Overberg District - District Health Plan 2018/2019 to 2020/2021 - National Department of Health
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Overberg District
Western Cape
District Health Plan
2018/2019 to 2020/2021
1. EXECUTIVE SUMMARY BY THE DISTRICT
MANAGER
The Overberg District withstood the most pertinent of changes in the
past MTEF period, both values, structure and functions.
This district has accepted and assimilated the call on implementing
efficiencies across all levels of healthcare services. Each healthcare
worker in our service ambit has shown remarkable resilience and
leadership through this process. We will together as a team continue
to pursue the vision of achieving quality health care for all and
embed the principles of Healthcare 2030.
2018/2019 does not excuse itself from continued financial discipline, as we navigate the volatile
economic climate globally.
The district has successfully complied with all cost efficiencies and achieved outstanding health
care outcomes as well as accolades for clinical services and audit outcomes alike. This is akin to a
workforce who is focused, committed and passionate.
In the previous financial year, we as management, committed to recognising and rewarding staff
in across the district health service platform. In 2017/18 Overberg District received the following
awards:
- Cecelia Makiwane Award (Ms G Smith – Overstrand Sub-district)
- Health Outcomes Award for the Community Orientated Primary Audiology Care
- Team recognition for donation of Mobility Assistive devices
Infrastructure:
With great joy we celebrate the completion of the construction of the Napier Clinic towards the
end of 2017. The Clinic commenced operations on 06 November 2017.
We look forward in participating in the newly legislated Facility Boards and Clinic Committees. By
working together we can only grow, positively impacting the lives of the citizens in the Overberg
District.
The focus areas for 2018/2019 and beyond:
Implementing the COPC concept in 3 pilot areas (and look at rolling out to the rest of
the district)
Strengthening of operational services
Enhance Intersectoral collaboration
Centralize certain Corporate function to District Office and strengthen support to Sub-
districts
Implement cost saving projects.
Change will never be easy and to navigate through this difficult time, we commit to continuous
and open communication, support and respect to all staff within the district
Ms W M Kamfer
District Director: Overberg District
Rural District Health Services
22. ACKNOWLEDGEMENTS
Chief Director: Rural Districts: Dr R Crous
Director: Overberg District: Ms W Kamfer
Director Overberg Emergency Medical Services & Team
District Health Council Members
Professional Support: Ms RLC Zondo & Team
Comprehensive Health: Ms P Robertson & Team
Pharmaceutical Services: Ms H Brits & Team
Finance and Supply Chain Management: Mr A Niekerk & Team
People Management: Mr C Matshoza & Team
Information Management: Mr L Benjamin & Team
Sub District Management Teams
33. OFFICIAL SIGN OFF
It is hereby certified that this District Health Plan:
Was developed by the district management team of Overberg District with the technical
support from the Chief Directorate: Rural District Health Services and the Strategic Planning
unit at the provincial head office.
Was prepared in line with the current Strategic Plan and Annual Performance Plan of the
Western Cape Department of Health.
Ms WM Kamfer
District manager: Overberg District SIGNATURE
DATE
Cllr A Franken
Chairperson: Overberg District Health Council SIGNATURE
DATE
Dr R Crous
Chief Director: Rural District Health Services SIGNATURE
DATE
Dr K Cloete
Chief of Operations SIGNATURE
DATE
Dr B Engelbrecht
Accounting officer (Head of Department) SIGNATURE
DATE
44. TABLE OF CONTENTS
1. EXECUTIVE SUMMARY BY THE DISTRICT MANAGER ............................................................. 2
2. ACKNOWLEDGEMENTS .......................................................................................................... 3
3. OFFICIAL SIGN OFF................................................................................................................. 4
4. TABLE OF CONTENTS ............................................................................................................... 5
5. LIST OF ACRONYMS ................................................................................................................ 6
6. EPIDEMIOLOGICAL PROFILE .................................................................................................. 8
6.1 GEOGRAPHIC OVERVIEW ...................................................................................................... 8
6.2 DEMOGRAPHIC OVERVIEW ................................................................................................... 8
6.3 SOCIAL DETERMINANTS OF HEALTH .................................................................................... 11
6.4 CAUSES OF MORTALITY ........................................................................................................ 13
6.5 BURDEN OF DISEASE ............................................................................................................. 15
7. SERVICE DELIVERY PLATFORM AND MANAGEMENT ......................................................... 17
7.1 HEALTH FACILITIES PER SUB-DISTRICT .................................................................................. 17
7.2 HUMAN RESOURCES FOR HEALTH (FILLED POSTS) ............................................................. 18
7.3 BASELINE DATA 2016/17 ...................................................................................................... 19
8. QUALITY OF CARE ................................................................................................................. 26
9. ORGANISATIONAL STRUCTURE OF THE DISTRICT MANAGEMENT TEAM .......................... 31
10. DISTRICT HEALTH EXPENDITURE ............................................................................................ 32
11. DISTRICT PERFORMANCE INDICATORS ............................................................................... 33
11.1 DISTRICT HEALTH SERVICES .................................................................................................. 33
11.2 DISTRICT HOSPITALS .............................................................................................................. 40
11.3 HIV AND AIDS, STIs AND TB CONTROL (HAST) ................................................................... 44
11.4 MATERNAL, CHILD AND WOMEN’S HEALTH (MCWH) AND NUTRITION............................ 49
11.5 DISEASE PREVENTION AND CONTROL ................................................................................ 57
12. DISTRICT FOCUS FOR THE YEAR ........................................................................................... 60
ANNEXURE A: OVERBERG DISTRICT POPULATION ESTIMATES BY AGE ........................................ 64
ANNEXURE B: TARGETS FOR SDG 3 – “GOOD HEALTH AND WELL-BEING” ................................. 65
ANNEXURE C: FACILITY LIST ............................................................................................................. 66
ANNEXURE D: TECHNICAL INDICATOR DESCRIPTIONS ................................................................. 68
ANNEXURE E: COMMUNICATION PLAN ......................................................................................... 80
55. LIST OF ACRONYMS
AIDS Acquired immune deficiency syndrome
ALOS Average length of stay
APL Approved post list
APP Annual Performance Plan
ART Anti-retroviral treatment
BANC Basic antenatal care
BUR Bed utilisation rate
CBS Community-based services
CDC Community day centre
CDU Chronic dispensing unit
CHC Community health centre
CHW Community health worker
COPC Community oriented primary care
COPD Chronic obstructive pulmonary disease
DHC District Health Council
DHER District Health Expenditure Review
DHP District Health Plan
DHS District Health Services/Systems
DR TB Drug resistant TB
EC Emergency centre
EDR Electronic drug-resistant TB register
EMS Emergency medical services
EPWP Expanded Public Works Programme
ETR.net Electronic TB register
GSA Geographic service area
HAST HIV and AIDS, STIs and TB control
HCBC Home and community based care
HCT HIV counselling and testing
HIV Human immunodeficiency virus
HPV Human papillomavirus
HR Human resource
ICD-10 International classification of disease coding
ICT Information and communication technology
ID Infectious diseases
JAC Electronic Pharmacy Management Inventory System
LG Local government
M&E Monitoring and evaluation
MDG Millennium development goal
MDR-TB Multi-drug resistant tuberculosis
MHS Municipal Health Services
MMC Medical male circumcision
6MOU Midwife obstetric unit
MTEF Medium-term expenditure framework
MTSF Medium-term strategic framework
NCS National core standards
NDP National Development Plan
NHLS National Health Laboratory Services
NIMART Nurse Initiated Management of Anti-retroviral Therapy
NPO Non-profit organisation
OPD Outpatient department
OSD Occupational specific dispensation
PACK Practical Approach to Care Kit
PCE Patient centred experience
PCR Polymerase chain reaction
PCV Pneumococcal conjugate vaccine
PDE Patient day equivalent
PHC Primary health care
PHCIS Primary Health Care Information Systems
PMTCT Prevention of mother-to-child transmission
PPIP Perinatal problem identification programme
PTB Pulmonary tuberculosis
QIP Quality improvement plan
RCS Rural clinical school
RDHS Rural District Health Services
RIC Retention in care
SAM Severe acute malnutrition
SCM Supply chain management
SD Sub-district
SDG Sustainable development goal
STI Sexually transmitted infection
TB Tuberculosis
TIER.net HIV electronic register
VPUU Violence Prevention through Urban Upgrading
WCG Western Cape Government
WCGH Western Cape Government Health
WCCN Western Cape College of Nursing
WHO World Health Organisation
WoW Western Cape on wellness
XDR-TB Extreme drug resistant tuberculosis
YTD Year to date
76. EPIDEMIOLOGICAL PROFILE
6.1 GEOGRAPHIC OVERVIEW
The Overberg is one of five rural district municipalities in the Western Cape Province and is
the smallest district in the province, making up only 9% of its geographical area.
The district consists of four local municipalities, namely: Cape Agulhas, Overstrand,
Swellendam and Theewaterskloof.
The district office for Western Cape Government: Health (WCG: Health) is situated in
Caledon in the Theewaterskloof Sub-district. There are 42 primary health care (PHC) facilities
in the district of which 19 are fixed facilities. There are four district hospitals (one in each sub-
district) and no regional or TB hospitals.
Figure 1: Map of Overberg District
[Source: https://municipalities.co.za/map/146/overberg-district-municipality]
6.2 DEMOGRAPHIC OVERVIEW
The National Department of Health distributed revised population estimates during 2017,
based on the mid-year population estimates received from Stats SA for 2002 to 2016 and the
short term projections for 2017 to 2021.
The revised population estimates reflect financial years rather than calendar years as was
previously the case. These estimates will be implemented from 2018/19 going forward and is
reflected in the tables below.
8Table 1: Sub-district population size and density 2016/17
Sub-district Town(s) Total Geographic area Population
population(A) (per km²)(B) density (per
km2)
Cape Agulhas - Agulhas 34 168 3 471 10
- Arniston
- Bredasdorp
- Elim
- Klipdale
- Napier
- Protem
- Struis Bay
- Suiderstrand
Overstrand - Betty's Bay 94 734 1 675 61
- Birkenhead
- De Kelders
- Fishershaven
- Franskraal
- Gans Bay
- Hawston
- Hermanus
- Kleinmond
- Onrus
- Pearly Beach
- Pringle Bay
- Rooi-Els
- Sand Bay
- Stanford
- Van Dyks Bay
- Vermont
Swellendam - Barrydale 37 457 3 835 10
- Buffeljagsrivier
- Infanta
- Malagas
- Suurbraak
- Swellendam
Theewaterskloof - Bot River 115 664 3 259 36
- Caledon/Myddleton
- Genadendal
- Grabouw
- Greyton
- Riviersonderend
- Theewaterskloof
- Villiersdorp
District total 282 022 12 239 24
[Source A: Circular H11/2018: Population data]
[Source B: https://municipalities.co.za/overview/146/overberg-district-municipality ]
9Overberg District is the rural district with the second lowest population. The sub-districts
consist of several towns and small dwellings that are spread out over a large surface area
which results in a lower population density. The population density in Overstrand is
significantly higher than the other sub-districts.
Figure 2: Sub-district population distribution in Overberg District 2016/17
Cape Agulhas
12.1%
Theewaterkloof
41.0%
Overstrand
33.6%
Swellendam
13.3%
[Source: Circular H11/2018: Population data]
There is a decrease of 4.1% between the total population estimates for 2018/19 (i.e. all age
groups) that were release in 2014 and 2017 respectively. Overberg District is the only district
in the Western Cape for which the estimated population under 1 year is in line with the
previous estimates (there is a 0.7% difference). Provincially, there is an 8.9% increase in the
estimated population under 1 year.
For more detailed information on the population breakdown per age group for the district,
refer to Annexure A.
10Figure 3: Overberg District population pyramid for 2016/17
80 years and older
75 - 79 years
70 - 74 years
65 - 69 years
60 - 64 years
55 - 59 years
50 - 54 years
45 - 49 years
40 - 44 years
35 - 39 years
30 - 34 years
25 - 29 years
20 - 24 years
15 - 19 years
10 - 14 years
5 - 9 years
Under 5 years
-15 000 -10 000 -5 000 0 5 000 10 000 15 000
Male Female
[Source: Circular H11/2018: Population data]
6.3 SOCIAL DETERMINANTS OF HEALTH
Social determinants may have an impact on the health status outcomes of the district
population.
Table 3: Household dynamics in the Overberg District 2016
Age groups Cape Theewaters-
Overstrand Swellendam District
Agulhas kloof
Households 11 321 35 718 11 678 33 118 91 835
Average household size 3.2 2.6 3.4 3.5 3.1
Female headed households 34.0% 33.8% 28.3% 30.5% 31.9%
Formal dwellings 88.1% 79.0% 96.0% 77.5% 81.8%
Housing owned 76.5% 52.7% 65.9% 33.6% 50.5%
[Source: https://municipalities.co.za/overview/146/overberg-district-municipality ]
Note: The highest and lowest value for each item is coloured orange and green respectively.
11Figure 4: Overberg District education levels 2016
Education levels by sub-district
32.0%
35.0%
29.4%
27.7%
27.6%
30.0%
24.7%
25.0%
15.6%
20.0%
15.0%
9.7%
7.1%
6.9%
6.6%
10.0%
4.4%
3.7%
3.2%
2.3%
1.5%
5.0%
0.0%
Cape Agulhas Overstrand Swellendam Theewaterskloof District
No schooling Matric Higher education
[Source: https://municipalities.co.za/overview/146/overberg-district-municipality ]
Figure 5: Overberg District household services 2016
Household services by sub-district
120.0%
96.9%
96.5%
95.7%
94.0%
93.9%
93.9%
90.2%
90.1%
87.4%
87.1%
86.7%
86.5%
86.3%
86.3%
84.5%
84.3%
100.0%
78.7%
78.6%
77.6%
75.0%
80.0%
60.0%
40.0%
20.0%
0.0%
Cape Agulhas Overstrand Swellendam Theewaterskloof District
Flush toilet connected to sewerage Weekly refuse removal
Piped water inside dwelling Electricity for lighting
[Source: https://municipalities.co.za/overview/146/overberg-district-municipality ]
12Figure 6: Main economic sectors in Overberg District
Community, social Other, 1.3%
and personal
services, 4.2%
Transport, storage
and communication,
8.3% Finance, insurance,
real estate and
business services,
Construction, 8.5%
25.1%
General
government, 10.5%
Manufacturing,
16.3%
Agriculture, forestry
and fishing, 12.1%
Wholesale and retail
trade, catering and
accommodation,
13.7%
[Source: https://municipalities.co.za/overview/146/overberg-district-municipality ]
6.4 CAUSES OF MORTALITY
Table 4: Leading underlying natural causes of death, Western Cape, 2015
Cape Western
Rank Central Karoo Cape Town Eden Overberg West Coast
Winelands Cape
Chronic lower Ischaemic
Diabetes Diabetes
HIV disease respiratory Tuberculosis heart Tuberculosis
1 mellitus mellitus
(7.2%) diseases (7.0%) diseases (7.9%)
(7.5%) (7.2%)
(9.1%) (7.1%)
Cerebrovasc Cerebrovasc Diabetes
Tuberculosis HIV disease HIV disease HIV disease
2 ular diseases ular diseases mellitus
(6.7%) (6.3%) (6.7%) (6.1%)
(6.9%) (6.6%) (7.4%)
Malignant
Ischaemic Ischaemic
Diabetes Cerebrovasc Cerebrovasc neoplasms of Cerebrovasc
heart heart
3 mellitus ular diseases ular diseases resp & ular diseases
diseases diseases
(6.7%) (6.2%) (6.6%) intrathoracic (7.2%)
(5.7%) (5.8%)
organs (6.5%)
Ischaemic Chronic lower
Cerebrovasc Diabetes Cerebrovasc
Tuberculosis HIV disease heart respiratory
4 ular diseases mellitus ular diseases
(6.6%) (5.2%) diseases diseases
(4.9%) (6.1%) (5.6%)
(6.4%) (6.6%)
Chronic lower Chronic lower Ischaemic
Diabetes Diabetes
respiratory Tuberculosis respiratory heart Tuberculosis
5 mellitus mellitus
diseases (4.5%) diseases diseases (5.3%)
(5.2%) (6.2%)
(6.2%) (5.6%) (5.8%)
13Cape Western
Rank Central Karoo Cape Town Eden Overberg West Coast
Winelands Cape
Ischaemic Chronic lower Chronic lower Chronic lower
Hypertensive Hypertensive
heart respiratory respiratory Tuberculosis respiratory
6 diseases diseases
diseases diseases diseases (5.0%) diseases
(5.2%) (4.6%)
(5.5%) (4.4%) (5.8%) (5.1%)
Malignant
Malignant Malignant Malignant neoplasms of Malignant Malignant
HIV disease
7 neoplasms neoplasms neoplasms resp & neoplasms neoplasms
(4.6%)
(5.0%) (4.1%) (4.2%) intrathoracic (4.9%) (4.5%)
organs (4.9%)
Malignant Malignant Malignant Malignant
neoplasms of neoplasms of neoplasms of Malignant Hypertensive Malignant neoplasms of
8 resp & resp & resp & neoplasms diseases neoplasms resp &
intrathoracic intrathoracic intrathoracic (4.6%) (4.0%) (4.4%) intrathoracic
organs (5.0%) organs (4.0%) organs (4.2%) organs (4.5%)
Malignant
Ischaemic Other forms Other forms
Hypertensive Hypertensive neoplasms of Hypertensive
heart of heart of heart
9 diseases diseases resp & diseases
diseases disease disease
(3.3%) (4.1%) intrathoracic (4.0%)
(4.0%) (3.7%) (3.3%)
organs (3.7%)
Other forms Other forms Other forms Other forms Other forms
Hypertensive Influenza and
of heart of heart of heart of heart of heart
10 diseases pneumonia
disease disease disease disease disease
(3.4%) (2.8%)
(3.2%) (3.8%) (3.1%) (2.5%) (3.2%)
[Source: Mortality and causes of death in South Africa, 2015: Findings from death notification, Statistical Release
P0309.3]
HIV and TB predominate in Age-Standardised Mortality Rates, due to their preponderance in
younger age group. For non-Standardised Rates, Cardiovascular causes of Mortality
predominate in the Overberg District. A sub-district breakdown of the underlying natural
causes of death was not included in the above publication.
Table 5: Institutional maternal mortality rate (iMMR) in Overberg District
2011 2012 2013 2014
Deaths during pregnancy, 0 1 2 0
childbirth and puerperium
iMMR 0 34.59 66.87 0
[Source: Saving Mothers, 2014]
Note: The source listed above is the latest published Saving Mothers Report.
Table 6: Infant and child mortality in Overberg District
District Infant mortality rate (< 1 year) Child mortality rate (< 5 years)
2011 2012 2013 2011 2012 2013
Overberg 30.5 27.7 22.7 38.2 33.7 26.5
[Source: Western Cape Mortality Profile 2013]
Note: The source listed above is the latest published Western Cape Mortality Profile.
146.5 BURDEN OF DISEASE
DISTRICT HIV AND AIDS PROFILE
Figure 7: Antenatal Survey HIV prevalence: South Africa vs Western Cape; 1990 - 2015
35.0
30.0
25.0
HIV prevalence (%)
20.0
15.0
10.0
5.0
0.0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Western Cape South Africa
[Source: National Antenatal Sentinel HIV & Syphilis Survey Report, 2015]
Figure 8: HIV prevalence among antenatal women, 2010 - 2015
HIV prevalence among antenatal women
35
30
25
HIV prevalence (%)
20
15
10
5
0
2010 2011 2012 2013 2014 2015
South Africa Western Cape Overberg
[Source: National Antenatal Sentinel HIV & Syphilis Survey Report, 2015]
15SUB-DISTRICT HIV PREVALENCE – OVERBERG
District 2012 2013 2014 2015 2016
16.6 16.1 15.2 18.9 -
Overberg
(13.8 - 19.5) (13.3 - 19.3) (11.8 - 18.6) (15.5-22.4) -
11.3 8.9 10.0 2.5 -
Cape Agulhas
(3.8 - 18.8) (1.8 - 16.0) (1.02 - 19.0) (0.2- 7.2) -
23.8 20.7 14.9 25 -
Overstrand
(17.9 - 29.6) (14.9 - 26.5) (9.2 - 20.6) (19.1-31.2) -
7.9 12.7 13.0 6.5 -
Swellendam
(2.1 - 13.7) (5.3 - 20.0) (3.6 - 22.4) (0-13.4) -
15.8 15.8 17.4 17.1 -
Theewaterskloof
(11.5 - 20.1) (11.2 - 20.3) (12.1 - 22.7) (15.4-27.6) -
*No survey done in 2016
DISTRICT TB PROFILE
Overberg district TB profile 2010 2011 2012 2013 2014 2015 2016
Population * 248 610 253 667 259 163 264 745 270 406 276 168 282 022
All PTB cases 2 412 2 266 2 138 2 062 2 074 2 171 1 906
New Smear positive cases 524 527 718 853 784 627 577
Incidence /100 000 211 208 277 322 290 227 205
Prevalence/100 000 970 893 825 779 767 786 676
* [Source: Circular H11/2018: Population data]; Population estimates per financial year
167. SERVICE DELIVERY PLATFORM AND MANAGEMENT
7.1 HEALTH FACILITIES PER SUB-DISTRICT
Table 7: Health facilities per sub-district as at 31 March 2017
Sub-district
Central/tertiary
District hospital
outreach team
Ward based
TB hospital
Regional
hospital
hospital
Satellite
Mobile
Clinic
CDC
CHC
Cape Agulhas - 2 2 3 - - 1 - - -
Overstrand - 1 4 4 1 - 1 - - -
Swellendam - 3 0 5 - - 1 - - -
Theewaterskloof - 8 3 5 1 - 1 - - -
District total - 14 9 17 2 - 4 - - -
[Source: Sinjani]
Overberg District renders health services on a District Health Services platform. The focus is
on Primary intervention. The main locus of service delivery is based around the Primary
Health Care facilities, which are based in the communities where citizens reside and work.
Overberg District implements community based health care moving towards a COPC
concept. The Overberg District does not have Ward based outreach teams.
The four District Hospitals provide a higher level of care that PHC Facilities refer to. There are
no tertiary services rendered within the Overberg District. Secondary health care needs are
referred outside the District to Worcester and respectively Cape Town CBD. Secondary
health services are augmented by a Monthly Specialist, Outreach and Support Team (6
basic disciplines) from Worcester Hospital. The six disciplines are Internal, Surgery, Psychiatry,
Obstetrics &Gynaecology, Paediatric and Anaesthetics.
177.2 HUMAN RESOURCES FOR HEALTH (FILLED POSTS)
Table 8: Filled posts as at 31 March 2017
Sub-district
Physiotherapist
Enrolled nurse
Occupational
health worker
Professional
Community
Audiologist
Pharmacist
therapist
therapist
assistant
Speech
Nursing
Dentist
Doctor
Admin
nurse
OVERSTRAND 38 - 23 27 59 11 4 1 1 1 - -
TWK 37 - 30 20 57 10 5 2 1 1 - -
SWELLENDAM 29 - 18 13 26 4 1 1 1 1 - -
CAPE AUGULHAS 13 - 15 9 26 3 1 - - - - -
DISTRICT OFFICE 23 - - - 6 2 1 - - - 1 1
District total 131 - 86 69 174 30 12 4 3 3 1 1
[Source: PERSAL] * Community Health worker -NPO Funded
Swellendam and CA SD shared services with Dental & Allied Health Services
TWK SD manages the Speech & Audiology Services, as well as the district.
Illustration of Sessional appointment which are not represented in the above table:
Psychologist, Medical Officers, Radiographer,
187.3 BASELINE DATA 2016/17
Table 9: Performance indicators for District Health Services
District wide Theewaters- Province wide
Programme performance indicator Data source / Type Cape Agulhas Overstrand Swellendam
Frequency value kloof value
Element ID
2016/17 2016/17 2016/17 2016/17 2016/17 2016/17
SECTOR SPECIFIC INDICATORS
1. Ideal clinic (IC) status rate Annual % 47.4% 33.3% 80.0% 40.0% 33.3% 17.2%
Numerator 3 9 1 4 2 2 47
Denominator 2 19 3 5 5 6 273
2. PHC utilisation rate (annualised) Quarterly No 2.6 2.9 2.7 2.7 2.4 2.3
Numerator 6 731 769 100 649 254 018 100 348 276 754 14 413 350
Denominator 7 282 022 34 168 94 734 37 457 115 664 6 318 281
3. Complaint resolution within 25 Quarterly % 96.5% 89.7% 98.6% 98.3% 91.7% 95.6%
working days rate (PHC facilities)
Numerator 10 273 35 146 59 33 3 175
Denominator 8 283 39 148 60 36 3 320
19Table 10: Performance indicators for District Hospitals
District wide Theewaters- Province wide
Programme performance indicator Data source Type Cape Agulhas Overstrand Swellendam
Frequency value kloof value
/ Element ID
2016/17 2016/17 2016/17 2016/17 2016/17 2016/17
SECTOR SPECIFIC INDICATORS
1. Hospital achieved 75% and more on Quarterly % 100.0% 100.0% 100.0% 100.0% 100.0% 69.7%
National Core Standards (NCS) self-
assessment rate (district hospitals)
Numerator 3 4 1 1 1 1 23
Denominator 4 4 1 1 1 1 33
2. Average length of stay (district Quarterly Days 2.8 3.0 2.3 3.2 3.1 3.2
hospitals)
Numerator 7 51 172 7 369 16 930 11 878 14 996 909 893
Denominator 8 18 528 2 431 7 468 3 744 4 885 280 580
3. Inpatient bed utilisation rate (district Quarterly % 68.9% 66.5% 64.4% 63.8% 82.2% 84.8%
hospitals)
Numerator 7 51 172 7 369 16 930 11 878 14 996 909 893
Denominator 9 74 225 11 073 26 283 18 617 18 252 1 072 731
4. Expenditure per PDE (district hospitals) Quarterly R R 2 094 R 1 911 R 2 229 R 1 941 R 2 147 R 2 139
Numerator 10 164 453 263 23 362 147 62 433 620 33 726 468 44 931 028 2 923 677 427
Denominator 16 78 533 12 225 28 009 17 372 20 928 1 366 831
5. Complaint resolution within 25 working Quarterly % 99.6% 95.2% 100.0% 100.0% 100.0% 90.4%
days rate (district hospitals)
Numerator 19 283 20 163 37 63 1 501
Denominator 17 284 21 163 37 63 1 661
20Table 11: Performance indicators for HIV and AIDS, STIs and TB control (HAST)
District wide Theewaters- Province wide
Programme performance indicator Data source Type Cape Agulhas Overstrand Swellendam
Frequency value kloof value
/ Element ID
2016/17 2016/17 2016/17 2016/17 2016/17 2016/17
STRATEGIC GOAL: Promote health and wellness.
1.1.1 TB programme success rate Quarterly % 90.9% 81.5% 92.0% 90.0% 92.0% 80.4%
Numerator 1 1 971 154 587 217 1 013 34 651
Denominator 2 2 169 189 638 241 1 101 43 099
2.1.1 ART retention in care after 12 months Quarterly % 68.0% 71.8% 74.4% 64.0% 63.0% 72.2%
Numerator 3 1 237 102 495 110 530 33 307
Denominator 4 1 820 142 665 172 841 46 120
2.1.2 ART retention in care after 48 months Quarterly % 66.1% 71.3% 72.9% 59.3% 61.1% 60.7%
Numerator 5 722 62 293 64 303 19 700
Denominator 6 1 093 87 402 108 496 32 455
SECTOR SPECIFIC INDICATORS
1. ART client remain on ART end of month Quarterly No 10 397 721 4 245 856 4 575 230 931
- total
Element 7
2. TB/HIV co-infected client on ART rate Quarterly % 84.3% 53.8% 90.6% 97.8% 81.5% 89.6%
Numerator 8 632 21 242 44 325 14 902
Denominator 9 750 39 267 45 399 16 637
3. HIV test done – total Quarterly No 74 349 10 976 20 934 11 404 31 035 1 379 375
Element 10
4. Male condoms distributed Quarterly No 6 536 300 771 000 2 012 700 927 200 2 825 400 113 913 868
Element 12
5. Medical male circumcision – total Quarterly No 616 71 213 74 258 11 687
Element 16
21District wide Theewaters- Province wide
Programme performance indicator Data source Type Cape Agulhas Overstrand Swellendam
Frequency value kloof value
/ Element ID
2016/17 2016/17 2016/17 2016/17 2016/17 2016/17
6. TB client 5 years and older start on Quarterly % 101.3% 96.2% 122.3% 97.9% 94.6% 92.9%
treatment rate
Numerator 19 1 119 102 291 188 538 21 007
Denominator 20 1 105 106 238 192 569 22 612
7. TB client treatment success rate Quarterly % 90.9% 81.5% 92.0% 90.0% 92.0% 80.4%
Numerator 21 1 971 154 587 217 1 013 34 651
Denominator 22 2 169 189 638 241 1 101 43 099
8. TB client defaulter / lost to follow up Quarterly % 3.2% 7.9% 3.4% 4.1% 2.0% 10.5%
rate
Numerator 23 69 15 22 10 22 4 514
Denominator 22 2 169 189 638 241 1 101 43 099
9. TB client death rate Annual % 3.2% 3.2% 2.7% 4.1% 3.3% 3.9%
Numerator 24 69 6 17 10 36 1 693
Denominator 22 2 169 189 638 241 1 101 43 099
10. TB MDR treatment success rate Annual % 29.1% 25.0% 14.3% 23.1% 35.5% 44.6%
Numerator 25 16 1 1 3 11 738
Denominator 26 55 4 7 13 31 1 653
22Table 12: Performance indicators for MCWH and Nutrition
District wide Theewaters- Province wide
Programme performance indicator Data source / Type Cape Agulhas Overstrand Swellendam
Frequency value kloof value
Element ID
2016/17 2016/17 2016/17 2016/17 2016/17 2016/17
SECTOR SPECIFIC INDICATORS
1. Antenatal 1st visit before 20 weeks rate Quarterly % 78.0% 88.3% 76.2% 82.2% 75.5% 61.0%
Numerator 1 3 310 444 974 402 1 490 60 384
Denominator 2 4 244 503 1 279 489 1 973 99 069
2. Mother postnatal visit within 6 days rate Quarterly % 69.8% 67.7% 65.2% 52.3% 80.3% 6.3%
Numerator 3 2 144 270 745 184 945 6 026
Denominator 4 3 071 399 1 143 352 1 177 95 337
3. Antenatal client start on ART rate Annual % 85.1% 96.7% 92.3% 87.5% 77.1% 6.3%
Numerator 5 387 29 169 21 168 6 026
Denominator 6 455 30 183 24 218 95 337
4. Infant 1st PCR test positive around 10 Quarterly % 0.0% 0.0% 0.0% 0.0% 0.0% 1.9%
weeks rate
Numerator 7 0 0 0 0 0 242
Denominator 8 494 29 258 17 190 12 617
5. Immunisation coverage under 1 year Quarterly % 71.8% 89.5% 74.5% 73.0% 64.9% 84.5%
Numerator 9 3 294 440 1 138 453 1 263 89 202
Denominator 10 4 585 492 1 527 620 1 946 105 611
6. Measles 2nd dose coverage Quarterly % 91.7% 111.9% 83.4% 98.1% 91.0% 1.9%
Numerator 11 4 313 565 1 307 624 1 817 242
Denominator 12 4 705 505 1 568 636 1 996 12 617
7. Diarrhoea case fatality rate Quarterly % 0.0% 0.0% 0.0% 0.0% 0.0% 0.2%
Numerator 16 0 0 0 0 0 12
Denominator 17 292 15 115 75 87 7 528
8. Pneumonia case fatality rate Quarterly % 0.0% 0.0% 0.0% 0.0% 0.0% 0.4%
Numerator 18 0 0 0 0 0 27
Denominator 19 546 70 236 77 163 6 395
23District wide Theewaters- Province wide
Programme performance indicator Data source / Type Cape Agulhas Overstrand Swellendam
Frequency value kloof value
Element ID
2016/17 2016/17 2016/17 2016/17 2016/17 2016/17
9. Severe acute malnutrition case fatality Quarterly % 0.0% 0.0% 0.0% 0.0% 0.0% 2.2%
rate
Numerator 20 0 0 0 0 0 14
Denominator 21 32 5 5 6 16 634
10. School Grade 1 - learners screened Quarterly No 0 458 832 199 1 842 27
Element 22
11. School Grade 8 - learners screened Quarterly No 0 215 642 511 1 159 27
Element 24
12. Delivery in 10 to 19 years in facility rate Quarterly % Not required Not required Not required Not required Not required 64.0%
to report to report to report to report to report
Numerator 26 - - - - - 1 072 570
Denominator 4 3 071 399 1 143 352 1 177 1 676 161
13. Couple year protection rate (Int) Quarterly % 97.2% 102.5% 92.3% 106.2% 96.8% 64.0%
Numerator 27 74 439 9 302 23 366 10 623 31 148 1 072 570
Denominator 28 76 569 9 077 25 305 10 003 32 185 1 676 161
14. Cervical cancer screening coverage Quarterly % 57.1% 82.7% 46.3% 59.2% 57.7% 57.7%
30 years and older
Numerator 29 4 026 746 1 160 545 1 575 87 397
Denominator 30 7 055 902 2 504 921 2 728 151 456
15. HPV 1st dose Annual No 0 134 510 191 747 27
Element 31
16. HPV 2nd dose Annual No 0 136 480 208 762 27
Element 33
17. Vitamin A 12 - 59 months coverage Quarterly % 52.6% 70.2% 45.4% 55.1% 53.1% 44.4%
Numerator 34 20 120 2 878 5 782 2 850 8 610 378 972
Denominator 35 38 219 4 098 12 733 5 170 16 219 852 972
24District wide Theewaters- Province wide
Programme performance indicator Data source / Type Cape Agulhas Overstrand Swellendam
Frequency value kloof value
Element ID
2016/17 2016/17 2016/17 2016/17 2016/17 2016/17
18. Maternal mortality in facility ratio Annual No per 89 0 152 0 79 69
100 000
Numerator 37 3 0 2 0 1 66
Denominator / 100 000 40 0.034 0.004 0.013 0.004 0.013 0.963
19. Neonatal death in facility rate Annual No per 1 000 7 15 5 11 5 10
Numerator 43 22 6 6 4 6 1 049
Denominator / 1 000 38 3.193 0.393 1.270 0.358 1.172 108.779
Table 13: Performance Indicators for District Health Services
District wide Theewaters- Province wide
Programme performance indicator Data source / Type Cape Agulhas Overstrand Swellendam
Frequency value kloof value
Element ID
2016/17 2016/17 2016/17 2016/17 2016/17 2016/17
SECTOR SPECIFIC INDICATORS
1. Cataract surgery rate (in uninsured Quarterly No per 0 0 0 0 0 1 553
population) million
Numerator 1 0 0 0 0 0 7 122
Denominator / 1 000 000 2 0.202 0.026 0.063 0.028 0.085 4.585
2. Malaria case fatality rate Quarterly % 0.0% 0.0% 0.0% 0.0%
Numerator 3 0 0 0 0 0 0
Denominator 4 3 0 2 0 1 68
258. QUALITY OF CARE
Table 14: Top 20 worst performing Ideal Clinic elements in PHC facilities 2017/18 YTD
Nr Worst performing elements Comments
1. Adolescent and youth friendly services are Training on Adolescent and youth friendly
provided services still need to be rolled out.
Clinic committees not in place- need to have
adolescent representation on the committee.
2. Staffing needs have been determined in Western Cape does not implement WISN.
line with WISN
3. Staffing is in line with WISN Western Cape does not implement WISN.
4. There is a functional clinic committee Currently in the process of being advertised.
5. Contact details of clinic committee Currently in the process of being advertised.
members are visibly displayed
6. There is an official memorandum of Not available from Provincial Office.
understanding between the district
management and Cooperative
Governance and Traditional Affairs
(CoGTA)
7. All external signage in place Challenges with Municipalities to put up
geographical location signage. In process to
address.
8. The National Policy for The Management Of Not available from National Department of
Waiting Times is available Health.
9. The facility has a dedicated budget Only Sub-District budget, not on facility level.
10. Building is compliant with safety regulations Older clinics do not have occupancy and
electrical certificates.
11. The National Referral Policy is available Not available from National Department of
Health.
12. There is an official memorandum of Not available from Provincial Office.
understanding between the PDOH and the
Department of Social Development
13. Patient record content adheres to ICSM Training given in record keeping
prescripts In the process of the roll-out of integrated
stationary
14. Clinic space accommodates all services Dedicated areas for Health Care Risk Waste are
and staff being built.
Older clinics do not have dedicated dirty utility
rooms.
15. Immunisation coverage under one year Some immunizations were out of stock.
(annualised) is at least 87% or has increased Immunization schedules have changed.
by at least 5% from the previous year Catch ups are being done currently.
16. All staff has received in-service training on Currently busy with informal training.
infection control standard precautions that Formal training with University of Stellenbosch on
is in-line with the Standard Operating hold for two years.
Procedure in the last two years.
26Nr Worst performing elements Comments
17. Staff are trained on the use of essential No evidence of previous training.
equipment Programme to train staff is in place.
18. Clinical audit meetings are conducted Clinical audits are being conducted now on a
quarterly in line with the guidelines regular basis.
19. Maintenance plan for essential equipment Maintenance plans rolled out.
is adhered to
20. Six monthly district/sub-district clinical M&E being distributed to clinics.
performance review report with action plan Must draw up an individualized action plan
from clinical quality supervisors available
[Source: Ideal Clinic Quality Improvement Plan 2017/18]
*WISN is not implemented provincially
Table 15: Top 20 worst performing National Core Standards in district hospitals 2017/18 YTD
Nr Worst performing elements Comments
1. There are quarterly emergency drills done. Evaluation training conducted last year to
ensure staff is competent.
Outstanding drills are being conducted.
2. The health establishment conduct at least Evaluation training conducted last year to
yearly drills to test the preparedness of their ensure staff is competent.
disaster plan including emergency/disease Outstanding drill are being conducted
outbreak/fire/natural disaster.
3. A fire certificate for the health One hospitals infrastructure not compliant to
establishment is available. safety regulations
4. Maintenance records show that Continuous quality improvement plans was put
recommendations of annual inspections into place
reports on safety hazards and maintenance
needs are implemented.
5. A pre-placement examination is performed SHERQ policy being rolled out.
before commencement of duty or within 14 Pre- placement medicals currently not being
days of employment if relevant. done, only in the process of establishing annual
medical surveillance.
6. There are records of mandatory pre- Pre- placement medicals currently not being
employment tests for food handlers. done, only in the process of establishing annual
medical surveillance.
7. The Health Care Risk Waste (HCRW) Monthly HCRW audits now being conducted.
management report undertaken in the Results must be included in continuous quality
previous two years shows management’s improvement plan.
plan and measures undertaken to address
identified risks.
8. There is evidence that a hand wash drive or One drive was done but no evidence was in
campaign is held at least annually in the place.
establishment Emphasis placed on having evidence.
All other drives had to be conducted.
27Nr Worst performing elements Comments
9. Security measures are adequate to Cameras that were not working had to be
safeguard new-borns and unaccompanied replaced.
children including restricted access and exit Too many access doors to these areas.
monitoring in wards /identification of new- Needs to be access controlled with specific
borns/children and their parents. monitoring of children.
10. The entries in the schedule 5 and 6 drug Training was done by nursing managers.
books are complete and correct and Balances and two signatures has to be in place.
include date/name of person who
administered it and balance in stock.
11. All staff wear PPE as needed in different Training on PPE given.
departments. Importance of ordering correct PPE as well as
wearing it correctly.
12. There are clean water and disposable cups Had to order water and cups for all waiting
available for patients in waiting areas. areas and not only main waiting areas.
13. Systems in place to ensure safe entry e.g. Cameras that were not working had to be
Security guards/CCTV replaced.
14. Security measures are positioned at Security only at main entrance and no security
vulnerable patient areas such as cameras.
maternity/paediatric/psychiatric and Must be ordered
emergency units and access and egress
points.
15. Patients can be consulted in a Document were outstanding: Standard
room/cubicle or receive treatment in a Operating Procedure written and now be in
ward I a manner which allows for privacy place
either through closed doors, screen or
curtains.
16. Health professionals/providers are wearing Name tags must be ordered for all staff.
name tags
17. Educational materials are available relating Standard educational material not available
to the treating unit. from Provincial office.
Pulled resources from other hospitals.
18. Managers have a leadership and Competency assessments only requested as part
management competency assessment of recruitments process.
performed in the past two years. Only compulsory as part of recruitment process.
19. There is a system in place to reduce waiting Card system was put into place.
times for files.
20. The stock control systems shows minimum Therapeutic support services will be included in
and maximum or re-order levels for medical audits to ensure that stock levels are monitored.
devices.
[Source: WebDHIS National Core Standards]
28Table 16: Top 10 challenges reported by patients in patient surveys and patient complaints
2017/18 YTD
Nr Challenges Comments Patient complaints Comments
reported in
patient surveys
1. Visiting hours Responsiveness Care and professional Health care professionals
were not long assessed. Staff must treatment adhering to the prescribed
enough be able to look at protocols, referring patients
individualized needs for second opinions where
without compromising indicated.
the hospitals rules. Staff that went the extra
mile to take care of
patient’s personal needs is
commended.
2. I was very Outsource activities Waiting times System must be in place to
reduce waiting times for
bored at the for patients to
files.
hospital respective NGO’s. Integrate services in PHC
Develop and include facilities.
in contract Short waiting times in
queues at service areas
Elderly and disables persons
are given priority treatment
3. I did not feel Security guards must Staff attitudes Strengthening of staff
safe at night at be visible. morale with Integrated
the hospital Security cameras must Wellness Support
be in working order - Wellness Days
and utilized - Interventions (
debriefing, Conflict,
Communication, Team
Building and Cohesion)
- Implementation of the
Values
- Training on courtesy.
4. I had to wait a System must be in Other Complaint couldn’t be
long time to get place to reduce categorized in another
my folder waiting times for files. category must be handled
according to that
complaint.
5. The hospital did Lack of adequate Food services This indicator is applicable
not assist me to Public Transport to hospitals.
get a lift home System Dietician to assist with
complaints.
6. Visiting hours Care and professional
were not long treatment
enough
29Nr Challenges Comments Patient complaints Comments
reported in
patient surveys
7. I was very Outsource activities Waiting times Improve on Patient waiting
bored at the for patients to. time survey
hospital Respective NGO’s. Implementation of Patient
Develop and include Records Management SOP
in contract
8. I did not feel Staff attitudes Strengthening of staff
safe at night at morale ito Integrated
the hospital Wellness Support
- Wellness Days
- Interventions (
debriefing, Conflict,
Communication,
Team Building and
Cohesion)
- Implementation of
the Values
9. I had to wait a Improve on Patient Food services This indicator is applicable
long time to get waiting time survey to hospitals. Implementation
my folder Implementation of of provincial guidelines ito
Patient Records food service management?
Management SOP
10. The hospital did Lack of adequate
not assist me to Public Transport
get a lift home System
[Source: Sinjani]
309. ORGANISATIONAL STRUCTURE OF THE DISTRICT
MANAGEMENT TEAM
Figure 9: Organogram for Overberg District as at 31 March 2017
Organisational Structure of the District Management Team
MEDICAL MANAGER: OVERSTRAND SUB-DISTRICT
OVERBERG DISTRICT
DR ERMA MOSTERT
DIRECTOR
MEDICAL MANAGER: THEEWATERSKLOOF SUB-DISTRICT
DR MAKONDELELE RAMBIYANA
Mrs W M KAMFER
MEDICAL MANAGER: SWELLENDAM & CAPE AGULHAS
SUB-DISTRICTS
DR JACQUES DU TOIT
DEPUTY DIRECTOR DEPUTY DIRECTOR DEPUTY DIRECTOR DEPUTY
DEPUTY DIRECTOR
PEOPLE COMPREHENSIVE
PROFESSIONAL FINANCE PHARMACY HEALTH
MANAGEMENT
SUPPORT SERVICE
ASHLEY NIEKERK HANLIE BRITS PETRO
RONELL ZONDO ROBERTSON
CHRIS MATSHOZA
ASSISTANT
DIRECTOR
ASSISTANT MANAGER
ASSISTANT DIRECTOR SUPPLY CHAIN
FACILITY BASESD
PEOPLE JOHLENE SERVICES
MANAGEMENT HONEYBALL
ALETTA LUDIK
WALTER SEPTEMBER
ASSISTANT
DIRECTOR
ASSISTANT
FINANCE MANAGER
ASSISTANT DIRECTOR
PERCIA LAMOHR COMMUNITY BASED
LABOUR
RELATIONSPEOPLE SERVICES
DEVELOPMENT
ESME HENN
NICO LIEBENBERG
ASSISTANT
DIRECTOR
HAST MANAGER
QUALITY
ASSURANCE EMELIA HANS
ASSISTANT DIRECTOR
DUEDONNE LE
TALENT SOURCING GRANGE
ANNE-MARIE BRITS
ASSISTANT
DIRECTOR
INFORMATION
MANAGEMENT
LEON BENJAMIN
3110. DISTRICT HEALTH EXPENDITURE
Table 17: Summary of district health expenditure 2016/17
BUDGET AND 2014/15 2015/16 2016/17
EXPENDITURE
Sub-programme BUDGET EXPENDITURE BUDGET EXPENDITURE BUDGET EXPENDITURE
2.1: District
Management 21 660 000 24 249 000 24 249 000 23 593 868 25 261 000 25 127 501
2.2: Clinics 104 948 000 91 87 000 91 87 000 90 127 069 99 583 000 99 112 285
2.3: Community
Health Centres 31 766 000 55 368 000 55 368 000 51 997 386 59 743 000 56 159 084
2.4: Community
Services 4 675 000 4 888 000 4 888 000 5 273 203 5 332 000 5 811 545
2.5: Other Community
Services 0 0 0 0 0 0
2.6: HIV/AIDS 58 259 000 66 148 000 66 148 000 63 706 867 72 062 000 73 808 438
2.7: Nutrition 2 656 000 2 918 000 2 918 000 2 930 418 3 235 000 3 224 182
2.9: District Hospitals 134 124 000 151 489 000 151 489 000 152 593 714 160 465 000 164 453 263
TOTAL DISTRICT 358 088 000 396 938 000 396 938 000 390 222 526 425 681 000 427 696 298
[Source: District Health Expenditure Review (2016/17) or BAS]
Program 2.3: Includes the CDC’s, Oral Health and School health budgets. To take into account
when looking at the calculated tables.
Cost Savings measures were relaxed in 2016-2017 after its initial implementation in 2015-16.
One can notice the year on year growth for the entire Overberg District, this is indicative of the
growth of the District since its establishment in 2006.
3211. DISTRICT PERFORMANCE INDICATORS
11.1 DISTRICT HEALTH SERVICES
Table 18: Performance indicators for District Health Services
Provincial
Data Estimated
Programme performance indicator Type Audited / Actual performance Medium term targets actual
Frequency source / performance
performance
Element ID
2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17
SECTOR SPECIFIC INDICATORS
1. Ideal clinic (IC) status rate Annual % 0.0% 0.0% 47.4% 68.4% 100.0% 100.0% 100.0% 17.2%
Numerator 3 0 0 9 13 19 19 19 47
Denominator 2 24 22 19 19 19 19 19 273
2. PHC utilisation rate (annualised) Quarterly No 2.5 2.5 2.6 2.5 2.5 2.5 2.5 2.3
Numerator 6 677 883 698 460 731 769 731 612 746 642 761 617 776 496 14 413 350
Denominator 7 270 406 276 168 282 022 287 777 293 506 299 204 304 859 6 318 281
3. Complaint resolution within 25 Quarterly % 95.5% 98.5% 96.5% 95.1% 95.6% 96.6% 96.0% 95.6%
working days rate (PHC
facilities)
Numerator 10 253 262 273 253 237 225 218 3 175
Denominator 8 265 266 283 266 248 233 227 3 320
33Table 19: Quarterly targets for District Health Services
Programme performance indicator Data source Frequency Annual target Quarterly targets
/ Element ID 2018/19 Quarter 1 Quarter 2 Quarter 3 Quarter 4
SECTOR SPECIFIC INDICATORS
1. Ideal clinic (IC) status rate Annual 100.0% - - - 100.0%
Numerator 3 19 - - - 19
Denominator 2 19 - - - 19
2. PHC utilisation rate (annualised) Quarterly 2.5 2.5 2.6 2.4 2.6
Numerator 6 746 642 186 514 192 501 173 989 193 638
Denominator 7 293 506 73 377 73 377 73 377 73 375
3. Complaint resolution within 25 working days rate Quarterly 95.6% 95.2% 95.3% 94.8% 96.9%
(PHC facilities)
Numerator 10 237 59 61 55 62
Denominator 8 248 62 64 58 64
34STRATEGIC ACTIVITIES
OBJECTIVE
Ideal clinic Supervisory visits monthly monitoring to ensure Essentials & Vital is in place.
OPM to focus on what is not in place and put measures in place to become compliant.
focus on infrastructure, patient flow,
Implementation of Adolescent Youth Friendly Services.
Self-assessments according to Annual audit schedule X1.
Use results of audits to compile a continuous quality improvement plan.
Working with supply chain to order outstanding equipment and consumables.
Ensuring all SOP’s are signed and implemented.
Implementation of Adolescent Youth Friendly Services.
Self-assessments according to Annual audit schedule X1.
Ensuring cleanliness of clinic both interior and exterior
Feedback from Need to embark on communication strategy to educate the community on ways to
community improve their facility e.g. not to brake a tap, to save electricity, open windows and open
complaints blinds, design pamphlets.
Building trust and rapport with community (implementation of new Complaints &
Compliments Guideline in all facilities).
Display resolutions (anonymous).
One community member serving on the Community Health Forum can attend on an ad
hoc basis. In the event that the CCSCs is not a stand-alone committee, but forms part of
other committees that deal with quality improvement, complaints should be put as the
first agenda point so that members of the Community Health Forum can be excused
once the agenda point has been discussed.
The monthly or quarterly report that is submitted to the Community Health Forum should
include a section on the management of complaint.
Media/communication plan( TV PowerPoint) to inform client on how complaints work
and to gain trust in the system
Verification/feedback system in place to inform operational managers of complaints
captured and resolved
Conduct a Patient Experience of Care (PEC) in all fixed clinics (19 fixed facilities, i.e.
clinics, CDC’s and the 4 district hospitals).
Ensure patient satisfaction results are part of Quality Improvement Plans (QIP) and
progress is measured regularly (integral part of staff meetings).
Focused approach on improving areas of concern or priority areas, especially
cleanliness of clinics, staff attitude and professionalism
Complaint Need to be at 90% resolution within 25 working days for all sub districts.
resolution rate Need to be at 96%. Info to draw monthly reports. Analyse, feedback, identify gaps.
Complaints officer needs to be appointed at all facilities.
The procedure for lodging, acknowledgement and investigating a complaint (including
telephonic complaints) must be in place.
Must determine the required action to be taken according to the severity of the
complaint (risk rating)
Identify patterns in system failures (categorisation)
The procedure for redress and timelines to be adhered to
Accurate recording of statistical data on complaints including the indicators for
complaints
Monitoring mechanisms and their response timelines
Mechanism to ensure children’s participation in the complaints process as well
vulnerable groups such as disabled people, the elderly, mentally ill people, illiterate
people and people speaking foreign languages can easily participate in the complaints
process.
Striving to resolve complaint within 15 days to ensure time to resolve if complaint has to
be escalated to higher level
Complaint resolution rate needs to be displayed on all facilities notice board.
Media Clippings and a quarterly report- communication –District Health Council
35STRATEGIC ACTIVITIES
OBJECTIVE
PHC utilisation rate Establish measures to assess access. Formulise strategies to effect continual improvement
(COPC mapping).
Identify and implement changes at specific facilities.
Home Based Care give key messages wrt types of services rendered at clinic.
Emphasis on first 1000 days.
Look at service flexitimes (staggered working hours for staff) in order for the facilities to
increase access (looking at specific times for children, antenatal follow ups).
• Appointment System standards implemented. Communication drive to staff and
patients to get a common understanding of what it entails.
Need to educate staff on the appointment system and the functionality thereof
Improve access to health services through specialized clinics, streamlining service
delivery and improving reception services.
Improved utilization of the Primary Health Care Information System (PHCIS) appointment
system.
Improve waiting times for children, elderly/frail and patients with disabilities by fast
tracking them in the system( measuring quarterly)
Improve access in facilities where immunization/vit A/preventative services targets are
not reached, by special time slots/days/CHW recall system and helping every referral
from school health/CBS platform
Infection IPC training in the Overberg District to all categories of staff.
prevention and Importance of standard precautions emphasized.
control (IPC) IPC Officers appointed in each facility
Biannual IPC audits conducted and results discussed in the appropriated forums.
Annual Hand hygiene campaigns and audits completed per facility
Ensure that all HCRW is removed according to SLA
Setting standards to provide and maintain a safe and infection-free environment
Recommending measures to resolve current and/or potential problems
Lowering the risk of health care acquired infections and the potential for infections for
patients, personnel, the community and the environment through the establishment and
maintenance of preventative and epidemiologically indicated precautions, as well as
the notification and management of infections
Implementing, monitoring and evaluating policies to guide the infection control
programme. Ensure that this and related policies are kept up to date and
communicated appropriately.
Implementing set policy by ensuring that personnel have the necessary authority and
resources to enforce it, and thereby ensuring the co-operation of all personnel
Co-ordinating and ensuring the co-operation of different expert departments during the
management and/or control of outbreaks of infection
Identifying and correcting risky and/or inefficient infection control procedures.
Ensuring that the different members of the committee have the necessary expertise in
decision making and problem solving. Monitor the implementation of IPC procedures
and practices, ensuring that the correct tools are used for measuring compliance with
recommended IPC practices
Respond to surveillance and audit results by instituting improvements. Ensure that all
documentation and reporting requirements relating to IPC are adhered to
Ensure that there are always sufficient supplies and equipment in place to comply with
recommended IPC practices
Ensure that IPC incidents are investigated and managed appropriately
Promote the appropriate use of disinfectants
Antibiotic stewardship
Promote awareness and training on appropriate antibiotic use
Basic infection control principles
Provide guidelines for antibiotic prescription according to antibiotic resistant patterns
Feedback from pharmacy audits discussed at facility level.
36STRATEGIC ACTIVITIES
OBJECTIVE
Occupational Appointment of 1 QA Managers to fully implement the SHERQ policy
Health and Safety Functional Quality and OHS committees in all four sub-districts.
(OHS) OHS Representatives and 16.2 Appointments to be done in all facilities.
Quarterly OHS audits conducted and results discussed in the appropriated forums.
Accident prevention, through early identification and elimination of unsafe conditions or
acts
Staff must be protected from workplace hazards through effective occupational health
and safety systems
Management and Staff share the responsibility to identify hazards and development of
control measures to make the workplace as safe and healthy as reasonably practicable.
Each facility will have a documented protocol for Occupational acquired diseases such
as TB or HIV or exposure to blood and other bodily fluids
When an employee suffers an injury to the extent that he/she requires medical treatment
other than first aid, section 24 requires the employer to investigate the incident and
complete applicable forms.
All staff who have potential contact with Health care risk waste and bodily fluids must be
vaccinated against Hepatitis B.
All facilities must have a Fire and Disaster/Emergency Plan
All facilities are required to have a current fire safety certificate
All facilities are required to have service agreement with an accredited provider to
check and service fire safety equipment
A logbook must be kept as proof of maintenance of fire safety equipment
All staff working in the facility will be familiar with procedures in case of fire or
emergencies
Evidence of staff training in Fire and Emergency management will be available and
updated on an annual basis.
An incident form must completed for all adverse events causing a risk for Occupational
Health and Safety
All incidents must be recorded on the monthly Adverse event, Occupational Injuries or
Safety and security report.
“No Smoking” signs will be visible in all public areas
PPE will be available to staff in their working area
All staff must be trained in the correct use of appropriate PPE
All staff will use PPE as required and directed
All staff must be informed about ICAS and method of access
Active promotion of ICAS must be encouraged by all
M&M/adverse Monthly M&M Meetings in all sub-districts.
events Include EMS and CFM in all meetings
Monthly reporting on AIRMS system
Quarterly review of the indicators.
Standardise Home Support and strengthening the piloting of COPC in the 3 sites for the Overberg District
and Community (Villiersdorp, Grabouw and Hermanus).
Based Care Enrolment of Level 3 health promote course
(HCBC) Increase focus on wellness activities by CHW’s.
implementation Quarterly reviews on the set targets
Strengthen the NGO and clinic 2 weekly meetings to ensure Continuum of
care/feedback of referred patients
Quarterly data feedback sessions with NGO/facilities to measure progress w.r.t SLA and
targets
Continuous data strengthening through verification checks, more involvement of IM,
refresher data training
NGO Audits, 6 monthly reviews, claims verification and contract management to be
shared between HAST co and CBS Co including finance
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