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Johannesburg - We have noted a report from SECTION27 that paints a grim picture of the state of hospitals and clinics in Gauteng.
While accepting the right of any individual or organisation to state their views about health, we would have liked an opportunity to have a direct engagement with the authors before the report was published. If we were given an opportunity, we would have been able to bring to their attention the progress that has been made and is being made in addressing the matters contained in their report.
The report is unfortunately based on matters that the department has addressed. Some of these issues have been resolved or are at various stages of being resolved. These are the steps we took last year when we started the Turnaround Strategy 2012-14 to address the issues contained in the report.
Human Resources: The department appointed 2 259 personnel to critical posts. These included 752 nurses, 595 clinical professionals, 528 allied professionals, 41 allied support staff, 71 management staff, 397 administration staff and 144 support staff.
In December, 920 medical and allied trainees who completed their community service were absorbed against funded vacant posts. This included 739 professional nurses, 80 medical practitioners, 30 pharmacists and others.
The appointment of anaesthesiologists and nurses at Steve Biko Academic Hospital in Pretoria was fast-tracked to ensure the reactivation of three theatres and intensive care units. Chris Hani Baragwanath Academic Hospital in Soweto appointed 141 nurses, four pharmacists, 20 cleaners, 10 porters and 10 security officers. The capacity of the neonatal ICU was increased.
Charlotte Maxeke Johannesburg Academic Hospital in Joburg was assisted to employ about 250 nurses, doctors and other staff. Most of the new employees were nurses (150) and doctors (56).
Infrastructure: Infrastructure maintenance and provisioning of electro-mechanical equipment were notably improved in last year. At Charlotte Maxeke there are 14 autoclaves, 12 generators, five chillers, six gas sterilisers and five boilers in working order. It is scheduled to have 16 lifts replaced. Fourteen of these lifts are already on site and work will start this week. Equipment at the oncology unit has been repaired and the unit is fully functional.
At Bara, medical and ICU wards have been refurbished and new lifts installed. Chillers and boilers have been installed. To eliminate challenges in theatres during power outages, new generators have been put in place and permanent on-site maintenance officials appointed. All autoclaves at the hospital were serviced.
Maintenance work was also done at Dr George Mukhari Hospital in Ga-Rankuwa. Five autoclaves were replaced in 2010/11 and a further four were repaired last year. A big chiller to replace two smaller ones has been delivered on site. One boiler is being replaced.
The maintenance of oncology equipment at Steve Biko improved last year after the department switched the maintenance contract from Phambili to Siemens. In addition, 40 bedpan washers were serviced last month and are all functional. Maintenance work was done on chillers, autoclaves and generators.
The department spent more than R12 million to provide critical equipment to its central hospitals, including cardiac monitors, thorascopy sets, paediatric bronchoscopy, laparoscopic camera system, blood warmers and others.
An equipment survey is under way to identify old and defunct equipment, inform the purchasing of new equipment, and maintenance. A proposal has been approved that will allow institutions to acquire urgently needed equipment.
We are planning an overhaul of the health information system, to gather accurate demographic and epidemiological data that can be accessed in real time to inform evidence-based interventions and allow accurate and transparent monitoring and evaluation of programmes and facilities.
Availability of medicine: Focused attention was paid to improving the availability of drugs last year. This resulted in the improvement of essential drugs from 40 percent in April to 76 percent in December. Payment of medical suppliers was improved and most are now paid within 30 days of invoicing.
The challenges that were experienced with the supply of medicine were as a result of suppliers having difficulties with manufacturing. There were instances where contracted suppliers could not supply due to mandatory upgrades of manufacturing facilities.
In some instances, manufacturers experienced batch failures. The availability of Pentaxim, a vaccine, was affected by this as well as the freezing stock en route to South Africa. Other drugs such as insulin, phenytoin, warfarin, morphine and paracetamol are available.
The department has started preparations for the introduction of fixed-dose combination antiretroviral drugs. The department is expecting to receive 60 000 units of the drug this month in preparation for its introduction in April.
Budgeting and financial management: Great strides were made to clear accruals and stabilise finances. By the end of January, R4.2 billion had been paid to service accruals. A total of 34 927 invoices were paid within 30 days in the period between April last year and January.
For the same period last year, the department was reporting amounts owed to suppliers in the region of R1.5bn. The department is reporting an amount of R250m that is awaiting cash to be released to suppliers.
The department has therefore settled about 99 percent of the total accruals that were owed. A minority of invoices relating to prior financial years, but processed in the current financial year, is undergoing a prepayment audit. This is to ensure that only legitimate invoices are paid after verification that goods and services have indeed been received.
Accountability and discipline: Following on the Special Investigating Unit (SIU) investigation of a case of tender fraud, the department has taken disciplinary action against three senior management officials. The SIU is expected to complete its investigation of the contracts it is probing this month. The department processed several disciplinary cases involving our staff last year and these are at various stages, including appeals.
Neonatal deaths: Retired nurses have been appointed to assist with infection control and support interventions to prevent the spread of nosocomial infection in neonatal units. Morbidity and mortality meetings are held weekly and monthly in 90 percent of institutions to identify missed opportunities and avoidable factors leading to this. The perinatal mortality rate (death of neonates from birth to 28 days) has shown a decline in the third quarter (October to December), compared to the same period in the previous year. The rate was 26.7/1 000 in 2012 – a reduction from 28.7/1 000 for the same period in 2011. Mother to child transmission of HIV is at 2.5 percent for Gauteng
* Hope Papo is the Gauteng MEC for health.