Issued by: Gauteng Provincial Government
June 26, 1997
Introduction
Since October, when the Gauteng Health Department tabled its Structural Transformation Plan, the Department has consulted with various stakeholders and done additional research and much of the groundwork for implementation.
In the first week of June the Provincial Bargaining Chamber formally recorded the consultation process between the Department and major health sector trade unions, noting substantial areas of agreement and two instances in which the parties agreed to differ.
Although the talks with the unions were not the only significant consultations, they were the most wide-ranging. Therefore, when the Chamber recognised the consultation process, the way was effectively cleared for implementation.
The revised plan incorporates a number of changes proposed by stakeholders - the health sector unions, institutions within the public health service, medical schools and local interest groups. However, not all proposals were accommodated.
The broad principles of the original plan remain clearly recognisable. One of a number of new features is the phasing of implementation. The first phase covers the closure of three hospitals and the conversion of several others into community health centres. And this forms the focus of the present media release.
Background
The purpose of structural transformation is:
The Structural Transformation Plan is not a panacea for all ills in the provincial health service. While it lays a solid foundation and makes a real contribution in all of the above areas, it does not fully answer them. Additional change strategies are necessary and some of these are being pursued simultaneously.
The closure or conversion of each of the above institutions is a process, rather than a single event. Each institution has an individual plan for incremental implementation. In addition, at every hospital (not only those closing or converting) a Structural transformation Action Team exists or is being established to advise management on the operational detail and precise time scales. Such teams are coordinated by management at the institutions and involve a range of institution and regional staff, trade unions and (in some cases) local authorities.
The closures will take place first, with some steps being implemented as soon as July 1.
At Andrew McColm, which was largely used for private patients, doctors have already stopped admitting their patients. Fewer than 20 patients are currently in the hospital and there is no out-patients department. At the start of July, existing patients will be transferred to Pretoria Academic Hospital. The staff will remain to attend to the task of closure and to settle their own work options. Virtually all of them will be seconded elsewhere by the end of July.
At Westfort, closure depends on the availability of alternative facilities for patients. The 170-odd psychiatric patients will be transferred to GaRant Hospitals. Alterations to facilities at the latter two institutions should be complete by the end of July. As wards become available, patients will be moved in an ongoing process and an appropriate number of staff will be seconded with each group. The leprosy patients constitute a mere handful and Sizwe Hospital for Infectious Diseases will accommodate them. By early August the 100-year-old hospital will be virtually empty.
At Khayalami Hospital admissions effectively stopped in January because of staff shortages. During July, the out-patients department will be wound down, with the formal referral of most patients to local authority clinics. These clinics will, at the same time, be boosted with seconded provincial staff so that they can begin to offer a full-time comprehensive service. Again, staff will have to July to settle their secondments.
The conversions will generally not proceed as quickly as closures. The timescales will vary according to individual conditions. Once again, there has to be a balance between closinty at the hospitals which are designated to take in-patients from the converting institutions. At Hillbrow Hospital the conversion will be more protracted than anywhere else.
In most cases, the real switch to primary health care at the converting institutions ought take place around October.
At Hillbrow the relocation of specialist services will proceed in phases and be negotiated with the various "patient recipient" hospital absorb Hillbrow's in-patients and some of their out-patients. Needless to say, they will have to be closely involved in jointly planning the conversion process.
Although December 1997 has been set as a provisional date for the Hillbrow Community Health Centre to start functioning, this does not mean that all hospital units will have moved by then. For instance the extremely sophisticated radiology and radiation department, widely acknowledged for its role in cancer treatment, will continue at the site for some months.
Eventually, the radiology department will move in its entirety to Johannesburg Hospital. But special accommodation will have to be prepared to house the equipment. It will not be easy for the radiology staff to continue their work once the in-patient facility, the full casualty service and other departments with which they work closely have moved out. In fact, it will be an artificial situation which is only tenable, even as an interim measure, because it is unavoidable. We are consulting with the staff to find mechanisms (such as improved patient transport between Hillbrow and Johannesburg) to make the situation workable.
What are community health centres?
Community health centres (CHCs) are distinguished from small hospitals, on the one hand, by the absence of in-patient care (except for a small number of maternity beds and short-stay beds to stabilise casualty patients). They are distinguished from clinics by a wider scope of primary health care services, some degree of specialist services and by the sophistication of the service. They act as a resource and a referral institution for the clinics.
All CHCs will offer promotive, preventive and curative services in the areas of: mother and child health (including immunisation); reproductive health; treatment and care for infectious diseases (including HIV and TB); management of chronic conditions (like hypertension, diabetes and asthma); geriatric services; community based rehabilitation services; mental health services; oral health services; and medico-legal services.
The above are considered "core" services of CHCs. General shortages of specialised staff, such as psychiatrists and physiotherapists, will mean that not all services will be offered on a full time basis.
In addition, the new CHCs will have a number of optional services. These intric units, where women with uncomplicated pregnancies may deliver their babies.
The CHCs will require staff in all categories: doctors, various kinds of nurses; administration staff; cleaners and porters; and allied staff (pharmacists, physics, social workers etc).
The facilities will be open from 7h00 to 19h00 for the non-emergency "clinic-type" services, while casualty will be open until 22h00 (and all night at Hillbrow).
Initially CHCs will operate in existing hospital buildings. But the suitability of the location and the accommodation will be evaluated in each case. Relocation of some CHCs is a future possibility.
The impact on our staff
About 1 000 staff will be directly affected by the closure of the three institutions and a further 2 900 by the conversions. More than 2 000 of this group are at Hillbrow.
While some staff will move to new CHCs and effectively remain at their present workplaces, many will be required to transfer. However, it should be emphasised that there will be no retrenchments.
Where closure occurs soon, a period of secondment will preceed the formal transfer process. At a later stage all staff who are required to move in terms of structural transformation will bess. ave been consulted with the traded in the implementation of it.
What happens to the buildings?
In the case of the closing institutions both the land and the buildings will be sold. Both An McColm and Khayalmai are viable hospital buildings. The normal government tender process will be conversion will continue to be usvestigating the possibility of other nd appropriate NGOs using empty portions of these buildings.
The future of other hospitals
In the original plan every hosp level of service it offers and classified accordingly. Staff allocasification. In reviewing the plan a number changes were made to classn the attached table.
Changes from the original plan include:
Work in progress
Regarding the planning which underpins the broader transfer of staff between better-resourced and under-resourced institutions, extremely detailed planning is nearing completion. This work is obviously critical to the overall costing of the revised plan and detailed information willeased by the Gauteng Health Department
Contact persons: Popo Maja - Spokesperson for the MEC for Health 082 373 1169
Jo-Anne Collinge - Director Health Promotion & Communication 011 355 38 76 or 11 622 6027