Security compliance at clinics and district hospitals countrywide sits at only 58%, the Office for Healthcare Standards Compliance (OHSC) says.
OHSC CEO Dr Siphiwe Mndaweni told MedicalBrief that central and regional hospitals are outperforming lower-level healthcare facilities with their security compliance at 75%.
Chris Bateman reports that Mndaweni’s “inadequate” 42 inspectors managed to inspect 832 facilities in both the public and private sector over the 2022/23 financial year, finding that 346 (or 42%), met the overall required norms and standards. (That represents a workload of 20 facilities per inspector per year.)
A compliance certificate, valid for four years but requiring annual OHSC self-reporting, was then issued when relevant. Mndaweni said the same self-reporting mechanism would be used to glean clinical care outcomes in general and specialist practice – to which NHI reimbursement would be linked, according to the man responsible for NHI implementation, Dr Nicholas Crisp.
Admitting that on her relatively thin budget the OHSC had “a mountain to climb” to be adequately prepared for when the NHI kicks in, Mndaweni singled out ‘sufficient human capital” – and financing – as the keys to her outfit’s future success.
‘Once we have all our inspection tools validated – and we’re already far advanced there – we plan on generating our own income by charging a fee for inspections – which will be in everybody, especially the patients’, best interests.”
Among the findings of the OHSC inspections, were that “security services are not provided on a 24-hour basis, as expected, and that they have inadequate personnel plus a distinct lack of security at night”. “Broken fences remain unrepaired and outside lights are dysfunctional, making it difficult for any security service to conduct their duties at night. When we try to establish the root causes, it always comes back to a lack of staff,” she adds.
The OHSC often found security breaches were recorded but not followed up on. Mndaweni stressed that if serious security breaches “come to our attention” (i.e, via annual self-reporting by compliant facilities), her inspectors could revoke the compliance certificate.
Mndaweni said the problem began at health establishment leadership level where there was often a lack of awareness, immediate action and or coercive measures. “Each doctor has their own responsibilities, but it always comes back to leadership. The problem needs to be escalated to the correct level where overall responsibility lies. It’s important to have a designated person to have oversight of security – that’s the greatest challenge at clinics and district hospitals,” she said.
In the 2019/20 financial year (when OHSC norms and standards were first promulgated), 647 public sector facility inspections were conducted, of which 95 proved compliant (15%). This improved to 80 (or 20%) of 387 inspected public sector facilities being compliant in 2020/21, to 178 (or 33%) of 544 public sector facilities compliant in 2021/22. In 2022/23 the OHSC inspected 832 facilities (including private sector facilities for the first time), of which 346 (or 42%), were compliant.
Of the 832 facilities inspected last year, 51 were private acute hospitals, among which 44 were compliant, (86%), faring far better than the public sector.
Mndaweni said that OHSC capacity was ‘a gradual process’, adding that restructuring with decentralisation to inspectorates in every province was ‘well advanced’. “We currently operate from a central office in Pretoria, but regional offices will enable us to get closer to facilities. Our approach has always been to start at primary health care level, which is now pretty much covered. We’re finalising general practice and are in the final stages of consultation with general practitioners in all the provinces so we can develop an inspection tool there. The problem there is that we need to accommodate the GP’s hours, so those inspections will need to happen at weekends or after hours.”
This consultation should be completed by the beginning of April, followed by a piloting inspection of about 10 private practices spread over urban and rural areas over the next month and a half.
On how the OHSC would expand sufficiently in time to provide the crucial support needed for the NHI to succeed, Ndaweni said: “It’s very difficult to project too far ahead but we have a five-year strategy plan which will see us fully decentralised and striking a balance between public and private facilities. At present we’re solely dependent on National Treasury allocations but we’re legally empowered to generate our own revenue based on our own activities. We’re benchmarking based on other countries and working with the National Health Council and the NDOH on the fee structure.”
News24 reports that cCrime in and around Coronationville, Johannesburg, is getting out of hand and negatively affecting Rahima Moosa Mother & Child Hospital staff and patients, said the Gauteng Department of Health, which has called for heightened policing in the area.
Department spokesperson Motalatale Modiba said a hijacking and a shooting had been reported at the facility in the past month – the first case involved a nurse who was held at gunpoint as she was leaving, and in the second, two people were shot during a hijacking at the hospital gate minutes after they’d driven in.
Modiba said patients constantly complained about being mugged on their way to the hospital, with their phones or handbags snatched.
The department had asked the Sophiatown Police Station to increase patrols and for a police mobile unit to be stationed outside the facility.
“The community policing forum is also actively patrolling the area,” Modiba added, and the department was “exploring other avenues to improve security measures”.
See more from MedicalBrief archives:
Violent attacks prompt special training for Gauteng healthcare staff
Gauteng to probe R708m in ‘irregular’ hospital security contracts
35 Gauteng healthcare facilities are ‘crime hotspots’
Crime adds to burden carried by SA healthcare workers