1. Put our customers at the centre of everything we do. 2. Strengthen stakeholder relations with our partners and clients

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2 We saw in this year greater alignment of the NHLS strategy with that of the Department of Health. The organisation reviewed its score card and repositioned itself to: 1. Put our customers at the centre of everything we do 2. Strengthen stakeholder relations with our partners and clients 3. Give greater focus and attention to building stronger and more meaningful Academic relations 4. Create an enabling environment for staff to grow professionally and to be more creative and innovative in responding to our key mandate 5. Position the NHLS as an employer of choice for young health professionals 6. Encourage appropriate and relevant research 7. Explore ways to reduce the costs of service provision to our customers

3 The NHLS makes tremendous contribution into the country s public health system. We help doctors determine a diagnosis for millions of patients across the country. We conduct groundbreaking research that impacts health delivery We are involved in training the next generation of pathology professional, scientists, medical technicians and technologists in collaboration with the Faculties of Health Sciences and Universities of Technology.

4 SUPPORT FOR NATIONAL DEPARTMENT OF HEALTH PRIORITY PROGRAMMES 70 CD4 Sites 21 Viral Load Sites 11 HIV/PCR Sites 15 TB Culture Sites

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7 TB MICROSCOPY VOLUMES Pathology, the only true pathway to medical understanding

8 TB CULTURE VOLUMES Pathology, the only true pathway to medical understanding

9 CD4 TEST VOLUMES Pathology, the only true pathway to medical understanding

10 VIRAL LOAD TEST VOLUMES Pathology, the only true pathway to medical understanding

11 PCR TEST VOLUMES Pathology, the only true pathway to medical understanding

12 DAILY PHC COVERAGE Pathology, the only true pathway to medical understanding REGION Central 95% 95% Northern 85% 95% KZN 52% 69% Coastal 60% 65%

13 IN-LAB LAB-TAT Pathology, the only true pathway to medical understanding

14 NATIONAL INSTITUTE FOR COMMUNICABLE DISEASES During this period we were confronted by outbreaks of avian flu, Arena virus, meningitis and cholera. The National Institute for Communicable Diseases (NICD) responded outstandingly to these outbreaks.

15 OUTBREAK RESPONSES 1. Cholera Import from Zimbabwe (12,634 cases and 64 deaths) 2. Novel arenavirus Lujo Johannesburg (4 cases and 3 deaths) 3. Crimean Congo Haemorrhagic Fever (CCHF) 8 cases 4. Foodborne outbreaks Gauteng (75), Mpumalanga (1,199) 5. Meningococcal meningitis Several outbreaks Gauteng, Northern Cape 6. Rift Valley fever Limpopo (14) 7. Diphtheria Western Cape (1) 8. Pertussis Gauteng (1) 9. Measles Gauteng and NW Province (4)

16 RESEARCH AND PROFESSIONAL OUTPUTS Research Publication published: 76 Conference Presentations International: 103 National: 49 Professional Development Graduate Degrees: 17 (5 x PhD, 7 x MSc, 4 x BSc(Hons), 1 x DTM&H) Registered for higher degree: 28 (11 x PhD, 16 x MSc, 1 x MPH)National: 4

17 TRAINING NATIONAL & INTERNATIONAL A ACILT African Centre for Integrated Laboratory Training A Established 2008 with CDC B 5 courses in 2008 TB & HIV Laboratory Diagnostics C Students from 14 African countries A SAFELTP South African Field and Epidemiological Laboratory Training Programme A 1 st cohort of 10 graduates 2008 B 3 rd cohort 11 South African & 2 West African 2008/09

18 PUBLICATIONS

19 2009/2010 STRATEGIC FOCUS Sustained funding sources for surveillance programmes which were initiated with grant funding Establishment of web-based facilities for information dissemination Coordination with DoH of national field epidemiology network including FELTP graduates for surveillance Formalization of collaborations with international bodies such as Health Protection Agency (UK) On-site dormitory facilities for visiting students Upgrading of WHO Reference laboratories influenza and polio E-learning programmes MediaSite facility

20 SERVICES (REFERRED PERSONS, SITE & LABORATORY ASSESSMENTS) Public & private sectors (incl NGO & Trade Union sectors) Pathology (deceased ex-miners) Occupational Medicine Clinical specialist referral service Surveillance Ergonomic assessments Immunology & microbiology

21 SERVICES (REFERRED PERSONS, SITE & LABORATORY ASSESSMENTS) Occupational hygiene (risk assessments & hazard management) Analytic services & Toxicology Information services Query handling Resource centre Electronic journals (across NHLS)

22 DISEASE RATES PER 1000 AUTOPSIES Pathaut: 1998, 2008

23 RESEARCH Postgraduate training (Honours, Masters & PhDs) Special emphasis on mining sector (ODMWA); also construction & health sector Scientific (peer reviewed) Translation of science for popular use

24 EDUCATION & TRAINING Training in Occupational Medicine, Occupational Hygiene & Pathology Continuing educational development Short courses Updates Journal clubs Support to universities Professional groups, Government, Private Sector & Trade Unions Support for training in SADC region

25 AREAS OF CONCERN Silicosis & TB in the mining sector HIV and the workplace Fragmented (policy, legislative, organisational and delivery system) Lack of greater involvement of trade unions SMMEs & informal sector Occupational Health Services (for public sector; public entities) Expanded Public Works programe & Occupational Health & Safety

26 THE NATIONAL CANCER REGISTRY National Cancer Registry providing surveillance data on cancers Chronic Diseases of Lifestyle Report: Cancer The 4th leading cause of death in South Africa

27 THE NATIONAL CANCER REGISTRY Started in 1986 Staff of 12 Passive pathology based registry covering all NHLS laboratories & some private laboratories Provides surveillance data on cancers Report on data available Assisted with draft regulations on cancer registration with DoH needs finalisation 27

28 THE NATIONAL CANCER REGISTRY Cancer epidemiology research group started in 1995 with support from Cancer Research UK; awarded MRC status in Conducts research on Exposures that lead to cancers (HIV, Tobacco) Potential & contributing factors (HPV, hormone contraceptives) Tracking major cancers (cervix, breast, prostate, oesophagus, lung) Increasing incidence (Kaposi Sarcoma) 28

29 TOTAL NO OF CANCERS REPORTED TO NCR (1991, 2001) Cancer No. Rank No. Rank Breast Cervix Prostate Colorectal Lung Oesophagus Melanoma Bladder Kaposi Sarcoma Non Hodgkins Lymphoma Others TOTAL

30 LEADING FIVE CANCERS IN MEN (2001) Rank African Coloured Indian White 1 Prostate Prostate Prostate Prostate 2 Oesoph Lung Colorectal Bladder 3 Kaposi Sarcoma Colorectal Lung Melanoma 4 Lung Stomach Stomach Colorectal Oral* Oral* 5 *mouth, lip, tongue, gum *mouth, lip, tongue, gum Bladder Lung

31 LEADING FIVE CANCERS IN WOMEN (2001) Rank African Coloured Indian White 1 Cervix Breast Breast Breast 2 Breast Cervix Colorectal Melanoma 3 Oesoph Lung Uterus Colorectal 4 Uterus Colorectal Cervix Cervix 5 Kaposi Sarcoma Uterus Stomach Lung

32 KAPOSI SARCOMA VERIFIED MICROSCOPICALLY (1988 TO 2001) 32

33 PAP SMEAR HISTORY WOMEN DIAGNOSED WITH CERVICAL CANCER ( ) Place of Residence No. with previous Pap smear*/total *>2yr prior to diagnosis % Soweto 29/ Other Jo burg 13/ All Jo burg 42/ Other Gauteng 34/ All Gauteng 76/

34 CANCER INCIDENCE RANKING (IARC, 2000) Rank High Income Low Income Worldwide Sub- Saharan Africa South Africa (2001) Sub-Saharan Africa (2008) 1 Lung Lung Lung Cervix Breast Cervix 2 Breast Colorectal Stomach Breast Cervix Kaposi Sarcoma 3 Colorect. Breast Breast Liver Prostate Breast 4 Stomach Prostate Liver Prostate Colorectal Liver 5 Liver Stomach Cervix Stomach Lung Prostate

35 CERVICAL CYTOLOGY

36 CERVICAL CYTOLOGY

37 CERVICAL CYTOLOGY

38 CERVICAL CYTOLOGY

39 OUR MANDATE To provide cost-effective laboratory services; academic training for health sciences and to support research.

40 ACADEMIC RELATIONS MEASURABLE: FOSTER GOOD STAKEHOLDER RELATIONSHIPS Finalise Bilateral Agreements with 50% Signed More complex negotiating environment than originally anticipated 9 Universities with 9 different Conditions of Service & HR Policies vs. NHLS However, 12 month extension to the Umbrella Agreement drafted and signed to allow for the ongoing negotiations of the Bilateral Agreements

41 RESEARCH: PROMOTE AND SUPPORT RESEARCH Increase Number of Peer-reviewed Publications Increased 30.5% on PY

42 QUALITY ASSURANCE MEASURABLE: IMPROVE CUSTOMER PERCEPTIONS Develop Standardised Customer Satisfaction Index Tool AND Pilot in Clinics / Hospitals in each region Dimension Combined Central Coastal KZN Northern Reliability Responsiveness Competence Access Courtesy Communication Credibility Integrity Understanding Tangibles AVERAGE 54% 61% 60% 49% 53%

43 QUALITY ASSURANCE MEASURABLE: IMPROVE HIGH SERVICE QUALITY Increase % of Academic & Regional Labs accredited Increase year-on-year score of functional audits 100 % reporting for each PT scheme

44 KEY CHALLENGES: ACADEMIC TEACHING & RESEARCH Academic Teaching Lack of a National Strategic 10-year HR plan to inform the pipeline Market and geographic challenges the NHLS suffers the same challenges as health care in general Rural/urban divide Public/private divide Migration of healthcare workers (abroad and to pursue other career opportunities) Feminisation of professional pathology/ laboratory careers Research unfunded mandate entirely reliant on Grants, which impacts retention of good researchers & sustainability of research Drive & Measure Outcomes & Impacts vs. Outputs Has the research changed policy or practice?

45 SUPPORT SERVICES

46 HUMAN RESOURCES TRAINING AND SKILLS DEVELOPMENT A total of R5,5 million was invested in training and skills development interventions internally, nationally and internationally NHLS employed 1,092 registrars and interns for the period at a cost of R174 million Bursaries were awarded to 165 undergraduate students at various universities at a cost of R1,3 million Significant improvement of student medical technology pass rate from 51% to 69% (2008/2009); 4% above the national average Recruitment drive was intensified with NHLS branding and attracted quality students through visits to 100 schools across South Africa Workplace Skills Plan was submitted and approved by the Department of Labour.

47 EMPLOYMENT EQUITY Employment Equity (EE) Plan is in place. Affirmative action measures and numerical targets are detailed Black registrar increased from 31% to 57% in line with the EE drive to influence the race and gender profile of pathologists in the medium term Medical scientists are predominantly female (77%) with 36% being African females Medical technology students continue to be predominantly African female (60%) Of the 12 executive management positions, a race and gender profile has improved significantly Promotions were predominantly among black employees (86%), this included senior and top management positions

48 WORKPLACE PROFILE The overall headcount increased as a result of: An increase in the number of pathologists, medical officers, registrars, medical technologists and student medical technicians. Retention of core staff continues to be a challenge. Mechanisms for career development and recognition of individual effort is in place. 60% of terminations for the period was permanent employees. Main reasons resignations included remuneration, conditions of employment and career change.

49 GOVERNANCE AND MANAGEMENT HR Committee of the NHLS Board: continued to review performance of the Human Resources function Executive management: in addition to the 5 executive management placements reported, a further 2 were filled. Recruitment is underway for the last 2 vacancies Policies: performance management and core discipline career management policies were approved and the systems are being implemented. Employee relations environment is stable Personnel costs: the total increased by 22,2% from R1,063 R1,298 billion as a result of the 11.25% across the board salary increase and increase in core staff and student intake

50 INFORMATION TECHNOLOGY Laboratory Information Systems NHLS Selected TrakCare-Lab LIS Phase 1 Implementation KZN Region Currently 9 of 53 labs live on TrakCare-Lab Remaining 44 labs completion end Mar 2010 Phase 2 Other regions of NHLS

51 SYSTEM OVERVIEW

52 INFORMATION TECHNOLOGY Benefits of TrakCare-Lab LIS Enhanced Delivery of Lab Results thus Improving Patient Healthcare Access to Results via Web Laboratory Automation resulting in: Enhanced Efficiencies Turnaround Times Reduction in Transcription Errors Easy Access to Information Automated Billing

53 INFORMATION TECHNOLOGY Electronic Lab Results Delivery NHLS provided Web Results Access to Provinces Western Cape making good use of this facility Instantaneous access to Lab Results Reduces over servicing Over 1000 users configured for Western Cape Working with other Provinces to facilitate access

54 INFORMATION TECHNOLOGY SMS Lab Results Delivery (TB Microscopy) SMS used for delivery of TB Microscopy Results Delivery to Cell Phones & SMS Printers Improves turnaround times Significant growth in usage since Jul TB Mic s delivered by SMS to date

55 INFORMATION TECHNOLOGY

56 INFORMATION TECHNOLOGY Management Information Continued development of Data Warehouse CDW Supports National Priority Programs Interface Developed to WamTech TB System Management of TB Drug Resistance Early Warning System Developed Outbreak Response (eg Cholera) Development of Executive Dashboard

57 DATA WAREHOUSE ACCESS

58 FINANCIAL HIGHLIGHTS POSITIVES: Unqualified Audit Opinion 3rd year in a row 6.7% of turnover invested in capital infrastructure NEGATIVES: 3 Matters of Emphasis Title Deeds Completeness of grant income Board not fully constituted Positive cashflow not generated due to high debtor days

59 6 YEAR FINANCIAL SUMMARY (R000 S) Year 2004/5 ex KZN 2005/6 ex KZN 2006/7 2007/8 2008/9 Volume 29,874 38,382 65,752 71,301 80,362 Volume Growth % 22.2 % 71.3 % 8.4 % 12.7 % Turnover 1,060,670 1,323,500 1,745,558 2,232,292 2,676,092 Net Surplus 93, , , , ,010 Change in Working Capital (81,189) (13,787) (138,508) (256,414) (263,606) Capital Exp. 56,859 56, , , ,126 Capital Exp. % of Turnover 5.4 % 4.3 % 7.3 % 5.7 % 6.7 % Net Cash Generated / (Utilized) (876) 199,914 42,526 (74,874) (116,582)

60 DEBTORS VS CASH ON HAND-RM

61 2009/10 OUTSTANDING DEBTORS (RM)

62 DEBTORS DAYS

63 KEY PERFORMANCE INDICATORS 2008/9 Perspective Strategic Value Driver Measurement Target 08/09 Achieved Achieve Surplus Surplus % of Revenue (10%) Surplus 7% of Revenue Financial Perspective Ensure Financial Sustainability in: a) Services b) Research c) Health Science Education Ensure Cash Cover of 4 Months of Operational Expenditure Ensure Capital Expenditure % of Revenue R860.8m as budgeted R139.6m achieved 9% as budgeted 6.7% of revenue spent Debtors Days (average) 90 days 147 days achieved Secure Grant Income R64.2m as budgeted R7m under budget Improve on-time Delivery Decrease in-lab TAT CD4 36 hrs hours Decrease in-lab TAT Viral Loads 84 hrs 196 hours Customer Value (Service Delivery) Foster good Stakeholder Relationships Provide Information useful to decision-making to internal and external stakeholders a) Timeously b) Accurately c) Accessibly Finalise Bilateral Agreements LIS Implementation (As per IT Balanced Scorecard) 50% Signed Bilateral Agreements Implement Pilot Laboratory LIS in KZN Not Signed Pilot Lab not Implemented

64 KEY PERFORMANCE INDICATORS 2008/9 Perspective Strategic Value Driver Measurement Target 08/09 Achieved Manage and Mitigate Risk Reduce Residual Risk of top 10 risks by 10% 10% Reduction Not Achieved Operational Efficiency (Internal Operations) Improve Processes through Technological Advancement Ensure % of Labs implemented automation vs. those planned 90% 57% lab automation implemented Increase % reporting of PT Schemes 100% report submitted Not Achieved Improve High Service Quality Ensure % of Established and Functional Expert Committees / Total No. disciplines 50% of Established Functional Expert Committees Not Achieved Determine Skills Requirement Strategy and methodology document drafted Measure deferred to 2009/2010 due to time and capacity constraints. Enhance Skills Acquisition Reduce Vacancy Rate Positions filled as budgeted Vacancies in core occupations as determined in January Situation not improved by end of financial year. People Value (Learning and Growth) Extend Skills Development Increase No. of Interns (Scientists, Medical Technologists, Technicians) recruited Appoint 18 intern scientists, 230 intern medical technologists and 45 student medical technicians in 12 month period Appointed 27 intern scientists Appointed 82 student medical technologist. Appointed 164 student medical technologists Enhance Skills Retention Develop the Survey tool to measure Employee Satisfaction Survey questionnaire drafted Measure deferred to 2009/2010 due to time and capacity challenges in HR Improve Transformation Ensure % Achievement of the EE Plan 80% achievement of numerical targets and 50% of affirmative action measures Achieved 56% of targets as per draft EE Plan for Improve Communication Establish the communication division (Employee Satisfaction Index Survey relating to communication) Survey questionnaire drafted Measure deferred to 2009/2010 due to time and capacity challenges in HR

65 Lab policy - setting a national framework Developing a 10 year master-plan for NHLS Health technology Infrastructure Human resources Developing a new funding model lab service provision Reviewing current funding model for teaching and research Customer(patient) centric strategy

66 End to end It connectivity strategy Creating consolidated networks

67 Our thanks to the honourable chair and honourable members of the Portfolio committee for this opportunity to present the 2008/09 annual report of NHLS. Adv Sesi Baloyi (chair) Sagie Pillay(CEO)

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