The Office of Health Standards Compliance (OHSC) has published a report looking at the extent to which public hospitals, clinics and other healthcare facilities in South Africa comply with the standards of healthcare prescribed by the minister of health in relation to the national health system.
The healthcare facilities inspected are assessed across seven key domains, and given a compliance score – expressed as a percentage – which indicates what concerns and actions need to be taken.
The seven key domains are:
- Patient rights
- Patient safety, clinical governance and care
- Clinical support services
- Public health
- Leadership and corporate governance
- Operational management and
- Facilities and infrastructure
These are all graded according to the following table:
During 2016/17 the OHSC inspected 696 public health facilities and 204 additional inspections were conducted. Of these additional inspections, 155 were carried out within 6 months from the first inspection.
Using its methodology, it found the national average compliance score was 59% in hospitals, 50% in Community Health Centres (CHCs) and 47% in clinics.
The highest average percentage outcome score among provinces was 61% from Gauteng whilst Eastern Cape and Limpopo provinces had the lowest average percentage outcome score of 43%.
Of the 7 domains, the domain Patient Safety, Clinical Governance and Care had the average performance score of 63% in hospitals, 48% in CHCs and 47% in clinics.
The group said that provinces should work harder to improve their scores, while clinics and CHCs should receive focus and be assisted to improve their average performance scores “as they are the centre of primary health care”.
“There were notable improvements and decline in scores amongst the reinspected health establishments in relation to the time elapsed between the first and subsequent inspections.
“Hospitals that were re-inspected after a time lapse greater than two years showed a significant decline of 20% and above. Following re-inspections, the scores generally improved in the majority of health establishments; however, none of the health establishments reached a compliance status of 80%,” the OHSC said.
The low compliance levels led to claims in the media that the South African healthcare systems was “in shambles”, however, the OHSC rejected the notion, saying the report was more in-depth than a simple score.
“The OHSC presented a report that showed some improvement in certain areas, and stagnation and decline in other areas. The report cannot be characterised as an indication that the health care system is ‘in shambles’,” it said.
The report identified the following key problem areas at facilities that had low compliance scores:
- Leadership and management, including operational management, was poor or lacking;
- Minimal to lack of supportive supervision by competent qualified senior staff;
- Operational management was mostly noncompliant;
- Lack of competence and inadequate supportive supervision from relevant authorities;
- Improvement work has not been implemented;
- Inadequate documentation of the collection, collation, analysis and reporting of incidents;
- There was generally poor knowledge on adverse events and disaster management;
- No clear delegations of authority to make decisions;
- Lack of staff.
As part of its findings, the OHSC provided an overall look at how public healthcare facilities performed in districts across all provinces.
A total of 48 of 52 districts were inspected during the 2016/17 financial year, the group said.
The City of Tshwane was the top performer, with an average score of 70% across facilities. This was followed by eThekwini and Ekurhuleni at 67% and 66%, respectively, and Sedibeng and Uthukela rounding out the top five.
Gauteng and KwaZulu-Natal had the best performances, provincially.