Wide acknowledgement exists of serious challenges in the acquisition, quality, delivery, operation and maintenance of public health care facilities. To address this, the national Department of Health (DoH) initiated a multimillion, multiyear collaborative effort called the Infrastructure Unit Systems Support (IUSS) project. The CSIR is responsible for two focus areas of the project.
The IUSS was created against the backdrop of documented under-expenditure of allocated budgets for public health care infrastructure and acknowledgement of challenges in the acquisition, quality, delivery, operation and maintenance of health care facilities.
“In a decisive response to these challenges, the national DoH initiated the three-year IUSS in October 2010, with collaboration from the Development Bank of Southern Africa and the CSIR, as well as input from health care and related specialists,” notes Peta de Jager, CSIR project leader of IUSS. “Our aim is to optimise the planning, acquisition, operation and management of South Africa’s public health care infrastructure through all stages of the its life-cycle. This encompasses infrastructure development from the strategic planning phase through to the operation and disposal of building,” she explains.
De Jager expands on the origin of the initiative: “The IUSS was the brainchild of the Minister of Health’s special advisor, who also heads the infrastructure unit at the national DoH.”
Supporting the NHI
“While work is proceeding in many areas, the current IUSS focus is on integrated health planning, primary health care, infection prevention and control – all areas key to the National Health Insurance (NHI) and the NHI Infrastructure Support Programme.
“We thus have a strong drive to pilot the early deliverables from the IUSS focus areas to support and inform the infrastructure requirements arising from the impending roll-out of the NHI, right from the pilot phase,” emphasises De Jager.
CSIR’s R&D role
The IUSS project has five initial interlinked focus areas, namely:
- Development of new national norms, standards, guidelines and performance benchmarks for all levels of health care facilities, spearheaded by the CSIR;
- Rapid capital project status assessments of all public health sector projects in South Africa to understand and identify problem areas in the infrastructure delivery chain (red-flagged projects);
- Support for acquiring and implementing a project management information system for health care projects in South Africa for use on an ongoing basis as a common support framework;
- Setting up a project monitoring and oversight support unit to enable the infrastructure unit of the national DoH and its partners to address red-flagged projects; and
- Development of a health care infrastructure cost-modelling capability led by the CSIR. This will be a decision-support tool, as expenditure can be projected during the various life-cycle phases of any category of health care facility. The modelling takes into account both the cost of the infrastructure and the cost of operating facilities.
Some of the members of the CSIR team who do research for the IUSS project (project leader, Peta de Jager, appears in the centre of the photo).
At the formal inception of the IUSS initiative, a working group was convened to oversee the two categories where the CSIR takes the lead namely, the development of infrastructure norms and standards; and cost models for all categories of health care facilities. The group’s activities are honed to support an affordable and sustainable health building estate; buildings of improved quality and equity; streamlined procurement and operation of facilities; and alignment with the people’s needs and the national DoH’s policies
Expertise applied by the CSIR in the IUSS project includes quantity surveying, mechanical engineering for developing building services requirements, and the architectural discipline for design aspects. This is firmly supported by technical skills in software development, building performance analysis and computer-assisted design.
The development of a sustainable set of national norms, standards, guidelines and benchmarks is structured into 46 different work packages. “These include clinical services like wards, theatres and intensive care units, as well as cross-cutting issues such as building engineering services, infection prevention and control, health care technology, sustainability and the environment, and tomorrow’s health care environments,” explains De Jager.
The CSIR team and its partners have made significant progress in developing a set of norms and standards, with care being taken to ensure that these are responsive to the specific health, service delivery and affordability environment in South Africa. The CSIR held 20 information-gathering workshops for clinical and infrastructure professionals.
Multidisciplinary specialised task teams with clinical and built environment expertise have been mobilised to drive the development of a suite of documents and tools in each of the identified work packages. Several tools have been developed to assist decision-makers and planners to determine order of magnitude cost estimates and time-lines for their health care capital works projects.
Draft documents and full workshop proceedings are released through the dedicated project website www.iussonline.co.za created by the CSIR as the documents become available for comment and early adoption. Stakeholder feedback is also invited through formal national and provincial channels. Feedback will be incorporated into proposal documents for formal submission to the national DoH’s Technical Review Committee. Once approved, documents will be submitted for formal endorsement by the National Health Council before the adoption of norms and standards become mandatory.
De Jager notes: “It is clear that the successful development and adoption of norms, standards and cost models for public health care infrastructure will depend on these being tailor-made for the particular context, constraints and service delivery objectives of South Africa.”
Visual aids to determine space requirements for adult in-patient accommodation.
The resources available in South Africa for health care service delivery – in particular the limited staffing resources – and the poor legacy and condition of much of the existing public health estate provide a challenging starting point. The challenge is for norms and standards to provide a clear, achievable and affordable view of updated, upgraded and accessible building infrastructure that provides a fit-for-purpose platform for delivering health care services.
“We expect that the fruits of the ambitious IUSS project will take some time to manifest as the initiative is developed, adopted and refined. However, there is general optimism that South Africa’s public health care infrastructure is showing signs of steady improvements, with a marked improvement already noticed in past under-spending on infrastructure grant funding,” De Jager concludes.
Peta de Jager