Presentation to the Health Portfolio Committee

NHLS 2011/2012 Annual Report

Sagie Pillay (CEO)Adv Sesi Baloyi (Chair)

Oct 2012

10 years of supporting a long and healthy life for all South Africans

Mission and Vision

Vision• To be the leader in pathology; service, surveillance and academic health sciences

Mission• To provide quality, affordable and sustainable health laboratory services, train for health

science education and undertake innovative and relevant research.

Values • Excellence

• Responsive

• Ethical

• Accountable

• Customer service

• Respect

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NHLS 10 point plan

1. Developing a new service delivery model that is more affordable for the public sector;

2. Determine a best fit service delivery model;3. Deliver a quality, customer focused service;4. Align resources, support services and infrastructural development

for service delivery;5. Become laboratory services “Employer of Choice”;6. Prioritise innovation and research to be relevant, appropriate and

leading edge;7. Become the health information powerhouse; 8. Drive stakeholder collaboration;9. Position NHLS as the “Provider of Choice” for NHI; 10. Protect our community and environment.

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Annus Horribilus

• Worse cash flow crisis ever experienced by the NHLS

• Closed the year with a total crippling debt of R2.1b• KZN and Gauteng a staggering R1.7b• Timely intervention by Minister of Health averted

closure of labs.• Mediation initiated in March 2011 by Minister Re:

KZN debt.

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2011 – 2012 Financial Highlights

Positives• Unqualified Audit Opinion – 6th year in a row• Delivered average price increase of just 0.1%• Priority tests pricing reduced by 5%• Compared to private prices below 50% on average

Negatives• Debtors collections is poor• Capital Expenditure% of Turnover of 4% - well

below the targeted 7%

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5 Year Financial Summary2008 2009 2010 2011 2012

Turnover 2 236 963 2 667 398 3 033 151 3 455 924 3 958 409

Growth % 28% 20% 14% 13% 15%

Materials 614 354 804 586 904 034 867 799 1 052 538

Overheads 1 425 376 1 422 827 1 804 505 2 105 271 2 661 372

Net Capital Expenditure 122 669 176 527 213 326 108 058 165 138

Invested in Debtors 115 468 379 855 -9 201 458 005 452 088

Net Cash Generated/(Utilised) (40 904) (116 397) 120 487 (83 209) 401 311

Net Capital Expenditure % of Turnover 5% 7% 7% 3% 4%

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Debtors as at 31 AUG 2012Region

Total Outstanding Current 30 days 60 days 90 days > 90 days Debtor

R'000 R'000 R'000 R'000 R'000 R'000 Days

Eastern Cape 107 093 023 41 675 293 17 532 198 13 412 187 7 157 976 27 315 371 80

Free State 36 005 596 22 235 646 11 758 119 1 642 927 359 290 9 614 54

Gauteng 470 775 129 96 523 968 91 600 661 88 171 881 22 692 356 171 786 264 154

KZN 1 458 618 841 114 728 555 113 200 902 95 629 028 103 303 533 1 031 756 823 420

Limpopo 55 416 731 21 504 557 16 707 597 7 963 171 1 302 749 7 938 656 86

Mpumalanga 17 182 267 22 916 605 (188 284) (2 473 924) (335 518) (2 736 612) 25

North West 35 985 096 19 632 832 10 558 707 1 321 928 1 866 902 2 604 727 57

Northern Cape 12 207 041 7 758 034 3 482 947 298 175 (18 845) 686 730 51

Western Cape 57 684 255 42 493 676 8 785 704 1 721 025 10 228 4 673 622 43

2 250 967 980 389 469 166 273 438 550 207 686 399 136 338 670 1 244 035 194 186

17% 12% 9% 6% 55%

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Creditors

Year 2012 2011

R’000 R’000

Creditors Balance as at 31 March 304 233 186 100

Creditors Days as at 31 March 109 62

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Audit and Corporate governance

• Despite smaller board all meetings took place• NHLS once again received an unqualified audit not

even matters of emphasis.• NHLS continued to maintain high standards of

corporate governance, proper reporting and goodaccountability.

• Statutory requirement deadlines were adhered to.

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Key Performance Indicators10

Key Performance Indicators11

Our People - Our Priority: A Customer Centric Workforce

• Committed, dedicated staff : In adversity, we rise to new heights

• Showed their true worth in difficult times • Organisation/patient before self

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NHLS Learning Academy: Growing Our Own

• Introduced a phlebotomy technician course• Leadership courses• Management Development Programs• Technical Training Courses• Learnerships• ABET

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NHLS Learning Academy: Growing Our Own• Phlebotomy Technique Learnership Programme: 64 • Leadership Development Programme:• Fundamental Management Programme: 45• Management Development Programme: 67• Executive Development Programme: 24

• ABET programme:• Level 1: 14• Level 2: 15• Level 3: 3• Level 4: 1

• External bursaries for Medical Technology students: 64

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NHLS Learning Academy: Growing Our Own

Internship and Registrar Programmes:

• Externally funded: • Department of Science and Technology : 12 Medical

Technology Interns.

• NHLS funded: • Medical Technology students: 355• Medical Scientist Interns: 68• Registrars: 216• Student Technicians: 389• Experiential students: 23

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Workforce Profile: Permanent Staff

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Workforce Profile: Students

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Workforce Profile: Training

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There has been a steady increase in the intake of registrars trained to become specialist pathologists.

Workforce Profile: Training

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Figure 5 above indicates the total intake of registrars increased from 213 to 224 (5.2%)

Figure 5.2 above reflects that the black registrar representation increased by 13%; 42% of these are African females

Turnaround Time (TAT) and Volume Growth

• Met all TAT targets except for Cytology• Demand for cytology service grew by 46% with

cervical smears up by over 17%• Tests for HIV and TB grew by 10%• Processed over 80m tests • Growth for routine testing flat, attributable to gate

keeping initiatives

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Monitoring tools for TAT’s21

The new automated DNA test for TB, the Xpert MTB/RIF

• simultaneously diagnoses Mycobacterium tuberculosis

• (MTB) complex and rifampicin (RIF) resistance in about two hours and is more sensitive than smear microscopy

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GeneXpert Revolutionised MTB/RIF diagnosis

• A total of 305 paediatric patients have been tested on the Xpert assay and compared to culture results: sensitivity was71.43% and specificity was 98.8%.

• An important finding was that >50% of paediatric specimens were below the required volume for Xpert testing.

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GeneXpert Roll out supporting the NDOH

• 77 GeneXpert instruments of varyingsizes (GX4: 36; GX16: 40; GX48: 1) placed in 55 sites – both urban and rural settings.

• 725 laboratory and clinical staff membershave been trained.

• performed 311,1176 Xpert MTB/RIF tests in the public sector.

• Raised funding (together with NDOH to support National roll out.

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Academic mandate• Training was protected despite cash flow• In training 218 pathologists, 201 medical

scientists, 1388 technologists and 639 technicians. • Representation of black pathologists increasing by

5.26% while African women pathologists increased by 16.95%

• Registrars increased from 213 to 224 (5.2%), with African registrar representation increasing by 13%, 42% of these being African women.

• Very impressive, 448 peer reviewed publications.• Raised R454m in research grants

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Quest for Quality: Good is no longer good enough……..

• SANAS accreditation for a further 12 laboratories (7 tertiary, 3 regional, 1 NICD and 1 NIOH) with another 3 ready for assessment.

• Effective internal accreditation programmes continued to maintain and/or improve Quality for rest of laboratories.

• Selected to be the Quality Assurance Regional Centre of Excellence for the SADC.

• Customer satisfaction survey averaged 3.5 out of 5• Established Health Technology Assessment and only African

member of INATA

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The National Institutes: NICD and NIOHSavings lives and protecting people

• The two world class institutes • Primary objective: Servicing worker and public

health needs of all South Africans.• Support National Department of Health (NDOH)

and Provinces.• Continued existence of institutes, and expansion is

of strategic importance to the country and the continent.

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NICD: Highlights

• NICD is internationally recognised as an important public health resource in South Africa.

• Collaborated with Centers for Diseases Control and Prevention (CDC) (USA), established the 8th

Global Disease Detection (GDD) centre, the third to be established in Africa.

• Realigned to support NDOH public health priorities• GermSA

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NICD: Highlights • Restructured to develop a more integrated approach in

contributing and responding to priority communicable disease challenges in South Africa.

• Bio safety level 4 (BSL4) facility commissioned and certified after extensive upgrading.

• Supporting the evaluation of the effectiveness of the national PMTCT programme

• Establishment of the Centre for HIV and STIs : a resource of knowledge and expertise in HIV and other regionally relevant STIs, to the South African government, SADC countries and the African continent

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NICD: Highlights

• Continued support in providing laboratory support for a project on TB management in Swaziland conducted by the Medecines Sans Frontieres

• NICD’s Centre for Tuberculosis supports the government’s objective of halving the number of new TB infections and deaths by 2016

• NICD’s Outbreak Response Unit established a network to improve reporting and investigation of food borne illness, including DoH stakeholders and all NHLS public health laboratories.

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NIOH: Highlights

• Continues to provide policy advice and technical support to the departments of Health, Labour, Mineral Resources and Public Service and Administration.

• Implementing the Regulations for the National Cancer Registry (NCR).

• NIOH’s application as a World Health Organization Collaborating Centre was renewed.

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NIOH: Highlights

• Contribution made to three special projects, namely TB/HIV, ultra violet germicidal irradiation and GeneXpert TB analyser, further strengthening NHLS strategic objectives.

• NIOH played a key role in the further development of the OHASIS system by loading the HIV and TB modules, onto the local system.

• Subject matter experts drafted a Point-of-Care technology policy for submission to NDOH

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NIOH: Highlights

• NIOH’s Analytical Services Section invited to serve as a reference laboratory by the German External Quality Assessment Scheme.

• Prof Gulumian has been invited by the WHO to join the Committee on Health Risk Assessment Training in Developing Countries, especially Africa

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Information Technology: Faster results reducing waste and narrowing the divide • Roll out of TrakCare complete in 86 labs in Northern

Province.• Access to results improved through enhancements in

sms, web view• Supported gate keeping , GeneXpert and Point of

Care roll out • Developed interface to access results for eKapa• Significant enhancements to IT infrastructure • Co-sourced models to lever scarce competencies,

transfer skills medium term sustainability.

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Knowledge management: enhanced, well informed decisions……

• Established an Information Management Unit• Upgraded capacity, software and server to enhance

Information Management capabilities.• Introduction of dashboards, relevant reports to

NDOH and Provinces to monitor progress and plan better.

• Data mining to create routine, periodical and ad-hoc reports.

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Conclusion

• Road Map process: Mapping NHLS’ new strategic path for a sustained future; - right result, right people, right time, right price

• Proposals for separate funding for Institutes and teaching/research

• Pilot NHI districts

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Thank you

Honourable Chair and

Committee Members

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