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					 STATUS OF PRIMARY
HEALTH CARE CLINICS
PORTSHEPSTONE HOSPITAL
                Agenda
• Key message
• Situation and complications
• Organisation structure proposal
            KEY MESSAGE
The current structure is cumbersome and
 duplicative ,constraining service delivery

A decentralized management of the Primary
  health care system will improve service
  delivery to accelerate and improve fully
  integrated services ,accessible to all and a
  higher level of accountability at all levels .
                   0
                       1
                           2
                               3
                                      4
                                                  5
  Availability of




                                   3.26
    training



     Career




                                   3.16
   progression


Communication
    with
 management                        3.26



      Quality of
                               2.95



      facilities


     Quality of
                                                        Staff Survey




    service you
                                                 4.32




      deliver


  Effectiveness
                                           4.00




     of PMS



 Overall quality
                                          3.89




of management



  Responsible
                                          3.79




  use of budget
                                                                         Staff morale appears good except for
                                                                       quality of facilities and career progression
Patients are happy with service except
   for time taken (turnaround time)

                                            Patient Survey

5
                                     4.5
                                                                                                        4.3
                                                      4.1              4.1
                      3.9                                                             3.8
4

       3.0
3


2


1


0
    Time taken   Helpfulness of   Cleanliness   Access to toilets   Quality of   Availability of   Skills of staff
                      staff                                          service      medicines
      HUMAN RESOURCES
SITUATION   COMPLICATIONS RESOLUTION

1.Staff     Lack of         Comfortable
shortage    accommodation   beds with base
                            and a mattress
            Unattractive
            accommodation
  HUMAN RESOURCES cont.
SITUATION COMPLICATION         RESOLUTION

Staff      Failure to retain   Clinic professional
Shortage   staff at clinics    nurse entry grade
                               post be upgraded
                               to level 7
        PHYSICAL SPACE
SITUATION     COMPLICATION RESOLUTION

Lack of privacy Spatial         Build more
Overcrowding problem/physical   structures / add
                space           temporary office
                .               space
       PHYSICAL SPACE cont.
SITUATION       COMPLICATIONS RESOLUTION
Lack of privacy Addition of new   Use temporary
Overcrowding programs             park homes/
                                  porter camps
       CLINIC MAINTENANCE
SITUATION     COMPLICATIONS RESOLUTION

Poor          Communication     Structured visits
maintenance   lines undefined   to clinics by
              /absence of       identifiable
              responsible       maintenance
              contact person    person
     REPORTING PROCEDURE
SITUATION        COMPLICATIONS RESOLUTION

Duplication of   Organizational       Simplified
reporting        structure            organizational
procedures       problems/            structure with
                                      direct reporting
                 Parallel reporting   lines
                 structures /
                 procedures
Current structure
                                                           HOD

                CHO                                         COO                                      CFO
               (DDG)                                       (DDG)                                    (DDG)
               CD CD

          D    D     D       D    D

          DD DD DD DD
                                                                                                            Province

          Area 1                      Area 2                   Area 3               Area Manager
       Manager (CD)                Manager (CD)             Manager (CD)                (CD)                      Area


District       District          District       District     District        District
Manager        Manager           Manager
 Ilembe        eThekwini           Ugu
                                                Manager      Manager         Manager                          District

    Clinical       Service                                                    Hospital
     Pro-          support            Finance      DHS             HR         Manager        Hospital 2   Hospital..
   grammes
      …                  …               …           …
      …                  …               …           …             Duplication

     PHC
                         …               …           …
      …                  …               …           …

                Lack of integration between hospital                    Finance/
                                                              HR                   Medical     Nursing    PRO
               and clinics, lack of clarity of roles and                Systems
                            responsibilities                                                                    12
                                                                                                          Institution
…causes delays
                                                      HOD

                 CHO                                   COO                                       CFO
                (DDG)                                 (DDG)                                     (DDG)
                CD CD                                              IT                     Procure-
                                                                Committee                   ment
           D    D    D       D    D

           DD DD DD DD
                                                                                                        Province

           Area 1                     Area 2               Area 3               Area Manager
        Manager (CD)               Manager (CD)         Manager (CD)                (CD)                      Area


 District       District         District    District    District        District
 Manager        Manager          Manager
  Ilembe        eThekwini          Ugu
                                             Manager     Manager         Manager                          District

     Clinical             District IT
                    Service                                               Hospital
      Pro-          support      Finance        DHS            HR         Manager        Hospital 2   Hospital..
    grammes              Committee
       …                 …               …        …
       …                 …               …        …

      PHC
                         …               …        …
       …                 …               …        …

                                                                    Finance/
                                                          HR        Systems    Medical     Nursing    PRO
                                                                                                       8 months!!
                                                                                                           13
                                             Need new printer – big delay in outpatients!!            Institution
Proposed structure                                                                                                    Province
                                                              HOD

                                                                                DDG
                DDG                              DDG                          Service                             DDG
             (Planning)                          (HR)                         Delivery                          Finance
                                                                               (COO)




  District Managers use support structures of Province but sit at the “coal face”
District   District   District      District     District    District      District     District     District     District      District
Manager    Manager    Manager       Manager      Manager     Manager       Manager      Manager      Manager      Manager       Manager




  NHLS
separate              Hospital                                                                                               Public
structure             Manager        Hospital 2       Hospital 3        Hospital 4      Hospital 5      Hospital 6           Health
                         1



                         Finance/                                             Clinical
                 HR      Systems       Medical     Nursing         PRO        Manager                                        Local


                                                        Clinic 1        Clinic 2      Clinic 3     Clinic…
                                                                                                                               14
            SIYABONGA
THANK YOU

DANKIE

ENKOSI

RE A LEBOGA

				
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posted:12/1/2009
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