The OHSC IS an independent entity that conducts inspections in health establishments, to measure their performance against prescribed norms and standards regulations. The inspections conducted by OHSC are aimed at ensuring that health establishments – tertiary, regional and district hospitals to community health centres, and clinics – comply with the legislated prescribed norms and standards.
The Minister of Health promulgated norms and standards regulations for various categories of health establishments from which, OHSC develops inspection tools used to conduct the inspection and determine compliance with norms and standards.
The inspection process results in the two outcomes, compliance or non-compliance with norms and standards. Compliant health establishments are issued with a certificate, while non-compliant health establishments are issued with compliance notice that state the nature and severity of the non-compliance. Timeframes are stated within which health establishments should address the identified areas of non-compliance. Once the stated timeframes lapse, a re-inspection is scheduled to determine whether the deficiencies identified have been addressed. The outcome of a re-inspection is compliance – leading to certification, or non-compliance – leading to enforcement.
Inspections of health establishments by the OHSC, using the promulgated norms and standards regulations commenced during the year 2018. Inspection tools, derived from these regulations were finalised in 2019. Prior to 2019, the National Core Standards (NCS) were followed to assess quality in public sector health establishments. The OHSC adopted an incremental approach to developing inspection tools from the norms and standards, the details of which are stated below:
• Inspection tools go through a process of development in consultation with stakeholders, piloting, and finalisation prior to implementation in the health establishments.
• The OHSC prioritises engagement of relevant stakeholders during the development phase of the inspection tools. Currently engagement is ongoing with the private sector hospitals.
• In 2019, the OHSC had finalised inspection tool for primary healthcare clinics in the public sector. Inspections were conducted in primary healthcare clinics in the public sector.
• In 2022, the inspection tool for community health centres were finalised.
• Public hospitals in the category of district, and regional hospital inspections commenced during 2022. Pilot inspection in private hospital were conducted during 2022.
• The General Practitioners’ practice tool has been aligned to the promulgated norms and standards. The Unity Forum for Family Practitioners (UFFP) has been engaged to solicit their inputs on the practice tool and the process is ongoing. The consultative workshops for GPs will resume once the inputs from the UFFP have been incorporated and draft 3 of the practice tool is available.
• The regulatory private acute hospital inspection tool has been completed in 2022. The training workshops are conducted in preparation for implementation.
• Regulatory central hospital inspection tool is finalised. Review, and incorporation of stakeholder feedback is ongoing in preparation for national workshop to formally adopt the inspection tool.
• Regulatory provincial tertiary hospital inspection tool is completed. Review, and incorporation of stakeholder feedback is ongoing in preparation for national workshop to formally adopt the inspection tool.
• Emergency medical services (EMS) norms and standards have been developed and published by the National Department of Health for comments.
The OHSC is required to disseminate the annual inspection strategy on its website and other platforms every year. Any establishment that is selected for inspection is notified in advance.
QUALITY STANDARDS IN HEALTH ESTABLISHMENTS
As a regulatory body of healthcare establishments in the country, the OHSC is applying standards for the improvement of quality of healthcare. The OHSC is confident that healthcare professionals also want the best for healthcare users.
The OHSC is concerned with achieving quality standards that will contribute towards improving the South African health system and by improving quality of the services provided and safety in health establishments. Upholding these standards benefits both users and healthcare providers by creating an environment in which risks are minimised and positive results enhanced. The promulgated norms and standards are essential to effective and quality healthcare and should be achievable by all.
Historically, inequalities in the provision of health services, improving quality in health services is only one issue in addressing historical inequality. These inequalities were as a result of many other factors, including on underfunded public sector. It is widely acknowledged that a lot of work still needs to be done to improve the quality of both public and private health establishments. The Competition Commission’s Health Market Enquiry highlighted that quality of health services is not solely dependent on the available resources but quality standard.
The OHSC has a clearly defined role in the National Health Insurance (NHI) Programme. The NHI Bill provides that health establishments seeking service contracts with the NHI Fund must be accredited by the NHI Fund. The process of accreditation of healthcare providers will require that health establishments are inspected and certified by the OHSC. It is important to note that, while the OHSC is critical to the unfolding of NHI, its broader role of improving the quality of public and private sector healthcare remains its fundamental mandate.
The draft National Health Insurance (NHI) Bill provides that certification by the OHSC will be a precondition for health service providers seeking to obtain accreditation and ultimately be able to contract with the NHI Fund.
SCOPE OF NORMS AND STANDARDS REGULATIONS
The regulated norms and standards for health establishments apply to public and private hospitals, public sector clinics and community health centres, private health clinics and General Practitioners (GPs) practices. Since the scale and range of services offered differ among these different healthcare sectors, different inspection tools are developed and used to measure compliance. The main categories of standards are:
User rights – User information; access to care; and waiting times
Clinical governance and clinical care – User health records and management; clinical management; infection prevention and control; waste management; and responses to adverse events
Clinical support services – Medicines and medical supplies; diagnostic services; blood services; medical equipment
Facilities and infrastructure – Management of buildings and grounds; engineering services; transport management; security services
Governance and human resources – Governance; human resources management; occupational health and safety.
Telephone: 012 942 7700
Office of Health Standards Compliance
79 Steve Biko Road, Prinshof, Pretoria
Private Bag X21 Arcadia, 0007