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National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 6 : Reorganisation of the Health Care System and Services under NHI

6.1 Service Delivery

6.1.2 Implementation of Quality Improvement Initiatives


149. NHI aims to provide coverage to quality health services for all South Africans. Therefore, NHI will accredit and contract eligible health facilities that meet nationally approved standards. To meet these standards, health facilities must be certified by the Office of Health Standards Compliance (OHSC). The OHSC was established in 2013 through amendments to the National Health Act of 2003. The role of the OHSC is to ensure compliance with National Quality Standards for Health by all health establishments in both the public and private health sectors. The role of the Inspectorate within the OHSC is to enforce compliance with the norms and standards. The Health Ombud function of the OHSC which became operational in 2016 ensures that complaints lodged by users of health care services are appropriately and speedily investigated.


150. The National Quality Standards for Health are based on seven domains and six national core standards. The seven domains include patient rights; patient safety, clinical governance and care; clinical support services; public health; leadership and corporate governance; operational management including financial, asset and human resources management; and facilities and infrastructure. In addition, facilities must comply with National Core Standards that measure the following areas: cleanliness; attitude of staff towards patients; infection control; safety and security of staff and patients; reduction of waiting times; and availability of medicines at facilities. All health facilities must be fully compliant with national norms and standards for quality at all times. For compliance with these standards, essential health support services such as laundry, safety and security must be provided on a continuous and uninterrupted basis. Support services such as security, food supply, cleaning services, and laundry services, must not be outsourced but be provided in-house within the public health system.


151. Health facilities in the public sector have been implementing quality improvement interventions to comply with the quality norms and standards to varying degrees in preparation for NHI. These interventions include: (a) the scaling up of the Ideal Clinic model; (b) infrastructure improvement across the health sector; and (c) implementation of the World Health Organisation’s Workload Indicators for Staffing Needs (WISN) tool.


152. The interventions in public health facilities have had variable results with regards to meeting the core quality standards, mostly with poor scores for PHC facilities and slightly better scores for hospitals being recorded. However, the information obtained from the inspections has been used to develop and implement action plans across clinics and hospitals in and around the NHI pilot districts to support quality improvement plans. The OHSC inspection results are utilised to inform Operation Phakisa’s Ideal Clinic Realisation project to strengthen the implementation and monitoring of progress achieved by target facilities to achieve the National Core Standards for quality.


153. Patient satisfaction will be measured systematically through collaboration with the OHSC, other statutory bodies and stakeholders. This information will be used to identify gaps and put into place action plans to ensure sustained patient satisfaction.


154. The implementation of the Patients’ Rights Charter will be strengthened to ensure physical and mental well-being; to participate in the development of health policies and participate in decision-making on matters affecting their health; to access healthcare including timely emergency care in any health facility that is open regardless of their ability to pay; to information related to the type of health coverage; to choose a health provider or facility for treatment provided that such choice shall not be contrary to ethical standards and service delivery guidelines; to be treated by a named healthcare provider; to confidentiality and privacy and disclosure of information through informed consent except when required in terms of law or an order of court; to informed consent; to right of refusal of treatment provided it does not endanger the health of others; to be referred for a second opinion; to continuity of care; and to complain about health services.