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Province - The DPSA Review of Provinces DEPARTMENTAL REPORT

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Province - The DPSA Review of Provinces DEPARTMENTAL REPORT Powered By Docstoc
					The DPSA Review of Provinces


DEPARTMENTAL REPORT:



Province:                    KWAZULU NATAL


Department:                  HEALTH



Annexure: J


Date: 6 FEBRUARY 1997




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                                                                                  ANNEXURE J

                                       DEPARTMENT OF HEALTH


1.     Vision & Mission

       (a)     The vision of the department is as follows:

               To develop a single co-ordinated, comprehensive and integrated health
               system at all levels of care based on the principles of primary health care
               approach through district based health care.

       (b)      The mission, in order to realise this vision, is the following:

               1.     To meet the needs of individuals.

               2.     To be accessible and acceptable to our public.

               3.     To inculcate a sense of ownership and participation by all our
                      stakeholders.

               4.     To provide an efficient and effective service.

               5.     To ensure co-operation between provider, consumer and policy-
                      maker.

               6.     To ensure versatility, sustainability and measurability in all our
                      endeavours.

               7.     To provide a comprehensive, caring and compassionate service from
                      point of entry to point of exit.

               8.     To provide quality service as judged by our customers.

               9.     To keep our vision alive and owned by all.

               10. To maintain inter-sectoral collaboration.

               In addition the department is one of the piloting departments in the good
               governance programme of the province. This programme is aimed at
               creating a positive work culture and ethos in the province.

2.     Strategic Planning and Management

       2.1     Departmental Plans

               Although the senior management team of the department developed the
               above vision and mission, a strategic plan for the department is not yet in
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               place. A health plan for the province, linked to the national health policy,
               is however in place and has been properly communicated to all the
               regions of the department.

       2.2     Purpose and Functions

               Purpose:

               To satisfy the health care needs of the people in KwaZulu-Natal.

               Functions:

               1.     The rendering of comprehensive health care services.

               2.     The rendering of strategic and logistical support services.

       2.3     Policy decisions, planning & action

               Policy at provincial level is well aligned with national policy, especially in
               respect of primary health care. The department influences national policy
               by attending and participating in the Consultative Health Forum at national
               level. The department has decided to institute a similar forum at provincial
               level with unions, NGO’s and other stakeholders attending.

3.     Leadership and Management

       Regular meetings of the senior management of the department are held.
       Everyone is invited to add matters to the agenda and matters remain on the
       agenda until they are finalised. Minutes are kept of these meetings and are
       then distributed to all members. The same procedures apply in respect of
       middle management.




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4.     Structure

                                     AMALGAMATED STRUCTURE

                                      SUPERINTENDENT GENERAL

DDG: Health Care                            DDG: Support Services         Ministerial Support
                                                                          Component


       CD: Regions 1-4                              CD:   Management
                                                    Support Services

       CD: Regions 5-8                              CD: Administrative
                                                    Instructive Support
                                                    Services

       CD: Programme Development
       and Professional Service
       Support


                            PROPOSED RATIONALIZED STRUCTURE


                                      SUPERINTENDENT GENERAL

DDG: Health Care                            DDG: Support Services         SG’s       Support
                                                                          Services

       CD: Regions A, B, C
                                                    CD:   Management
       &F
                                                    Support Services
       CD: Regions D, E,
                                                    CD: Administrative
       G&H
                                                    Instructive Support
                                                    Services

       CD: Programme Development
       and Professional Service
       Support


       The rationalisation of the department has not been finalised yet, although an
       interim amalgamated structure was approved by the Provincial Service
       Commission. This structure is seriously flawed as it does not provide for some
       of the new functions added to Health, such as finance, labour relations, and
       communication. Although the proposed rationalised structure was approved by
       the DG and submitted to the Provincial Service Commission in October 1996,
       the matter has not been finalised yet and the Commission has indicated that
       departments in the province must operate on their amalgamated structures for
       at least a year before the rationalised structures can be considered.




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5.     Service Delivery Activities

       5.1     Performance

               Not all clients are satisfied. In some areas the department simply does not
               have the necessary staff and resources. The attitude of staff is also a
               problem. The accessibility to health services has however improved
               dramatically since the new government came into power. In the case of
               the primary health care the performance of service delivery is measured
               by means of a checklist which measures the performance of the workers.
               Questionnaires have also been developed which help with the
               measurement of service delivery. The response times in emergency
               cases is also measured and recorded. There has however been no full or
               formal performance audit. The necessary capacity needs to be built in this
               regard.

       5.2     The service providers

               The catering services at hospitals have been outsourced. The catering
               services seems to be comparable with those provided before by the
               department. There is, however, a lack of capacity to measure whether the
               outputs are still of the necessary quality after being contracted out. The
               privatisation of activities has generally been successful because staff are
               overburdened and does not have the time to provide quality services in all
               respects.




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Administrative activities

6.0    Personnel

       Most appointments, promotions, etc., are currently done at Head Office. The
       six institutions under the old NPA administration had many personnel
       delegations, whereas personnel matters under the old KZN administration were
       handled at Head Office in Ulundi. Personnel files are kept at Head Office
       (Natalia), Ulundi and Durban. Dummy files for personnel are also kept at Head
       Office.

       The department went live on PERSAL in October 1996. The finer personnel
       details are currently being entered into the system on a continuous basis
       whenever the staff finds the time for this.

                          No           of   Filled          Funded      Unfunded   Number on   Not
                          posts                             Vacant      Vacant     payroll     absorbed

Provincial DG’s Office

PERSAL                        58 000           51 000               -     7 000      51 000        -

Department



6.1    Rationalisation

       The fact that the amalgamated structure has not yet been replaced by the
       proposed rationalised structure is causing great uncertainty of personnel in the
       department. The policy is to fill those posts on both the amalgamated and
       proposed rationalised structures, whose contents have not changed
       appreciably. There has however been administrative delays in filling posts in
       the amalgamated structure. Because there is not enough senior personnel to
       drive health policy and health and financial planning, this had led to low staff
       moral. The department indicated that there has been no supernumerary staff
       so far.

       There was 1287 applications for the voluntary severance package in the first
       group to be processed, of which 231 were approved. The reasons for the low
       approval rate was the already high vacancy rate in the department, the fact that
       doctors could not be considered and the fact that a large number of nurses
       applied which could naturally not all be approved. A second group of 569
       applications has not been finalised yet.

6.2    Recruitment & appointment of staff

       All entry grade posts except in respect of medical and paramedical staff, have
       been frozen, until 31 March 1997 to save funds. Staff are being trained in
       especially the ex-KwaZulu hospitals in recruitment and interviewing procedures.
       Posts take two to three months to fill. This is due to a shortage of staff,
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       interference by the Provincial Service Commission and the fact that there are no
       effective delegations in place in respect of promotions. Another problem is that
       Public Service Vacancy Circulars are not being circulated properly in the
       province because of logistical problems.

6.3    Leave

       This is administered an institutional level. Head Office keeps the master files
       for the top structure. The planning and checking of leave are done at
       institutional level. There are reports of problems with leave being taken without
       being properly recorded. This is being addressed by means of spot-checks and
       internal audits. The personnel records of ex KwaZulu are generally not of the
       same quality as those of ex NPA. This is largely due to a lack of training.

6.4    Misconduct

       Misconduct is managed at Head Office. 1032 cases were reported in 1996 of
       which 10 have been finalised. 67 cases have been reported so far in 1997.
       The nature of cases range from fraud, theft, and AWOL to substance and
       alcoholic abuse. Frustration because of staff shortages leads to lack of
       discipline among personnel. A huge backlog has developed in the finalisation
       of cases because there is a shortage of personnel and a lack of personnel with
       legal expertise to undertake investigations. There is an effort to get staff trained
       for this purpose. The procedure is also cumbersome and highly centralised and
       should be decentralised.




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7.     Finance

       The Superintendent-General is the accounting officer for the department. The
       Superintendent-General is also the programme manager for the department.
       Responsibility managers are currently being appointed. There are problems
       because PERSAL and FMS do not allow proper monitoring. The 18 people in
       the department responsible for finance are mostly inexperienced but are
       developing themselves.

       The 1994/95 budget was basically a rule of thumb effort, based on history. In
       1995/96 the various budget were amalgamated and co-ordination began with
       other provinces and the national Department of Health. In 1996/97 the
       department did their first proper budget but was allocated less than they
       budgeted for. At that stage they foresaw a shortfall of R200 million, but this has
       since grown to a projected shortfall of R400 million. Certain control measures
       have been introduced to combat this, but this is not expected to make such of a
       difference.

       7.1     The Budget and Expenditure

               The total budget for the 1996/97 financial year is R3,5 billion. The year to
               date expenditure as at the end of January 1997 is R3,3 billion. As already
               mentioned above, the expected shortfall for 1996/97 will be ± R400 million.
               This is due to the fact that the department received less than they
               budgeted for to start with and because more functions were added, such
               as the primary school nutrition programme, without additional funding.
               The July 1996 improvement in conditions of service (new salary grading
               system) also put a further strain on the department’s financial resources.

               Personnel expenditure accounts for 61% of the budget, whilst only 2% is
               available for capital expenditure to develop infrastructure.

               The department has outsourced catering, security, cleaning and gardening
               services, as well as the transportation of patients, although the latter is
               being revisited because of abuse of the system. The services are
               monitored by the hospitals who have to determine whether the companies
               are delivery according to the terms of the various contracts. The oversight
               is however inhibited by shortages of staff.

               R362,646,000 million is paid in the form of transfer payments to local
               authorities and mission hospitals (R114 million for the primary school
               nutritional programme alone.) These institutions have to provide audited
               statements to the department at the end of each year. These statements
               are however not always submitted timeously. The accounts of the
               department are being handled centrally by the Department of Finance of
               the province.



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       7.2     Spending Approval/Delegations

               Most expenditure is approved at institutional level by hospitals. Each
               hospital has a responsibility manager. Hospitals can invite tenders of up
               to R250 000 to buy new equipment, although the Tender Board procedure
               can take up to 2 months to finalise. The department can also invite
               tenders of up R10 000 without the intervention of the Tender Board.

               Cheques in the department are generated in Pretoria through the FMS
               system and then sent to Pietermaritzburg via counter services, from where
               it is then posted to the various institutions. Hand-written cheques are also
               sometimes issued by the Department of Finance in Ulundi.

               The department has 530 paypoints.

       7.3     Provisioning

               The department makes their recommendations, but tenders have to be
               approved by the KZN Tender Board. Pharmaceuticals are purchased
               through a national contract in Durban.

       7.4     The financial management system

               The FMS system is being applied with mixed results that there is a need to
               build staff capacity to enable the department to get accurate and timeous
               information from the system. According to the department’s experience
               FMS and PERSAL are compatible, but there are however problems with
               interpreting reports. One of the weaknesses of the FMS system is that it
               lends itself to fraud.

       7.5     Management of Assets

               Inventories of assets are being kept at institutional level. There is no
               central record of assets at present but the department indicated that it is in
               the process of creating this.       There are major problems with the
               management of state vehicles. The Department of Transport controls
               ordinary vehicles, whilst the department controls vehicles in hospitals.
               The department has a total of 3 165 vehicles at its disposal, of which 357
               are ambulances. Of the department’s 2708 ordinary vehicles, 265 were
               lost in 1996; 21 were stolen, 3 were hijacked, 185 withdrawn for various
               reasons and 56 involved in accidents.           Of the department’s 357
               ambulances, 96 were lost in 1996; 16 were stolen, 3 were hijacked; 45
               were withdrawn and 32 were involved in accidents. The Wesbank Auto
               cards (for petrol) and the service contracts for government vehicles are
               also being heavily abused at great cost to the department. The only real
               attempt at that stage to address these problems is the fact that all vehicles
               are being fitted with gearlocks.

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               The department seems to feel itself unable to cope with the other
               problems surrounding state vehicles.

8.0    Information Systems

       The NHIS Committee at national level determines IT policy. There is also a co-
       ordinating IT committee between departments in the province and a
       departmental IT committee. The department faces serious constraints in terms
       of IT because of a lower budget and a loss of skilled staff to the private sector.

       In the previous they have different computer systems and programs in the
       hospitals. A patient can have a different number if he visits different hospitals.
       The don’t have a unique number of each patient. There is no link between the
       hospitals computer systems. They are now working on it to have the same
       hardware and software.

       Training is also a major problem in that there are often computers and printers
       available, but with no staff with the necessary skills to utilise them. People also
       need to be trained to appreciate the value of IT. But they have a Health-Net for
       13 hospitals.




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Provincial Staff Interviewed

       Name                                        Rank             Responsibility

       Prof RW Green Thompson                      SG               Health
       Mrs S Skweyiya                              DDG              Management/Administration
       Mr GE Mkhize                                CD               Administrative Support
       Mr H Conradie                               CD               Support Services
       Mrs DN Hook                                 Control PO       Services
       Mr B Gray                                   AD: PM           Personnel Provisioning
       Mrs EMR Durandt                             PPO              Personnel Establishment &
                                                                    Salary
       Mrs TT Hlongwa                              Control PO       Personnel: Discipline Merit &
                                                                    Promotion
       Ms PR Bailey                                AD: PM           Personnel:       Conditions of
                                                                    Service, Registry & Pensions
       Ms R Kara                                   Sen. Personnel   Personnel: Conditions of
                                                   Practitioner     Service
       Mr LWE Jones                                Chief Work Study Work Study
                                                   Officer
       Mr EP Motha                                 DD               Labour Relations and Legal
                                                                    Services
       PA Allwright                                SAO              Financial    Management      –
                                                                    Health
       NRR Radebe                                  DD               Financial    Management      &
                                                                    Logistics
       RF Kitching                                 AD               Fin. Management
       TZ Chili                                    SAO              Financial Management
       CA Coleman                                  Act. SAO         Assets Administration
       O Baloyi                                    DDG              Health Care
       D Hackland                                  DG               Health Care
       A Chathury                                  CD               Health Care
       JE Stewart                                  CD               Programme         Development
                                                                    Professional Support Services
       MG Hlongwane                                Director         Regional Director
       MR Bouwer                                   RD               Health Services
       AD Mitchell                                 RD               Health Services (Region A)
       ML Mhlongo                                  RD               Health Services (Region H)
       P E Emerson                                 Director: Prof.  Health Services
       Ms I Mustard                                Chief Admin.     Office Services
                                                   Clerk
       MJE Mkhize                                  Chief Director   Support Services
       M Zwane                                     DD (Acting): D   Support Services
       Mr GC Van Der Merwe                         DD               Health Informing




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General Issues / Constraints

1.     The department has been experiencing major problems because the Provincial
       Service Commission has been delaying for ± 9 months now in approving the
       proposed rationalised structure after approval by the DG. This has led to low
       staff moral.

2.     Because of a general lack of delegations and the inability of Head Office to
       provide adequate support, the department has been unable to fill key positions
       at both the senior and middle management levels. This has led to people being
       overworked and low staff morale.

3.     The Tender Board’s procedures are causing great delays in purchasing
       equipment, particularly emergency equipment for hospitals. A moratorium
       placed on period contracts has also halted the whole process.

4.     Because of the fact that allowances have been stopped in terms of the new
       salary grading system, some doctors are receiving up to R3 000 less per month.
       Allowances for nurses in trauma wards have also been stopped. These nurses
       are now requesting to be moved to less stressful jobs. There has also been
       consistent problems regarding overtime payment for doctors and nurses.

5.     The department is experiencing problems in placing personnel on the second
       and third notches of the new salary scales. This is causing frustration amongst
       personnel.

6.     The department is of the opinion that Gauteng and the Western Cape is being
       favoured as provinces in terms of their health budgets as percentages of the
       total national health budget.

7.     There is a very high level of violence prevalent at clinics, which has caused
       problems for some of them to render proper services and to stay open as long
       as they should.

8.     The department is experiencing serious resistance to change amongst its
       personnel and their uncertainty concerning the province’s capital is also causing
       problems.

9.     There are problems with the FMS and PERSAL systems in that personnel are
       not properly trained to use these systems and that there are problems in
       interpreting the information provided by the FMS system.




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Recommendations

1.     The province will have to address the finalisation and approval of rationalised
       organisational structures as a matter of the utmost urgency.

2.     The department should be enabled through proper delegations to fill key vacant
       posts, especially those appearing unchanged on both the amalgamated and
       proposed rationalised structures.

3.     The ability of the Tender Board to deliver services efficiently and timeously will
       have to be revisited.

4.     The financial, human resource management and IT functions in the department
       need to receive serious attention in terms of capacity building of staff.

5.     The problems regarding allowances and overtime for doctors and nurses will
       have to be revisited urgently at national level.

6.     Clear guidelines should be put in place at national level to facilitate the
       placement of personnel on the second and third notches of the new salary
       scales.

7.     The equity of spending on health in the various provinces as a percentage of
       the national health budget should be revisited.

8.     Better security should be provided at clinics of the department to enable them to
       provide better quality services and stay open for longer hours.

9.     Personnel in the province should be kept abreast of changes and progress with
       the rationalisation process in the province by means of proper communication
       and training programmes.

10. Personnel in the department must be properly trained in the use of the FMS and
    PERSAL systems as a matter of urgency.

11. The department needs capacity building in IT.




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