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21 November 2008

Programme director,
MEC of Health in the Free State Mr Bellot
Dr Stella Anyangwe, WHO WR in South Africa
Councillor Mayathula-Khoza representing South African Local Government Association (SALGA)
Dr Pierre Barker of the Institute of Healthcare Improvement
Dr Neeraj Kak, Vice-President of the University Research Corporation
Dr Francis Omaswa, Executive Director of the African Centre for Global Health and Transformation
Heads of associations, bodies and institutions
Representatives of labour
Academics
Members of the media
Distinguished guests
Ladies and gentlemen

This is indeed a great day for all of us as concerned people in our country. Today witnesses the addition of yet another building block in this huge yet crucial effort of enhancing quality in the delivery of healthcare in our country.

On behalf of government and the people of South Africa I wish to thank all the stakeholders for making time to participate in this national effort. Most importantly though, I wish to thank our guests from outside our country for making time to be part of this unfolding story of enhancing the quality of life of our people. We thank you for making time to share with us and the people of South Africa your experience and knowledge as engage in this national effort.

Thank you, your love for our country is greatly appreciated. Outside of this room are our patients, their families and loved ones who are waiting with anticipation as we do this work. They are right in their expectation that what we will have here as the outcome will indeed further enhance the performance of their health system.

Quality is never an accident. It is always the result of high intention, sincere effort, intelligent direction and skilful execution, and that it represents the wise choice of many alternatives. Since 1994, our intention as government has continuously been high and our efforts to address quality, truly sincere. These efforts are reflected in a wide range of initiatives that either directly or indirectly relates to the various dimensions of quality as we view it.

Perhaps we could say that in South Africa, it all started with the development of the patients Rights Charter in 1997; justly so, because, 'the patient' has been and remains the focus of our business as health the fraternity depicted by this gathering. The charter was launched in November 1999 and a National Policy on Quality in Health Care for South Africa followed suit to provide a strategy to improve the quality of care in the public and private sectors, to encourage the many health professions to work together to improve professional standards and to foster a partnership between the public and private sectors.

Our policy seeks to create an environment in which quality care is encouraged through strengthening the hand of the user, through focusing on equity of health care and vulnerable populations, promoting private, public partnership and the accountability of both sectors for quality improvement by promoting partnership between public and private sectors, and through reducing errors and increasing safety in health care. The policy also seeks to build capacity to improve quality through fostering evidence based practice and innovation, adapting our organisations for change, engaging the health care workforce, and through investing in information systems that measure quality improvements both in the public and private sector. In short, the policy re-affirms the right of the public to expect and demand good quality services and to be helped to judge these through explicit standards of health care delivery for specific services.

Further initiatives of note worth mentioning are the comprehensive primary health care service package that was launched in September 2001 in view of addressing equity through quantifying requirements in terms of staffing, infrastructure, equipment and financial resources at primary health care level, regular patient satisfaction surveys, the development and implementation of evidence based clinical guidelines, the introduction of performance specific appraisal tools for amongst others, clinic supervisors, infection prevention and control officers and hospital appraisal teams, and the introduction of a revitalisation programme and its accompanying quality improvement component for public hospitals. And recently, a set of national "core standards for health establishments", setting out a comprehensive statement of expected organisational performance, was also developed and launched.

These core standards reflect current national policies and guidelines and are thus a reasonable statement of what is expected of management. Performance against these standards was measured by means of a customised tool through a national peer-review appraisal process in an initial group of 27 public hospitals and four Community Health Centres. The reports were shared on-site with the hospital management teams and were used to develop improvement plans as well as to benchmark good practice.

I am glad to announce that management has responded enthusiastically to this initiative, both in claiming recognition for good practices identified and in identifying weak areas that need to be corrected. Since the appraisals were conducted, there has also been good progress made in addressing the weak areas. Some of these good practices are showcased outside and I would therefore like to invite you to pay a visit through the course of today, to these provincial stands and celebrate with them their achievements. To a very large extent the National Health Act of 2003 has also become a significant statutory public health initiative in the field of quality assurance.

Reading through the Act it becomes very clear that the Act is very explicit in a number of sections on the importance of quality of care and the compliance with standards. Some of the more salient points in the Act deal with the rights and duties of users and the mechanisms for laying complaints, the Certificate of Need and the certificate's quality prerequisites for issuing a certificate, the evaluation of the services of health establishments as it may relate to human resources, health technology, equipment, hygiene, premises, the delivery of health services, business practices, safety and the manner in which users are accommodated and treated, and with the structural arrangements to monitor and enforce compliance with the quality requirements and standards contemplated in the Act.

In this regard the Act refers to the office of standards compliance, to an ombuds-function and to the inspectorates for health establishments respectively.
But, note has also been taken of the private sector and this sector's sincere efforts to improve the efficiency and effectiveness of the care that is being provided. Well-developed systems of clinical governance and supportive patient information systems are widely evident within the private hospital sector and there is a clear commitment towards ensuring that this sector's reputation for excellence remains strong. In their quest to demonstrate their level of excellence, many hospitals have also been seeking the services of reputable local and foreign accrediting bodies to mirror their performance against internationally recognised organisational and clinical standards.

However, having said this, the situation in other critical components of the private health care system, is not as clear. Providers such as general practitioners, nurses and pharmacists provide a large but not very well monitored service to a very wide patient base. In some instances professional councils and or boards have implemented the principle of continuous professional development to address the technical dimension of quality and some health professionals have grouped themselves together to form managed health care organisations in view of becoming more effective and efficient.

I think all present here today will acknowledge that my list of initiatives as Minister of Health is not an exhaustive list and that each and everyone present might well be able to add one or more quality improvement initiatives to the list. But, notwithstanding the length of our collective list of initiatives, my question to you today is, if we were to review the other side of the coin the areas where perhaps we are failing to deliver the best quality care, what would be on that list?

We would not be alone in admitting to failures. As the World Health Organisation recognises in its publication, health care and the results it achieves cannot be seen independently of the system through which it is delivered. And these systems can and do still suffer under the burden of prolonged illness, incorrect treatment, misdiagnosed patients, incorrect use of drugs, wasted materials, a suspicious community, dissatisfied patients, unnecessary and or futile services, frustrated health workers, lost productivity, and death. Are any of these problems to be found here? Should we not question how intelligent we have been in directing our efforts and how skilful we have been in executing the many plans we have made in the past to raise the standard of the care we provide, when considering the significant amount of public spending on healthcare?

Delivering poor quality of care comes at a cost no country can afford, as has been clearly shown around the world where studies have calculated these costs, including in the more developed economies. Reviews of mortality among women and children in South Africa and investigation of outbreaks of hospital acquired infections have identified common health system weaknesses as contributing to poor outcomes. Monitoring of patient complaints and media reports also reveal a level of dissatisfaction. Complaints of negligence and cases of litigation reflect these weaknesses. Complaints statistics show us that we are still struggling in some areas, especially in the area of staff attitudes and courtesy.

We know that health providers may not follow evidence based guidelines or comply fully with national and provincially set standards. Often we experience that patients do not adhere to prescribed treatment regimens. Some reviews of the public health sector have shown poor levels of functioning in basic management and support systems. Private sector providers are not immune from these concerns, and have been accused of unethical behaviour and a lack of compassion. I am sure that if we were to be truly honest, we will agree that this list is also not an exhaustive list and that each and everyone present might well be able to also add one or more examples to the list.

I believe that collectively we do have a moral responsibility to do all within our power to improve our health care system. This turnaround can only come about if we all commit ourselves towards putting quality at the centre of all we do. This will however require that we inspire and involve our staff and our people in living the culture of quality every day, that we jointly define what we want to achieve in terms of quality, that we measure our performance and that we plan and act to improve on our current performance.

Our being here today is to discuss a National Quality Improvement Programme for South Africa that should pull together these elements. In doing so, I am quite sure we will learn from one another, enrich one another and reflect on the "wise choice of the many alternatives" we may generate in meeting our goal of "ensuring the best possible outcomes for the South African health system, as reflected in improved health status, satisfied users and staff and best use of resources".

Through your presence here to day at this consultative meeting, we will be consolidating all that we have worked on together up to this point. We are asking you all to share with us your wisdom and your expertise and your experience, to assist us in this effort and to put forward a very concrete plan that will see us move forward together from here.

I would like to conclude. A traveller with camera in hand was walking past a building site in Italy where three gentlemen were busy chipping away at bulky rocks with hammer and chisel. He stopped and asked the three gentlemen separately what they were doing. The first man mumbled, "Can't you see, I am chipping these heavy rocks". The second man heaved a sign and said, "I am earning a living". The third man smiled and answered, "I am building a cathedral!"
To effect a shift to the 'new', our health care system needs people that are willing to build a cathedral … with a smile on their face! I am sure this venue is filled with such people.

Honourable programme director, honourable guests, ladies and gentlemen, I hope that this Colloquium on a National Quality Improvement Programme for South Africa, will inspire you to make the important interventions that we just have to make together to ensure that we have a vibrant, effective and efficient health care system that will help make South Africa a better place for All.
May you find motivation and strength to continue doing the good work you are already doing. Be reminded that quality is a never ending journey, a continuous struggle that leaves no room for complacency.

Let us live our national vision of creating an accessible, caring and high quality health system in line with our value system of Ubuntu.

Thank you very much.

Issued by: Department of Health
21 November 2008
Source: Department of Health (http://www.doh.gov.za/)