10 June 2018

Following the release of the OHSC 2016/17 annual inspection report on 5 June 2018, and the subsequent enquiries following the release of the report, the OHSC promised to engage further with the media.

This press briefing is aimed at clarifying certain sections of the report, mainly the interpretation of the scoring.

The Office has regulatory powers by law and assess facilities with established norms and standards, issue guidance to the norms and standards, certify facilities as compliant or non-compliant with norms and standards, monitor compliance and further receive and investigate complaints, the function of the Health Ombud. This is achieved through conducting unannounced inspections in facilities; health facilities are not pre-warned of the Office’s inspections.

It is important to mention that inspections are a snapshot in time, therefore findings will be for that particular moment an inspection is undertaken in a facility; however, what is required for patient safety and uninterrupted service delivery is consistent compliance with standards. In order for the OHSC’s inspection programme to achieve the best chance of this happening, the emphasis is on fostering the implementation of systems and processes within health establishments that will consistently deliver the desired outcomes. Therefore, the focus of the Office is not only to assess the outcome available at the time of an inspection, however, to encourage facilities to establish systems and processes to improve quality and safety.

The Methodology utilized by the OHSC Inspectors included, document review and analysis, observations, patient interviews, staff interviews and patient record assessment.

The Sampling of facilities for the 2016/17 inspections was opportunistic, the majority of facilities were the worst performing. There was also consideration of available resources such as the number of inspectors and the budget for the financial year.

Therefore, these findings should not be extrapolated as being representative of the overall performance of a province but should be used as a means of providing a glimpse or indication of performance in provinces.

Inspection tools developed from the National Core Standards (NCS) were used to assess health facilities. The NCS provide a common definition for quality and are based on the concept of Domains. A Domain is an aspect of service delivery where quality or safety can be at risk. A Standard is what is expected to be delivered in terms of quality care. These Standards are set high to promote patient safety and quality care. The inspections are designed to guide health establishments towards compliance with the norms and standards, in other words to highlight the steps and a process to be followed in order to achieve compliance.

The scoring framework considers scores in various functional areas in a health establishment and aggregated to determine a facility score. Facilities are then certified to be compliant or non-compliant with norms and standards using scores. There are six categories of the scoring framework; the first score is the highest =/>80% for a compliant health establishment. Scores between 70-79%, (compliant with a requirement); scores between 60-69% (conditionally compliant); scores between 50-59% (conditionally compliant with serious concerns); scores between 40-49% (non-compliant) and scores <40% (critically non-complaint).

Breakdown of scores of the 696 inspected in facilities in financial year 2016/17:

Total number of health establishments inspected = 696

• 80%: 5Health Establishments (2 clinics and 3 hospitals)
• 70-79%: 32Health Establishments (24 Clinics and 8 Hospitals)
• 60-69%: 79(64 Clinics, 2 CHCs and 13 Hospitals)
• 50-59%: 168(146 Clinics, 12 CHCs and 10 Hospitals)
• 40-49%: 240(219 Clinics, 12 CHCs and 9 Hospitals)
• <40%: 172(165 Clinics, 4 CHCs and 3 Hospitals)

Out of the 284 health establishments, five (5) heath establishments were found to be compliant, 279 health establishments were found to be complaint with various requirements and conditions. In FY 2016/17, the OHSC conducted inspections in 696 public health facilities.

In 2014/15 inspections, the baseline was high for most provinces. In the subsequent 2015/16 inspections, provinces showed a decline in performance and in 2016/17 slight improvements were noted.

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