Case Study: Mpumalanga Department of Health and Social Services Support Engagement

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Case Study Mpumalanga Department of Health and
Social Services Support Engagement

• Presentation to HR Steering Committee
• 17 September 2009

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PRESENTATION OUTLINE

• Purpose of the case study
• Background on the support programme
• Scope of the work
• Support approach and methodology
• Programme governance
• Overall findings
• Milestones achieved
• Impact
• Lessons learnt
• Recommendations
• Where are we now?

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Purpose of the Case Study

• To provide conceptual analysis of the identified
  problems encountered and highlight significant
  aspects of the project.
• To identify different models of support and
  lessons learnt that have the potential to inform
  future engagements
• To recommend activities that should be taken
  forward to ensure continuous improvement in terms
  of organizational review and development in the
  public service.

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Background on the Support programme

• In April 2008 the Mpu DHSS requested the MPSA to
  assist with a supportive intervention to improve
  the Departments readiness to deliver services.
• After consultation with departmental senior
  officials on 15 May 2007, it was agreed that the
  development of a new organizational structure
  should be prioritized, and that the dpsa would
  allocate the team on site to provide assistance.
• In May 2008, the MEC requested the team to assist
  with the unbundling of the Department of Health
  and Social Services into 2 independent
  Departments of Health and of Social Development.
• The President assented to the abolition of the
  DHSS and the creation of a Department of Health
  and a Department of Social Development by way of
  proclamation, published in the Government Gazette
  of 15 August 2008.

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Scope of Work (1)

• 2nd Largest department in the province
• Department of Health
• Provincial Office, 3 District Offices, 18
  Sub-Districts, 33 hospitals, 305 Primary Health
  Care (PHC) Centers, 26 456 posts
• Department of Social Development
• Provincial Office, 3 District Offices and 18
  Sub-Districts, 59 service delivery points and 5
  Social Development Institutions, 1635 posts.
• Other Sub-Projects
• Unbundling the department into two independent
  Departments of Health and of Social development.
• Validation of the staff establishment of both
  departments consisting of 28 091 active posts
  loaded in Persal.
• Development of new delegations commensurate with
  the new organogram
• Review and development of Social Services SDIP.

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Scope of Work (2)

• Development of organograms
• Service delivery model/ design model
• Functional structure
• Establishment validation
• Benchmarking (organograms and post norms)
• Establishment development
• JE
• Prioritization/multi year implementation plan
• Costing
• Delegations
• Validation
• Organogram count/Persal count/Head count
• Correcting Persal
• Managing cost overruns/ out of adjustments

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Support Approach and Methodology

• The support approach was project based and
  extensively consultative.
• The consultative process took the form of
  workshops, meetings with components and
  one-on-one interviews where necessary.
• The overall project accountability and
  responsibility remained with the Department.
  Officials from the two Departments played a
  leading role as content specialists.
• The dpsa provided technical advice and assistance
  on site, as well as the facilitation of planning,
  programme management and in social Development,
  programme roll-out.
• Health initially opted for a different approach,
  and led the facilitating and review processes
  itself. This approach did not yield expected
  results, and the Branch was advised by EXCO to
  adapt to the Social Development approach, where
  the dpsa team lead and provided technical advice
  on the organisational review, redesign and
  development process.

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Programme Governance (1)

• Project Team The Dpsa team designed the overall
  engagement programme and managed it.
• Departmental Operational (Management) meetings
  provided a platform for managers active
  involvement in the projects. Line Managers were
  responsible for the functional content.
• The Office of the Premier was engaged with
  specific projects such as Job Evaluation (JE) and
  also provided on-going technical support.
• Technical Task Team appointed by the MEC to
  ensure that all role players prioritize the
  project appropriately and fully co-operate in the
  finalization of the project.
• Fortnightly progress reports were provided to the
  Technical Task Team to track progress and to
  provide inputs of a technical nature.
• Political Task Team appointed by the Premier to
  provide project governance (3 MECs).
• The role of the Political Task Team provided a
  basis for accelerated implementation and
  monitoring.
• Fortnightly progress reports were provided to the
  Political Task Team for inputs regarding
  strategic/political interface issues and decision
  making on the way forward.

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Overall findings (1)

• The organisational structure was last reviewed in
  2003, and therefore outdated.
• Was not aligned to the strategic plan, priorities
  of the department, the budget structure, or the
  delegations.
• The strengthening of the management core of the
  Department was inhibited (ceiling of DDG for
  Health Branch).
• The previous structure was characterized by
  duplications and it still included
  institutions/offices transferred to provinces
  such as Gauteng. Still contained SASSA functions.
• Necessary for the integration of the Bushbuck
  ridge Sub-District and 5 Social Development and
  23 Health service delivery points which were
  operating outside the formal structure
  (transferred from Limpopo 3 years before).
• Professional post provision markedly under
  national averages

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Overall findings (2)

• Health was recruiting approximately 4000 staff
  with a compensation budget of R2.1 billion. This
  was enough to pay for 14 000 staff, while they
  already had more than 17 000 warm bodies on the
  payroll. Even without further recruitment, they
  would have faced a cost overrun of between R200
  million and R300 million.
• Health had 10 501 posts filled out of adjustment
  out of 16 142 filled posts (Of these,
  approximately 7 000 could be attributed to the
  OSD for Nurses). This also contributed to high
  compensation cost
• Social Development had only 16 out of adjustment
  staff, out of 1191 warm bodies.
• The appointment of sessional doctors, as
  permanent employees, skewed Human Resource
  information, as more than one sessional
  appointment could be appointed against one post,
  depending on the number of sessions worked by the
  incumbents.
• It was discovered that there were a growing
  number of support staff working overtime
  permanently. This also exacerbated the
  overspending in the department.

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Milestones achieved

• Department split into independent Dept of Health
  and of Social Development.
• Post establishments validated and cost overruns
  averted
• New service delivery model focused on
  decentralized delivery developed.
• Organization and establishments developed
  (Benchmarked with similar departments, aligned
  with strategic plans, service delivery model and
  professional post provision closer to national
  averages).
• Multi-year implementation plan developed and
  costed.
• New HR delegations aligned to service delivery
  model and organizational structure developed
• SDIPs developed.

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Impact

• Systems and Service delivery readiness improved
  as a result of
• Strengthened capacity in identified priority
  areas and programmes (PHC, finance etc.)
• Alignment between strategic priorities and
  service delivery infrastructure
• All informal changes to the organogram since 2003
  has been included in the proposed organogram.
• The establishment is now validated and aligned to
  Persal
• Financial management strengthened, especially at
  district and coal face level.
• Alignment between Budget Structure and service
  delivery infrastructure
• Sdips focused on improving priority services
• First organograms for the institutions Social and
  PHCs
• The organizational structure created alignment
  between the roles of the Provincial Office, the
  Districts and the coal face
• The structure strengthened good governance in the
  department and therefore facilitates
  accountability by the departmental top management
  (improved planning, ME and reporting).
• Delegations enforced decentralized
  decision-making and responsiveness to clients at
  the coal face.

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Lessons learnt (1)

• External Support Approach
• Provided objectivity to the process. It avoids
  what is it in for me, and places the focus on
  what would work best for the department.
• Provides technical expertise not located I the
  Department (JE, OD, SDM, Delegations)
• Working Culture and values
• The planning and implementation phases of the
  programme were characterized by lack of
  cooperation and commitment by the dept officials.
• The dpsa team was seen as an obstacle in
  resolving departmental challenges rather than a
  partner in the whole process.
• The involvement of then Social Services Deputy
  Director General and the Political and Technical
  Task Teams led to a maturing relationship between
  stakeholders. The commitment and the passion of
  the MEC also played a vital role in facilitated
  decision making processes and accelerated
  implementation of the project.

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Lessons learnt (2)

• Governance arrangements
• The model of effective Political and Technical
  Task Teams ensured the successful implementation
  of the project (Better model than Steering
  Committee proposed by dpsa).
• The model yielded results, as the commitment of
  leadership in any project is vital in achieving
  project goals.
• The Political Task Team provided a basis for
  performance and monitoring of progress and
  quality of deliverables immediate decisions at
  fortnightly meetings.
• This structure also made senior managers more
  responsible and accountable for the results of
  the programme.
• Communication and active Participation
• The programme design process made use of focus
  group sessions and workshops, which ensured
  active participation of officials at different
  levels at Provincial Office, Districts,
  Sub-Districts and service delivery points level.
• This enabled the opinions and reactions of staff
  to play a meaningful role in information
  exchange. The involvement of the Technical Task
  Team and Management meetings provided ownership
  of the programme by the department.
• An effective communication strategy should be put
  in place at the planning phase, which was not the
  case in this project.

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Lessons learnt (3)

• Support Vs Advice
• The composition of the project team must provide
  for strong representation of departmental
  officials, who can make decisions.
• The project manager should be an official from
  the department to ensure that the dpsa team plays
  an advisory and support role rather than taking
  over the project. This is important for
  ownership.
• The advantage of the on-site approach is the
  ability of the team to establish trust and a
  working relationship with stakeholder, which
  contributed to the success of this project. It
  also provides for independent and objective
  external views.
• The disadvantage is that the approach is costly
  in terms of accommodation and travel.
• External role players also take longer to
  familiarize themselves with the working culture,
  legislative mandates, programme priorities and
  environment.

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Lessons learnt (4)

• Scope and Time-frames
• The initial time-frames set (3 months) for the
  implementation phase grossly underestimated the
  scope of the programme. This might be because the
  diagnostic process was conducted by a different
  team which did not make use of a standardized
  diagnostic tool.
• The initial time-frames did not take into
  consideration that the then department comprised
  of two line Branches, as well as the complexity
  of both functions.
• The initial time-frames did not also take into
  consideration that the focus was not only on the
  provincial office, but also on the district and
  sub-district offices and service delivery
  institutions/service points.
• These is also a trend to plan too conservatively.
• In order to break down resistance by certain top
  managers, the team had to allow for an acceptable
  minimum level of scope creep. If not managed
  well, this can lead to extensive cost overruns.
• Some of the additional requests had strengthened
  the implementation of the project. For, example
  the splitting of the department into two
  independent departments was not part of the
  original scope of the project, but came as an
  additional request which contributed to the
  quality of the deliverable.

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Lessons learnt (5)

• Cost-sharing Model
• Although the dpsa does not charge departments for
  the advisory/support/consultancy services, the
  two departments agreed to share the costs, as the
  adopted assistance approach required the team to
  remain on-site.
• It required that the dpsa covers the subsistence
  and travel costs, and the DHSS was responsible
  for accommodation costs.
• The model ensured a high level of commitment by
  both the dpsa and the DHSS more departmental
  resources working on the project ensured better
  time management and buy-in for the project
  outcomes.

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Lessons learnt (6)

• Validation of the Staff Establishment Information
• Transpired to be critical process to ensure the
  alignment of the organisational structure to
  PERSAL and to determine actual compensation
  costs.
• Although it was a time consuming process, the
  exercise identified discrepancies and also
  assisted in abolishing unfunded posts on the
  structure.
• The findings of the validation process provided a
  reliable foundation of baseline information that
  was utilized to develop the proposed
  establishment and to finalize the costing and
  development of the Multi-year implementation
  Plan.
• It provided some indication that the information
  that has been provided by departments on the
  number of posts and vacant posts might be
  unreliable as it became clear that it included
  unfunded posts. Do we really know what the true
  size of the Public Service is?
• The poor quality of this information and the fact
  that this Department (still) has a high number of
  staff employed out of adjustment, played a role
  in the Dept of Health almost overspending on its
  compensation budget.

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Lessons learnt (7)

• Delegation of Authority
• It is necessary for the departments to develop or
  review Human Resource and Financial Delegation of
  Authority after the organisational review or
  re-organization processes to ensure proper
  alignment with the service delivery model.
• The practice is in-line with good management
  practice, as it ensures effective decentralized
  decision making to relevant levels in the
  Department.
• The development of the Delegation of Authority
  also provided support to the emerging service
  delivery and design model. A decentralized design
  model is ineffective if it is not supported by
  decentralized decision making.

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Lessons learnt (8)

• Development of post establishment
• The national Department of Social Development has
  set a norm for the allocation of posts of Social
  Worker in terms of a ratio of 1 Social Worker for
  every 3000 of the population (1 3000).
• It emerged that this would provided a staffing
  establishment that might not have effectively
  responded to direct service delivery challenges.
  A sweeping norm based on Social Worker per number
  of population does not take into account that
  certain areas may have a larger percentage of
  needy citizens requiring Social Worker support,
  and this might disadvantage the needy
  areas/population. Implementation of the norm is
  expensive.
• The provision of Social Workers should be based
  on their case load per area rather than the norm
  based on the population figures.

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Lessons learnt (9)

• Development of post establishment
• No formal norms exist to determine post provision
  norms for health professionals, but the NDH
  considers the development of norms as a future
  priority area.
• Difficult to distinguish between whish list and
  objective need, therefore a comparison with the
  national averages of post provision for health
  professionals in the public service was made.
  Except for dentists, Mpu establishment was much
  below the national averages
• This was still not a concrete guideline as it
  only compared the post provision in Mpu against
  the averages as a baseline
• Norm based on caseload/bed occupancy needed.

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Recommendations

• Development of a framework on the implementation
  of institutional support programmes. This
  framework should be aimed at assisting the
  departments in approaching, planning,
  implementing and ensuring the sustainability of
  the support programmes.
• Development of a framework for organizational
  capacity assessment to accurately diagnose
  departmental service delivery readiness
• dpsa to prioritize its functional analysis
  function to ensure the alignment of health
  cluster functions to the changing priorities and
  programmes of government.
• The design and development of generic
  structures to guide departments in terms of the
  aligned configurations when reviewing
  organisational structures.
• The development of post provision norms.
• The development of a generic system for
  delegation of authority.
• HR and Internal Audit to continuously monitor the
  validity of staff establishment information of
  their departments.
• The dpsa to verify whether the information
  provided and reported on vacancy rate does not
  include unfunded posts as this could provide an
  incorrect picture with regard to the number of
  posts and vacancies in the public service.
• Provinces that have centralized organisational
  development (work study) functions should afford
  large departments such as Health and Education an
  opportunity to provide human capacity for OD
  functions.

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Where are we now?

• Development of a framework on the implementation
  of institutional support programmes on
  operational plan deferred until NMOS is
  completed.
• Development of a framework for organizational
  capacity assessment to accurately diagnose
  departmental service delivery readiness well
  advanced- piloting expected in 2010
• Project for the design and development of
  generic structures for health and social
  development departments well advanced
  implementation expected with effect from 2010
  financial year.
• Post provision norms for HR developed as part of
  NMOS only broad average ratio of HR/ line staff
  for different classes of departments at this
  stage.
• Generic system for delegation of authority
  developed and presented to Cabinet.
• The dpsa ME Unit now verifying establishment
  information through Vulindlela to ensure that
  vacancy information is not contaminated with
  unfunded posts huge task.

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Ke a leboga