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South Africa: Innovative Service Delivery Institutions
Source: Mail and Guardian Newspaper
Source Date: Tuesday, November 26, 2013
Country: South Africa
Created: Nov 26, 2013

Rea Vaya, which means ‘we are going’, is the city’s first dedicated BRT system and will play a key role in the development of the city’s public transport system.
BRT aims to provide a fully integrated system to assist in creating integrated public transport modes in the city of Johannesburg that offer residents a modern, safe, efficient, reliable, clean and affordable transport option.
Innovation: The implementation of integrated public transport systems today carries one million people per month.
Implementing the BRT has been a multi-faceted, complex national project that has taken several years.
Strategically, the system employs many technical aspects of a centralised, rail-based mass-transit system.
By working with buses on dedicated exclusive roadways, BRT is designed to feed into a high-volume service.
It has become a catalyst for land-use transformation and has begun to change Johannesburg’s apartheid spatial legacy.
Even today Johannesburg is separated into a developed, wealthy north and a much-neglected south.
Over one million people pass through the Johannesburg CBD daily and more effective public transport system goes a long way towards equalizing rights for those who suffered from inequalities of apartheid.
Project Name: Improve Maternal Health at Phola Nsikazi CHC
Organisation: Phola Nsikazi CHC
Province: Mpumalanga
Phola Nsikazi Health Care Centre in Mbombela North in Mpumalanga has a catchment population of 98 000 with seven satellite clinics and decided to address the maternal health challenges in the community.
Innovation: The Phola Nsikazi CHC organised an imbizo to involve other family members, such as grandmothers and husbands, and worked with them at the OPD so that as soon as women are pregnant, they are sent for maternity care.
They begin with antenatal classes immediately and also have access to information and posters at the antenatal classes.
The starting times were also increased and the hours were made flexible to suit the clients.
This helped to improve early bookings as well as the detection and management of HIV infections.
Family members are more involved in improving maternal health, and there is an improvement in early identification of high risk management and referral.
It improved update of the prevention of mother to child infection programme, increased negative PCRs ( a form of diagnostic test) and improved family planning.
Project Name: Tshilidzini Gateway Project
Organisation: Tshilidzini Gateway Clinic
Province: Limpopo
Tshilidzini Gateway Clinic started to operate in October 2006, with four professional nurses, two enrolled nurses and two nursing assistants.
The clinic was established as a way to relieve Tshilidzini Hospital’s overload of patients at outpatient and casualty as it is a regional hospital. It was established to serve as a first contact for patients.
Innovation: The clinic provides accessible service to the community around the hospital and medication to patients who were not getting treatment at their local clinics.
It also provides health education to patients and the community at large and renders preventative, promotive, curative and rehabilitative services to patients, and seeks to ascertain that patients, families and the community have developed an understanding of conditions and have quality care.
The clinic has a walk-in service for non-urgent cases/patients daily for a doctor’s assessment at the clinic, which promotes access of doctors to patients without cost.
The establishment of the clinic has helped reduce unnecessary death, admissions, relapse, malnutrition and the spread of communicable diseases.
It also reduced the Hospital burden especially on out-patient department (OPD) and Casualty.
This has resulted in good working relationship among different stakeholders and health workers.
Project Name: Carolina Hospital Revitalisation
Organisation: Carolina Hospital
Province: Mpumalanga
Carolina Hospital was old and dilapidated with peeling paint, a leaking roof and broken floor tiles. The nosocomial (hospital-acquired) infection rate was very high at 7% monthly.
The cleaning systems were inadequate with no colour code cloths and mops leading to higher nosocomial rates.
The waiting times for patients were very long at up to six hours per patient.
Hospital grounds were dirty with uncut grass. This led to dissatisfaction and many patient complaints about service delivery and staff attitude.
The image of the hospital was tarnished as a result of this and staff members became demoralised, which in turn resulted in high staff turnover.
Innovation: The staff took it upon themselves to organise fun days to paint and renovate the hospital, the management bought paint.
The hospital roofs were repaired, new ceilings were put in, missing tiles replaced and the maintenance systems improved.
The cleaning system was overhauled after benchmarking in private hospitals. Colour-coded cleaning cloths, buckets and mops were introduced. The floors were sealed with polymer and thoroughly cleaned.
A buffing machine was bought to assist with buffing and sealing of floors daily. The cleaning company also provided free training to staff.
Tools were developed to monitor the waiting times on a monthly basis, and waiting times were reduced.
Landscaping was done and additional lawn mowers were bought while old lawn mowers were serviced and maintained.
The infection control practices were strengthened when staff was sent for formal training at Wits.
New handwashing facilities were procured and hygiene practices were enforced.
Training on hand hygiene was introduced and staff members were monitored. Surveillance tools were developed and surveillance was initiated in high-risk areas, such as the paediatric, maternity, nursery, theatre, casualty and isolation units.
Quality assurance was introduced targeting staff members and training was introduced to improve staff attitude. Staff conducted team building activities and organised debriefing sessions with their own funding.
Patients were made aware of the importance of quality service delivery and their right to complain. Tools were developed for patients to give feedback.
Innovative enhancements of internal govt systems
Project Name: Improvement of food security through community based mechanisation
Organisation: Department of agriculture, rural development and land administration
Province: Mpumalanga
The department wanted to assist farmers to increase their food security initiatives through ploughing and planting 108 000 hectares.
At the time, some of the budgeted funds had to go to the service providers, who had managed 358 tractors. As a result, fewer hectares were ploughed, wrong hectares were reported and farmers complained about the service.
The department looked for an innovation to cut out the service providers and give farmers cooperatives at secondary level the responsibility to run the fleet.
Innovation: The mechanisation co-operative programme is community driven. Members of the co-operative are decision makers and implementers of the programme, which has led to local economic growth and development, a sense of ownership and cost effectiveness.
The innovation has assisted in lowering the operational cost, equipping farmers with the skills to manage and operate the tractor.
More jobs were created because management and administration of the mechanisation was localised. To date the number of jobs created is 7 642 and 23 farmer co-operatives are now managing the mechanisation and inputs for food security.
This has led to more than 230 farms being equipped with fleet management skills, as well as repair and assembly skills.
Project Name: Strengthening Malaria surveillance as a priority strategy for elimination
Organisation: Department of health Mpumalanga provincial government
Province: Mpumalanga
Strengthening of malaria surveillance in the 2012/2013 financial year was mainly because the Mpumalanga Malaria Programme must eliminate malaria by 2018, according to the World Health Organisation’s phased approach to malaria eradication.
Being in this elimination phase surveillance becomes a priority strategy.
Innovation: A specially designed malaria prevention notification form is used at health facilities to classify each case as either local or imported due to the historical travel history of each patient.
The system is unique in South Africa in that it has all the malaria components on one system and data can easily be cross-queried.
The way in which case investigations are conducted and data is collected improved case investigation and disease surveillance.
The analysis and reporting tool (called the Disease Profile) is automated to produce 180 PowerPoint slides on the current malaria situation within a short time.
The malaria outbreak identification system of Mpumalanga was started in the province and then expanded by the national department of health to other provinces.
The system provides managers with information that is used for quick intervention and response.
Local malaria cases decreased by 39% and local malaria deaths decreased due to early presentation and awareness.
Project Name: Performance Monitoring and Evaluation
Organisation: Department of performance monitoring and evaluation
Province: Gauteng (National)
The management performance assessments tool (MPAT) project was started to provide the executive with monitoring information on the state of management practices.
Innovation: For the first time in government the MPAT provides a link between policy makers and implementers.
MPAT is a collaborative initiative with the centre of government departments that aims to strengthen and improve existing systems and performance in government.
By undertaking self-assessments, senior management in a department are given the opportunity to ascertain its strengths and weakness.
This results in ownership of the problems by the department and commitment to implement improvements.
The MPAT system has created a database of knowledge and information across all national and provincial departments.
This allows for sharing of good practice and collaboration with other government departments to minimise on reporting duplications.
Project Name: Ekhaya Project: In-House Fleet Management Service
Organisation: Department of transport
Province: Eastern Cape
There was an urgent need for a more effective and more economic fleet management service for the Eastern Cape Provincial Government.
The project was initiated in 2010 with the feasibility study and went through various stages until the trading entity started operating in 2012.
Innovation: This was the first time use was made of an internal departmental task team rather than external consultants.
This action learning team approach promotes learning in the here-and-now while public administrators tackle a real challenge with real work colleagues in real time.
Participants have had to reflect on their real-time experiences in recording the action learning achievements.
The Ekhaya Fleet Management Trading Entity is the first trading entity to be established by any government entity in the Eastern Cape provincial government.
A hybrid model was developed through benchmarking and selecting the successful components of other models in the country.
The final structure of the trading entity is unique to the Eastern Cape.
This article forms part of a supplement paid for by the Centre for Public Service Innovation (CPSI).
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