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An investigation into the cost, management and ways of improving the Thuthuzela System

Authors: Conrad Barberton and Adrian Grieve
Date: 2004-06-05

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This study was commissioned by The Bureau of Justice Assistance in 2004, prior to the handing over of the Thuthuzela Care Centres to the NDPP – the centres focus on handling cases of rape, and caring for and protecting victims through the reporting to prosecution process. The report makes recommendations outlining the next steps for implementation. Today, the Thuthuzela Care Centre project is considered an example of best practice.

The aim of this study was threefold: to cost the budgetary implications of one of the existing Thuthuzela Care Centres, and identify the roles to be played by the different departments and the costs incurred by them; to explore ways in which the Thuthuzela Care Centre concept might be improved; and to describe and cost a management system for establishing and managing multiple Centres. 

This in-depth study gives a fascinating look at the importance of obtaining the relevant buy-in, structural clarity, and clear definition of roles across departments, as well as of individuals providing support, and a clear mandate. The finding of the initial study was that success was hampered by a lack of coordination in service delivery, arguably down to the level of being able to define a clear purpose, universally understood. Standardised systems for data collection and management – including management of inventory, and financial management – as well as a systemic understanding of protocols and processes were found to be inadequate. Public awareness about the role and expected services of these centres was also found to be lacking, and the study encouraged the development of protocols for visitors to the centre, and a client charter to publicise the protocols. Other issues addressed by the study included a need to implement a training programme, ways of allocating scarce emergency personnel for maximum efficiency, and ways in which to expand the utilisation rates of centres, such as by serving a greater number of police stations or expanding the range of offences dealt with.

The costing exercise sought to define the budgetary cost of the value added elements of establishing and running one local unit of the Thuthuzela System (namely, a Thuthuzela Care Centre and associated components) and the management systems. Given the ideal systemic design, wherein each unit consists of a
Thuthuzela Care Centre and a Thuthuzela Prosecuting Unit, a costing tool was developed to analyse the proposed establishment of a centre and its associated management system. Similarly, the infrastructure costs, and other start-up costs, are considered. The expected Operational Costs are analysed. On the other side, the costing exercise considers factors relating to centre use, and information on case numbers; two scenarios are costed – the 350 scenario and the 1 000 scenario – in order to analyse the association between case load and staffing costs. Processing of cases is analysed, based on information around case through-put rates, as well as qualitative information with regards to how cases are being processed, such as service efficiency and quality of care.

The study explores the feasibility of offering a 24-hour service, and it finds that centres should remain open over weekends, with trained counsellors skilled to man centres present. Counselling and on-the-ground support systems are the stumbling block when trying to scale up public healthcare and education support services, so the most cost-effective ways of providing these services, at the required standards, were explored.

The component parts and management of the Thuthuzela System

 

The study opens a broader question of problematic cross-departmental coordination, challenges that arise regularly when a function overlaps two or more major areas of governance, sometimes with systemic differences that become highly complex to reconcile. The Thuthuzela Care Centre model has proved a great success, and is noted as an example of best practice. This is attributed, to the high quality of medical care and support provided through this system.