NHI Pilot Districts12 months progress report

Parliament 4 June 2013

Background

• August 2011: NHI Green Paper – action plan• April 2012: NHI pilot districts to prepare for:

– Purchasing of services; – Engaging the private sector; – Introducing a district health authority;

• April 2013: Rapid appraisal to:– Assess progress in preparing for NHI– Provide a framework for monitoring

NHI domains appraised

1. NHI management2. Hospitals3. Quality4. Primary Health Care

re-engineering5. Infrastructure &

Equipment

6. Human Resources7. Health information8. District Management

Teams9. Conditional Grant10.Referral11.Contracting Private

Providers

Key  

  Nearly or completely achieved (where numerical data available >75%)

  Partially achieved (where numerical data available 25 - 74%)

  Minimally, or not achieved (where numerical data available <25%)

No data available

Not applicable

Tabular summary per District

NHI management & coordination

Hospital Reform

Quality

PHC facility OSC inspectionsBaseline and 2013 follow-up scores and differences for each districtEight districts showed a fall in scores (five less than 5%)Two districts showed significant improvements (17% and 8%)

District

Number of PHC facilities

inspected

Baseline

Score %

2013 follow-up

Score %

Score difference %

Vhembe 12 53.1% 32.0% - 21.1%

Oliver Tambo 25 63.9% 48.1% - 15.8%

Dr Kenneth Kaunda 10 60.2% 47.2% - 13.0%

City of Tshwane 13 78.4% 69.8% - 8.5%

Amajuba 10 59.8% 55.5% - 4.4%

Umzinyathi 7 66.4% 62.4% - 4.0%

Eden 1 56.9% 54.7% - 2.2%

uMgungundlova 10 58.6% 58.4% - 0.2%

Thabo Mofutsanyane 11 68.1% 72.7% 4.6%

Pixley ka Seme 6 48.4% 56.8% 8.4%

Gerte Sibande 17 33.9% 51.2% 17.2%

PHC Re-engineering

Infrastructure

Equipment Audit in Primary Health Care Facilities

Summary of facilities assessed in NHI pilot districts

District Total Complete Remaining

OR Tambo 131 43 88

Thabo Mofutsanyane 73 23 50

City of Tshwane 60 60 0

Amajuba, Umzinyathi,

uMgungundlova91 45 46

Vhembe 112 47 65

Gerte Sibande 55 30 25

Dr Kenneth Kaunda 27 20 7

Pixley ka Seme 29 23 6

Eden 31 10 21

Total 609 301 308

Human Resources for Health

Health Management Information

District Management

Referral systems

GPs in districts on national contract

Summary• NHI management and coordination in place and

DHMTs realigning their priorities• NHI Conditional Grants have contributed to progress• Quality improvement interventions underway• Hospital reform being introduced• Referral mechanisms are in place• PHC Re-engineering: Three streams (DCSTs, WBOT and

School Health) teams not yet complete• Health staff is insufficient; WHO WISN norms and

standards being used to motivate increased funding, • Private providers – districts ready for private GPs to

work alongside nurses in primary health care facilities