Operation Phakisa and the ideal clinic realisation and maintenance lab
The Operation Phakisa Ideal Clinic Realisation and Maintenance (Ideal Clinics) Lab convened from 12 October to 21 November 2014 and brought together practitioners and experts from multiple National Departments, provinces and metros across South Africa’s public health system. Key players from outside government were also involved – including participants from Statutory Councils, trade unions, Schools of Public Health, non-governmental organisations (NGOs), development partners and the private sector.
With 164 participants, and facilitated by external consultants, the Lab’s purpose was to develop an implementation plan to transform all of PHC facilities across the country to Ideal Clinic status (from a base of 0 in 2014). The Ideal Clinics Lab was divided into eight work streams, as follows:
Service Delivery focused on solutions to ensure all PHC facilities deliver optimal quality health care, including a comprehensive and standardised package of services, 100% availability of medicines and supplies and a clean and safe environment.
Waiting Times focused on solutions to reduce patients’ waiting times at clinics and to set and communicate clear expectations of the waiting time to improve patients’ experience of care. The targets that were defined included a three hours-maximum total waiting time for patients in all clinics as well as80% of patients reporting a positive experience of care.
Infrastructure focused on developing an effective infrastructure roll-out plan to ensure all PHC facilities have world-class infrastructure that is delivered on time and well maintained for the future.
Human Resources for Health focused on creating an equitable distribution of well-trained workers with the required capabilities (leveraging the private sector as well) to ensure the professional, efficient, effective, cost-effective and sustainable delivery of health care.
Financial Management focused on developing a realistic budgeting process that accurately forecasts the funding requirements orphic facilities, allocates resources equitably and improves financial accountability.
Supply Chain Management focused on steps to ensure the continuous availability of medicines and supplies, to reduce the costs of procurement and distribution of commodities and to improve turnaround times for the delivery of non-standard stock items.
Institutional Arrangements focused on developing effective institutional arrangements and inter-governmental agreements to support the realisation and maintenance of Ideal Clinics in South Africa.
Scale-up and Sustainability focused on developing a national scale-up framework and an implementation plan to enable all 3,507 PHC facilities in South Africa to achieve Ideal Clinic status.
Across these eight work streams, the Ideal Clinics Lab developed and prioritised 46 of these. Detailed implementation plans at the “3 feet” level of detail were developed for each of the 46 initiatives, which map out the activities to be carried out by responsible parties at national, provincial, district and facility level. The sequencing of the implementation of these initiatives at district and clinic level will be informed by their cost, which is still being estimated by the NDoH. Subsequently, National and Provincial Departments of Health have prepared implementation plans for the scale-up of the Ideal Clinic to all 3,507 facilities nationwide, as part of a coordinated transformation programme.
Together, the 46 initiatives developed and prioritised in the Ideal Clinics Lab advance four strategic themes for achieving Ideal Clinics across PHC. These themes are:
- Patient-centric approach – focusing on patient health, patient experience and ensuring that patients are treated with dignity. Key initiatives to drive this theme include adjusted clinic opening hours; developing new ways of accessing PHC; strengthening community service; evaluating, improving and communicating patient experience; and reinforcing
Back to basics in the clinics – ensuring all clinics have acceptable infrastructure and are equipped for service and maintained over time. Key initiatives to drive this theme include refurbishing and rebuilding infrastructure; and standardised maintenance practices, including maintenance services “on call”.
Career of choice – ensuring the best and brightest come and work in the PHC facilities. Key initiatives to drive this theme include creating more attractive conditions for staff; developing clearer lines of accountability for clinic managers; and strengthening clinics’ operational efficiency, so ensuring that staff spends more time with patients.
Effective processes – ensuring all processes are streamlined and focused on improving the outcomes of the system and the experience of patients and staff. Key initiatives to drive this theme include improving procurement processes; strengthening management capabilities; and putting in place better information systems.
Ideal Clinics Events
The Ideal Clinics Lab was launched on 18 November 2014 in Pretoria. The lab started on 12 October 2014 and concluded on 21 November 2014. Over 164 delegates from national and provincial government departments, the private sector, civil society, labour and academia participated in the Ideal Clinics Lab.
The Health Lab started on 13 October 2014.
It is undertaken in collaboration with provinces, districts and clinic managers with the aim of producing a detailed plan for improving service delivery in public sector clinics in all provinces, including indicators, targets and timeframes; and a guideline for clinic managers to develop and sustain these improvements.