Category: Featured

The Office of Health Standards Compliance (OHSC) Board and management are deeply concerned about the impact of the ongoing labour unrests in several healthcare facilities in the country which are disrupting health services with reports of violence and intimidation to patients and healthcare workers. These acts of violence affect patient care, safety and destroy much needed infrastructure and equipment in healthcare facilities. In some instances, access to healthcare facilities has been restricted as a result of strike actions, affecting the work and safety of healthcare workers on duty and patient care and well-being.

The OHSC as the regulator of health services has a responsibility to protect and promote the health and safety of users of health services in the public and private health sectors. An integral part of improving quality and safety is consistent, sustained health services rendered across all healthcare facilities. The OHSC calls on all parties to cease and desist from all activities that compromise patient care and safety of patients and healthcare workers. Such disruptions pose a risk in the provision of quality health services and impede service delivery. 

The OHSC believes that health professionals have ethical standards to adhere to and a responsibility and obligation to serve diligently. The OHSC urges all sectors to honour the commitment to patient care irrespective of the challenges that might have been experienced.

Notwithstanding the labour unrest in progress, all public or private health establishments are required to adhere to policy priorities of providing safety, security as well as acceptable standards of care.

Even though it is a protected labour strike, and the right of healthcare workers to strike is respected, this right must not trample upon the rights of the users of healthcare services.  

Issued by the Office of Health Standards Compliance

For more information contact: Ricardo Mahlakanya: 066 473 8666, or rmahlakanya@ohsc.org.za

The Office of the Health Ombud (OHO) releases a report detailing the findings and recommendations of an investigation into allegations against Rahima Moosa Mother and Child Hospital (RMMCH) in Gauteng Province. The report of the Ombud is issued in terms of Section 81A (11) of the National Health Amendment Act (NHAA), 12 of 2013, which gives the Ombud the powers to consider, investigate and dispose of the complaint relating to breaches of the norms and standards in a fair, economical, and expeditious manner.

The investigation was undertaken following a complaint lodged by Hon. Haseenabanu Ismail (Hon. H Ismail), a Member of Parliament’s Health Portfolio Committee on 06 April 2022, into allegations of the circumstances relating to the care of expectant mothers at RMMCH. The complaint was risk-rated high.

The complaint was prompted by two main factors, including the media uproar sparked by video footage published by News24 https://www.news24.com/news24/SouthAfrica/News/watchpregnant–women– sleeping–on–thefloor–at–joburg–hospital–20220402?s=08; and an email from Ms Salma Bhikhoo (Ms S Bhikhoo) relating to the unpleasant conditions found at RMMCH when she took a family member, Ms Nazeerah Ismail (Ms N Ismail), to the hospital for delivery.

In the main, Hon. H Ismail (the Complainant) alleged that:

• Expectant mothers at RMMCH were sleeping on the hospital floor.
• The Hospital’s Chief Executive Officer (CEO), Dr Nozuko Precious Mkabayi (Dr NP Mkabayi), was not working full-time to ensure everything ran smoothly at the hospital. Since the CEO was appointed on 01 January 2021, she had only spent 182 days at the hospital.
• Patients’ health and dignity, and the well-being of healthcare workers was severely affected.
• RMMCH has seen an increase in patient load, with no concurrent increase in infrastructural development. The hospital has two maternity obstetrics units in its drainage area that refer patients to it.
• The hospital is classified as a specialised hospital, and patients are referred from hospitals in the West Rand, as well as the Community Health Centre (CHC) and clinics in regions B and C of the Johannesburg Metropolitan Council.

The Ombud’s investigations established the following:

a) Whether expectant mothers at RMMCH slept on the hospital floor.

i. The allegation that expectant mothers at RMMCH slept on the hospital floor was substantiated and confirmed.

ii. Based on the evidence gathered, pregnant women sitting on chairs and sleeping on the floor were not attended to in a manner that was consistent with the ‘nature and severity of their health condition’.

iii. Expectant mothers sitting on the chairs and sleeping on the floor at RMMCH was purportedly due to shortage of space and overcrowding.

b) Whether Dr. NP Mkabayi was working full-time at the hospital to ensure that everything was running smoothly and whether she spent 182 days at the hospital since her appointment on 01 January 2021.

i. The allegation that the CEO of RMMCH was not full-time at the hospital to ensure that everything ran smoothly was substantiated and confirmed.

ii. The investigation considered the question tabled by Mr. Jack Bloom, Democratic Alliance (DA) member, to the Gauteng Provincial legislature on 08 March 2022 and Dr. NE Mokgethi’s response to the legislature on 24 March 2022 that Dr. NP Mkabayi had physically spent 182 days at the hospital since her appointment on 01 January 2021. Based on the answers provided, the investigation found that 27 days were unaccounted for, and there were substantive irregularities regarding Dr. NP Mkabayi’s leave.
iii. An additional question enquiring about “the latest information about how many days the CEO has been at work since she was appointed” was raised by Mr. Jack Bloom on 26 July 2022. In the response provided by Dr. NE Mokgethi to the Gauteng Provincial Legislature dated 08 August 2022, she indicated that Dr. NP Mkabayi had spent 346 days at RMMCH since she was appointed.’ However, the investigation found that 71 days were unaccounted for.

iv. The investigation further found that the GDoH failed to promote and implement relevant HR policies (e.g. the “work from home” policy based on Circular No. 1 of 2021) in a standardized and transparent manner. This led to so-called “trust agreements”, between supervisors and supervisees where each party “trusted” that the other party was fulfilling their professional responsibilities. It has been demonstrated that this manner of working is not only fraught with pitfalls (once the trust relationship has broken down), but it is also open to abuse, as there is no accountability.

c) Whether the health and dignity of patients, and the well-being of healthcare workers is severely compromised.

i. The allegation that the health and dignity of patients and the well-being of healthcare workers is severely compromised was substantiated and confirmed.

ii. The investigation revealed crumbling infrastructure throughout the hospital, free- flowing sewage between buildings, a pervasive foul-smelling environment, filthy ablution facilities, and leaking steam pipes leading to poor heating in the wards, which does not provide a conducive, healthy, and safe environment for the provision of quality care for patients by healthcare workers.

iii. Due to overcrowding in the antenatal ward, clinical decisions were made based on what was written on the patient file without assessing the patient thoroughly. Most elective patient operations were postponed due to the need to accommodate emergency caesarean sections, leading to a backlog of cases and long waiting times (up to two weeks), which affected patients negatively, as some ended up with complications.

iv. The challenges of overcrowding, staff shortages, and a dire lack of specialised nursing staff compromised the health and well-being of healthcare workers. Significantly, these challenges affect patient safety, by placing patients’ lives at risk.

d) Additional findings include issues pertaining to:

i. Human Resources
ii. Infrastructure
iii. Blood Bank (SANBS) and Laboratory (NHLS) Services
iv. Radiology services (CT scan)
v. Hospital Board
vi. Security challenges
vii. Shortage of Nursing Staff
viii. Flouting of Supply Chain Management (SCM) Processes
ix. Infection Prevention and Control
x. Lack of an Intensive Care Unit (ICU) for adults at RMMCH

Breaches of norms and standards

No         Investigation Findings		Related Norms and Standards
1.	The dignity and well-being of pregnant women was compromised as they were expected to sit on plastic chairs in the prenatal ward (ward 15) while awaiting delivery, and sleep on the hospital floor due to overcrowding.	Regulation 5 (1) states that “the health establishment must ensure that users are attended to in a manner which is consistent with the nature and severity of their health condition.” Regulation 8 (1) provides that “the health establishment must maintain an environment which minimises the risk of disease outbreaks, the transmission of infection to users, health care personnel and visitors.”
2.	RMMCH Human Resource Department (HRD) failed to ensure proper controls to monitor leave processes at the hospital. RMMCH HRD failed to put measures in place to control and monitor HR files of health personnel	Regulation 19 (1) provides that “the health establishment must ensure that they have systems in place to manage health care personnel in line with relevant legislation, policies and guidelines.”
3.	The dignity of patients and the wellbeing of healthcare workers are severely compromised.	Regulation 5 (1) states that “the health establishment must ensure that users are attended to in a manner which is consistent with the nature and severity of their health condition.” Regulation 19 (1) states that “the health establishment must ensure that they have systems in place to manage health care personnel in line with relevant legislation, policies, and guidelines.”
4.	RMMCH was built in 1943 and has never received any substantial upgrades. The aging infrastructure and sewage reticulation system are failing, leading to pipe spillages and toilet blockages	Regulation 15(1) provides that: “the health establishment must ensure that engineering services are in place”.  Sub-regulation (2) provides that, for the purposes of sub-regulation (1), “the health establishment must have 24 hour electrical power, lighting, medical gas, water supply and sewerage disposal system”.
5.	RMMCH security is inadequate. There are no access control measures to monitor hospital entry and exit.	Regulation 17(1) states that: “the health establishment must have a system to protect users, health care personnel and property from security threats and risks.”
	A case of hijacking within RMMCH premises was reported; most interviewees stated that they felt unsafe within the hospital premises.	Sub-regulation (2) states that “the health establishment must ensure that security staff is capacitated to deal with security incidents, threats, and risks.”
6.	Severe chronic shortage of nursing staff for over five years. RMMCH is dependent on Nursing Agencies to provide staff and skilled professional nurses. Procurement of these services is through the goods and services budget, leading to over-spending.	Regulation 19 (1) provides that “the health establishment must ensure that they have systems in place to manage health care personnel in line with relevant legislation, policies and guidelines.” Sub-regulation (2) (a) states that: “for the purpose of sub-regulation (1) the health establishment must, as appropriate to the type and size of the health establishment, have and implement a human resource plan that meets the needs of the health establishment.”
7.	Sporadic incidents of nosocomial infections in the neonatal unit. Use of diluted disinfectant (Povidone- Iodine) solution for skin cleansing preoperatively led to eleven postoperative ‘relook’ surgeries between August – September 2022	Regulation 8 (1) provides that “the health establishment must maintain an environment which minimizes the risk of disease outbreaks, the transmission of infection to users, health care personnel and visitors.”
8.	Non-functional RMMCH Hospital Board	Regulation 18 deals with Governance and it provides that: “the health establishment must have a functional governance structure with written Terms of Reference”

Recommendations

Given the complexity of the findings uncovered by the investigation and following comments to the Provisional Report, recommendations are made to the Gauteng Provincial Department of Health and the acting RMMCH CEO.
These include:

1. Appointment of a suitable and permanent RMMCH CEO who is ‘fit for purpose’
2. Transfer of Dr. NP Mkabayi to GDOH Provincial office
3. Prioritization of RMMCH for Infrastructure Refurbishment

a) Implement Recommendations made in the 2017 report “An Unsafe Hospital” by Prof. A Coovadia and Prof. H Lombaard.
b) Availability of 24-hour Laboratory and Blood Bank Services
c) Establishment of an adult ICU at RMMCH
d) Construction of additional maternity capacity
e) Security System upgrades

4. Address Leadership and Governance issues

a) Strengthen Gauteng HoD oversight of hospitals
b) Monitoring of RMMCH Hospital Board

5. Strengthen Human Resources

a) Review Provincial HR processes for the appointment of Hospital CEOs
b) Development of RMMCH HR capacity
c) Review RMMCH staff establishment

6. Gazetting of RMMCH as a Tertiary Hospital
7. Disciplinary Inquiry

The report is available on the ombud website: www.healthombud.org.za.

Issued by Professor Malegapuru W Makgoba14 March 2023
Enquiries: Mr Ricardo Mahlakanya – 066 473 8666

The handover ceremony is part of the OHSC in ensuring consistent, safe, and quality improvement across the public and private health sectors.

The OHSC delegation was led by the Board Chairperson, Dr Ernest Kenoshi and Chief Executive Officer, Dr Siphiwe Mndaweni and supported by the executives and senior managers.

The Office of Health Standards Compliance (OHSC) Board supported by the executives and senior managers will be embarking on national roadshows starting from September to November 2022 in public and private health sectors.

The purpose of the roadshows is to interact with the public and private health sector stakeholders of cross-cutting findings about the implementation of the norms and standards. These interactions are aimed to further bolster the important role the OHSC have in the implementation of the National Health Insurance (NHI), including the overall quality and safety improvements in public and private sector health establishments.

For more information contact: Ricardo Mahlakanya: at 066 473 8666, and rmahlakanya@ohsc.org.za    

18 February 2022

The Office of the Health Standards Compliance (OHSC) an entity established to ensure both the public and private health establishments comply with the required health standards engages various communities around Pixley Ka Seme Local Municipality in Mpumalanga. The campaign aims to educate and empower community about these services:

• The standards of care expected of various health establishments.
• The role of the OHSC in enforcing compliance with these standards.
• How individuals can leverage the OHSC – through lodging complaints or advocacy to address lapses in quality of care.

The areas to be visited around Pixley Ka Seme Local Municipality are listed in a table below:

Venue	Date	Time
Perdekop Community Hall Ward 6	21/02/2022	10h00 -12h00
Amersfoort Community Hall Ward 8	21/02/2022	14h00 – 16h00
Daggakraal Community Hall Ward 9	22/02/2022	10h00 – 12h00
Wakkerstroom Community Hall Ward 5	22/02/2022	14h00 – 16h00
Amersfoort Community Hall Ward 7	23/02/2022	10h00 – 12h00
Volksrust Town Hall Ward 4	23/02/2022	14h00 – 16h00
Daggakraal Community Hall Ward 10	24/02/2022	10h00 – 12h00
Kwa- Moloi Community Hall Ward 2 & 3	24/02/2022	14h00 – 16h00
Daggakraal Community Hall Ward 11	25/02/2022	10h00 – 12h00
Vukuzakhe Multi-Purpose Hall Ward 1	25/02/2022	14h00 – 16h00

Issued by the Office of Health Standards Compliance
For more information contact: Ricardo Mahlakanya: Mobile. 066 473 8666, and Email. rmahlakanya@ohsc.org.za.

 

5 November 2021

The Office of Health Standards Compliance (OHSC) was created by Parliament to protect and promote the health and safety of users of health establishments across the country.

Among the core functions of the OHSC is the conduct of routine inspections of health establishments to measure them against norms and standards determined by the Minister of Health. The assessment process results in the certification of those health establishments that meet the required norms and standards, or the issuing of compliance notice to health establishments that fail to meet the norms and standards.

Once the Minister of Health has promulgated norms and standards for various categories of health establishments, the OHSC develops inspection tools that are used to ascertain whether norms and standards have been met.

Scope of norms and standards

The regulated norms and standards for health establishments apply equally to public and private hospitals, public sector clinics and community health centres, private health clinics and General Practitioners (GPs) practices. Since the scale and range of services offered differ among these different healthcare sectors, different inspection tools are developed and used to measure compliance. The main categories of standards are:

User rights – User information; access to care; and waiting times

Clinical governance and clinical care – User health records and management; clinical management; infection prevention and control; waste management; and responses to adverse events

Clinical support services – Medicines and medical supplies; diagnostic services; blood services; medical equipment

Facilities and infrastructure – Management of buildings and grounds; engineering services; transport management; security services

Governance and human resources – Governance; human resources management; occupational health and safety

Routine inspections for different categories of health establishments can only commence once norms and standards for that category have been prescribed and related inspection tools have been finalised in consultation with stakeholders. This is a phased process:

• By 2019, the OHSC had finalised regulatory processes and began to inspect public sector clinics and community health centres.
• From 2022, public and private hospitals will form part of the OHSC’s compliance inspection schedule.
• The development of Inspection tools for district and regional hospitals in the public sector have been completed.
• Inspection tools for private hospitals are at an advanced stage of development and approval.
• The OHSC has been engaging stakeholders on the development of inspection tools for general medical practitioners (GPs).
• Emergency medical services tools have been developed and will be the next major category to receive attention.

Although the OHSC conducts hundreds of routine inspections, unannounced and risk-based inspections each year, it will have to significantly increase its capacity to inspect and consider certification of health establishments in all categories.

The OHSC publishes an annual inspection plan on its website in April of every year, and any establishment that is selected for inspection is notified in advance.

Quality – our starting point and destination

As a regulatory body, the OHSC stands on solid ground in terms of enforcing standards for the improvement of quality of healthcare. We believe that healthcare professionals also want the best for our healthcare users.

The OHSC is concerned with achieving minimum standards in relation to the systems and procedures of health establishments. Upholding these standards benefits both users and healthcare providers by creating an environment in which risks are minimised and positive results enhanced. The promulgated norms and standards are essential to effective and quality healthcare and should be achievable by all.

In a country such as ours, with significant historical inequalities in the provision of health services, it is critical that we approach the challenge of quality by addressing inequities through raising the overall quality of healthcare services. This approach is also essential to the introduction of National Health Insurance (NHI), that will finance essential health services from a single national health insurance fund.

It is widely acknowledged that a lot of work still needs to be done to improve the quality public health services. Furthermore, the Competition Commission’s Health Market Enquiry underscored the existence of substantial quality issues even in the better-resources private health sector.

The draft National Health Insurance (NHI) Bill provides that certification by the OHSC will be a precondition for health service providers seeking to obtain accreditation and ultimately be able to contract with the National Health Insurance Fund. Perhaps stakeholders are anxious about fulfilling this requirement timeously in light of the current pace of inspections. We are very conscious of this issue and seeking both to increase the resourcing of the OHSC and improve efficiencies.

Telephone: 012 942 7700 • Physical Address: Office of Health Standards Compliance, 79 Steve Biko Road, Prinshof, Pretoria • Postal Address: OHSC Private Bag X21 Arcadia, 0007 • Email: admin@ohsc.org.za • Website: www.ohsc.org.za

22 September 2021

The OHSC embarks on a series of community outreach campaigns at Joe Morolong Local Municipality, Northern Cape. The purpose of the campaigns is to inform members of the community about the functions of the OHSC and Ombud.

The campaign to be held in these areas listed in a table below Joe Morolong Local Municipality:

Community	Date	Time
Heunningvlei Community	27 September 2021	14:00 – 16:00
Bothitong Community	28 September 2021	10:00 – 12:00
Gamorona Community	28 September 2021	14:00 – 16:00
Madibeng Community	29 September 2021	10:00 – 12:00
Cassel Community	29 September 2021	14:00 – 16:00
Bendel Community	30 September 2021	10:00 – 12:00
Dithakong Community	30 September 2021	14:00 – 16:00

Issued by the Office of Health Standards Compliance
For more information contact: Ricardo Mahlakanya: Mobile. 066 473 8666, and Email. rmahlakanya@ohsc.org.za.

The Office of Health Standards Compliance (OHSC) is deeply concerned that essential healthcare services have been badly affected by the ongoing violence and destruction of property, particularly in the provinces of KwaZulu-Natal and Gauteng. Several medical centres, private practices and pharmacies have been looted, and the vaccination rollout programme has also been disrupted. A ripple effect of the instability has been the obstruction of access to public and private healthcare facilities for both healthcare workers and service users.

The task of the OHSC is to safeguard the safety of users of health services and healthcare workers and to ensure quality services in our healthcare facilities. When we see access to healthcare facilities blocked, medicines looted, blood service premises vandalised, and oxygen deliveries delayed, it is our duty as a regulator in the provision of health services to spell out clearly that such actions are life-threatening and potentially deadly.

The protests have also put additional strain on the health system and healthcare workers, already stretched to the limit by the surge in COVID-19 cases. In areas affected by the violence, healthcare facilities are experiencing an influx of patients seeking medical attention for trauma and injuries suffered in the prevailing environment.

The OHSC would like to appeal to communities to protect and respect the vital role of healthcare facilities and preserve precious infrastructure and prevent the unnecessary loss of life. Around the country, dedicated health professionals have been trying their utmost to improve the quality of care available to the public, including managing the COVID-19 pandemic.

The OHSC further appeals to all communities to join hands during this difficult time and work together in supporting all healthcare facilities to restore the much-needed health services in the affected areas. Government is urged to accelerate coordinated efforts to halt the destruction in large parts of the country, negatively affecting the economy and seriously affecting the health system and services.
The healthcare sector cannot afford to lose the ground we have gained over the years.

The OHSC is a statutory body charged with promoting quality healthcare by ensuring health services meet prescribed standards. It does so through the inspection of health establishments, the certification of those establishments complying with standards, and the investigation of complaints about poor-quality care.

Issued by the Office of Health Standards Compliance
For more information contact: Ricardo Mahlakanya: Mobile. 066 473 8666, and Email. rmahlakanya@ohsc.org.za.