Virtual learning for the Office of Health Standards Compliance. November 2020

BETTER HEALTH PROGRAMME SOUTH AFRICA

STORIES

NOVEMBER 2020

Virtual learning for the Office of Health Standards Compliance

The Office of Health Standards Compliance (OHSC) is a regulatory authority, which has the mandate of ensuring that all health establishments in South Africa comply with established health standards and offer quality health services. The OHSC’s current team of 41 health inspectors is required to visit over 3,000 health facilities every year and these will have to be certified before they can be part of the planned National Health Insurance. BHPSA has supported the OHSC by developing a sampling strategy and inspection business case that examines different methodologies, resourcing tactics and financial models to increase the OHSC’s capacity to carry out their inspections. This five-month study was informed by learning sessions with England’s equivalent body, the Care Quality Commission (CQC). These aimed to strengthen the OHSC’s important work in regulating the country’s health facilities by sharing key lessons from England.

Mock inspections by OHSC in progress, South Africa 2014.

Managing the workload

In August and September 2020, representatives of the CQC, the OHSC and BHPSA engaged in two virtual learning events on inspection strategies for primary medical services and hospitals. The Q&A sessions focussed on strategies to manage the huge volume of inspections that must be conducted by such a small team. CQC shared their experience around both physical and remote inspections, which includes remote data analysis and site visits. While remote inspections are relevant in a time of COVID19, and require a reduced inspection capacity, it became clear that these are not currently appropriate in South Africa as only a small percentage of facilities have been inspected to date. This means that a solid baseline is still to be established. Once all facilities have been physically inspected at least once, the OHSC will look to applying a number of efficiency levers such as remote inspections, outsourcing and standards twinning with other regulatory bodies already be active in the facilities. OHSC participants were interested in the CQC’s systemdriven analytics, which enable them to get early warning on potential red-flag areas and at-risk facilities, while also being able to aggregate such data for reporting and policy purposes. It was also noted that there was immense value in the CQC’s approach to streamlining the reporting process and the reports themselves. This results in easily accessible and digestible information being made available, not only to stakeholders in the health fraternity, but also to the general public. In addition, the CQC also highlighted the critical importance of building and maintaining credibility with stakeholders, both within the health fraternity - such as hospital managers and policymakers - and outside of it, which includes the UK’s patient base and the general public. For the OHSC, a good communication strategy that creates visibility and builds trust would be central to any success in achieving their mandate. BHPSA has already begun supporting the OHSC to develop a stakeholder engagement and communication strategy that will be implemented in the coming months. The first group of stakeholders identified are the country’s 9,000 private sector GPs, many of whom are unaware of the fact that their facilities are required to be inspected and certificated by the OHSC.

Positive outcomes

The OHSC participants reported that the sessions were extremely valuable and that they appreciated the openness of the CQC in sharing their experiences. The technical input from the learning sessions strengthened the draft business case and resulted in a flow of CQC documents (e.g. policy papers, standard operating procedures, guidelines) to support the OHSC’s development process. As a direct result of the willingness of the CQC to openly share their experience, the Chief Executive Officer (CEO) of the OHSC invited the CQC to comment and reflect on the draft inspection strategy and sampling methodology within the business case.

In early October, the draft business case was presented to the OHSC Board, which consists of a number of highly respected healthcare professionals from both the public and private sectors. The Board approved the new direction proposed in the business case, saying it provided them with optimism for the future of the OHSC. A summary of the document has also been presented to the Minister of Heath.

The UK’s Better Health Programme (BHP), is a global health system strengthening programme led by the UK Foreign, Development and Commonwealth Office (FCDO) and delivered in South Africa by Mott MacDonald.