An inspection report of over 600 public health facilities makes grim reading – both because many facilities have deep-rooted problems and because the report is riddled with mistakes, says a Health-e News report.
The vast majority of South Africa’s clinics failed to score more than 50% for standards and quality of care when visited by independent inspectors, who checked things such as cleanliness, infection control, management and availability of medicines.
The report said the inspectors, from the Office of the Health Standards Compliance (OHSC), visited 567 clinics and 51 hospitals covering district, regional, provincial and central hospitals, which offer the highest level of specialised care. The OHSC says that facilities should score at least 80% to claim an acceptable level of care. Only two of Limpopo’s 59 clinics and five of the 53 Free State clinics scored over 50%. Meanwhile, only 12 of the 100 Eastern Cape clinics managed to scrape over 50%, while the majority scored between 30%-39%. The province’s average for clinic leadership and governance was 7%.
The report says the OHSC was set up in terms of an Act of Parliament in 2013 to conduct independent inspections of all public and private health facilities in the country, to rate them according to a complex list of priorities and to encourage facilities to improve. The OHSC presented its inspection report to parliament a few weeks ago, but took a little while to put the report online. Sadly, the report says, the written report is so riddled with inaccuracies – including graphs that bear little resemblance to the accompanying commentary, incorrect spelling of facilities and entire paragraphs that are incoherent – that it undermines the data as well as public confidence.
The report says public confidence is essential as the OHSC is intended to play a crucial role in setting up the National Health Insurance (NHI) system. Once the health department has finalised regulations setting down National Core Standards, every health facility will be compelled by law to meet these standards. In the longer term, an NHI fund is to be set up and it will only be able to disburse funds to facilities that can deliver a certain standard of care.
But reaching that goal is proving to be a bit like a slow slog through quicksand. Since it was set up, the OHSC has concentrated on trying to raise the professional level of the country’s 3816 public health facilities (it plans to start checking the dirty laundry of private facilities during this financial year).
The latest – and second ever – inspection report covers 10% of facilities. It prioritises six areas: availability of medicines and supplies; cleanliness; patient safety; infection prevention and control; positive and caring attitude of staff; and patient waiting times.
According to Professor Lizo Mazwai, the OHSC’s chair: “The Inspection Report shows increasingly challenging circumstances experienced at organisational and management levels, some areas of good care being delivered and encouraging levels of improvement taking place in some re-inspected health establishments.” But, the report says, despite Mazwai’s upbeat comments, the OHSC also expresses concern at “some evidence of significant deterioration in the quality care at inspected health establishments which undermines patients rights”.
The OHSC points to the crippling effect of “budget constraints” which have resulted in “vacant clinical and allied professional posts, inadequate infrastructure and maintenance budget, (and shortages of) medical equipment, medical supplies, consumables, including pharmaceuticals”.
The report also notes that “governance and oversight, including responsive, hands-on leadership, effective, decisive management” are areas of “significant concern and needs attention”. Only a handful of places offered acceptable management. Grey’s Hospital– a provincial tertiary hospital in Pietermaritzburg – emerged as the country’s rock-star hospital, scoring over 90% for patient safety, clinical governance and clinical care and availability of medicines and supplies.
Four central hospitals inspected – George Mukhari and Charlotte Maxeke in Gauteng Province, King Edward VIII in KwaZulu-Natal Province and Nelson Mandela in the Eastern Cape. They performed better than the other categories of facilities inspected, but not one of them scored over 70% for cleanliness. The report says this is a concern, given that the sickest people – who need the highest level of care and also infection control – are treated at these top-level hospitals. There were worrying deficiencies: King Edward had no security at newborns’ wards, no isolation wards for highly infectious patients and some equipment was missing from its emergency trollies.
The dunce of the provincial tertiary hospitals (one below central) was Kimberly Hospital in the Northern Cape, with an overall average of 47%. It’s leadership scored below 20%, cleanliness was rated a lowly 41% and it had no oxygen and expired items on its trolley to treat emergencies. Kimberly was also inspected in 2012, when it had scored a respectable 75% overall so there has been a dramatic drop in its standard of care.
The seven regional hospitals inspected posted a pathetic 29% average for leadership and governance, with the Free State’s Dihlabeng Hospital bottom of the group with dirty toilets and weak leadership. Rahima Moosa in Gauteng was at the other end of the spectrum, doing particularly well for availability of medicines and supplies.
Of the 27 district hospitals inspected, Free State’s Diamond-Diamant hospital and the Northern Cape’s Prieska (Bill Pickard) Hospital performed worst. Four of the hospitals had been inspected in 2012 yet three failed to improve – St Elizabeth, Niemeyer and Nkonjeni. District hospitals in the Northern Cape, Free State, Eastern Cape and Limpopo all scored below 50%.
“There is urgent need for hospitals, clinics, districts and provincial management and staff to operate on a more professional and proactive basis and, be better positioned to withstand scrutiny of OHSC environment that is certain to become more demanding,” declares the report.
Provincial and national government need to implement a system of accountable management, where health staff across facilities face disciplinary action if they fail to do their jobs. Only once the implementers face serious consequences if they fail to deliver, will our health institutions improve, the report says.
And according to a written reply to a question from the DA in the Gauteng legislature, Health MEC Gwen Ramokgopa said all state hospitals in Gauteng have failed safety tests. DA Gauteng MPL Jack Bloom is quoted in a Polity report as saying: “According to Ramokgopa, the Department of Labour has conducted various audits, inspections and investigations covering hazardous biological agents, construction compliance, noise measurements and occupational hazards.” Bloom says that according to Ramakgopa: “All the audited facilities received either a non-compliance finding, such as a contravention and/or improvement compliance notice”.
The health facilities that were inspected and found to be non-compliant on various measures include Chris Hani Baragwanath Hospital, Helen Joseph Hospital, George Mukhari Hospital, Pretoria West Hospital, Sebokeng Hospital, Hillbrow Community Health Centre, and Odi, Temba and the Cullinan emergency management services.
Ramokgopa reportedly attributed the failures to “old poor buildings, infrastructure and equipment” and also “ever-increasing patient load, re-emerging of infectious diseases, the burden of HIV and TB and general overload in our facilities”.
Bloom said he “was appalled that not a single hospital in Gauteng was compliant in the critical area of worker and patient safety”. He said hospitals that have not been inspected were “probably non-compliant in large measure”. Bloom said it was very worrying because hazardous biological agents are infectious and toxic. “They cause allergic reactions such as hypersensitivity pneumonitis‚ allergic rhinitis‚ some types of asthma and organic dust toxic syndrome. Non-compliance with safety standards increases the risk of health workers and patients becoming infected.”
He said the huge maintenance backlog leads to contraventions of the Occupational Health and Safety Act that increases risks such as the recent roof collapse at the Charlotte Maxeke Johannesburg Hospital.
“I hope that the inspections are a wake-up call to the department to drastically improve safety conditions in our hospitals and clinics,” said Bloom. “The goal must be strict compliance with all safety standards.”
The report says the health department was not immediately available for comment.
[link url="https://www.health-e.org.za/2017/04/18/grim-findings-health-facilities-inspections/"]Health-e News report[/link]
[link url="http://us-cdn.creamermedia.co.za/assets/articles/attachments/68604_ohsc_annual_inspection_report_draft_4_20170318.pdf"]Report[/link]
[link url="http://www.polity.org.za/article/all-gauteng-state-hospitals-fail-safety-tests-da-2017-04-20"]Polity report[/link]