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Health Portfolio Committee Annual Report 2006-2007. Purpose and mandate. Provide cost-effective health laboratory services Provide training for health science education Support health research. NHLS Sites. [PMG note: Diagram not included]. Head Office & NICD. - PowerPoint PPT Presentation
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Health Portfolio Committee
Annual Report
2006-2007
Purpose and mandatePurpose and mandate
• Provide cost-effective health laboratory services
• Provide training for health science education
• Support health research
NHLS Sites
[PMG note: Diagram not included]
Head Office & NICDHead Office & NICD
PMG note: Diagram not included]
OfficesOffices
PMG note: Diagram not included]
StructureStructure
NHLS Board
Operations Corporate Surveillance
Central RegionNontombi Mbelle
Coastal RegionSipho Mahlati
Northern regionVacant
Finance & AdministrationGeorge Sentoo
Human ResourcesHarriet Kwinda
Information TechnologyStelios Michas
Quality Assurance &
Academic AffairsMartin Hale
NICDBarry Schoub
NIOHVacant
CEOJohn Robertson
Kwazulu NatalNelly Mkhize
National Cancer Registry
NHLS Services
Primary Healthcare Clinics
District Hospitals
Regional Hospitals
Tertiary Hospitals
National Institute for Communicable Diseases
National Institute for Occupational Health
NHLS Service ModelNHLS Service Model
Fee for Service
Sole Provider
Training
Research
FacilitiesFacilities
Laboratories
268 laboratories across nine provinces
Personnel
5591 Total personnel
2029 Technologists and Technicians
181 Pathologists
197 Registrars
Financials
HighlightsHighlights
Unqualified Audit Opinion 2006/2007Unqualified Audit Opinion 2006/2007
Real Revenue Growth YOY - 18.2%Real Revenue Growth YOY - 18.2%
KZN Integration successfully achievedKZN Integration successfully achieved
Increased cash from R40m (2003) to R 296m ( 2007)Increased cash from R40m (2003) to R 296m ( 2007)
Emphasis of matter
• Title deedsThis emphasis of matter will appear again as we are still in the process of transferring titles in the name of the NHLS
• Completeness of external research grant program
This is a technical emphasis of matter which is unique to research organisations
• Tender RegulationsTenders are advertised in the Government Gazette but adjudicated internally
Summary of Group Results Summary of Group Results
R'000's12 months
200712 months
200612 months
200512 months
200418 months
2003
External Revenue 1,745,558 1,323,500 1,060,670 891,056 919,168Cost of Sales (1,057,521) (751,339) (649,993) (592,719) (527,115)Gross Profit 688,037 572,161 410,677 298,337 392,053Operating Expenses (550,689) (440,411) (398,857) (369,830) (469,425)Other Operating Income 115,963 94,165 86,694 58,350 38,836Operating Profit/(loss) 253,311 225,915 98,514 (13,143) (38,536)Transfer payments for CCTP 0 0 20,000 20,000 0Income from NHLS Trust 0 0 0 0 30,000Investment Income 19,753 5,955 (158) 70 7,367Provision for post retirement medical aid (89,830) (61,447) (20,945) (25,309) (103,269)Net profit/(loss) 183,234 170,423 97,411 (18,382) (104,438)Release of revaluation reserve 3,833 3,833 3,833 3,422 0Surplus for the year 187,067 174,256 101,244 (14,960) (104,438)
Summary of Cash flows Summary of Cash flows
12 months 12 months 12 months12 months18 months
2007 2006 2005 2004 2003
Net profit (loss) 183,234 170,423 97,411 -18,382 -104,438
Investment in P, P & Equipment -126,647 -56,376 -56,859 -22,583 -16,842
Working capital change -203,283 -369 -82,495 47,517 -38,303
Non-cash items 64,696 24,094 18,861 14,747 12,724
Provision for PRMA 89,830 61,447 20,945 25,309 103,269
Acquisitions/(Disposals) of investment 0 0 0 4 69,485
Loans raised 0 0 1,261 0 0
Increase in Finance Lease obligations 609 696 0 2,582 0
Net increase in cash 8,439 199,915 -876 49,194 25,895
R'000's
Financial Financial DimensionsDimensions
Income 0.3% Derived from teaching
2.0% Research grants
2.8% Derived from govt grants
90.5% Derived from fees
4.4% Other income
Expenditure 2.2% Teaching and Research
1.8% Occupational Health
5.0% Surveillance & Epidemiology
80.3% Laboratory Services
10.7% Administration
NHLS
Ave Price Revenue Volm (06/7) Ave Price RevenuePrice
Change **
Ave Price
RevenuePrice
Change **
Anatomical 93.61 129,188,176 1,380,079 98.29 135,648,407 5.00% 104.89 144,752,470 6.71%Chemical 33.32 713,843,866 21,425,846 34.52 739,678,387 3.62% 35.16 753,267,958 1.84%Genetics 430.47 19,535,579 45,382 466.84 21,185,949 8.45% 495.37 22,480,879 6.11%Haemotology 35.92 320,583,061 8,925,149 37.48 334,521,606 4.35% 38.43 342,950,047 2.52%Microbiology 51.78 579,368,445 11,188,242 53.22 595,412,005 2.77% 53.91 603,161,934 1.30%
Total 41.02 1,762,519,127 42,964,698 42.51 1,826,446,355 3.63% 43.45 1,866,613,288 2.20%
05/06 07/0806/07
State
Change in Price
NHLS
Volm (06/7) Ave Price Revenue Ave Price Revenue
Anatomical 1,380,079 108.56 149,823,997 10.5% 113.90 157,185,889 8.6%Chemical 21,425,846 44.75 958,712,082 29.6% 46.93 1,005,479,645 33.5%Genetics 45,382 486.78 22,090,914 4.3% 510.63 23,173,369 3.1%Haemotology 8,925,149 64.56 576,184,004 72.2% 67.72 604,439,778 76.2%Microbiology 11,188,242 79.09 884,828,073 48.6% 82.97 928,337,092 53.9%
Total 42,964,698 60.32 2,591,639,070 41.9% 63.28 2,718,615,773 45.6%
CMS
Change in Price
06/07CMS v STATE
07/08CMS v STATE
Tariff DevelopmentTariff Development
Top 20 Tests – Rand Value
Rand Value %Rank Test Description State 07 Difference CMS 08
1 EasyQ Viral Load 300.00 128% 685.02 Full Blood Count Incl Platelet 42.10 103% 85.373 Profile Discrete Analyser U&E 62.50 106% 128.694 CD4 PLG 60.00 186% 171.495 Micro TB Misc. Fluor 31.00 160% 80.536 HIV Elisa 84.70 35% 114.577 Creatinine - Automated 22.30 32% 29.418 Alanine Transaminase - A 34.00 29% 43.859 Histology 1 Additional Block 89.40 15% 102.98
10 Diff Count and Comment Manual 23.10 118% 50.3811 Aspartate Transaminase - A 33.30 32% 43.8512 C-Reactive Protein Nephelometer 53.50 26% 67.2513 Albumin - A 29.50 32% 39.0014 HIV PCR 365.00 67% 609.4215 R/M Culture TB No Growth 68.90 27% 87.8016 Hepatitis Per Antigen 91.50 29% 117.7317 Glutamyl Transpeptidase - A 33.30 32% 43.8518 Phosphatase Alkaline - A 31.80 33% 42.1619 Histology 1 Block 154.20 15% 177.4920 Bilirubin Total - A 25.90 50% 38.79
Top 20 Tests – Volume
Volumes %Rank Test Description State 07 Difference CMS 08
1 Full Blood Count Incl Platelet 42.10 103% 85.372 Creatinine - Automated 22.30 32% 29.413 Micro TB Misc. Fluor 31.00 160% 80.534 Diff Count and Comment Manual 23.10 118% 50.385 Profile Discrete Analyser U&E 62.50 106% 128.696 RPR Slide Test 14.30 28% 18.237 Alanine Transaminase - A 34.00 29% 43.858 Albumin - A 29.50 32% 39.009 CD4 PLG 60.00 186% 171.49
10 Bilirubin Total - A 25.90 50% 38.7911 Potassium - A 22.30 32% 29.4112 Urea - A 22.30 32% 29.4113 Aspartate Transaminase - A 33.30 32% 43.8514 Sodium - A 22.30 32% 29.4115 Phosphatase Alkaline - A 31.80 33% 42.1616 Chloride - A 15.90 32% 20.9717 Glutamyl Transpeptidase - A 33.30 32% 43.8518 Protein Total-A 19.10 32% 25.3019 Micro TB Misc. 19.00 28% 24.3520 Bilirubin Direct Automated 19.70 49% 29.41
Total spend BEE Spend % BEEConstruction 23,029 13,425 58%
Cleaning, security & garden services 9,941 8,889 89%
Medical waste 5,292 5,292 100%
General medical supplies 22,492 15,880 71%
Couriers 29,216 24,603 84%
Information Technology 43,282 35,132 81%
Printing, stationery, office equipment 20,360 20,360 100%
Office furniture 3,552 1,743 49%
TOTAL 157,164 125,324 80%
Category R 000's2006-07
ProcurementProcurement
The above excludes procurement from internationals
Laboratory ServicesLaboratory Expenditure by Province 2006/7
GP WC FS MP NW NC EC KZN LP RSA
067 Budget 10,404R 6,323R 3,250R 2,912R 3,428R 1,291R 6,893R 11,737R 5,448R 51,686
067 Conditional grant 1,610R 979R 503R 451R 531R 200R 1,067R 1,817R 843R 8,000
067 Billing [incl VAT] 670R 329R 155R 131R 144R 49R 231R 300R 120R 2,128
Population [Mid-year estimate 2005] 9,018 4,646 2,953 3,220 3,824 902 7,039 9,651 5,635 46,888
# of NHLS laboratories 40 22 12 17 27 5 54 52 36 265
Population per laboratory 225 211 246 189 142 180 130 186 157 177
Health expenditure per capita 1,332 1,572 1,271 1,044 1,035 1,653 1,131 1,404 1,116 1,273
Lab expenditure per capita 74 71 52 41 38 54 33 31 21 45
Lab expenditure % Budget 5.6% 4.5% 4.1% 3.9% 3.6% 3.3% 2.9% 2.2% 1.9% 3.6%
Provincial Spend and per Provincial Spend and per Capita SpendCapita Spend
R 0
R 50
R 100
R 150
R 200
R 250
R 300
R 350
GP WC KZN EC FS LP NW MP NC
R m
-
10
20
30
40
50
60
R p
er
pe
rso
n
NHLS Invoicing incl Vat Lab Expenditure per Capita
Human Resources
Human ResourcesHuman Resources
OverviewOverview• Headcount:Headcount:
– March 2003: 3 509March 2003: 3 509
– March 2004: 3 797 March 2004: 3 797
– March 2005: 3 880March 2005: 3 880
– March 2006: 4 132March 2006: 4 132
– March 2007: 5 591March 2007: 5 591
• Payroll:Payroll:
– March 2003: R 489 971 millionMarch 2003: R 489 971 million
– March 2004: R 559 358 millionMarch 2004: R 559 358 million
– March 2005: R 584 932 millionMarch 2005: R 584 932 million
– March 2006: R 676 172 millionMarch 2006: R 676 172 million
– March 2007: R 859 830 millionMarch 2007: R 859 830 million
Human ResourcesHuman Resources
Achievements 2006 to 2007Achievements 2006 to 2007
• Successful transfer from KZN - 999 employees.
• Final phase of the Broadband and remuneration and career management system
• Successful recruitment drive visiting majority of universities
Workforce ProfileWorkforce Profile
WORKFORCE PROFILE: EXECUTIVE MANAGEMENT: 2005 TO 2008
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Africanmale
Africanfemale
Colouredmale
Colouredfemale
Indianmale
Indianfemale
Whitemale
Whitefemale
Per
cen
tag
e Mar-05Mar-06Mar-07Jan-08
Workforce ProfileWorkforce Profile
WORKFORCE PROFILE: SENIOR MANAGEMENT: 2005 TO 2007
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Africanmale
Africanfemale
Colouredmale
Colouredfemale
Indianmale
Indianfemale
Whitemale
Whitefemale
Per
cen
tag
e
Mar-05
Mar-06
Mar-07
Workforce ProfileWorkforce Profile
WORKFORCE PROFILE: MEDICAL SCIENTISTS: 2005 TO 2007
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Africanmale
Africanfemale
Colouredmale
Colouredfemale
Indianmale
Indianfemale
Whitemale
Whitefemale
Pe
rce
nta
ge
Mar-05
Mar-06
Mar-07
Workforce ProfileWorkforce Profile
REGISTRARS: 2005 TO 2007
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Africanmale
Africanfemale
Colouredmale
Colouredfemale
Indianmale
Indianfemale
Whitemale
Whitefemale
Per
cen
tag
e
Mar-05
Mar-06
Mar-07
Workforce ProfileWorkforce Profile
WORKFORCE PROFILE: LABORATORY MANAGERS: 2005 TO 2007
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Africanmale
Africanfemale
Colouredmale
Colouredfemale
Indianmale
Indianfemale
Whitemale
Whitefemale
Pe
rce
nta
ge Mar-05
Mar-06
Mar-07
Workforce ProfileWorkforce Profile
WORKFORCE PROFILE: MEDICAL DOCTORS AND SPECIALISTS: 2005 TO 2007
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Africanmale
Africanfemale
Colouredmale
Colouredfemale
Indianmale
Indianfemale
Whitemale
Whitefemale
Pe
rce
nta
ge Mar-05
Mar-06
Mar-07
TrainingTraining
• Affiliated to 9 Medical Universities
• Affiliated to 11 Universities of Technology
• Successful signing of the umbrella agreement
Registrar Appointments by year per discipline
12
8
21
16
6 65
128
11
2
6
1
910109
0
45
11
3 32
11
56 3
8 8
11
00 01
0 100 0 00
5
10
15
20
25
2001 2002 2003 2004 2005 2006 2007
No o
f reg
istra
rs
Anatomical Pathology
Chemical Pathology
Haematology
Microbiology
Clinical Pathology
Oral Pathology
Registrar appointments by year by discipline 2001 - 2007
Registrars in posts as at April 2007 by year of appointment by Discipline
9
20
16
9
65
13
5
910
2
7
110
7
3
0
86
11
6
9
1 1
0
13
1
6
13
4
1 002
01
00 00
5
10
15
20
25
2001 2002 2003 2004 2005 2006 2007
No o
f reg
istra
rs
Anatomical Pathology
Chemical Pathology
Haematology
Microbiology
Clinical Pathology
Oral Pathology
Registrars in posts as at April 2007 by year of appointment by
discipline 2001 - 2007
Graduates 2005-2007
DISCIPLINE Count of SCIENTISTS Count of PATHOLOGISTS
2005 2006 2007 2005 2006 2007
Pathology (Anatomical) 1 1 0 15 5 8
Pathology (Chemical) 1 0 0 2 3 5
Pathology (Haematological) 1 2 2 7 3 7
Pathology (Immunology) 2 0 0 0 0 0
Pathology (Microbiology) 3 0 0 6 6 7
Pathology (Oral) 0 1 0 0 0 0
Pathology (Virological) 4 1 2 5 0 1
NICD 1 1 1 0 0 0
NIOH 0 0 0 0 0 0
Research Units (Prof Klugman) 1 1 2 0 0 0
Research Units (Prof V Mizrahi) 2 0 0 0 0 0
GRAND TOTAL 16 7 7 35 17 28
Research
2001 NHLS Research Trust Capital R30m
2006 NHLS Research Trust Capital R80m
2007 NHLS Research Trust Capital R108m
2001 NHLS Research Trust Allocation R1.5m
2006 NHLS Research Trust Allocation R5m
2007 NHLS Research Trust Allocation R7m
NHLS Research Trust
6 MRC units6 MRC units
1 NRF Centre of Excellence1 NRF Centre of Excellence
Cancer RegistryCancer Registry
191 Scientists191 Scientists
392 Research publications annually392 Research publications annually
Research
PublicationsNICD 77 67 65 55
NIOH 24 15 21 43
Anatomical Pathology 37 28 36 50
Chemical Pathology 19 15 36 37
Clinical Pathology 6 0 0 0
Forensic Pathology 1 0 0 0
Haematology 28 32 44 29
Human Genetics 19 9 8 0
Human Genomic Diversity & Disease Research Unit 4 0 13 12
Total Immunology 13 5 23 24
Microbiology 30 44 12 50
Molecular Mycobaterial Research Unit 8 6 5 4
Respiratory & Meningeal Pathogens Research Unit 0 0 16 21
University of Western Cape 2 0 4 0
Pathology 4 0 0 0
Virology 40 40 51 67
310 261 334 392
DISCIPLINE2004-20052003-2004 2006-20072005-2006
Publications
Cape Town 60 34 73 64
University of Western Cape 2 0 4 0
Kwa-Zulu Natal - - - 19
Limpopo 0 26 8 21
OFS 8 10 10 12
Pretoria 27 25 28 44
Stellenbosch 33 16 34 50
Walter Sisulu University 0 0 1 1
Witwatersrand 67 62 72 67
Human Genomic Diversity & Disease Research Unit 4 0 13 12
Witwatersrand Molecular Mycobacterial Research Unit 8 6 5 4
NICD 77 67 65 55
NIOH 24 15 21 43
310 261 334 392
UNIVERSITY2004-20052003-2004 2006-20072005-2006
QA DivisionQA Division
Provision of Proficiency Testing Programmes
Protocols for evaluation of systems, methods and reagents
Implementation of Quality Standards to conform with international norms
Guidance with preparation for SANAS accreditation
Training of Auditors
Training of QA personnel
Monitoring effectiveness of the management of laboratories
GOALS of NHLSPROFICIENCY TESTING
To facilitate the implementation of appropriate procedures for all service laboratories and the harmonization of laboratory resultsTo provide analysis of performance data for users and managementIdentify deficiencies with regard to the technical quality of resultsDirect resources in an efficient manner order to correct such deficiencies
Identification ofNon Conformance
Proposed Corrective Actions
& Resolution
Monitor Effectiveness
of Change
MonitoringRelative to
PerformanceCriteria
The Proficiency Testing Process
PT Programmes Currently PT Programmes Currently ProvidedProvided Clinical ChemistryClinical Chemistry
General chemistryGeneral chemistry EndocrinologyEndocrinology Therapeutic drugsTherapeutic drugs Blood GasBlood Gas
HaematologyHaematology General HaematologyGeneral Haematology Differential and slide assessmentDifferential and slide assessment CoagulationCoagulation CD4CD4
MicrobiologyMicrobiology BacteriologyBacteriology MycologyMycology ParasitologyParasitology TB microscopy and cultureTB microscopy and culture Syphilis serologySyphilis serology HIV testingHIV testing
PT Programmes Currently PT Programmes Currently Provided contProvided cont
Utility of PT Schemes in Utility of PT Schemes in the the context of the HIV and TB context of the HIV and TB PandemicPandemicEstablishing the diagnostic efficiency in:
A: Identifying infected individuals
B: Monitoring disease progress
C: Identifying opportunistic infections
D: Monitoring levels of toxicity of therapeutics
E: Monitoring effectiveness of treatment
F: Identification of opportunistic infections
Participating Laboratories Participating Laboratories By SchemeBy Scheme
0
50
100
150
200
250
ChemHaem Bact
Para
– Sto
ol
Para
– Blo
od
Myc
ology
Yeasts
Myc
ology
Moulds
TB Mic
ro
TB Cultu
re R
PR
TPHA
HIV S
erolo
gy
Participating Laboratories
Laboratory AccreditationLaboratory Accreditation
Accredited Labs by Year
4
8
4 5
10
2
11
15
354
12
16
21
31 30
36
51
0
10
20
30
40
50
60
Calendar Year
Nu
mb
er
of
Lab
s
New Accreditations Withdrawn Net Total
NICD
NATIONAL INSTITUTE FOR NATIONAL INSTITUTE FOR COMMUNICABLE DISEASECOMMUNICABLE DISEASE
1. Academic & training
2. Surveillance & monitoring of communicable diseases
3. Outbreak response & management
4. International
5. Communication & consultation
6. Research – applied & operational
7. Quality assurance & reference
PMG note: Diagram not included]
PMG note: Diagram not included]
South African Field Epidemiology and Laboratory Training Program (SA FELTP)
NICD
SOUTHERN AFRICAN CENTRE FOR SOUTHERN AFRICAN CENTRE FOR INFECTIOUS DISEASE SURVEILLANCE INFECTIOUS DISEASE SURVEILLANCE (SACIDS)(SACIDS) Virtual centre/network linking institutions in southern Africa with those in the UK and other science centres of the "North"
• Director: Professor Mark RweyemamuSokoine University of Agriculture at Morogoro, Tanzania; Visiting Professor, Royal Veterinary College, University of London; and nominated as Extraordinary Professor, Faculty of Veterinary Science, University of Pretoria, South Africa
• Deputy Director (Medical): Professor Barry Schoub National Institute for Communicable Diseases, South Africa
• Deputy Director (Veterinary): Professor Rudovick Kazwala Sokoine University of Agriculture, Morogoro, Tanzania
AFRICAN CENTRE FOR INTEGRATED AFRICAN CENTRE FOR INTEGRATED LABORATORY TRAINING ( ACILT )LABORATORY TRAINING ( ACILT )
VISION:
A healthier Africa through quality laboratory practices that support efforts to combat major infectious diseases
MISSION:To provide integrated hands-on training courses to expand laboratory
capacity in Africa for diagnosis and monitoring of major infectious diseases including HIV/AIDS, TB, and malaria
0
100
200
300
400
500
600
700
800
Year and week
Nu
mb
er o
f co
nsu
ltat
ion
s
0
10
20
30
40
50
60
70
80
Nu
mb
er o
f re
spir
ato
ry v
iru
s is
ola
tes
Influenza Virus Isolates
Chronic Respiratory Disease
Influenza
Pneumonia
Influenza Virus Isolates
Influenza Isolates
0%
1%
2%
3%
4%
5%
6%
7%
8%
Year and epidemiologic week
% o
f to
tal a
dmis
sion
s
0
20
40
60
80
100
120
140
Num
ber
of in
fluen
za v
irus
isol
ates
Influenza isolates
% Acute upper respiratory infection
% Influenza-like illness
% Acute lower respiratory infection
▀PMG note: Diagram not included]
Diagnostic Services
Extension of service to all Extension of service to all the communities in the the communities in the countrycountry
• Transport logistics deployed to service the Transport logistics deployed to service the Primary Health Care (PHC) facilitiesPrimary Health Care (PHC) facilities
• Extend consultation and outreach Extend consultation and outreach pprogrammes to rural provinces rogrammes to rural provinces
Primary Health Care Primary Health Care CoverageCoverage
Branch Total number of clinics (Incl small hospitals)
Number
Clinics covered
(daily)
%
Clinics covered (daily)
%
Clinics covered (weekly)
Central 1 084 1 029 95% 100%
Coastal 1 333 799 60% 100%
KZN 509 264 52% 100%
Northern 1 110 812 73% 100%
Total 4 036 2 904 72% 100%
Provincial ProgramsProvincial Programs
• Support both national and provincial health Support both national and provincial health programsprograms
• Information resource to provincial coordinators.Information resource to provincial coordinators.
• Focussed TB, Cervical Cancer Screening, CD4 and Focussed TB, Cervical Cancer Screening, CD4 and Viral load managementViral load management
TB
TB Culture Labs 1LD 2LD
Number of MGITs per Lab
Cape TownGreen Point x x x 18Groote Schuur x 3Tygerberg x 1
Port ElizabethPE Central x x x 11Umtata x x x 2
BloemfonteinPelonomie x 5Universitas x 1
KimberleyKimberley x x 6
DurbanAlbert Luthuli x x x 19
PretoriaTswane Academic x x 6George Mukari x x 4Tsepong x x 4
JohannesburgBraamfontein x x x 19
PolokwanePolokwane x x 3
Ermelo Ermelo x 1
TOTAL NHLS 15 10 5 103
TB Culture FacilitiesTB Culture Facilities
PMG note: Diagram not included]
QUALITY ASSURANCE
SOPs
NICD EQA Proficiency Testing
National Blind Re-checking Programme
EQA for Culture and Drug Susceptibility Testing
Indicators (CDW)
Accreditation/Laboratory Check Lists
Training
SURVEILLANCE
Corporate Data Warehouse
MDR-TB/XDR-TB Registers/Notifications
Drug Resistance Survey (Feb 08 – Jul 09)
MDR-TB Centre XDR prevalence
DST Pattern Surveillance
TB Microscopy Volumes
TB Microscopy per 100,000 Population
TB Microscopy % Positive
TB Microscopy - Positive Severities
Sensitivity Tests Adjusted per 100,000 Population & MDR & XDR
DIAGNOSTICS
Rapid Diagnostics Project (FIND) (Jul 07– Jul 08)
Automation of Culture Processes (Sept 07– Jul 09)
Validation/Migration Bactec DST to MGIT
Validation other diagnostics (PCR, QFT, LAM etc)
TB Cultures as % TB Tests
Gauteng: proposed flowchart forPCR diagnosis
Positive smears20
Negative smears80
PCR
Resistant Sensitivie
1MDR
Sizwe
Culture + DST
Treat:Individual
19
Treat:standard
1 week
Still symptoms45
low Index of Suspicion35
culture
15 positive 30 negative
PCR
Resistant2
Sensitive13
Sizwe
Culture+ DST
Treat:Individual
Treat:standard
discharge
Suspect100
Suspect100
TURN AROUND TIMES
Transport coverageCouriers
“in-house”
Intra-laboratoryExtended hours
Indicators
“extended laboratories”
SMS Auto faxing
Accreditation type Corrective Action Sheets
Monitoring
Reporting formats
TRAINING
SA-FELTP
RILTC (SADC countries)
‘In-house’ Microscopy/Culture courses
Nurses/Doctors/Students
Technical Assistance SADC
In-Laboratory TAT
PMG note: Diagram not included]
PMG note: Diagram not included]
PMG note: Diagram not included]
PMG note: Diagram not included]
PMG note: Diagram not included]
CCMT
Laboratory Capacity
Number of laboratories Number of systems Test Capacity Test utilizationCD4 tests 56 78 250 800 190 000 (75%)Viral load tests 18 22 63 360 52 000 (82%)HIV PCR tests 10 11 25 740 16 000 (62%)
Province CD4 laboratories Viral load laboratories PCR laboratories Districts with CD4 labsGauteng 11 6 4 5 of 6Free State 4 1 1 3 of 5Northern Cape 1 1 Planned 1 of 5North West 4 1 Planned 3 of 4Mpumalanga 4 1 Planned 3 of 3Limpopo 5 1 Planned 5 of 6Western Cape 4 2 2 2 of 6Eastern Cape 6 2 2 5 of 7KZN 17 3 1 11 of 11 Total 56 18 10 38 of 53
Laboratory capacity in support of the CCMT for HIV and AIDS
Number of labs per province / district with CCMT laboratories.
Number of CD4 tests by month
Number of CD4 tests by month
0
50000
100000
150000
200000
Apr-04May-04Jun-04Jul-04Aug-04Sep-04Oct-04Nov-04Dec-04Jan-05Feb-05Mar-05Apr-05May-05Jun-05Jul-05Aug-05Sep-05Oct-05Nov-05Dec-05Jan-06Feb-06Mar-06Apr-06May-06Jun-06Jul-06Aug-06Sep-06Oct-06Nov-06Dec-06Jan-07Feb-07Mar-07Apr-07May-07Jun-07Jul-07Aug-07Sep-07Oct-07Nov-07Dec-07
Month
Number of tests
Percentage CD4 cell counts
Percentage CD4 cell counts <= 200 cell / ml
0
20
40
60
80
100
Apr-04 Aug-04 Dec-04 Apr-05 Aug-05 Dec-05 Apr-06 Aug-06 Dec-06 Apr-07 Aug-07 Dec-07
<=200
>201
CD4 Penetration
Provincial penetration per million population for CD4 testing: 2004-2007
0
5000
10000
15000
20000
25000
30000
35000
40000
EC FS GP KZN LP MP NC NWP WC NationalProvinces
Q3 2004
Q3 2005
Q3 2006
Q3 2007
Number of Viral Load tests per month
Number of viral load tests per month
0
10000
20000
30000
40000
50000
60000
May-0
4Jun
-04 Jul-04
Aug-0
4Sep
-04Oc
t-04
Nov-0
4De
c-04
Jan-05
Feb-05
Mar-0
5Ap
r-05
May-
05Jun
-05 Jul-05
Aug-0
5Sep
-05Oc
t-05
Nov-0
5De
c-05
Jan-06
Feb-06
Mar-0
6Ap
r-06
May-0
6Jun
-06 Jul-06
Aug-0
6Sep
-06Oc
t-06
Nov-0
6De
c-06
Jan-07
Feb-07
Mar-0
7Ap
r-07
May-0
7Jun
-07 Jul-07
Aug-0
7Sep
-07Oc
t-07
Nov-0
7De
c-07
Viral Load Percentage Trend
Viral Load Percentage Trend
0
10
20
30
40
50
60
<=50 or 400
401 - 50 000
50 001 - 100 000
>100 001
Number of PCR per month
Number of PCR tests per month 2004-2007
02000400060008000
1000012000140001600018000
Sep-04
Oct-0
4No
v-04
Dec-0
4Jan
-05Feb
-05Ma
r-05
Apr-0
5 M
ay-05
Jun-05
Jul-05
Aug-0
5Sep
-05Oc
t-05
Nov-0
5De
c-05
Jan-06
Feb-06
Mar-0
6Ap
r-06
May-0
6Jun
-06Jul
-06Au
g-06
Sep-06
Oct-0
6No
v-06
Dec-0
6Jan
-07Feb
-07Ma
r-07
Apr-0
7Ma
y-07
Jun-07
Jul-07
Aug-0
7Sep
-07Oc
t-07
Nov-0
7De
c-07
PCR Percentage Positive WC vs SA
Comparison between percentage positive PCR in the WCP and the rest of South Africa
0
5
10
15
20
25
30
35
40
Sep-
04Oc
t-04
Nov-
04De
c-04
Jan-
05Fe
b-05
Mar
-05
Apr-0
5 M
ay-0
5Ju
n-05
Jul-0
5Au
g-05
Sep-
05Oc
t-05
Nov-
05De
c-05
Jan-
06Fe
b-06
Mar
-06
Apr-0
6M
ay-0
6Ju
n-06
Jul-0
6Au
g-06
Sep-
06Oc
t-06
Nov-
06De
c-06
Jan-
07Fe
b-07
Mar
-07
Apr-0
7M
ay-0
7Ju
n-07
Jul-0
7Au
g-07
Sep-
07Oc
t-07
Nov-
07De
c-07
Percentage positive all other provinces
Percentage positive WCP
ENDEND