Managing records in public healthcare institutions in South Africa Shadrack Katuu The views expressed herein are those of the author and should not be attributed to the IMF, its Executive Board, or its management
Outline 1) Historical perspective 2) Issues based discussion 2(a) Administrative challenges 2(b) Legislative challenges 2(c) Levels of care 3) Discussion points
1) Historical perspective First health records just after 1654 with importation of ships surgeons Summary of four centuries of development imprint of Dutch colonists, French Huguenots, British settlers and colonisers, Boer pioneers as well as different African indigenous practices. First ordinance was in 1807 with subsequent legislation/regulation in 1830, 1883, 1897 and 1919. Apartheid affected provision of health from the 1940s to the 1990s specifically the systematic racial fragmentation of South African society. Ref: Van Rensburg, H. C. (2004). Health and health care in South Africa, Van Schaik Publishers. Challenges since 1994 can be examined at different levels including administrative and legislative
2(a) Administrative challenges Before 1994 the country was divided into four provinces (Natal, Orange Free State, Transvaal and Cape) and several homelands Each of these homeland authorities had their own health authorities offering services to their citizens Image reference: http://en.wikipedia.org/wi ki/file:homelands.png 20 September 2011 records management in public healthcare institutions in South Africa 5
2(a) Administrative challenges Currently, the country has 9 provinces divided into 52 districts. Image reference http://en.wikipedia. org/wiki/file:south_ Africa_Districts_Apri l_2006.png 20 September 2011 records management in public healthcare institutions in South Africa 6
2(a) Challenges in South Africa administrative reorganization Pre 1994 Post 1994 20 September 2011 records management in public healthcare institutions in South Africa 7
2(a) Administrative challenges Former homeland and provinces Capital Eastern Cape Cape, Ciskei, Transkei Bisho Free State Orange Free State, Qwa Qwa Bloemfontein Gauteng Transvaal Johannesburg KwaZulu Natal KwaZulu, Natal Piertermaritzburg Mpumalanga Bophuthatswana, KwaNdebele, KwaNgwane, Transvaal, Nelspruit Limpopo Gazankulu, Lebowa, Transvaal, Venda, Polokwana Northern Cape Cape Kimberly North West Bophuthatswana, Cape, Transvaal, Mafikeng Western Cape Cape Cape Town 20 September 2011 8 records management in public healthcare institutions in South Africa
2(b) Legislative framework The legislative framework in South Africa can be divided in three basic categories Fundamental Acts The current national Health Act (61 of 2003) has had several predecessors (including Health Act 116 of 1990 and Health Act 63 of 1977) Specific policy areas These include termination of pregnancy, hazardous substances, mental health care, mine health and safety, occupational health and safety, tobacco products control etc. Statutory bodies These include traditional health practitioners, allied health professions, council for medical schemes, dental technicians, national health laboratory, medical research council
2(b) Challenges in South Africa legislative The legislative environment in the health sector is highly complex. There is minimal interaction between the health sector legislation and other legislation including the National Archives Act, FOI legislation, Promotion of Administrative Justice Act etc. (Debbie Pearmain 2007, Kate Allan 2009) Considering these facts, any records intervention has to be cognizant of the complexity. According to my research, this has barely began.
2(c) Levels of care Primary care Global trends South Africa s situation Primary care Secondary care Tertiary care Quaternary care Secondary care Tertiary care
2 (c) Levels of care No. of public health institutions in South Africa (ref: Health Systems Trust) Primary Secondary Tertiary 855 715 566 431 425 378 390 343 170 70 19 54 30 21 5 14 22 38 26 25 6 8 19 4 6 40 21 Eastern Cape Free State Gauteng KwaZulu Natal Limpopo Mpumalanga Northern Cape North West Western Cape
Challenge of managing records in public health care institutions in South Africa
2 (c) Challenges in South Africa levels of care The country s many primary care institutions are regarded to have very bad RM programmes. Several graduate research projects have indicated that recordkeeping is so bad that patients are asked to keep their records (Norden 2002, Okorie 2003). Australia is cited as one of the countries were PRMR or patient retained medical records are a common phenomenon. Technology is seen as the panacea for poor recordkeeping. The widely known project from one of the provinces where, over the course of 16 years, authorities have been trying to introduce technology to deal with, among other things, poor records management with less that impressive results (Littlejohns, Wyatt and Garvican 2003 )
References Allan, Kate (ed) (2009) Paper wars: access to information in South Africa Johannesburg: Wits University Press Carstens, Pieter and Debbie Pearmain (2007) Foundational principles of South African Medical Law Lexis Nexis: Durban Health Systems Trust (2011) District Health Barometer http://www.hst.org.za/district healthbarometer dhb 2 Littlejohns, Peter, Jeremy C Wyatt and Linda Garvican (2003) Evaluating computerised health information systems: hard lessons still to be learnt British Medical Journal Vol. 326 pg. 860 863 Norden, A L (2002) Patients thoughts on patient retained medical records unpublished Masters thesis, Medical University of South Africa Okorie, C I (2003) Why do patients leave their patient retained medical records (PRMR) at home when they consult at Empilweni Gompo Health Centre, Eastern Cape? unpublished Masters thesis, Medical University of South Africa Pearmain, Debbie (2007) Health policy and legislation in South African Health Review, Health Trust Systems, pg. 19 31. Contact details: Shadrack Katuu skatuu@gmail.com
3) Discussion points UK At a policy level there are indications that the Ministry of Health has interaction with The National Archives. US There is a huge cohort of medical records professionals. Their professional association, AHIMA, supposedly has more members than ARMA. The complex nature of the judicial system makes any kind of reform very difficult There has been continuing discussion about the electronic health record (EHI). In 2004, former President Bush called for all Americans to have the EHI by 2014. Oceania region Barbara Reed Regarding health records, have we made the recordkeeping argument?