Quicker service at Gauteng’€™s health facilities should be available from December, when the province will adopt “standards around waiting times”.

One of the biggest complaints from patients is the time they spend waiting to be admitted, treated and given their medicine.

Dr Laetitia Rispel, head of Gauteng’€™s health department, says the waiting standards will enable her officials to “measure how health facilities are doing” as part of the department’€™s pledge to improve the quality of health services.

She says a study conducted two years ago by her staff posing as patients showed that the biggest bottleneck was caused by the administration when patients arrived, rather than the time they spent waiting to be treated.

“We have to make sure that we set realistic targets,” says Rispel. “We are never going to eliminate queues, but the critical factor is reducing the time people spend in those queues.”

Provincial hospitals are also being rated according to 10 indicators, including cleanliness, absenteeism and availability of drugs on the Essential Drug List.

“By the end of the financial year, [the quality assurance team] will have visited 50% of all health facilities. Often they only give 24 hours’€™ notice that they are coming,” says Rispel.

Those hospitals that do well may get budget increases, while those that consistently fail to improve their ratings may face penalties and the managers responsible may face censure.

Staff and funds shortages have caused Gauteng hospitals to cut over 3000 beds between 1997 and 2000, with 16 715 beds available for the province’s sick in 2000, according to the SA Health Review. This translates into 3,49 beds per 1 000 citizens — the second highest ratio in the country after the Western Cape (3,54 beds per 1 000).

Rispel acknowledges that the exodus of nurses from public health is creating difficulties for service delivery.

“What we have found is that there is not a big difference in the salaries of nurses in public and private healthcare, but there is a difference in terms of working conditions,” says Rispel. An extra 250 nursing posts were funded this financial year, while the budget for training student nurses has been taken away from hospitals and put in the hands of nursing colleges to protect posts from budget cuts.

A recent summit between the department and healthworkers also identified a number things management could do to improve the working conditions of doctors and nurses.

“We are working to ensure that support services function, so that nurses and doctors do not feel overburdened by tasks,” says Rispel. “For example, management needs to ensure that equipment works and that there is adequate support staff. There needs to be proper supervision and staff who do well need to be acknowledged.”

However, Gauteng has the highest proportion of doctors (6,5 per 10 000 people) in the country. Gauteng recently handed over a number of powers to the chief executive officers of the province’€™s six major hospitals.

Rispel says this will ensure “a greater sense of ownership and greater efficiency as the lines of decision-making will be a lot shorter than before. Ultimately, this should mean improved quality for patients.”

However, Rispel acknowledges that “you can’€™t look at greater efficiency without addressing losses”. For this reason, the Costwise campaign was launched to “raise financial awareness” amongst the 43 000 health staff and to try to reduce theft.

Gauteng has also spent a lot of money installing closed circuit TVs in stores, pharmacies and kitchens to stop theft.

Gauteng and the Western Cape are the two healthiest provinces in terms of service delivery, and Rispel is clearly taking her service pledge very seriously. However, HIV/AIDS is proving to be a massive drain on healthcare, with some hospitals reporting that 80% of beds in their medical wards are taken up by HIV positive people. While the province has a sound HIV/AIDS strategy, its management of the epidemic in the next few years will prove crucial.
‘€“ Health-e News Service.