Download
1 / 64
640 likes | 647 Vues
BRIEFING TO SELECT COMMITTEE ON APPROPRIATIONS Expenditure on National Health Insurance Grant and NHI Pilot sites 2014 /2015. 9 JUNE 2015. Outline. Focus areas for the National Health Insurance Conditional Grant (NHI-CG) in 2014/15 GP Contracting
E N D
BRIEFING TO SELECT COMMITTEE ON APPROPRIATIONS Expenditure on National Health Insurance Grant and NHI Pilot sites 2014 /2015 9 JUNE 2015
Outline • Focus areas for the National Health Insurance Conditional Grant (NHI-CG) in 2014/15 • GP Contracting • Expenditure on Schedule 5 and Schedule 6 CG 2014/15 FY • Expenditure and activities (Donor funding and Global Fund) • 2014 / 2015 NHI Rapid Appraisal
GP Contracting • The following two slides show the number of GPs by NHI Pilot District as well as NHI pilot district doctor coverage. • Three options were being tested: • Direct contracting through NDOH • Service Provider • Western Cape option
Total Number of Contracted GPs (working as at 31 March 2015)
The introduction of an independent service provider to recruit and place GPs in facilities has increased the number of GPs contracted. The contract only came into effect in November 2014, Prior to the introduction of the independent service provider, just over 150 doctors were recruited during the 21 months of the project. Since November 2014, a further 150 doctors have been recruited increasing the number of doctors to 256. The service provider has a further 300 doctors in the recruitment pipeline however this is contingent on funding During 2015/16 the intention is to supply a minimum of 180,000 hours to clinics in 9 pilot districts. GP/Doctor Contracting
Placement limited to 156 FTE (Due to the budget cut for FY 15/16 only 156 Full Time Equivalent (FTE) doctors could be contracted) • Original target was to recruit 450 FTE’s • i.e. 50 doctors/district for the 9 participating NHI districts. • (Eden district elected not to participate)
Western Cape approach • The Western Cape DOH is excluded as they are implementing a different framework. • The WCDOH is using a principle of deploying existing medical officers employed by the WCDOH to clinics in the Eden district, and using the grant funding, they are employing doctors on sessional basis in hospitals to cover the gap left by the medical officers deployed to clinics. • According to the WCDOH, this has proved to be highly effective strategy as attracting private GPs to hospitals is easier than to clinics. • The team is assessing the impact of this model against the NDOH and the service provider model.
NHI-CG Schedule 6 Focus AreaGP Contracting • GPs were slow in signing up for the GP contracting initiative because of concerns that the state of our health facilities will hamper their quality of work • Their concerns about the state of our PHC facilities are being addressed through the Ideal Clinic programme and while the working environment in many of our clinics is still being attended to, the GPs who have signed on have reported that they have been pleasantly surprised by the good working conditions in some of clinics. As result many have since increased the working hours they spend working in public health facilities • Contracting numbers improved with the appointment of an external service provider
NHI-CG Schedule 6 Focus AreaGP Contracting • This feedback is gathered through interactions with the GPs during orientation sessions and during support visits to the health facilities where they are providing services • This positive trend has also been demonstrated by the constantly increasing number of GPs who have signed on • At the end of March 2014 we had 119 GPs working to complement permanent staff in public health facilities. This number increased to 256 at the end of March 2015 • The number of GPs on contract now will expend 100% of the budget for 2015/16
Project Deliverables in NHI Pilot Districts using donor funds during 2014-15
NHI Green Paper Phase 1: Focus Areas • NHI White Paper and Legislative Process • Management reforms and designation of Hospitals • Establishment Office of Health Standard Compliance • Public Health facility audit, Quality Improvement and Certification • Building capacity to manage NHI Through the strengthening of District Management • Costing Model • Establishment of NHI Fund • Accreditation and contracting of private providers by NHI Fund
NHI Green Paper Phase 1: Focus Areas • Hospital Reimbursement reform • Appointment of District Clinical Specialists Support • Municipal Ward-based Primary Health Care Outreach Teams • School -Based PHC services • Public Hospital Infrastructure and Equipment • Human resources for health • Information management and systems support • NHI Conditional Grant to support piloting of initial work in 10 Districts • Population Registration • ICT • Accreditation and contracting of private providers by NHI Fund
Hospital Reimbursement reform • Fist phase for developing and testing of a Diagnosis Related Grouper (DRG) as an alternative reimbursement tool for hospitalswas completed • This involved developing a base DRG tool for the 10 central hospitals across the country. • As at March 2015, the Department had managed to extract clinical and financial data from central hospitals. • The data has been categorised into 25 Major Diseases as part of the preliminary technical work to develop and apply a disease algorithm. • Technical work on case mix and actuarial analyses has been undertaken on the data that has been aggregated and a triangulation process has been undertaken with regards to data from other third party sources.
Hospital Reimbursement reform • A group of 10 professional nurses with extensive clinical (diagnostic and procedural) coding experience were employed to collect the data. • The coding team was deployed to 8 of the 10 central hospitals in South Africa. • The team was supported onsite by a team supervisor, project management assistant and project management team. • The clinical data collection tool was developed, tested and approved for use. • From 17 June 2014 until 6 March 2015, a total of more than 24 000 files were coded (final total in verification process). This exceeded the target of 22 500 files expected. • All data is maintained in the secured database
National DCST Recruitment Status Source: National DCST Database: 31 March 2015
WBOT being trained on the mHealth: • Those teams reporting to DHIS have received basic orientation to use of cell phones • Scheduled training on the full mHealth manual
School Health Services • To improve access to school health services additional School Health Mobile Vehicles were purchased and distributed in the NHI Pilot Districts • 27 Mobile PHC Trucks • 17 Oral Health Mobiles • 3 Eye Care Mobiles
Information management and systems support Patient Administration Rationalisation of RegistersAssesment of PHC Patient Information systems
Background • The Health Systems Trust (HST) has been commissioned to coordinate and manage the national roll-out of the rationalised set of registers in all PHC facilities and provide technical support to provinces during this process. • Reducing the 56 Registers used in PHC facilities to 6 Registers • The set of rationalised registers that was implemented is as follows: • PHC comprehensive daily tick register + reception daily headcount register • TIER.net: ART for all HIV positive patients (including TB, Pregnant women, HIV+e babies) • TB registers (case identification and treatment registers) • Theatre register ( for facilities performing MMC and TOPs) • Delivery register • Midnight census for PHC facilities providing inpatient services
Findings: positive perceptions • Waiting time reduced. • Reporting on fewer elements and workload is less • Uniformity of data collection tools leading to less administration and more better recording • More time spent with patients • Removal of duplications • Easy to collet correct data elements as layout on one page • Better reporting
Primary Health Care Patient Information System • In preparation of the development of an automated patient based information system the HNSF work was extended to include the assessment of patient-centric primary healthcare (PHC) systems currently in use in the country, inlcuding systems used in the private sector and aimed at primary healthcare. Open Expression of Interest yielded 37 responses; • 23 systems were shortlisted based on eligibility criteria; • 1 Vendor retracted their submission; • Rigorous evaluation process including: • Definition of PHC system requirements; • Collection of detailed information from system vendors; • Representations from each system vendor; • Site visits where each of the systems were deployed;
Primary Health Care Patient Information System • This assessment culminated in recommendations on the most appropriate PHC Patient based information system to be deployed in PHC facilities • The outcome of this assessment is Automated PHC Patient Information systems - implemented in the NHI pilot districts ( 700 facilities) and be linked to the second phase of the scale up (1400 facilities)
Health Patient Registration System (HPRS) • Secure central database on a web based platform available to public health facilities to capture and verify beneficiary identification via bar coded identity documents and biometric methods. It also records patient visits to facilities. • Patient registry – a critical component to implement electronic health records nationally. • Planning tool because beneficiaries are linked to facilities based on the their demographic details. • Currently implemented at PHC facilities in NHI Pilot Districts. • Auto-generates a unique Health Patient Registration Number (HPRN) and assigns to registered and successfully verified beneficiary. • HPRN is an internal system number that could be able to uniquely identify health beneficiaries for all other patients (including Foreign nationals). • South African National ID Number remains the primary identification for South African citizens.
KZN Beta Implementation September 2014 Focus on Patient Registration Reception Desk Support Integrated Team Approach HPRS Certification of Competency Daily Data Capture Onsite Training RIPDA
