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Eastern Cape Department of Health Budget, 2005/06 Financial Year. Presented to the National Portfolio Committee of Health Cape Town, 5 April 2005 L. BOYA (MR.) SUPERINTENDENT GENERAL FOR HEALTH, EASTERN CAPE PROVINCE. INDEX. INDEX, continued. OVERVIEW. - PowerPoint PPT Presentation
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Eastern Cape Department of Health Budget, 2005/06
Financial YearPresented to the National Portfolio
Committee of Health Cape Town, 5 April 2005
L. BOYA (MR.) SUPERINTENDENT GENERAL FOR HEALTH, EASTERN CAPE PROVINCE
2
INDEXTopic PageOverviewPolicy mandatesMajor Health ChallengesKey focus areas for 2005/06 Financial YearBudget FiguresTrends in SpendingTrend by Economic ClassificationGrowth in nominal and real termsTransfersConditional Grants
45812161718192021
3
INDEX, continuedTopic PageExpenditure Amount Per CapitaProgram 1: Health AdministrationProgram 2: District Health ServicesProgram 3: Emergency Medical ServicesProgram 4: Provincial Health ServicesProgram 6: Health Sciences and TrainingProgram 7: Health Care SupportProgram 8: Health Facilities Development & MaintenanceConclusion
222325303336384144
4
OVERVIEW
• Continue to strengthen the provincial health system, in particular the district health system, improve the service delivery model to align with the above strategic objective.
• Strengthening of clinical governance and systems for community participation
• Emphasize on norms and standards in care, staffing, resourcing and funding
• Use of activity based budgeting• Provincial fiscal environment and its impact on
health services• Deepening and sharpening the turnaround
strategy.
5
POLICY MANDATES
• The Department derives its mandates and is informed by the following:- – the priorities identified by National Department of
Health, the Batho Pele principles, the Eastern Cape Provincial Strategic Plan, the Youth Development Programme and the Gender Programme.
– the Strategic Position Statement where affordability and sustainability guide the planning and implementation process
– SMT Programme of action adopted by the Department and the 2005/06 MEC’s Policy speech.
6
POLICY MANDATES (CONTINUED)
• The Strategic and Operational Plans are also aligned to the Eastern Cape Provincial Growth and Development Plan (PGDP) with the following specific deliverables:– halting, managing and improving health
outcomes for HIV/AIDS and TB by 2014.– reducing by ⅔ the under five infant and child
mortality rate by 2014.– reducing by ¾ maternal mortality rate in
2014.
7
POLICY MANDATES (CONTINUED)
– increasing infrastructure and human resources development
– strengthening research development initiatives in the Eastern Cape Province for better health services
– halting and beginning to reverse the spread of Tuberculosis
8
MAJOR HEALTH CHALLENGES
• In-equitable development and access of health services affecting mostly, the North Eastern part of the Eastern Cape Province:--in-equitable development is characterized by lack of infrastructure and
information technology in the Northern Eastern part of the Province,-lack of access, implies, long distances and poor transportation to
health facilities especially in the North Eastern part of the Province, -shortage and to some extent un-available drugs, medicine, equipment,
and human-resources is a major challenge in the Province,
• Poor quality of our health institutions.
9
MAJOR HEALTH CHALLENGES, continued
• Poor quality of health care.• Un-even and underdeveloped community
participation and partnerships • Improving compliance in all sectors of the Eastern
Cape Department of Health.• Improving communication within the Department.• Ensuring effectiveness and efficiency and
achievements of health outcomes through judicious employment of resources.
• Lack of long-term planning.• Underdeveloped information and monitoring and
evaluation systems.
10
MAJOR HEALTH CHALLENGES, continued
• Improving overall organisational performance management.
• Successful implementation of the Comprehensive Treatment Management and Care including ARV’s.
• Improving health outcomes especially in the four priority programmes.
• Re-aligning the service delivery model to the district health system approach.
11
MAJOR HEALTH CHALLENGES, continued
• Improving and strengthening the referral system• Improving emergency medical services and patient
transport• Improving safety in the health institutions.• Shortage of professional, managerial and technical skills• Still high vacancy rate in spite of continuous attempts to
fill posts• Lack of accommodation making it difficult to retain staff
in rural areas
12
KEY FOCUS AREAS / PRIORITIES FOR
2005/06 F/YIn addressing the above challenges, the
Department focus on the Following:-• Strengthening the service delivery platform
especially for PHC through determination and enforcement of minimum norms and standards, setting correct baselines, and benchmarking.
• Revitilisation of health institutions• Strengthening Quality Assurance Systems• Promote Partnerships and Public Participation
13
KEY FOCUS AREAS / PRIORITIES FOR 2005/06
F/Y,continued• Ensure compliance across all sectors
• Effective communication and branding of the department, institutions and programmes
• Improving and re-engineering business processes for long term sustainable quality health care delivery.
• Long range planning towards a quality public health system
• Strengthening information systems towards more effective monitoring and evaluation.
14
KEY FOCUS AREAS / PRIORITIES FOR 2005/06
F/Y• Improvement overall organizational
performance through intensification of Performance Management Development Systems (PMDS)
• Implementation and rollout of the Comprehensive Treatment Plan including ARV.
• Strengthening the maternal and child health programme
• Improve TB cure rate
15
KEY FOCUS AREAS / PRIORITIES FOR 2005/06
F/Y• Improving access to health care by
developing the district health system and the delivery of the PHC Package
• Addressing inequity in service provision throughout the province
• Improving emergency and patient transport system
• Improving capacity and access to regional and tertiary services in the province.
• Provide ongoing training and skills development for health workers
• Implement programmes for attraction and retention of essential human resource skills
16
Budget Trends
Budget 2003/04 2004/05 2005/06
R'000 R'000 R'000
Equitable Share 4,478,263 4,272,980 5,183,164
Conditional Grants 592,080 628,286 848,172
Other: Treasury Reserve 276,000
Own Revenue 41,543 44,000 56,455
5,111,886 5,221,266 6,087,791
Total Expenditure 5,243,012 5,172,977
-131,126 48,289
17
Trends in spending
Programme Audited 2001/02
Program %
Audited2002/03
Program %
Audited 2003/04
Program %
Budget2004/05
Program %
Budget2005/06
Program %
Health Administration 168,947 4.34% 191,694 4.92% 215,110 5.53% 286,582 7.36% 295,052 7.58%
District Health Services 2,124,752 54.59% 2,247,675 57.74% 2,518,346 64.70% 2,367,902 60.83% 2,794,563 71.79%
Emergency Medical Services 87,314 2.24% 128,464 3.30% 194,488 5.00% 151,389 3.89% 186,846 4.80%
Provincial Hospital Services 1,237,957 31.80% 1,531,892 39.36% 1,764,282 45.33% 1,795,285 46.12% 1,850,037 47.53%
Central Hospitals - - - - -
Health Sciences and Training 76,756 1.97% 96,124 2.47% 122,884 3.16% 137,393 3.53% 337,245 8.66%
Health Care Support Services 6,765 0.17% 9,168 0.24% 23,027 0.59% 16,607 0.43% 45,806 1.18%
Health Facilities Dev & Maint 189,962 4.88% 288,212 7.40% 404,875 10.40% 466,108 11.97% 578,242 14.86%
Special Functions - 13 - -
TOTAL 3,892,453 4,493,242 5,243,012 5,221,266 6,087,791
18
Trends by Economic Classification
Economic Classification 2001/02 2002/03 2003/04 2004/05 2005/06
R'000 R'000 R'000 R'000 R'000
Compensation of Employees 2,429,383 2,490,865 2,815,673 3,087,550 3,308,547
Goods and Services 942,248 1,048,669 1,225,405 1,137,148 1,608,486
Transfers and Subsidies to 502,179 690,056 735,594 551,985 651,089
Payments for Capital Assets 18,643 263,652 466,340 444,583 519,669
TOTAL 3,892,453 4,493,242 5,243,012 5,221,266 6,087,791
19
% Growth in nominal and real terms
GROWTH 2002/03 2003/04 2004/05 2005/06
% Increase year on year in nominal terms 15.43 16.69 (0.41) 16.60
Value of budget in Nominal Terms 4,493,242 5,243,012 5,221,266 6,087,791
% increase year on year in Real Terms2 8.29 6.76 (6.76) 11.79
Value of budget in Real Terms2 4,215,049 4,796,900 4,888,826 5,836,808
20
TRANSFERS 2005/06AGENCY R’000
Local Government 218,133
Provincially Aided Hospitals 86,608
Life Care 49,860
Nutrition 26,316
NGO’s for AIDS 75,813
SANTA’s 66,793
HPTD Grant 127,566
TOTAL 651,089
21
CONDITIONAL GRANTS 2005/06
Conditional Grants
2004/05 R’000
2005/06R’000
% Increase (Decreas
e)
National tertiary services 272,036 353,022 29.77
Health Profession’s training & research 97,464 127,566 30.88
HIV/AIDS 98,970 159,005 60.65
Hospital revitalization 116,354 157,732 35.56
Integrated Nutrition Programme 23,933 26,313 9.94
Hospital Management Improvement 19,529 24,531 25.61
Total 628,286 848,172 34.99
22Source IGFR, 2004 National Treasury
EXPENDITURE AMOUNT PER CAPITA
23
PRG 1: ADMINISTRATIONProgram 1: Administration
2004_05 2005_06 2006_07
2007_08
Office of the MEC 5,211
4,362
4,530
4,802
Management
255,375
290,690
259,631
275,62
9
Total
260,586
295,052
264,161
280,43
1
Compensation of Employees
62,334
92,653
94,363
94,725
Goods and Services
188,252
188,415
156,682
166,68
5
Transfers
242
251
263
Capital (Assets)
10,000
13,742
12,865
18,758
Total
260,586
295,052
264,161
280,43
1
24
HEALTH OUTPUT MEASURES - PROGRAMME 1• Formulation and facilitation of implementation
various policies, i.e.– Demand management, Logistic management,
Management of fleet– Management of equipment, General
administration service• Implementation of programmes
– Attraction and retention of essential human resources
• Ongoing provision of training and skill development
• Decentralisation of HR, Finance, Procurement and Asset through Corporate Service Centres
25
PROGRAMME 2: DISTRICT HEALTH SERVICES• Aim :
– To develop and support District Health Services in the Eastern Cape
• Key objectives:– To improve access to PHC through the
implementation of DHS policy– To reduce morbidity and mortality through the
implantation of maternal, child and women’s health
– To strengthen prevention / treatment of HIV/AIDS and Sexually Transmitted Infections
– Tuberculosis programmes– To decrease communicable and non-
communicable diseases– Improve provision of district hospital services
26
PRG 2: DISTRICT HEALTH SERVICES
Program 2: District Health Services 2004_05 2005_06
2006_07 2007_08
2.1 District Management
85,324
140,000
143,988
149,397
2.2 Community Health Clinics
721,396
771,488
781,486
827,646
2.3 Community Health Centres
331,097
315,869
320,751
339,996
2.4 Community Based Services
53,120
57,668
50,017
53,018
2.5 Other Community Services
9,120
8,464
8,869
9,401
2.6 HIV/Aids
131,970
177,580
237,543
249,420
2.7 Nutrition
23,933
26,316
- -
2.8 Coroner Services
-
-
- -
27
PRG 2: DISTRICT HEALTH SERVICES, continued
2.9 District Hospitals
1,328,142 1,297,178 1,440,106 1,591,822
Total
2,684,102 2,794,563 2,982,760 3,220,700
Compensation of Employees
1,835,804 1,760,079 1,842,831 1,952,810
Goods and Services
466,736 591,853 681,317 784,846
Transfers
367,391 422,171 436,515 459,842
Capital (Assets)
14,171 20,460 22,097 23,202
Total
2,684,102 2,794,563 2,982,760 3,220,700
28
HEALTH OUTPUT MEASURES - PROGRAMME 2Objective Target
Increase access to Comprehensive Care Treatment and Support programme for people infected and affected by HIV AIDS
Total of 65 Sites to provide ART
Ensure accessibility to VCT services
113 Fixed PHC facilities accredited
Improve number of TB patients treated according to MTDP
80% of TB patients have DOT supporters
Increase number of facilities implementing IMCI strategy
60% of facilities to implement IMCI
Increase number of facilities providing ANC
92%
29
HEALTH OUTPUT MEASURES - PROGRAMME
2, continuedObjective Target
Nutrition: Contribute to food security
30 Clinic Gardens
Disease Prevention and Control:Reduce morbidity and mortality rate in traditional circumcision
80%
30
PROGRAMME 3: EMERGENCY MEDICAL
SERVICES• Aim:
– To render efficient and effective emergency medical services to all the inhabitants of the Province of the Eastern Cape.
• Key objectives– Provision of pre-hospital emergency
care– Transportation of the sick and injured
31
PRG 3: EMERGENCY MEDICAL SERVICESProgram 3:
Emergency Medical Services 2004_05
2005_06 2006_07
2007_08
3.1 Emergency Transport
33,487
132,531
126,366
133,166
3.2 Planned Patience Transport
31,878
54,315
55,814
59,163
Total 65,365
186,846
182,180
192,329
Compensation of Employees
8,327
117,669
117,147
124,176
Goods and Services 57,038
68,670
64,507
67,600
Transfers 507
526
553
Capital (Assets)
Total 65,365
186,846
182,180
192,329
32
HEALTH OUTPUT MEASURES - PROGRAMME 3Objective TargetFill vacant posts to reduce single crew ambulances
Fill 10% of the 49% vacancies
Develop Mount Ayliff into a fully fledged Metro Centre
70% completion
Improve monitoring of response times by introducing Vehicle Management/Plotter system
20 Minutes Urban45 Minutes Rural
33
PROGRAMME 4: PROVINCIAL HOSPITAL
SERVICES• Aim: – To provide cost effective, good quality, high level
specialised services to the people of the Eastern Cape in collaboration with the Health Sciences Faculties.
• Key objectives:– Plan, develop and deliver hospital services– Reclassify and right size hospitals i.e. Provincial
Hospitals– Redistribute beds equitably across the Province– Strengthening of Hospital management systems-
financial controls, efficiency and quality.
34
PRG 4: PROVINCIAL HOSPITAL SERVICES
Program 4: Provincial Hospital Services
2004_05
2005_06
2006_07
2007_08
4.1 General (Regional ) Hospital
1,459,0
23
1,524,9
61
1,657,7
06
1,875,6
88
4.2 TB. Hospitals 51,287
96,279
120,818
139,276
4.3 Psychiatric/ Mental Hospital
192,934
228,797
240,573
255,007
4.4 Chronic Hospital
4.5 Dental Training Hospital
4.6 Other Specialised Hospital
Total
1,703,244
1,850,037
2,019,097
2,269,971
Compensation of Employees
1,043,8
80
1,164,6
67
1,221,2
03
1,294,4
75
Goods and Services
500,613
571,400
655,119
813,325
Transfers
148,751
100,245
124,932
143,436
Capital (Assets)
10,000
13,725
17,843
18,735
Total
1,703,2
44
1,850,0
37
2,019,0
97
2,269,9
71
35
HEALTH OUTPUT MEASURES; PROGRAMME 4
Objective Target
To develop guiding document for service delivery plan needs to be linked to modernization of tertiary services
Hospital complexes complying with national standards in provision of tertiary services and efficiency indicators
Implementation of referral system
Complexes and hospitals implementing referral system
Establishment of additional 85 beds for Psychiatric services across the province
100%
Establish 2nd MDR TB Centre 20%
36
PROGRAMME 6: HEALTH SCIENCES AND
TRAINING• Aim:
– To provide training of all Health Professionals in the Province of the Eastern Cape.• Key Objectives:• To implement programmes for attraction and retention of essential
human resource skills through:– Creation of ECDOH pool of health personnel through bursary, internship and
learnership programmes (succession planning) – Increased exposure of health science students to EC rural Health Services – Active Recruitment of Graduates
• To provide ongoing training and skills development for health workers, ensuring appropriate skills to impact on health status of people in EC province through:– Staff Growth and Learning with implementation of Workplace Skills Plan and
District Health Management and Leadership programmes – Compliance with HPCSA standards of Continuing Professional Development (CPD)
and internship accreditation – Compliance with SANC Acts and Regulations
• To improve staff morale through:– Implementation of results-driven Performance Management & Development
System – Career Development Planning– Academic & Service Support
37
PRG 6: HEALTH SCIENCES AND TRAINING
Program 6: Health Sciences & Training 2004_05 2005_06 2006_07 2007_08
6.1 Nursing Training College
154,857
170,679
180,728
190,041
6.2 EMS Training College
1,000
1,000 1,300
1,365
6.3 Bursaries
7,669
38,000
43,245
45,407
6.4 Primary Health Care Training
-
-
-
6.5 Training Other
127,566
127,566
133,944
Total
163,526
337,245
352,839
370,757
Compensation of Employees
152,350
164,908
170,101
180,307
Goods and Services
11,176
4,445
54,834
56,151
Transfers
127,892
127,904
134,299
Capital (Assets)
Total
163,526
337,245
352,839
370,757
38
PROGRAMME 7: HEALTH CARE SUPPORT
SERVICES:• Aim:
– To render specialised clinical orthotic and prosthetic services.
• Key Objectives:– Improve access to Health care for
persons with disability– Facilitate recruitment of medical
orthotists and prothetiasts (MOP’s ) from outside the country.
39
PRG 7: HEALTH CARE SUPPORT
Program 7: Health Care Support 2004_05 2005_06 2006_07 2007_08
7.1 Laundries
7.2 Engineering
7.3 Forensic Services
7.4 Orth and Prosthetic Services
21,607
45,806
39,608
40,906
7.5 Medicine Trading Account
Total 1,607 45,806
39,608
40,906
Compensation of Employees 8,300
8,571
7,933
8,409
Goods and Services
13,307
33,703
31,641
32,462
Transfers
32
34
35
Capital (Assets) 3,500
Total 21,607
45,806
39,608
40,906
40
HEALTH OUTPUT MEASURES - PROGRAMME 7Objective Target
To improve staff level by recruitment of O&P Staff and training of students
6 trained students
To provide wheelchairs and hearing aids and assistive devices
60% of persons with disability supplied with devices
41
PROGRAMME 8: HEALTH FACILITIES
DEVELOPMENT AND MAINTENANCE• Aim:
– To improve access to Health care services by providing new health facilities, upgrading and maintaining existing facilities
• Objectives– To improve access to Health Care
services by providing new Health facilities, upgrading and maintenance existing facilities.
42
PRG 8: HEALTH FACILITIES, DEVELOPMENT &MAINTENANCE
Program 8: Health Facilities Development & Maintenance 2004_05 2005_06 2006_07 2007_08
8.1 Community Health Facilities
142,000
122,413
193,601
215,395
8.2 Emergency Medical Rescue Services
-
-
-
-
8.3 District Hospital Services
257,614
392,329
389,816
411,550
8.4 Provincial Hospital Services
112,250
63,500
193,866
215,672
8.5 Central Hospital Services
8.6 Other Facilities
Total
511,864
578,242
777,283
842,617
Compensation of Employees
Goods and Services
8,796
110,000
63,805
77,255
Transfers
Capital (Assets)
503,068
468,242
713,478
765,362
Total
511,864
578,242
777,283
842,617
43
HEALTH OUTPUT MEASURES: PROGRAMME 8
Objective TargetTo improve access to health care services by providing new health facilities and equipment
5 new clinics
Upgrade/replace clinics 36 facilitiesRevitalise hospitals, upgrade and maintain existing facilities
8 hospitals
Revitalization of Hospitals (through the conditional grant)
5 hospitals
44
CONCLUSION
• Consolidation and deepening of the turn around strategy.
• Continue to build capacity for delivery and strengthen the service delivery platform
• Make greater improvements in quality of care
• Austerity measures will continue to impact on ability to fulfill our mandate
• We remain committed and willing to serve
45