Speaking at the national department of health's quality seminar held in Boksburg earlier in November, director general Precious Matsoso reinforced the commitment of government to forge ahead with the implementation of the national health insurance (NHI) scheme.
However, she stressed that for this to happen, a certain level of health standards needs to be adhered to by the country's hospitals and clinics.
"Quality has to be the precondition for healthcare. By focusing on the future legislated functions of the office of health standards compliance, our healthcare facilities need to be accredited to ensure that quality remains the prerequisite to be part of the NHI," she said.
Part of this renewed focus on quality follows assessments done by the department at some of its health facilities across the country. Matsoso said that to some extent the horror stories people have been reading about in the media regarding the standards of healthcare in South Africa are true.
"We asked our inspectors to do mock inspections at a variety of faci-lities as if the new quality laws were in place already. In general, quality managers met these inspections with enthusiasm but there was still a degree of apathy from some hospital managers."
To a certain degree, she attributed this to a lack of resources and support but said that there have been quite a few instances of outright non-compliance and neglect.
"There are pockets of excellence regarding the quality of healthcare, but there is also a lack of compliance, disregard for procedures and elements of corruption at certain facilities."
Getting the house in order
This has seen the department call for the two-day health quality seminar to articulate what the new laws mean and to show healthcare providers and managers that quality is something that is the responsibility of every individual at a health facility.
"Everybody needs to take an interest in quality. It is ridiculous to have to remind people that hospitals need to be kept clean.
"We have to bring back the culture of cleanliness and inculcate it in the behaviour of people. Quality is not about technical jargon but also about behaviour."
Matsoso said that improvements in the supply, capacity and management of the human resources of the department have been the focus of a number of initiatives. There has also been a focus on making improvements in the supply and management of its infrastructure and health technology.
"We have spent the last 18 years dealing with a legacy of poor and inequitable access to healthcare. The question we need to answer now is: access to what? Is it access to effective, timely, safe and acceptable care?"
Quality healthcare has technical and administrative components. She said proper procedures that are informed by science and facts need to be in place. There also needs to be a much stronger focus on partnerships between the public and private sectors and with users of health services.
"Quality can best be achieved through a planned set of actions designed to provide users with the product they expect to receive. The goal of the establishment of the independent office of health standards compliance is to ensure that patient care meets acceptable standards."
Developing practical skills
Matsoso said that while a lack of consequences has seen some managers be non-compliant over the years, there has also been a lack of the necessary skills. It does not appear to be a case of unqualified people but more of people not having the required experience.
"South Africa has become a nation of people collecting degrees. Our real challenge is finding people with practical experience to manage hospitals. We need to refocus our workforce so that more on-the-job training takes place."
To this end, the establishment of an academy of health leadership that determines how training is designed and accredited has become crucial.
Matsoso said that a hospital consists of a myriad elements and that hospital chief executives need to understand how each of these elements interlinks and works with the others for a successful operation.
"A hospital has many sections. There is hospitality that takes care of things like food, laundry and security. The administrative department oversees the management of the hospital, its finances and human resources. On the clinical side, there is the matter of patient care that needs to be addressed.
"Unfortunately, it seems that the governance aspect has not been as effective as it should be. We need to make sure our hospital boards are properly orientated for this," said Matsoso.
Making it law
She said that once the independent office of health standards compliance has been established, the legislative framework will allow for the regulation of clear national standards and norms, with measurements that are objective and uniform. This will enable benchmarking and enforcement.
"The office of standards compliance that already operates within the departments has been carrying out external inspections to check on the level of compliance and whether improvements can be seen. In some cases there have definitely been improvements, but we need to grow this even further."
The period prior to the law coming into effect provides healthcare providers with a valuable opportunity to learn and to test their compliance, she said.
Short-term targets involve the establishment of the office of standards compliance next year and the training of all 97 hospital chief execu-tives from January onwards.
"We are working with academic institutions and partners from the United States, the United Kingdom and Italy to offer our chief executives best practice skills through relevant case study material. Our intention is to get results much faster by focusing on a more practical approach."
Another obstacle that needs to be overcome is access to quality healthcare services in rural areas. A lack of infrastructure and the long distances to hospitals are two of the challenges that have to be addressed.
"When we assess the quality of healthcare services we also factor in the issues of transport. Part of the NHI plan is to use a model that attracts services closer to communities and not hundreds of kilometres away. There are two groups that are especially vulnerable — rural communities and communities in informal settlements."
For example, patients from these communities could use the last of their money to travel to a hospital, only to be told they have to come back the following day, due to a lack of resources. Those people then have to borrow money so they can travel back to the hospital the next day.
"We are prioritising these communities and bringing services closer to them. We have come up with a proposal and the minister will make the necessary announcements as soon as it has been approved."
Providing quality healthcare
"Improved quality leads to improved health outcomes, by reducing unintended harm or medical error. This happens by improving the safety and reliability of clinical care given to patients and is influenced by choosing the correct interventions or by clinical knowledge and competence," she said.
Matsoso said that the department has the leadership and the commitment from government to ensure that this happens.
How effective this will be depends on the commitment and passion of the healthcare providers across South Africa, she said.