X X X X X X X X X X X X X X X X X X
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 45
ANNEXURE E: STATUS ON THE IMPLEMENTATION OF RECOMMENDATIONS OF THE PSC’S INSPECTIONS CONDUCTED IN 2009
Details of the clinic Recommendations Implemented Not implemented
FREE STATE
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 are in the queues are attended
to instead of being sent home because it is knock off
time. This should be done immediately.
Yes
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 46
Details of the clinic Recommendations Implemented Not implemented
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 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
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 47
Details of the clinic Recommendations Implemented Not implemented
LIMPOPO
Bela-Bela Outside signage should be displayed by April 2010. Yes
Bela-Bela Business hours should be reflected by December 2009. Yes
Bela-Bela Computers should also be provided by April 2010. Proper
training should be provided to staff to enable them to
effectively use the computers. (In this regard a plan of
action should be in place by April 2010).
Yes There is a data capturer but not all are trained
to use the system.
Marishane Computers should also be provided by April 2010. Proper
training should be provided to staff to enable them to
effectively use the computers. (In this regard a plan of
action should be in place by April 2010).
Yes There is a data capturer but not all are trained
to use the system
Marishane Business hours should be reflected by December 2009. Yes
Bela-Bela Designated help-desks manned by suitably trained
personnel and stocked with appropriate forms should be
provided (In this regard, a
plan of action should be in place by April 2010)
Yes No suitably trained personnel for the help desk
NORTH WEST
Tlapeng Clinic 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.
Demarcated parking areas should be made available (In
this regard a plan of action should be in place by April
2010).
No (District lack capacity). Not yet implemented.
Clinic building should be properly maintained Yes
Reception areas should be erected (In this regard a plan
of action should be in place by April 2010).
No Not yet implemented.
Service Charter should be translated into the local
language (In this regard a plan of action should be in
place by April 2010).
No Not yet implemented.
Staff should be provided with name tags by April 2010 Yes
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 48
Details of the clinic Recommendations Implemented Not implemented
and they must wear them
Manager should immediately arrange for proper removal
of medical waste
Yes
Clinic should be provided with functional computers, fax,
and photocopy machine. (In this regard a plan of action
should be in place by April 2010).
Only have
functional
computer.
Provision of
Fax and
photocopy
machine still
not
implemented.
Dryharts Clinic Service Charter should be translated into the local
language (In this regard a plan of action should be in
place by April 2010).
No Not yet implemented.
Clinic should be provided with functional computers, fax,
and photocopy machine. (In this regard a plan of action
should be in place by April 2010).
Only have
functional
computer.
Provision of
Fax and
photocopy
machine still
not
implemented
Clinic should immediately be provided with sufficient
diesel for the generator to ensure that the clinic
functions properly even when there is power failure.
Yes
Clinic should ensure that the clinic facilities remain clean
at all times. This should be done immediately.
Yes
Consolidated Report on service delivery inspections of district hospitals and clinics regarding availability of medicines and medical equipment and the role of Health District
offices. Page 49
Details of the clinic Recommendations Implemented Not implemented
WESTERN CAPE
Phola Park Clinic The facilities of the Phola Park clinic, such as toilets
should be refurbished and properly maintained.
The Phola Park clinic should be provided with a new key
to their complaint box.
Clinic managers should device a strategy of dealing with
the long waiting periods at the clinics.
Yes.
Yes.
Yes.
The Department has a Chronic Dispensing Unit which prepares
patient medicine packages which are delivered to the users’
nearest clinic. This measure has eradicated the practice of
patients having to queue at pharmacies and has created a
rather quick pick-up collection point for medicines.
Public Service Commission
50
ANNEXURE F: FEEDBACK ON IMPLEMENTATION OF THE PSC’S RECOMMENDATIONS CONTAINED IN THE REPORTS ON INSPECTIONS OF
DISTRICT HOSPITALS AND CLINICS REGARDING AVAILABILTY OF MEDICINES AND MEDICAL EQUIPMENT AND THE ROLE OF HEALTH
DISTRICT OFFICES IN THE DEPARTMENTS OF HEALTH IN THE FREE STATE, LIMPOPO, NORTH WEST AND WESTERN CAPE PROVINCES
Implemented
Partially implemented
Not implemented
PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
FREE STATE ANNOUNCED INSPECTIONS
a) 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
Vacancies: Approval has since been granted to recruit
and appoint staff according to the critical needs and
availability of funds at Tokollo hospital. The department
also decentralized the appointment functions to
institutions to improve and fast-track recruitment of staff.
Further appointment will be prioritized in the new financial
year in line with allocation for compensation of
employees.
Vacant posts for operational managers and local area
managers at Bophelong and Brentpark clinics will be
prioritized in the next financial year 2015/16.
36 qualified Pharmacist Assistants were appointed on a
one year contract and will be appointed permanently
before their contracts expire in July 2015.
Accommodation: National Hospital doctors quarters
were renovated and handed over to the provincial
Department. The facility is currently being used to house
doctors and internship students.
Proof of a submission to
appoint two professional
nurses and two assistant
nurses was provided as well
as a submission to create,
funds and appoint two
clinical associates on the
staff establishment of
Tokollo/Mafube District
Hospital.
A copy of submission for the
appointment of 36
Pharmacist Assistants on a
one year contract was
provided.
The existence of the doctors
quarters at the National
Hospital were verified. The
PSC team was informed that
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
be put in place by
June 2015)
The existing structure at Manapo Nursing college is being
renovated and upgraded to alleviate accommodation
problems.
Phase 1 of the Emergency Medical Services college
accommodation has been completed and the second
phase is planned for 2015/16.
Plans to renovate Huis Idahlia at Universitas were
completed, however due to budgetary constraints this
was postponed to the next financial year 2015/16.
the place was renovated in
2013 and the doctors started
occupying the place in 2014.
It was indicated that these
quarters were reserved for
doctors who are living with
their families.
There are two existing
structures for the Nursing
College at Manapo Hospital.
It was established that one
structure is dilapidated and
will cost a lot of money to
upgrade, whilst the other
one was in the process of
being renovated and
upgraded.
b) 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 service rendered is monitored in terms of quality and
time that goods are delivered. Poor quality goods are not
accepted, only the right quality that meets specifications
is accepted. Timely delivery is crucial to service delivery.
Continuous follow-up on delivery of goods and services is
made until the delivery date.
Non-adherence to delivery timeframe by the contractor is
recorded as non-compliance and appropriate action is
taken against the supplier.
The visited facilities
indicated that they have not
developed a plan of action
for poor quality equipment
as this is not a crucial matter
considering they rarely
receive goods that are not
according to specifications.
c) The FSDoH should A rating system is in place for visiting of primary health The District offices utilize the
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put a system in
place which is linked
to performance
management to
ensure 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.
clinics by supervisors and it has been monitored quarterly
through reporting against the annual performance plan.
The target for supervisor visit rate is 85%. Although the
target was not achieved in three quarters (1st quarter =
56.9%; 2nd = 65.2% and 3rd = 68.6%) of 2013, there is
steady improvement. Progress was affected by the
limited number of dedicated clinic supervisors, hence the
arrangement to conduct clinic supervision through visits
by provincial program managers and district program
managers.
Red Flag/Regular Review
Tool for clinic visit as part of
monitoring. However, it was
found that the visits were not
done monthly as required by
the Handbook for Clinic/CHC
Managers. The last visit at
Phuthaditjhaba Clinic by the
Facility Manager was on 30
September 2014. The Team
was informed that the
District Program Manager
who is responsible for the
visits is a supervisor in 7
clinics and Facility Manager
at Bluegumbosch clinic. The
manager also has health
related challenges which
affect performance.
In an attempt to resolve the
problem of non-visits to the
clinics the Local Area
Manager convened a
meeting in February 2015 to
discuss how best they can
assist in ensuring that the
clinics are visited. The way
forward was that the Local
Area Manager should assist
the District Program
Manager with some
administrative duties so that
the visits will be done as
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required. The minutes of the
meeting were provided to
the PSC team.
d) 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.
The Department strives to pay suppliers within 30 days
as prescribed; however, this is sometimes affected by the
budgetary constraints. Close monitoring of payments was
implemented to ensure that payments are prioritized and
where there are challenges suppliers are engaged and
informed.
There is slight improvement since the last visit to the
medical depot and the Department has appointed the
CEO at the Medical Depot in November 2014.
The team was informed by
the Medical Depot that they
are unable to pay suppliers
within 30 days as required
by Treasury Regulations due
to budgetary constraints.
They indicated that when
they received funds they
prioritized old payments and
Small, Medium and Micro
Enterprise (SMMEs) as
there will be consequences if
they are not paid within 30
days. For example: the
companies that supply
critical medicines,
threatened to put the
account on hold if they were
not paid within 30 days.
It was, however, noted that
there is improvement in
paying the medical depot. It
was further observed that
payment was made to the
medical depot few days
before the PSC’s second
visit. The only outstanding
payment was for orders not
yet received from suppliers,
which were overdue over a
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period of less than 60 days.
The team was also informed
that the Elizabeth Ross
Hospital was also unable to
pay the suppliers within 30
days as prescribed due to
lack of funds. Payments of
suppliers by the hospital
require prior approval by the
Provincial Head Office,
which in most cases results
in delays.
e) 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.
As part of its orientation programme, Pharmaceutical
services undertakes training to all newly appointed
Medical Interns, Community Services and other Health
Care Professionals on Principles of Medicine Supply
Management, which includes good dispensing practices,
adverse drug reactions and other medicine related topics.
The orientation training activities on all pharmacy related
policies took place between February and May 2014.
The training activities are conducted at the beginning of
the year and midyear when the need arises. Continuing
Professional Development meeting held quarterly.
Development Partners such as Management Sciences
for Health Systems Trust also conduct these at the
request of the Districts.
Attendance registers and
training programme were
submitted as evidence that
the Pharmaceutical services
had conducted training in the
following categories:
- 44 officials underwent
Pharmacy Manual
Induction training which
includes dispensing
protocols and adverse
drug event.
- 395 officials were trained
on STG, Essential
Medicine List (EML) and
Free State Formulary
training which includes
dispensing protocols and
adverse drug event.
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- 513 officials were trained
on Stock management
training.
- 223 officials were trained
on Cold Chain training.
- 31 officials were trained
on National Core
standard.
- Adverse drug events
forms part of the ARV
training conducted via
Integrated Computer-
Aided Manufacturing
(ICAM).
The training activities were
conducted in 2013/14. It was
envisaged to conduct these
activities again during the
period 2014/15, however this
did not happen due to
financial constraints.
The Pharmaceutical
Services indicated that it did
not have a structured
training programme,
however, participants were
invited whenever a need
was identified.
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f) 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).
Shortage of computers and network points at Tokollo
hospital is not resolved due to unavailability of suitable
contractors on the State Information Technology Agency
(SITA) database. The Provincial Information Technology
Unit is looking at other alternatives to ensure
connectivity.
A new X-ray machine was procured and installed at
Tokollo hospital.
A needs analysis to complete the roll out of RX Solution
in the province was prepared in August 2014. The cost
implications are summarized as follows:
- IT, computers, printers, networking= R27 056 000.00.
- Pharmacist Assistants= R35 308 000.00.
The total cost for the roll out is R62 364 000.00. Funds
are currently not available; however, the Department is
seeking support from the National Department and other
health partners.
The Management Sciences for Health (MSH) and Health
Systems Trust (HST), which are Non-Governmental
Organizations (NGOs), appointed a total of 4 people to
provide technical assistance and training in the Free
State to facilitate the roll-out and implementation of RX
Solution.
45% of the facilities in the Free State have computers
and the RX Solution program. The biggest limiting factor
is IT network and equipment as well as security.
56.5% of the facilities with computers and the RX
The existence of X-ray
machine at Tokollo hospital
was verified.
It was also found in both
Districts, that the rolling out
of the RX Solution to all
clinics is still a problem due
to financial constraints.
However, PSC the team was
informed at Phuthaditjhaba
District that they managed to
buy RX Solution equipment
for several clinics, including
Phuthaditjhaba and
Bluegumbosch clinics, using
the National Health
Insurance grant.
The Medical Depot
confirmed the appointment
of four people by MSH and
HST to provide technical
assistance and training in
the Free State to facilitate
the roll-out and
implementation of the RX
Solution, however, there was
a challenge with the
procurement of IT
infrastructure.
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Solution program use the RX Solution for stock control.
The main limiting factor is availability HR capacity, IT
network and facility infrastructure.
Lejweleputswa district got permission to buy 45
computers for implementation of the RX Solution, and will
be included in the district’s acquisition plan for the
financial year 2015/16.
A submission for appointment of personnel on the
HIV/AIDS Conditional grant, including pharmacy
personnel, was approved. The appointment processes
are underway in the districts.
Pharmaceutical Services submitted a request to the
National Department of Health in February 2015 for funds
to procure the necessary IT infrastructure.
Although the following challenges also hamper full scale
implementation of RX Solution, the province will continue
to explore and implement measure to overcome them:
- In some facilities the pharmacy is small and clinics
have no storeroom or proper access control, which
makes it impossible to control the medicine stock.
- Security remains a challenge as all the sites and
facilities experience regular burglaries and theft of IT
equipment.
g) The FSDoH should
address the
concerns of waiting
time through
consultation
Clinic staff is encouraged to continuously communicate
with patients waiting to be served, especially in cases of
longer waiting periods due to staff shortage.
An action plan was developed to address the concerns
The Integrated Chronic
Disease Management
Manual was introduced in all
clinics and hospitals of
Phuthaditjhaba as part of an
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
processes in line
with Batho Pele (In
this regard, a plan of
action to be in place
by December 2014).
on waiting time. The plan is part of the national initiative
on ideal clinic. To date the following was achieved:
- Draft policy on waiting time is available.
- Standard operating procedure on waiting time was
developed.
- Training was conducted on management of waiting
time for all front line workers.
- The plan is currently implemented in Thabo
Mofutsanyana as National Health Insurance pilot
district and will be rolled out to other districts from
April 2015.
action plan to reduce waiting
time. Officials (Nurses and
frontline workers) were
trained on the management
of waiting time.
The Manual provides
guidance to Nurses and
frontline staff on how to
make appropriate
appointments for patients
with major ailments. For
example, patients booked on
certain dates to collect
medication do not need to
wait upon arrival at the
clinics as nurses would
already have packaged their
medication. It was observed
that the patients were
satisfied and complimented
the system.
A Non-Governmental system
under the Department of
Health System Trust
conducted training on the
Right to care for patients as
part of reducing waiting time.
The Manual was found to be
helpful and provides
guidance on how to treat
patients. For example, it
guides nurses on how to
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treat a patient who
complains about stomach
cramps.
In addition, Phuthaditjhaba
and Bluegumbosch clinics
had an action plan in place
to reduce long waiting time
with an indication of the
challenge, recommendations
to resolve the challenge, the
person dedicated to address
the challenge and timeframe
within which to resolve the
challenge.
At Elizabeth Ross Hospital a
graph mapping monthly
statistics on waiting time was
presented to the PSC team.
According to the graph the
hospital has reduced waiting
time from 4 to 2 hours since
June 2014 after the
appointment of six additional
doctors.
UNANNOUNCED INSPECTIONS
a) The refurbishing of
Brentpark and
Bophelong clinics
should be
undertaken to
address the
challenge of lack of
Both Brentpark and Bophelong clinics were assessed by
the Department’s infrastructure unit for future
improvements. It was recommended that both should be
converted into health posts after completion of the new
clinic being built in the same area.
Hinges were planted to close the cracks which were
It was observed that cracks
that were affecting the floor
at Bophelong clinic were
repaired.
The team also found that the
grounds of both Brentpark
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space (at Brentpark)
and the identified
crack (at
Bophelong). (In this
regard, a plan of
action should be put
in place by April
2015).
affecting the floor at Bophelong clinic. The provincial
infrastructure unit was also requested to support with
fixing the crack permanently as the hinges were used to
address the problem temporarily.
Fezile Dabi district management team established a
roving team to clean the grounds in all health care
facilities in the district. This was done to ensure that the
grounds are kept clean while the district is looking into
appointing general workers for maintaining the grounds in
all facilities. The Brentpark clinic committee volunteered
to clean the grounds while awaiting the visit from the
roving team.
and Bophelong clinics were
clean. Furthermore, it was
indicated that there are
community volunteers who
assist with the cleaning
since the roving team from
Community Work
Programme only came once
or twice in 2014. In addition,
the Department of Social
Development had a cleaning
project that helped with the
cleaning at some stage.
b) 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.
A standby generator was installed in September 2014
and it is functional.
The existence of the standby
generator at Elizabeth Ross
hospital was verified and it
was fully functional. It was
indicated that the generator
was installed in September
2014.
It was further indicated that
the hospital shares the same
line of power supply with the
community. It also emerged
that the hospital has on
several occasion engaged
the Municipality to provide it
with an independent power
supply, however there has
been any positive response.
This is affecting the hospital
during power cuts and load
shedding as the generator
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consumes lots of diesel.
c) Brentpark clinic’s
filing system should
be reviewed to
ensure
confidentiality of
information on
patients in line with
the NHA. This
should be done by
31 March 2015.
The practice of labelling patients’ files was stopped as it
was discriminating. This will never happen.
It was found that the
labelling of patient files has
been stopped. Instead, the
clinic uses dates of birth and
identity document (ID)
numbers for storage and
retrieval. As a further
confidentiality measure, files
are not handed to patients
but are taken directly by
clinic staff to the pharmacist
after consultation. However,
the clinic still experiences a
challenge of storage space.
There are still no medicine
carry bags in both clinics
which impacts on full
confidentiality.
d) 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
Fezile Dabi District Municipality is responsible for
monitoring the quality of water and ensuring supply of
quality water to all citizens. The municipality conducts
water quality inspections on a regular basis.
Brentpark clinic
Moqhaka Local Municipality has resolved the lack of
water supply around Brentpark clinic and promised to
avail water through a mobile truck should the need arise.
The donated water tank could not be installed as it was
found to be unsuitable for the purpose following an
assessment. The District will prioritize the installation of
new water tank at Brentpark clinic.
Brentpark clinic
The team observed that the
clinic has water. However,
the donated water tank was
still not installed due to the
fact that it was damaged.
The team was informed that
the District Office plans to
replace it. It was also noted
that Moqhaka Municipality
does not have a mobile truck
to supply water during water
cuts as indicated in the
report. Instead, the clinic
uses old water bottles and
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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.
Bophelong clinic
The clinic does not experience water shortages any
longer as the municipality addressed the problem.
buckets to store back up
supplies during water
shortage. It emerged that
when water cuts occurred,
the dental and pap sections
would close.
Bophelong clinic
It was observed that the
clinic has water, however, it
does not have a water
reservoir in case of water
cuts. It also emerged that
the Municipality does not
provide water during water
cuts.
The PSC has requested the
Member of the Executive
Council (MEC) for
Cooperative Governance
and Traditional Affairs
(CoGTA) to engage the
Maluti-a-Phofung and
Moqhaka Local
Municipalities with regard to
the experienced water and
electricity supply challenges.
LIMPOPO a) The LDoH should
engage the
provincial
Department of Public
Works to address
the poor condition of
The Development Bank of South Africa (DBSA) was
commissioned by the LDPW to conduct an assessment
of the state of all the health facilities and completed its
assessment on 30 August 2014. The DBSA is the
implementing agent for the purpose of addressing the
identified infrastructure.
Copy assessment report
provided, although the copy
was of poor quality. The
PSC is awaiting an
electronic copy of the report.
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buildings and lack of
space experienced
by health care
facilities especially at
Ellisras and Messina
hospitals as well as
at Bela-Bela and
Namakgale clinics.
Furthermore, an
audit should be
conducted of the
state of health care
facilities in the entire
province to eradicate
all dilapidated
physical structures.
An action plan
should be devised
by 31 March 2015.
b) The LDoH should
engage the
provincial DPW to
address the
shortage of doctors’
accommodation at
Messina Hospital. In
addition, the LDoH
should explore the
possibility of an
incentive programme
aimed at offsetting
and cushioning the
property costs in
case of doctors
The process of developing and constructing a new 240
bed hospital with staff accommodation at Messina is at
an planning stage and the land has been secured. In the
meantime the Department continues to lease
accommodation for health professionals.
The Department provided a copy of its recruitment and
retention strategy, which seeks to address
accommodation challenges and explore other staff
retention incentives.
The PSC is still waiting for
the requested plan.
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requiring to acquire
own property in
order to encourage
their recruitment and
retention. An action
plan to be in place
by 31 March 2015.
c) There is a need to
replace the X-Ray
equipment and
surgical lights at
Ellisras hospital to
ensure sustained
quality service
delivery. In addition,
the Department
should develop a
Medical Equipment
Management Plan to
ensure timeous
procurement and
regular maintenance
of such equipment at
all health facilities. A
plan of action to be
in place by 31 March
2015.
The X-ray machine has been maintained and repaired. It
is fully functional and has passed the Radiation Control
Board. Another X-ray machine was acquired from
Thabazimbi hospital. This machine is also functional and
meets the requirements of the Radiation Control Board.
The LDoH will develop and present a report on Medical
Equipment Management Plan by 31 March 2015.
It was observed that
maintenance of the X-ray
machine has been
conducted and additional
machine acquired from
Thabazimbi hospital. Both
machines are functional.
Surgical lights are also
functional.
Other observations
- Dysfunctional ventilators
reported now functional.
- Nebulizer masks for
babies are not available
in the pharmacy.
- Adults’ masks are in
stock. In the meantime
the hospital uses re-
breathers in the absence
of nebulizer masks for
babies. The hospital
indicated that they keep
on placing orders for
these masks but they
have also been told that
these masks are not
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available in the Province.
The MSD also confirmed
that there is a problem
currently.
d) The LDoH should
ensure that an
electronic
information system
is in place at all the
inspected health
care facilities, which
is linked to the
MSD’s electronic
ordering system to
ensure speedy
processing of the
requisition of
medical supplies. An
action plan to be in
place by 31 March
2015.
The Department has recently started to roll out the new
electronic stock management system (i.e. RX Solution),
which will be implemented in hospitals This system has
already been rolled out to 6 hospitals. The Department to
implement a different application in the primary health
facilities.
The depot still uses the old
system but confirmed that
the RX Solution has already
been rolled out to
Mankweng, Mokopane,
Warmbath and Witpoort
hospitals.
e) A system should
immediately be put
in place which is
linked to
performance
management to
ensure that District
Offices visit health
care facilities,
especially clinics,
monthly as required
by the Handbook for
Clinic/CHC
Performance agreements (PAs) of both District Executive
Managers and their teams for the 2015/16 financial year
will include a key result area (KRA) on monthly support
visits to health facilities.
District Pharmacists’ PAs for the same period will also
have a KRA that binds them to provide fortnightly reports
on availability of medicine and consumables.
Furthermore, audits have been conducted in 2013/14 in
hospitals and clinics and these continued during the
2014/15 financial year.
The PSC is still waiting for
an electronic copy of the
audits conducted as the one
provided is of poor quality.
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Managers. In
addition, District
Hospital
Pharmacists should
conduct an audit of
the extent of
shortage of
medicines and
medical supplies at
the facilities as well
as the key
contributory factors.
In this regard (A plan
of action to be put in
place by 31 March
2015.
f) The LDoH should
also immediately
ensure that the
pharmaceutical
license of the MSD
is renewed as
required by the
SAPC to ensure that
the operations of the
depot are legal and
in line with section
22 of the Pharmacy
Act, 1974.
The MSD has a valid registration certificate with the
SAPC which was issued in 2007 that allows it to function
as a public pharmacy. It is also an accredited facility for
Pharmacist Assistants’ training. The LDoH is in the
process of applying for the registration of the entity with
the National Department of Health.
The MSD is in the process of obtaining accreditation by
the MCC and has undergone several inspections and
upon accreditation it will then be empowered to operate a
pharmaceutical warehouse business in line with the
requirements.
The PSC has confirmed that
the MSD has a valid
certificate from the SAPC
and also that the entity is in
the process obtaining an
MCC license. It was further
observed that the MCC
conducted inspection of the
facility and a report on
resolving the accreditation
will be provided once
completed.
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g) Security measures
should be improved
at all health facilities’
storerooms and/or
pharmacies by
augmenting existing
measures with
electronic equipment
and dedicated
security officials to
control authorized
access and conduct
searches. Plan of
action in place by 31
March 2015.
The Department is in the process of addressing the
matter. Dysfunctional cameras and monitors at the MSD
will be repaired and additional ones installed in strategic
areas. It will also develop a security plan for all health
facilities that store, distribute and dispense
pharmaceuticals.
The PSC observed that the
cameras and monitors at the
MSD are still not functional
and the entity is not aware of
any plan to resolve the
problem.
Other observations:
- The current control room
does not meet the
standards and needs to
be moved to a
demarcated room.
- There is no alarm
system in place in case
of an emergency to warn
staff members.
- There are no smoke
detectors.
- Officials do not have
access cards or name
tags and access control
is therefore poor.
- The entity does not have
a scanner or walk
through detector, and
relies solely on physical
searches.
- Visibility around the
MSD is poor especially
at night because there
are no lights and security
personnel are at risk at
night when they have to
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conduct routine patrols.
- The building is not user-
friendly for people with
disabilities.
h) The LDoH should
urgently investigate
the veracity of the
allegations of
malpractices relating
to conduct of the
Nurse-in-Charge
reported at Messina
Hospital.
Report to be provided by the end of March 2015. The PSC is awaiting the
report on the outcome of the
investigation.
i) The LDoH should
ensure that DHPs
are in place
especially in the
Capricorn, Mopani,
Sekhukhune and
Vhembe districts in
line with the
provisions of the
NHA. These DHPs
should be developed
in consultation with
the health care
facilities and then be
sufficiently
disseminated to all
the health facilities.
The DHPs for 2013/14 were developed and
implemented. The DHPs for 2014/15 have also been
developed, approved and are being implemented.
Copies of the DHPs not
provided.
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
UNANNOUNCED INSPECTIONS
a) Outside signage for
Helene Franz
Gateway Clinic that
is visible from the
main road should be
erected immediately
by September 2014.
Furthermore, the
LDoH should
engage the local
municipality to
augment the outside
signage of health
facilities with
direction signs to
improve their
accessibility.
The Department is in the process of addressing the
signage aspects in all health facilities. A report will be
provided by 31 March 2015.
The report due on 31 March
2015 is still outstanding.
b) Training should be
provided to the staff
in the necessary
protocols of patient
care and customer
care especially
Batho Pele. Training
programme to be in
place by 31 March
2015.
Staff based training is on-going. Batho Pele Principles
workshop plan for 2014/15
submitted.
c) The LDoH should
address the
concerns of waiting
time through
consultation
Batho Pele Principles workshop also addresses this. Batho Pele Principles
workshop plan for 2014/15
submitted
I
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
processes in line
with Batho Pele (In
this regard, a plan of
action to be in place
by 31October 2014).
d) All facilities should
be equipped with
functional and
sufficient air-
conditioning
systems. A plan of
action to be in place
by 31October 2014.
Plan to be made available by end of March 2015. Most of the air conditioners
at Ellisras in the wards and
in the boardroom are not
functional.
The MSD also reported
problems with their air
conditioners. Officials
confirmed that the DBSA
conducted an assessment of
the condition of the facility.
e) The records
management system
at Ellisras Hospital
should be
overhauled to
improve retrieval of
patients’ records and
also comply with the
OHS regulations. a
plan of action must
be in place by
October 2014. in
addition, it fire
extinguishing
equipment should be
serviced urgently.
The Department is in the process of reengineering the
records management system in the province and the plan
will be submitted by 31 March 2015.
The report due on 31 March
2015 is still outstanding.
f) Provision should be
urgently made for
The process of developing and constructing a new 240-
bed hospital at Messina is at a planning stage and the
Waiting for the requested
plans
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
additional beds at
Messina Hospital.
land has been secured. In the interim overflow of patients
being managed through referrals to Tshilidzini Hospital.
g) A system should
immediately be in
place to ensure
feedback or action
following receipt of
any complaint or
suggestion lodged.
The Department is in the process of establishing patients’
complaint management system including setting up
committees in all facilities in compliance with the National
Protocol on complaints management and resolution.
Awaiting further feedback
and evidence of the
complaint management
system.
h) Adequate parking
should be provided
for members of the
public at both
Namakgale and
Bela-Bela clinics
The Department will engage municipalities concerned
regarding making land available but future designs will
prioritize parking.
Awaiting further feedback.
NORTH WEST ANNOUNCED INSPECTIONS
a) The NWDoH should,
in collaboration with
the North West
Department of Public
Works (NWDPW),
address the
shortage of
accommodation for
medical
professionals at the
Brits District
Hospital. (A plan of
action must be in
place by April 2015).
The Department of Health issued a tender for Brits staff
accommodation which closed on the 14th November
2014. Project is under adjudication and appointment of
the contractor is expected by the beginning of February
2015.
On 20 April 2015, the
NWDoH provided evidence
of the advertisement of the
tender for the Brits staff
accommodation. However,
submission for the
appointment of the
contractor is awaiting
approval.
b) The NWDoH should
ensure that all
District Offices visit
all health facilities,
Clinic supervisions are included in the Annual
Performance Plan (APP) of the Department, and also
form part of PMA of sub -district managers and CEO.
This would be monitored to enable improvement. ln the
The Department’s APP has
included a performance
target on clinic supervision
(refer to page 69 of the
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
especially clinics,
monthly as required
by the Handbook for
Clinic/CHC
Managers to
oversee their
operations and
ensure availability of
the required
medicines and other
resources. In this
regard, the visits
should be linked to
the applicable
performance
management system
by April 2015.
Ruth Segomotsi Mompati District Clinical Specialist
Teams (DCST) are visiting all facilities and managers are
also visiting facilities every Wednesdays.
APP). In addition, scrutiny of
the performance report
relating to the 4th quarter
indicated an improvement of
94% in this area.
c) The NWDoH should
immediately ensure
that asset
management unit of
the Ngaka Modiri
Molema District
Office attends to the
broken equipment
found at Unit 9 Clinic
in terms of the
relevant SCM
prescripts. In
addition, the
responsible asset
officials should be
held accountable for
the delays in
The PSC contacted the NWDoH to provide a response
regarding concerns of asset management of broken
equipment, and the following was submitted as evidence
on how the Department dealt with the matter:
- A copy of motivation for disposal of the assets.
- A copy of compliance checklist.
- A copy of a Disposal Certificate.
The PSC also observed
during its visit to the clinic on
17 April 2015 that the
obsolete equipment,
including the broken glass
doors were removed and the
grounds were tidy.
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
addressing the
matter. (In this
regard, feedback
should be provided
to the PSC by 31
December 2014).
d) The NWDoH should
strengthen its SCM
process for
procurement of
medical equipment
and ensure that a
system for suppliers
of equipment in
place to identify
those suppliers
found to provide
poor quality
equipment for
blacklisting. (A plan
of action must be in
place by 31 March
2015).
An essential audit was conducted and completed in
September 2014, gap analysis done and a plan
developed for purchase/procurement of equipment item
that were unavailable.
The Department has developed a plan for maintenance
of equipment’s through appointment and deployment of
Health Technology officers at each District.
A process will be put in place to identify non-performing
suppliers of equipment.
The PSC observed the
following:
- A copy of a letter dated
June 2014, which was
sent to the District
Clinical Specialist Team
to conduct an equipment
audit was provided as
evidence, together with a
copy of the resulting
audit report covering all
the Districts.
- A letter was provided
which directed Districts
to ensure the fast
tracking of the central
purchasing of equipment
for facilities.
- Copies of the Essential
Equipment list for
primary health facilities
and equipment
maintenance plan for
2014/15 were also
provided as evidence.
e) Back-up generators
should be provided
The Department carried out desktop audit on back-up
generators in all health facilities in November/December
- The PSC found that
there is still no back-up
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
to the Taung Station,
Tlapeng and Unit 9
clinics in order to
prevent disruption of
services in case of
power failure. (A
plan of action must
be in place by 31
March 2015).
2014. All hospitals and CHC's have generators, but some
needs maintenance.
ln the 2014/15 financial year, the Department started with
procurement of generators for 24 hour clinics and once
all facilities have been catered for, it will address the 8
hour clinics. Taung Station clinic is an 8 hours facility and
will be addressed later in the MTEF plans.
generator at Unit 9 clinic.
A generator was found
at Tlapeng clinic;
however, it has not been
working for a number of
years as it needs
repairing or replacement.
- The PSC is awaiting
evidence of the
procurement process for
back-up generators for
the 24 hour clinics.
f) The NWDoH should
immediately ensure
availability of linen at
Unit 9 Clinic.
The Department has ensured the availability of linen at
Unit 9 clinic as part of linen received and supplied by
Mafikeng provincial hospital.
The PSC has received a
Linen Inventory report
indicating that linen is
sufficiently available,
although some the items
needed replacement. The
staff at the clinic confirmed
that no new linen had been
received.
It was also observed that the
report stated that
procurement of new linen
forms part of the demand
plan of 2015/2016. The PSC
is awaiting a copy of the
demand plan as evidence.
g) Computers and
network points
should be provided
at all the health
Computers: Currently, computers have been procured
for all facilities and are functional.
Network: All hospitals currently have cable network and
The PSC has observed that
all the inspected health
facilities have computers. A
list was also submitted
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
facilities. (A plan of
action must be in
place by 31 March
(2015).
are running on LAN (Local Area Network). All
CHCs/Clinics have been provided with 3G cards as a
short term measure. The long term measure will be for
cabling, however, the Department has financial
challenges.
confirming that all the
facilities have received 3G
cards pending the necessary
LAN cabling. During the
PSC visit to Unit 9 clinic it
was confirmed that the 3G
cards were received.
h) The NWDoH should
review the human
resource plan of the
Bojanala District to
address the
shortage of staff by
31 March 2015.
The staff structure for the entire Department is under
review and therefore we shall await finalization of that
process.
A copy of the Departmental
human resource (HR) plan
has been provided.
UNANNOUNCED INSPECTIONS
a) The NWDoH should
engage the NWDPW
in order to address
the challenge of
space in all the
inspected health
facilities. This should
include the
refurbishing of the
buildings of Unit 9
and Tlapeng clinics.
(In this regard, a
plan of action should
be put in place by
April 2015).
Refurbishment of buildings in Unit 9 and Tlapeng clinics
Unit 9 clinic: The following were done at:
- The cracks in the wall had been repaired;
- The damaged ceiling and exposed electrical wiring
have been repaired; and
- The leaking taps and broken sewer and waste pipes
have not been repaired and the Sub District Manager
has been instructed to have these defects repaired
within 30 days.
Refurbishment of buildings in Unit 9 and Tlapeng clinics
Unit 9 clinic: It was found
on 17 April 2015 that-
- the identified cracks in
the wall have still not
been repaired;
- the broken sewer and
waste pipes had not
been repaired. However,
the leaking taps have
been repaired; and.
- The damaged ceiling
has largely been
repaired although other
areas still require
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
Tlapeng clinic: As with all other small "A" type clinics,
this clinic does not have a storeroom. However, a
bathroom is never used since maternity deliveries are not
conducted and no in-patients are admitted to the clinic. A
separate toilet is available for use by the personnel.
ln view of the above, the personnel has decided to utilize
the unused bathroom to store certain medical supplies
and equipment. The Department could not find fault with
this practice since the equipment is stored in a neat and
tidy manner.
attention.
Tlapeng clinic: It was
observed on 20 April 2015
that the unused bathroom is
used as a storeroom. The
room was also found to be
tidy with supplies and
equipment neatly stored.
The meeting set up between
the PSC and MEC for Health
on 28 April 2015 to address
the refurbishing of the clinics
did not take place.
WESTERN CAPE ANNOUNCED INSPECTIONS
a) The Western Cape
Department of
Health should
implement a
standardized
electronic system for
ordering medicines
in all the health
facilities in order to
ensure sustainable
efficient service
delivery. The
suggested roll-out of
the JAC System,
currently used in
tertiary and regional
hospitals in the
province, should be
Awaiting feedback. N/A
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
expedited. In this
regard, a plan of
action should be put
in place by January
2015.
b) The WCDoH should
consider installing
improved security
measures such as
CCTV and alarm
systems at all
facilities. A plan of
action must be in
place by January
2015.
The WCDoH has identified the need to upgrade
pharmacies, part of which will address the security of
pharmacies. The upgrading will include the installation of
limited CCTV within pharmacies as well as alarm
systems as per the norms. Roll-out has already
commenced in the Metro and will be further rolled out to
the Rural districts. The project brief will be submitted to
WCGTPW within the first quarter of 2015/16 for the
appointment of consultants. It is important to note that
implementation is planned over a three year period.
N/A
UNANNOUNCED INSPECTIONS
a) The WCDoH should
refurbish the clinics
to address the
challenge of space
(In this regard, a
plan of action must
be in place by April
2015).
Business Cases are being prepared by the end users at
PHC facilities to indicate the need for extension of current
facilities. The highest priorities with the greatest need
have been identified. The roll-out of this will take place in
terms of available funding and within the planning
parameters as identified in the 2015/16 User Asset
Management Plan. It is important to note that the need
exceeds current financial and human resources and
priorities will continually be updated.
A copy of the 2015/16 User
Asset Management Plan has
been requested and is
awaited.
b) The Department
should urgently
ensure the general
maintenance of
Great Brak River
Clinic and Alma
CDC, including
painting of the
external walls, to
Maintenance projects have been completed at both
facilities (see photographs below). However, both
facilities have to be replaced in the long term due to the
fact that these are pre-fabricated buildings. In addition to
this, Great Brak River Clinic falls within the flood line.
The PSC observed that
general maintenance has
been conducted at both
facilities and the facilities
were found to be neat as
indicated in the pictures
provided.
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PROVINCE RECOMMENDATIONS FEEDBACK OBTAINED FROM DEPARTMENT VERIFICATION BY PSC STATUS
address their
unattractive
appearance.
Picture 1: Alma CDC
Picture 2: Great Brak River Clinic
c) The delays relating
to the process of
disposal and
replacement of
medical equipment
should be addressed
urgently.
Awaiting feedback. N/A