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case Management and Community Empowerment
Tembisa tertiary Hospital

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Problems encountered before the implementation of the initiative The hospital’s Department of Revenue and Budget Administration was faced with a huge over-expenditure on voted budget which necessitated a mind shift towards and more aggressive and strategic approach to generate revenue in Public hospitals. Audit findings with regard to revenue and receivables. The current revenue management practices then did not meet compliance expectations and these were challenges in areas of Patients registration, administration, ICT systems, Billing Procedures and systems that ultimately compromise the effectiveness and efficiency with which revenue-related operation is executed. The audit findings were as follows: • Knowledge deficit : Relating to classification, processes and procedures of patients enrolled on medical aid after funds have been depleted or exhausted from the Private Sector/clinics patients are then transferred to the Public hospital and classified as HI or H2 (paying R45 per month)instead of being classified as Private medical aid patients and be charged as per Uniform Patient Fee Schedule tariffs and according to level of care that means: ICU-Intensive care unit-patients are charged R3060 for every twelve hours,Highcare-R1232 every twelve hours and General ward –R851 per day Incorrect capturing of pertinent data and ICD 10 Coding on the PAAB system especially patient enrolled on medical aid led to rejection of claims or stale accounts submitted for settlement to the Fund • Incorrect patient classification, capturing of patients pertinent data including private foreigners without proper documentation led to depletion of financial resources. • Immigrants were classified according to South Africans to mean test even when they did not fall under SADEC (South African Developing Countries) as such more revenue was lost. • Foreigners move from one place to another/ or province to province even to informal settlement without proper address and made tracing impossible ,thus debt cannot be settled, the outcome write-offs • Extended average length of hospital stay led to depletion of financial resources, cost and predisposed patients to nosocomial infections which impacted negatively on patient’s condition for example: Chronically ill patients (Senior Citizens) not on proactive treatment diagnosed as having stroke with speech impairment need Speech Therapist to restore normal speech In-coordination of joints and muscles need Physiotherapist and Occupational Therapist to restore the normal function of joints and muscle tone and terminally ill patients diagnosed as having cancer ,these patients need not be admitted to Tertiary hospital but may be referred to Non-Governmental Organizations for example: Home based care centres, Rehabilitation, Palliative or /Hospice centres which are 24/7 with doctor and nurses on duty for constant nursing interventions like observations, position changing to avoid bedsores, feeding and daily full wash and when necessary. The escalation of health care costs demands that health care providers develop processes at minimizing health financial risks. Gauteng Department of Health in line with the National Department of Health established case management services at public hospitals to facilitate, communication and coordination of services between the service provider, the patient and funders to promote quality, safe and cost effective health outcomes for the individual patient

B. Strategic Approach

 2. What was the solution?
This is a National project based at Gauteng Province initiated by the Department of Revenue and Budget Administration under the Department of Health The escalation of health care costs demands that health care providers develop processes at minimizing health financial risks. • Gauteng Department of Health in line with the National Department of Health established case management services at public hospitals to facilitate, communication and coordination of services between the service provider, the patient and funders to promote quality, safe and cost effective health outcomes for the individual patient. • Guidelines have been developed in line with National Core Standards for Health Establishment in South Africa,Domain3: Clinical Efficiency Management Systems ensure patients receive adequate, safe, quality health care by meeting the following: • To facilitate efficient, quality care • To determine whether the ongoing services are reasonable, medically necessary, and covered by the benefits • To provide a mechanism to continuously review the delivery process • To ensure financial risks for payment of care are managed so as to ensure patients are protected from unnecessary additional healthcare cost (see updates as evidenced and outcome)domain3: 3.7.1.1.4 • To reduce non-compliance to treatment and thus reduce re-admissions to hospital and health complications • Billing and case management systems ensure patients are not under/over charged can access benefits Strategy Implementation 2.1 PULL AND PUSH STRATEGY • Aggressively promoting the concept of Case Management, PMB (Prescribed Minimum Benefit) and building a reputation with customers. • (Administration and ward clerks, nursing staff, Executive Management and the CEO as the accounting Officer to buy-in and promote the new innovation and add value to the organization 2.2 TOOLS USED • Uniform Patient Fee Schedule • Prescribed Minimum Benefit • Training and development of staff • Mentoring and one-on-one interviews 2.3 Target Audience The second main aim is to generate revenue but we have to control cost by minimizing the average length of hospital stay hence we came up with innovative ideas to create an awareness in Community Empowerment Community Empowerment Chronically ill patients for example: senior citizens affected by stroke are referred to rehabilitation centres that housed three allied expertise under one roof with one practice number to avoid patients being tossed to and fro and fragmentation of services the family/patients are interviewed by case manager ,doctors and operational managers of the unit, family/patient should acknowledge that the patient is in need of specialized alternative care in lieu of hospitalization then sign consent, doctors assess the patient, complete in the assessment form and transfer the patient to the specific facility for continuation of care. For example: Kensington Rehab centre it is one facility with excellent patients outcomes such as • Reduce cyclical patterns of short-term/long -term readmission of chronically ill patients to acute facility thus: • Reduce average hospital stay See community empowerment attendee register, assessment forms, compliment letters eckler,mpela,hod attached 2.4 Goal of health talk/education To identify patients needs in line with The Six National Core Standards and establish Restorative/ Rehabilitative Nursing To identify nursing interventions that promote: • Patients ability to adapt • Attain maximum functional independence • Adjust to living as independently and safety as possible (c)To reduce cyclical patterns of short-term readmission to acute facility On-going training and development of staff on ICD10 coding, incorrect capturing of pertinent data, incorrect patients classification resulted in reduced claim rejections based on ICD 10 coding, and stale accounts (See Medikredit training attendee register) • Perception and staff attitude modified • One-on-one interview done for attitudes adjustment • Embarked on employee/customer survey to identify the perception and how patients and staff relates to case managers, nursing staff and administration (See attached video, teaching aids and attendee register) 2.5 REVENUE COST DRIVERS Initiative was to identify systems which will augment and generate revenue (These are externally funded patients) these patients are charged as private patients but at low premium using Uniform Patient Fee Schedule Tariffs rates guides. South African Police –prisoners waiting must be accompanied by a Police with Authorisation form SP70 Private Correctional Services –prisoners serving time must be accompanied by a Prison Warder with Authorisation form G111 Road Accident Fund-patients involved in Motor Vehicle Accident Private Medical Aid patients-patients enrolled /ensured on medical aid and those whose funds are exhausted or depleted from private clinics are then transferred to public hospitals and classified as private patients. The private sector /Fund cannot access the Prescribed Minimum Benefit funds which are paid from the pool but only by the Public Sector. The process is to contact the Fund/Medical aid company • Enquire if the member is active /or Availability of funds and ask for Authorisation number then charge per UPFS
 3. How did the initiative solve the problem and improve people’s lives?
Case Management is a new, unique concept in the Public sector and sustainable. Tembisa Hospital was identified as the best organization for Benchmarking in Gauteng Province also cross border hospitals e.g. Limpopo Province • Replicability was made possible by means of Benchmarking for case management with hospitals under Gauteng Province. They have since reported that revenue collection is steadily increasing. • Case managers are able according to Medical Scheme Act No.131 of 1998 to protect and mitigate against unnecessary cost being imposed on patients. • Members benefits from Prescribed Minimum Benefits- 270 Diagnosis and treatment pairs ‘Best Practice claims must be paid from the risk pool and Scheme must pay in full. • Appeal - Ex gratia application an additional financial benefit that members can apply when experiencing financial difficulty as a result of his/her health risk. Feedback report from National Core Standards Assessment M16 in regards efficiency and application of National Core Standards, Functional Risk Area scored 85.71% 2013, 2014-100% • Embarked on employee/customer survey to identify case managers attitudes on staff and customers • Enhanced the skill in generation of revenue in Public Sector Revenue target set for Tembisa hospital 2013/2014: R18, 000,000 Revenue collected: R19, 159,000.84

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
2014/2015 Activity Action Plan Comments on progress Success measure Start date Completion date Responsible person Case management authorization. Address late disclosure or reluctant to disclose if on medical aid. Incorrect classification of patients by administration clerks. Incorrect ICDI10 coding Stale accounts leading to rejections Ensure that admission clerks probe questions for patients to disclose if on medical aid. Training and development of staff, in-service training of Administration clerks and on orientation of new staff. Monitor pending cases for classification ,train ,mentor Mentor staff on ICD 10 coding Emphasize accountability on inappropriate coding Assist as Mentor for hospitals coming for benchmarking Attend regular operational meetings with Medikredit on operational issues initiate and contributes to case management processes to Improve skill performance in ICD 10 coding Formulates protocols to protect patients from financial risks and cost being imposed on them -Administration clerks to probe questions. -Orientation of new staff led to steady rise authorizations on admission. Improved skill performance in classification ,monitor and auditing files and teach ICD 10 coding in-service Lectures done and ongoing -Staff uphold ,adhere and are compliant to the principles of ICD 10 codes uphold to reduce rejections -Operational processes are in place where Claims /Invoices are extracted weekly by Medikredit incorrect ICD10 codes or item codes are identified corrected prior being sent to Funder. . Reduced frequency of rejected claims Reduced number of non-disclosures Increase in Revenue Reduced frequency of stale claims Reduced rejected claims based on ICD 10 code by 99.99% Reduce write-offs of hospital debts Developed a reputation of reduced rejected claims Protocols are in place to address shortcomings of financial risks and prevent patients from unnecessary cost being imposed on the patients. 01/01/2014 01/01/2014 01/03/2015 01/03/2015 M.Makwela Ward clerks /staff/case managers MMakwela Case manager Clinical efficiency and management, Communication and advocacy. Clinical efficiency management systems ensure patients receive timely, adequate, safe, quality health care Record keeping of update progress report There is evidence of adequate Case Management record keeping. Updates and feedback from funders. Case managers receive appropriate formal training and in-service updates in efficiency management topics -A process is in place to manage financial risks for payment of care and to protect patients from unnecessary costs. Positive member feedback /from the funders -Satisfied customers / Funders and employees -Evidence of course attended by case manager to reduce claim rejections -Reduce frequency stale accounts -Increase in revenue - Increase in Revenue -Reduced claims rejections -No stale accounts or claims. 01/01/2014 01/03/2015 M.Makwela Clinical efficiency and management, Communication and advocacy. Clinical efficiency management systems ensure patients receive timely, adequate, safe, quality health care Record keeping of update progress report There is evidence of adequate Case Management record keeping. Updates and feedback from funders. Case managers receive appropriate formal training and in-service updates in efficiency management topics -Protocol in place to protect patients from unnecessary cost Positive member feedback /from the funders -Satisfied customers / Funders and employees -Evidence of course attended by case manager to reduce claim rejections -Reduce frequency stale accounts -Increase in revenue - Increase in Revenue -Reduced claims rejections -No stale accounts or claims. 01/01/2014 01/03/2015 M.Makwela Client /patients satisfaction -Ensure that patients’ service is efficiency and professional. -Regular updates and reporting to Executive Management/Fund. -Advocate, communicate and facilitate processes to achieve positive outcomes for the patients and healthcare team. -Continuously review case management processes, work flow with a view to improve existing process Identify Gaps in the usage of charge sheet, billing and schedule training and development for staff to close in skill gap -Positive member feedback/ communication -Positive outcome in meeting program Patient excellent outcome 01/01/2014 01/03/2015 M.Makwela
 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The project was initiated by the Department of Revenue and Budget Administration originated in partnership with Case Management Society of America which is an international, non-profit organization established in 1990, affiliates to Case Management in South Africa which was launched in 2009, aspires to become nationally recognized as the representative body of Case Managers in South Africa. The provided us with Standards of case management Practice and Process Steps The Department of Health with Department of Revenue and Budget Administration introduced case management in the Public Sector. At Tembisa hospital Case Manager Margaret Makwela contributed to the design of Charge sheet, Update progress report and Daily processes, workflow processes as it differs much with private sector. Central Office staff management Benchmarked with Tembisa Hospital. Mrs. Zambelis Irene Facilitator for Government Case Managers contributed to the training of case managers on health risk management and policies relating to Medical Scheme Act 138 of 1999 Case Management Association in South Africa contributed to the training of case managers too Carol Garner the Director of MSO. Staff paid for the training and passed awarded certificate in short course of case management Implementation was carried out by individual hospitals in Gauteng Province same as Tembisa Tertiary hospital
 6. How was the strategy implemented and what resources were mobilized?
Executive Management together with Human Resources offered a spacious office and bought the following: Computer with CPU AND KEY BOARD Fax, Copier, Scanner and printer connected to our main server and Gauteng Province ICT main frame, BAS-Basic Accounting System .These connections make our work user friendly Tembisa Financial Department had laid down infra structure long time ago to fit the organization namely: Billing department, Tracing, Budget and Revenue .So, and Case Management unit came in as a new unique department but not that big enough to accommodate three people. Registered Nurse, Enrolled and Administration clerk At present post have been advertised for the unit case management unit to run the department efficiently staff is needed The project was funded by the Financial Department /Revenue and Budget Administration from Central Office under the Department of Health
 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Benchmarking: Central, Provincial and District hospitals, Benchmarked with Tembisa Tertiary hospital have acquired case management principles, standards and thus enhanced the skills, efficiency, coordination and communication skills in the Public sector These are the names of Gauteng Province that Benchmarked with Tembisa Chris Hani Baragwanath Hospital were assessed by National core standards and obtained 98% after benchmarking George Mkhari Academic hospital Natalspruit hospital Charlotte Maxeke Johannesburg hospital Pholosong hospital Bertha Qhowa hospital Leratong hospital Odi hospital Brits hospital Cross border hospital from Limpopo Province that is St.Ritas hospital The above mentioned hospital have since reported to be doing well • Community Empowerment minimized recurrence readmissions of chronically ill patients Our case managers will locate resources in the community and may point other organizations that will be able to provide key services once patients are discharged home or might want to visit. Advantages: • Adjust to living as independently and safety as possible • Attain maximum functional independence • Reduce cyclical patterns of short-term readmission to acute facility Evidence: A transfer to the most appropriate health care setting/provider • Perception and staff attitude modified • Provide an on-going in-service training on UPFS,CHARGE SHEET,ICD10 CODE and health education: • reduced rejected claims based on ICD 10 coding by 99.99% • reduced incorrect capturing of pertinent date • Reduced stale accounts • Increase generation of revenue • Increase generation of revenue Target set for Tembisa Tertiary Hospital for 2013/2014- R18, 000,000 Revenue collected prior the end of March 2014 financial year: R19, 200,000 Over collected by R1, 200,000 which was beyond our expectation • Tembisa Hospital was nominated as the best hospital efficient in implementation of case management and National Core Standards • Performance and Case management quality excellent implementation : Obtained 85.71% in 2013 for efficiency and excellent customer care Obtained 100% in 2014 for efficiency and excellent customer care We worked tirelessly in order to achieve the desired goals for Tembisa Hospital without any doubt • Compliments letters from Case Management Association in South Africa • Central Office Head of Department-acknowledgement letter • United States of America (Case Management Association of America
 8. What were the most successful outputs and why was the initiative effective?
• Marketing strategy :Strategy Implementation-Pull and Push Strategy as a long term • UPFS training. ICD 10 Coding. • Investing in ongoing training and development for patient excellent outcome • Mentoring and one –on-one interview • Knowledge and experience and application of policies, laws, standards, protocols and Memo circulars needed in order to manage the department. for e.g.: Constitution of South Africa Chapter2(Bill of rights),Minimum Information Security Standard, Medscheme Act 133 of 1998,National Health Act 61 of 2003, Nursing Act 2005(Act no. 33 of 2005),R2598,R387,R373,Code of conduct of Public servants. • Monitor and give Health education on compliance to treatment reduced many complications and minimized hospital re-admissions • Evaluate the outcome of Quality Assurance Committee meetings • Monitor the accurate auditing of records, problems identified note that quality improvement plan is written and recorded daily stats, weekly and monthly statistics gaps identified are closed almost immediately • Monitor if ward rounds are being taken daily to identify gaps and patients needs to address non-disclosure • Private Public Partnership –Medikredit/GEMS consulted for in-service lecture for Tembisa Administration clerks /Case Managers to enhance the skill on capturing of pertinent data • Attend seminars, workshops and conferences to enhance the skill in case management • Participate in monthly Quality Assurance Committee meetings to identify service delivery gaps • Auditing of records problems identified write quality improvement plan • Community work based project should be on-going
 9. What were the main obstacles encountered and how were they overcome?
Computer literacy: The majorities on nursing staff are not computer literate and a need for training by Information and Technology expertise needed to close in gap. Outcome staff were trained on computer and mastered the skill in typing and spelling • Shortage of resources for example: individual computers in each department for nursing staff and ward clerk-more computer have been motivated for the 2015/2016 financial budget • Overcrowding and non traceable of foreigners Tembisa community has grown up to Midrand/ Diepsloot. Daily consultations at Out-patient =2000 and average admissions per day 700.The community and foreigners sabotage the referral system and patients cannot be turned back to the clinics once inside the hospital. • Community Empowerment -Reduced average length of hospital stay of chronically ill patients from 27.8 days to 10 days(HIV/AIDS/TB) thus saved cost per patient Budget and Administration from Central Office have now introduced new technology to identify all patients coming to hospitals .These system is able to identify even foreigner since it linked to Home Affairs Data Base. • Perception and staff attitude were the main obstacle due to resistant to change but now are modified through ongoing training on the Six National Priorities modified-improving values and attitude of staff managers and patients • Non-disclosure: Value for money-Members enrolled on medical aid are reluctant to produce their cards since they claim public sector wards are not being clean, food not appetizing and no linen. Community need to provide blankets for their loved ones in hospital. • Less frequent admissions of chronically ill patients to hospital. • Measuring effectiveness based on changes in awareness after campaigning for PMB and Case Management and Community Empowerment showed positive impact: • Case management project created a competitive edge amongst staff to enter into different awards competitions to improve quality performance.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
• Preferences: There is a Paradigm shift, Customers / patients enrolled on medical aid are now consulting at Tembisa Hospital outpatient and had become the “thee” Designated Service Provider (DSP) for those that had been diagnosed as having chronic diseases. Pharmacy department opens up at 06h30, and patients are able to consult at Family medicine outpatient which is 24/7, get treatment and still manage to go to work in time. for e.g. Transmed Medical Aid –invoices to be sent to Prime cure, and Bank med to be referred to Care cross • Developed a reputation for reduced rejected claims by almost 99.99% and some months no rejections at all as per report from Medikredit • Provide an on-going in-service training on UPFS,CHARGE SHEET,ICD10 CODE and health education: • reduced rejected claims based on ICD 10 coding • reduced incorrect capturing of pertinent date • Reduced stale accounts • Enhanced the skill in generation or augment revenue in Public Sector and emphasis on Performance Financial Management Administration Revenue target set for Tembisa hospital 2013/2014: R18, 000,000 Revenue collected by the end of 31March 2014 financial year: R19, 159,000.84 Over collected by R1, 200,000 which was beyond our expectation (See revenue retrieved from Basic Accounting System (BAS) • Perception and staff attitude modified • Case management excellence implementation phase with progressive constant rewards: Creating awareness for case management for staff to buy in and thus excellent patients outcomes. Increase generation of revenue • Case management project created a competitive edge amongst staff to enter into different awards competitions to improve quality performance and raised a bar in the standard of nursing care Won the following awards by demonstrating the application of case management standards, nursing interventions, protocols and Batho- Pele Principles, National Core Standards-Six National priorities in case study x2 namely: • CMASA NATIONAL Awards at Cape Town 15th May 2013 (case study) • CMASA NATIONAL Awards at Indaba Hotel 18th April 2012 (case study) • Khanyisa Awards the best in Case Management July 2012 • Dinaledi Service Excellence Awards 2013-Face of Government and Best National Core Standards in Case Management • Khanyisa Awards won first prize in National Core standards 2014 • Central Public Service Innovation Award-First Prize 31 /10/2014 won a gold/silver plated trophy and a R10,000 FROM SPONSOR DATA CENTRICS • Community Empowerment -Reduced average length of hospital stay of chronically ill patients from 27.8 days to 10 days(HIV/AIDS/TB) thus saved cost per patient • Case Managers identify patients needs and refer patients to the appropriate facility for the right reasons. • Less frequent admissions of chronically ill patients to hospital. • Administration department- admission, ward clerks and nursing staff are now knowledgeable classify patients according to procedure manuals and probe questions prior classifying the patients in out-patients. • Executive and Management constantly communicate information, visibility and at every level on progress and actual performance to support and sustain the system • Performance and Case management quality excellent implementation : Obtained 85.71% in 2013 for efficiency and excellent customer care Obtained 100% in 2014 for efficiency and excellent customer care We worked tirelessly in order to achieve the desired goals for Tembisa Hospital without any doubt
 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
• Increase generation of revenue Target set for Tembisa Tertiary Hospital for 2013/2014- R18, 000,000 Revenue collected prior the end of March 2014 financial year: R19, 200,000 Over collected by R1, 200,000 which was beyond our expectation • Tembisa Hospital was nominated as the best hospital efficient in implementation of case management and National Core Standards • Benchmarking: Central, Provincial and District hospitals, Benchmarked with Tembisa Tertiary hospital have acquired case management principles, standards and thus enhanced the skills, efficiency, coordination and communication skills in the Public sector • Perception and staff attitude modified • Provide an on-going in-service training on UPFS,CHARGE SHEET,ICD10 CODE and health education: • reduced rejected claims based on ICD 10 coding • reduced incorrect capturing of pertinent date • Reduced stale accounts • Community Empowerment minimized recurrence readmissions of chronically ill patients Our case managers will locate resources in the community and may point other organizations that will be able to provide key services once patients are discharged home or might want to visit. Advantages: • Adjust to living as independently and safety as possible • Attain maximum functional independence • Reduce cyclical patterns of short-term readmission to acute facility Evidence: A transfer to the most appropriate health care setting/provider • Create Awareness of the concept of Case Management • Marketing strategy :Strategy Implementation-Pull and Push Strategy as a long term • UPFS training. ICD 10 Coding sustainable through training and development to enhance the skill for the staff members. • Investing in ongoing training and development for patient excellent outcome • Mentoring and one –on-one interview • Knowledge and experience and application of policies, laws, standards, protocols and Memo circulars needed in order to manage the department. for e.g.: Constitution of South Africa Chapter2(Bill of rights),Minimum Information Security Standard, Medscheme Act 133 of 1998,National Health Act 61 of 2003, Nursing Act 2005(Act no. 33 of 2005),R2598,R387,R373,Code of conduct of Public servants. • Monitor and give Health education on compliance to treatment reduced many complications and minimized hospital re-admissions • Evaluate the outcome of Quality Assurance Committee meetings • Monitor the accurate auditing of records, problems identified note that quality improvement plan is written and recorded • Monitor if ward rounds are being taken daily to identify gaps and patients needs to address non-disclosure • Private Public Partnership –Medikredit/GEMS consulted for in-service lecture for Tembisa Administration clerks /Case Managers to enhance the skill on capturing of pertinent data • Attend seminars, workshops and conferences to enhance the skill in case management • Participate in monthly Quality Assurance Committee meetings to identify service delivery gaps • Auditing of records problems identified write quality improvement plan • Community work based project should be on-going • Performance and Case management quality excellent implementation : Obtained 85.71% in 2013 for efficiency and excellent customer care Obtained 100% in 2014 for efficiency and excellent customer care We worked tirelessly in order to achieve the desired goals for Tembisa Hospital without any doubt
 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
We have to adapt to the new modern trends of doing things. Every one everywhere needs technology to be able to position our organisation in the competitive market and win the hearts if our customers We have to admit to customer service failure and act immediately Many services need to guide customers through safely through the service encounter and contribute to the Millennium Gauteng Strategy Customer is always right until proven wrong, Embark on qualitative and quantitative surveys research identifies service delivery gaps all the time Measure results in efficiency performances supported by quantifiable indicators and questionnaires. We have to strive to satisfy customer needs and wants for the value of money and add value to our organization. Collaborate ideas across spectrum thus create synergy and have strong Teams Recommendations Continuing Education -Training and development. Management should invest in knowledge in order to become a knowledge institution with excellent patients outcome Invest in Information Technology to position our institutions in the competitive markets

Contact Information

Institution Name:   Tembisa tertiary Hospital
Institution Type:   Government Agency  
Contact Person:   Makwela Margaret Makoma
Title:   Miss  
Telephone/ Fax:   +27119232321
Institution's / Project's Website:  
E-mail:   margaret.makwela@gauteng.gov.za  
Address:   Corner Flint and mazibuko Streets
Postal Code:   1665
City:   Olifantsfontein
State/Province:   Gauteng
Country:  

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