EASTERN CAPE EASTERN CAPE DEPARTMENT OF HEALTHDEPARTMENT OF HEALTH

Parliamentary Budget Parliamentary Budget Hearings Hearings

Tuesday, 08 June 2004Tuesday, 08 June 2004

22

INDEXINDEX

Page Page

1.1. OverviewOverview 33

2.2. Organisational EstablishmentOrganisational Establishment 44

3.3. Revised Service Delivery ModelRevised Service Delivery Model 5-65-6

4.4. Where do we want to beWhere do we want to be 7-97-9

5.5. Achievements according to Ten Point PlanAchievements according to Ten Point Plan 10 – 2010 – 20

6.6. Major challengesMajor challenges 21-2321-23

7.7. Alignment of goals with National and Provincial imperativeAlignment of goals with National and Provincial imperative 24-2924-29

8.8. PrioritiesPriorities 30-3430-34

9.9. Finance InformationFinance Information

1010 ConclusionConclusion

33

1.1. OVERVIEWOVERVIEW-- (WHERE DO WE COME FROM?) (WHERE DO WE COME FROM?)

1994 - 19961994 - 1996

Amalgamation Amalgamation of three of three

administration administration (Ciskei, (Ciskei,

Transkei & Transkei & Cape Provincial Cape Provincial Administration) Administration) into one health into one health

systemsystem

1997-1997-

Transformation of Transformation of services and policies services and policies

(e.g. Patients right (e.g. Patients right charter & charter &

government cluster government cluster system)system)

2002-2002-

Vision 2014Vision 2014

(Provincial (Provincial growth and growth and

development development plan - PGDP)plan - PGDP)

2003 /042003 /04

Interim Management Interim Management Team (IMT)Team (IMT)

Turnaround PanTurnaround PanStrengthened service Strengthened service

delivery and delivery and managementmanagement

Improved access to Improved access to servicesservices

Obtained unqualified Obtained unqualified audit reportaudit report

Implemented Implemented

legislative reformslegislative reforms

2004/052004/05

Ready to serveReady to serve

Peoples contract and Peoples contract and our contributionour contribution

44

MEC: HEALTH

SUPERINTENDENT GENERAL

DDG: Clinical Services

DDG: Corporate Services

CD:PHC

CDHSM

CD: QA

CD: FIN MNG

CD:PROC

CD: STRATPLAN

CD:FAC & ASSTS

CD: DHS

Acronyms: CD-Chief Director; DHS – District Hospital Services; PHC-Primary Health Care; HSM – Hospital Services Management;QA-Quality Assurance; FINMNG- Financial Management; PROC-Procurement; STRAT-Strategic & FAC-Facilities

2. ORGANISATIONAL ESTABLISHMENT

55

3. Revised Service Delivery Model3. Revised Service Delivery Model

7 District Managers

18 DistrictHospital Cluster

Managers

25 Sub DistrictOffices

Head Office

5 CEOs of Hospital

Complexes and Regional

Hospitals

District HospitalManagers

713 clinics 28 CommunityHealth centres

SERVICE DELIVERY MODELSERVICE DELIVERY MODELThe role of Head Office will be focused on The role of Head Office will be focused on programs coordination, integration and policy programs coordination, integration and policy formulation, monitoring and evaluation.formulation, monitoring and evaluation.Our PHC services are provided through 713 clinics Our PHC services are provided through 713 clinics and 28 Community Health Centres, and these are and 28 Community Health Centres, and these are managed by 27 Local Service Area (LSA) managed by 27 Local Service Area (LSA) managers. Patients that need high level of care will managers. Patients that need high level of care will be referred to Level 1 hospitalsbe referred to Level 1 hospitals18 Clusters of 47 district hospitals as well as 18 18 Clusters of 47 district hospitals as well as 18 provincial aided and 4 privately run hospitals provincial aided and 4 privately run hospitals provide level 1 services. Clustering will allow for provide level 1 services. Clustering will allow for sharing of resources including professional staff.sharing of resources including professional staff. The three complexes and two regional hospitals The three complexes and two regional hospitals provide levels 2 and 3 services. provide levels 2 and 3 services. The 7 district managers have responsibility over The 7 district managers have responsibility over 18 CEOs in the clusters and 25 LSA managers. 18 CEOs in the clusters and 25 LSA managers. They report to head office.They report to head office.The 2 regional and 3 complex CEOs report The 2 regional and 3 complex CEOs report directly to head office.directly to head office.

77

4.4. WHERE DO WE WANT TO BE?WHERE DO WE WANT TO BE?

4.1 VISION4.1 VISION A health service to the people in the A health service to the people in the

Eastern Cape Province promoting a Eastern Cape Province promoting a better quality of life for all.better quality of life for all.

88

4.2 MISSION4.2 MISSION

To provide and ensure accessible To provide and ensure accessible comprehensive integrated services comprehensive integrated services in the Eastern Cape emphasizing in the Eastern Cape emphasizing the primary health care approach the primary health care approach utilizing and developing all utilizing and developing all resources to enable all its present resources to enable all its present and future generation to enjoy and future generation to enjoy health and quality of life.health and quality of life.

99

4.3 VALUES4.3 VALUES

Human Rights, customer satisfaction, service Human Rights, customer satisfaction, service excellence and value for money are ensured excellence and value for money are ensured through adherence to the following values:-through adherence to the following values:-

Equity of both distribution and quality of servicesEquity of both distribution and quality of services Service excellence including customer satisfaction Service excellence including customer satisfaction Fair labour practices Fair labour practices Good work ethic and a high degree of accountability Good work ethic and a high degree of accountability Transparency demonstrated through consultations with Transparency demonstrated through consultations with

all stakeholders in the health industry/fieldall stakeholders in the health industry/field

1010

5. ACHIEVEMENTS ACCORDING 5. ACHIEVEMENTS ACCORDING TO THE TEN POINT PLANTO THE TEN POINT PLAN

(WHERE ARE WE NOW?)(WHERE ARE WE NOW?)

1111

2.2.

55..1. REORGANISATION OF 1. REORGANISATION OF CERTAIN SUPPORT SERVICESCERTAIN SUPPORT SERVICES

CORPORATE SERVICES CENTRESCORPORATE SERVICES CENTRES The department and the Interim Management The department and the Interim Management

Team (IMT) established 11 Corporate Service Team (IMT) established 11 Corporate Service Centres Centres • 3 Complexes3 Complexes• 7 Districts7 Districts• Head OfficeHead Office

to provide shared support services to provide shared support services • HR,HR,• Finance, Finance, • Procurement, Procurement, • Administration & Administration & • ITIT

1212

5.2. LEGISLATIVE REFORM5.2. LEGISLATIVE REFORM

Education and Training of Nurses and Education and Training of Nurses and Midwives Act no. 4 of 2003Midwives Act no. 4 of 2003

Medicines Act 90 of 1997 and Pharmacy Medicines Act 90 of 1997 and Pharmacy Act 88 of 1997 they will be applicable in Act 88 of 1997 they will be applicable in July 2005 to the State July 2005 to the State

Mental Health Act of 2002Mental Health Act of 2002

1313

5.3. IMPROVING QUALITY OF CARE5.3. IMPROVING QUALITY OF CARE

Health service awards launched in Health service awards launched in East London and Umtata aimed at East London and Umtata aimed at maintaining high standards in maintaining high standards in institutionsinstitutions

A 24 hr call centre has been A 24 hr call centre has been established with a toll free number of established with a toll free number of 0800032364 providing opportunity 0800032364 providing opportunity for grievances and suggestionsfor grievances and suggestions

In line with the prevention of In line with the prevention of blindness (Global vision 2020) we blindness (Global vision 2020) we are improving our cataract are improving our cataract performance yearly. performance yearly.

1414

5.4. REVITALIZATION OF HOSPITAL 5.4. REVITALIZATION OF HOSPITAL SERVICESSERVICES

PE Complex is our flagship in Rationalisation of PE Complex is our flagship in Rationalisation of Services Services

Provincial secondary and tertiary service Provincial secondary and tertiary service delivery plans have been developed and these delivery plans have been developed and these are linked to national modernisation of tertiary are linked to national modernisation of tertiary servicesservices

Outreach program focussing on mother and Outreach program focussing on mother and child health as well as anaesthetic trainingchild health as well as anaesthetic training

Rationalisation of psychiatric services Rationalisation of psychiatric services establishing psychiatric beds in the eastern side establishing psychiatric beds in the eastern side of the provinceof the province

Nelson Mandela Academic Hospital functional Nelson Mandela Academic Hospital functional and awaiting official openingand awaiting official opening

21 hospital construction projects completed,14 21 hospital construction projects completed,14 under construction, equipment procured for 50 under construction, equipment procured for 50 hospitals and maintenance done to 88 hospitalshospitals and maintenance done to 88 hospitals

1515

5.5. SPEEDING OF DELIVERY OF AN 5.5. SPEEDING OF DELIVERY OF AN ESSENTIAL PACKAGE OF SERVICE ESSENTIAL PACKAGE OF SERVICE THROUGH THE DISTRICT HEALTH THROUGH THE DISTRICT HEALTH

SYSTEMSYSTEM

Institutionalisation of the 18 hospital Institutionalisation of the 18 hospital clusters including appointment of clusters including appointment of management teams for these clustersmanagement teams for these clusters

Clustering will allow sharing of Clustering will allow sharing of resources resources

1616

5.6. 5.6. DECREASING MORBIDITY AND DECREASING MORBIDITY AND MORTALITY RATES MORTALITY RATES

THROUGH STRATEGIC INTERVENTIONSTHROUGH STRATEGIC INTERVENTIONS

Following implementation of standards in Following implementation of standards in Traditional Circumcision Act (Act no. 6 of 2001) Traditional Circumcision Act (Act no. 6 of 2001) there has been marked decrease in morbidity and there has been marked decrease in morbidity and mortality resulting from circumcision (statistics)mortality resulting from circumcision (statistics)

Placement of staff to oversee the ARV treatment Placement of staff to oversee the ARV treatment plan has been completed;plan has been completed;

270 nurses, doctors, pharmacists, dieticians and 270 nurses, doctors, pharmacists, dieticians and workers have been trained in the various aspects workers have been trained in the various aspects of disease managementof disease management

1717

5.7. IMPROVING RESOURCE 5.7. IMPROVING RESOURCE MOBILIZATION MOBILIZATION AND UTILISATIONAND UTILISATION

For the first time Eastern Cape had For the first time Eastern Cape had an unqualified reportan unqualified report

PPP – Kouga Partnership Hospital at PPP – Kouga Partnership Hospital at Humansdorp being the first co-Humansdorp being the first co-location PPP in the Provincelocation PPP in the Province

1818

5.8. IMPROVING COMMUNICATION AND 5.8. IMPROVING COMMUNICATION AND CONSULTATION WITHIN THE HEALTH SYSTEM CONSULTATION WITHIN THE HEALTH SYSTEM

AND WITH COMMUNITIES WE SERVEAND WITH COMMUNITIES WE SERVE

Communication unit established at head Communication unit established at head office and director appointedoffice and director appointed

Hospital boards clinic committees Hospital boards clinic committees establishedestablished

Three mental health review boards Three mental health review boards establishedestablished

Weekly slot in local radio station talking Weekly slot in local radio station talking about health issuesabout health issues

1919

5.9. IMPROVING HUMAN RESOURCE 5.9. IMPROVING HUMAN RESOURCE DEVELOPMENT AND MANAGEMENTDEVELOPMENT AND MANAGEMENT

Increased number of community service professionalsIncreased number of community service professionals Induction of community service professionals aimed at Induction of community service professionals aimed at

presenting our recruitment and retention strategypresenting our recruitment and retention strategy Learnerships & internships introducedLearnerships & internships introduced Delegations – human resources and financeDelegations – human resources and finance have been finalisedhave been finalised Implementation of scarce skills and rural allowancesImplementation of scarce skills and rural allowances Implementation of skills development planImplementation of skills development plan Gradual implementation of the Employment EquityGradual implementation of the Employment Equity

2020

5.10.5.10.STRENGTHENING CO-OPERATION STRENGTHENING CO-OPERATION WITH OUR PARTNERS WITH OUR PARTNERS

INTERNATIONALLYINTERNATIONALLY

Fred Hollows Foundation training programme to Fred Hollows Foundation training programme to assist in improving prevention of blindnessassist in improving prevention of blindness

Luxemburg-Aid in infrastructure development Luxemburg-Aid in infrastructure development (Mnquma – former Transkei(Mnquma – former Transkei

Communicable Disease Centre, British Columbia, Communicable Disease Centre, British Columbia, PEPFAR supporting the implementation of the PEPFAR supporting the implementation of the Comprehensive Treatment PlanComprehensive Treatment Plan

Training of rehabilitation technicians in TanzaniaTraining of rehabilitation technicians in Tanzania

2121

6. MAJOR CHALLENGES IN 6. MAJOR CHALLENGES IN THE DEPARTMENTTHE DEPARTMENT

2222

6.1 HEALTH 6.1 HEALTH CHALLENGESCHALLENGES

Management and reduction of communicable Management and reduction of communicable disease, Cholera HIV/AIDS, TB and STIs including disease, Cholera HIV/AIDS, TB and STIs including the Comprehensive Treatment Plan which includes the Comprehensive Treatment Plan which includes ARV roll-out.ARV roll-out.

Staff recruitment, retention and compositionStaff recruitment, retention and composition Management of childhood disease including low Management of childhood disease including low

immunization coverageimmunization coverage Cross boundaries movement of peopleCross boundaries movement of people Legislative reforms influenced by cultural factors Legislative reforms influenced by cultural factors

e.g. circumcision, and recognition of alternative e.g. circumcision, and recognition of alternative medicine including traditional healing medicine including traditional healing

Drug supplyDrug supply Backlog in health infrastructure developmentBacklog in health infrastructure development

2323

6.2 OTHER CHALLENGES6.2 OTHER CHALLENGES

Escalating crime calling for more Escalating crime calling for more security for staff working in primary security for staff working in primary health care facilities, establishment of health care facilities, establishment of Crisis Centres and counseling facilities Crisis Centres and counseling facilities for victims of abuse as well as calling for victims of abuse as well as calling for more collaborative endeavors with for more collaborative endeavors with other sectorsother sectors

The impact of increased motor vehicle The impact of increased motor vehicle accidents on emergency medical accidents on emergency medical services and other servicesservices and other services

2424

7. ALIGNMENT OF GOALS 7. ALIGNMENT OF GOALS WITH NATIONAL AND WITH NATIONAL AND

PROVINCIAL IMPERATIVESPROVINCIAL IMPERATIVES

2525

Alignment of GoalsAlignment of Goals

People’s ContractPeople’s Contract NDoHNDoH PGDPPGDP EC DoH EC DoH

Access to services Access to services

Sustainable Sustainable livelihoodslivelihoods

Strengthen Strengthen primary health primary health care (both public care (both public and private and private sectors) sectors)

Improving access Improving access to health by to health by prioritising health prioritising health resourcesresources

G1: Ensuring equitable G1: Ensuring equitable access by all access by all communities to essential communities to essential package of services package of services through DHS and referral through DHS and referral systems O1.1:Effective systems O1.1:Effective rendering of PHC & EHS rendering of PHC & EHS in the province in the province 01.2 01.2 :Implementation :Implementation

of programmes to of programmes to reduce morbidity and reduce morbidity and mortalitymortality01.3: Improve equity of 01.3: Improve equity of access to all services access to all services and infrastructure and infrastructure developmentdevelopment

2626

Alignment of Goals Alignment of Goals ContinuedContinued

People’s ContractPeople’s Contract NDoHNDoH PGDPPGDP ECDoHECDoH

Access to services Access to services

Sustainable livelihoodsSustainable livelihoods

Strengthen primary Strengthen primary health care (both health care (both public and private public and private sectors sectors

Equitable health Equitable health standards between standards between rural and urban rural and urban areasareas

G2: Health services to meet G2: Health services to meet quality standardsquality standardsO2.1: Set norms and O2.1: Set norms and standards for quality standards for quality assuranceassurance02.2: Implement monitoring 02.2: Implement monitoring and evaluation systemsand evaluation systems02.3: Revitalize our facilities02.3: Revitalize our facilities02.4: Strengthen drug 02.4: Strengthen drug distribution and information distribution and information systemssystems02.5: Accreditation of facilities02.5: Accreditation of facilities

2727

Alignment of GoalsAlignment of GoalsContinuedContinued

People’s People’s ContractContract NDoHNDoH PGDPPGDP ECDoHECDoH

Constitutional rights &

governance 

Participation of communities with effective

communication . Strengthen

social mobilisation

Funding leverage through

increased use of PPP’s for hospital

management. Participation by the public in the process of socio

economic change 

G3: Communities become active, responsible partners in health issues which affect them

O3.1: Strengthen governance structure at all levels for effective participation of civil society

03.2: Improving external and internal communication to harness service delivery

2828

Alignment of GoalsAlignment of GoalsContinuedContinued

People’s People’s ContractContract NDoHNDoH PGDPPGDP ECDoHECDoH

 Access to services

Growing economy

Human resource development and management –

need more coherent strategy

 Human resource development

-Learnerships and internship

programmes-Community Health Worker programme-Decentralisation of

powers and functions to district health

services

G4: Build capacity in the Dept. to support improved implementation of its goals O4.1:Implement programmes for recruitment and retention of essential HR skills04.2: Provide ongoing training and skills development for health workers04.3: Align skills to service delivery, by standardising nursing education, using PPPs, Section 21, employing medical assistants etc.Implement and maintain results driven PMDS programme

2929

Alignment of GoalsAlignment of GoalsEndEnd

People’s ContractPeople’s Contract NDoHNDoH PGDPPGDP ECDoHECDoH

A growing economySustainable livelihoods

Access to servicesCrime & Corruption 

 Enabling factor – relates to all health

priorities e.g.Affordable

medicines, including traditional medicines

Decentralisation of powers and functions to

district health office

Health infrastructure planning 

G5: Effective and efficient utilisation of the Depts. Finance and assets to achieve effective service delivery O5.1:Equitable resource allocation across the province05.2: Rationalise and integrate health services05.3:Ensure effective cash flow forecasting, efficient financial and asset management as well as financial controls

 

 

 

3030

8. PRIORITIES FOR 8. PRIORITIES FOR DEPARTMENT OF HEALTH IN DEPARTMENT OF HEALTH IN

NEXT 3 YEARSNEXT 3 YEARS

3131

8.1 CLINICAL SERVICES (PHC)8.1 CLINICAL SERVICES (PHC)

Roll out Comprehensive Plan to target 147 200 cumulative Roll out Comprehensive Plan to target 147 200 cumulative clients by 2008 including 2700 in 2004/05. Accreditation of clients by 2008 including 2700 in 2004/05. Accreditation of Ukhahlamba and Alfred Nzo phase 1 sites will be finalized Ukhahlamba and Alfred Nzo phase 1 sites will be finalized by end July 2004by end July 2004

Collaborative project with DWAF and Municipalities on water Collaborative project with DWAF and Municipalities on water and sanitationand sanitation

Expanded Programme of Immunisation campaign in July Expanded Programme of Immunisation campaign in July 20042004

R1 million set aside for food gardens to benefit 4000 clientsR1 million set aside for food gardens to benefit 4000 clients Commenced a programme on training professionals on Commenced a programme on training professionals on

maternity and child health servicesmaternity and child health services Finalise transfer of 174 Environmental Health Professionals Finalise transfer of 174 Environmental Health Professionals

to municipalitiesto municipalities

3232

8.2 CLINICAL SERVICES8.2 CLINICAL SERVICES (HOSPITAL) (HOSPITAL)

80 New EMS vehicles were purchased 80 New EMS vehicles were purchased between November 2003 and March 2004 between November 2003 and March 2004 for deployment. An Air Ambulance service for deployment. An Air Ambulance service has been implementedhas been implemented

Finalise recruitment of management in the Finalise recruitment of management in the District Hospital Clusters and District Hospital Clusters and implementation of clinical programmes implementation of clinical programmes

Aligning our service delivery plans with MTSAligning our service delivery plans with MTS NMAH commissioned and awaiting official NMAH commissioned and awaiting official

opening in 2004/05opening in 2004/05

3333

8.3 CLINICAL SERVICES 8.3 CLINICAL SERVICES (QUALITY OF CARE)(QUALITY OF CARE)

Implementation of fully-fledged call centre Implementation of fully-fledged call centre to be able to monitor and provide to be able to monitor and provide feedback in all our customer complaintsfeedback in all our customer complaints

Will establish clinical audit on target Will establish clinical audit on target clinical programmes to ensure on-going clinical programmes to ensure on-going monitoring and quality monitoring and quality

Will implement accreditation programme Will implement accreditation programme targeting 40 hospitals over the next 3 targeting 40 hospitals over the next 3 years (and targeting 5 accredited years (and targeting 5 accredited hospitals)hospitals)

3434

8.4 SUPPORT SERVICES8.4 SUPPORT SERVICES InfrastructureInfrastructure

-Roll-out revitalisation programme with 4 Hospitals at different -Roll-out revitalisation programme with 4 Hospitals at different phases of development (St Elizabeth, Frontier, Mary Terese phases of development (St Elizabeth, Frontier, Mary Terese and Rietvlei)and Rietvlei)

-Building of 46 clinics (including 13 in 2004/05) over the next 3 -Building of 46 clinics (including 13 in 2004/05) over the next 3 yearsyears

-Replacing 47 clinic over next 3 years-Replacing 47 clinic over next 3 years Roll-out Corporate Service Centres to all districts (functional Roll-out Corporate Service Centres to all districts (functional

by March 2005)by March 2005) Implementation of good finance governance and Implementation of good finance governance and

management principles management principles • Audit committeeAudit committee• Internal AuditInternal Audit• Risk assessment and managementRisk assessment and management• Decentralized pre-audit functionDecentralized pre-audit function

3535

Support Services Support Services continuedcontinued

Enhance HRM in the departmentEnhance HRM in the department• Robust recruitment and retention strategyRobust recruitment and retention strategy• Roll-out PMDS to all levelsRoll-out PMDS to all levels• Learnership and internship programmes and Learnership and internship programmes and

targeting 1000 school leavers training as targeting 1000 school leavers training as Nursing assistants and /or Community Health Nursing assistants and /or Community Health WorkersWorkers

Mobilization of resourcesMobilization of resources• Finalization of Drug PPPFinalization of Drug PPP• Implementation Humansdorp PPPImplementation Humansdorp PPP• Development of Port Alfred and Settlers PPP’sDevelopment of Port Alfred and Settlers PPP’s

3636

TOTAL HEALTH ALLOCATIONTOTAL HEALTH ALLOCATION IN 2003/04 IN 2003/04

R' 000R' 000 2003/042003/04 2004/052004/05% %

GROWTHGROWTH

ORIGINAL ORIGINAL BUDGETBUDGET 5,117,886 5,117,886

5,410,294 5,410,294 5.75.7

ROLLOVERROLLOVER - - - -

ADJUSTMENTADJUSTMENT (6,102)(6,102) - -

TOTALTOTAL 5,111,784 5,111,784 5,410,294 5,410,294

3737

6. BUDGET6. BUDGETTrends in Provincial Public Health expenditure by Budget Programme in current prices (R thousand)Trends in Provincial Public Health expenditure by Budget Programme in current prices (R thousand)

ProgrammeProgramme 2001/022001/02 2002/032002/03 2003/042003/04 2004/052004/05 2005/062005/06 2006/072006/07

   (Actual)(Actual) (Actual)(Actual) (Estimate)(Estimate) BudgetBudget MTEF MTEF MTEFMTEF

Health AdministrationHealth Administration 168,947 168,947

191,707 191,707

215,110 215,110

260,586 260,586

302,176 302,176

315,637 315,637

District Health ServicesDistrict Health Services 2,124,751 2,124,751

2,250,811 2,250,811

2,518,346 2,518,346

2,684,102 2,684,102

3,058,594 3,058,594

3,318,557 3,318,557

Emergency Medical Emergency Medical ServicesServices

87,314 87,314

122,464 122,464

194,488 194,488

65,365 65,365

86,923 86,923

90,306 90,306

Provincial Hospital Provincial Hospital ServicesServices

1,237,958 1,237,958

1,519,750 1,519,750

1,699,485 1,699,485

1,703,244 1,703,244

1,940,640 1,940,640

2,016,850 2,016,850

Health Sciences and Health Sciences and TrainingTraining

76,756 76,756

96,124 96,124

122,884 122,884

163,526 163,526

171,310 171,310

177,886 177,886

Health Care Support Health Care Support ServicesServices

6,765 6,765

9,168 9,168

23,027 23,027

21,607 21,607

26,873 26,873

27,907 27,907

Health Facilities Health Facilities ManagementManagement

189,962 189,962

303,218 303,218

468,806 468,806

511,864 511,864

624,375 624,375

675,329 675,329

TotalTotal 3,892,453 3,892,453

4,493,242 4,493,242

5,242,146 5,242,146

5,410,294 5,410,294

6,210,891 6,210,891

6,622,472 6,622,472

3838

PERCENTAGE REAL INCREASE PERCENTAGE REAL INCREASE BETWEEN 2003/04 AND 2004/05BETWEEN 2003/04 AND 2004/05

Trends in Trends in expenditureexpenditure 2001/022001/02 2002/032002/03 2003/042003/04 2004/052004/05 2005/062005/06 2006/072006/07

R’000R’000 (Actual)(Actual) (Actual)(Actual) (Estimate)(Estimate) BudgetBudget MTEF MTEF MTEFMTEF

   3,892,4533,892,453 4,493,2424,493,242 5,242,1465,242,146 5,410,2945,410,294 6,210,8916,210,891 6,622,4726,622,472

% Growth in % Growth in nominal termsnominal terms    15.43%15.43% 16.67%16.67% 3.21%3.21% 14.80%14.80% 6.63%6.63%

Budget in Real Budget in Real TermsTerms   

4,193,523 4,193,523

4,824,274 4,824,274

5,179,640 5,179,640

5,972,838 5,972,838

6,349,193 6,349,193

% Growth in % Growth in Real TermsReal Terms 7.73%7.73% 7.37%7.37% -1.19%-1.19% 10.40%10.40% 2.23%2.23%

3939

EXPENDITURE ON PERSONNELEXPENDITURE ON PERSONNEL

R’000R’000

Budget Budget 2003/042003/04 %%

Budget Budget 2004/052004/05 %%

Budget (excl Budget (excl Transfers)Transfers)

4,307,8504,307,850 4,894,1524,894,152

PersonnelPersonnel

2,928,5422,928,542 67.9867.98 3,110,3573,110,357 63.5563.55

Non-PersonnelNon-Personnel

1,379,3081,379,308 32.0232.02 1,783,7951,783,795 36.4536.45

4040

TRANSFERSTRANSFERS

AGENCYAGENCY R’000R’000

Local GovernmentLocal Government 150,000150,000

Provincially Aided HospitalsProvincially Aided Hospitals 82,48882,488

LifeCare LifeCare 48,00048,000

NutritionNutrition 23,93323,933

NGO’s for AIDSNGO’s for AIDS 63,00063,000

SANTA’sSANTA’s 51,25751,257

HPTD GrantHPTD Grant 97,46497,464

TOTALTOTAL 516,142516,142

4141

CONDITIONAL GRANTS 2004/05CONDITIONAL GRANTS 2004/0511

Conditional Grant Conditional Grant 2003/04 2003/04 R’000R’000

2004/052004/05R’000R’000

% Increase % Increase (Decrease)(Decrease)

National tertiary National tertiary servicesservices

195,504 195,504 272,036272,036 39.15 %39.15 %

Health Profession’s Health Profession’s training & researchtraining & research

79,873 79,873 97,46497,464 22.02 %22.02 %

HIV/AIDSHIV/AIDS

38,934 38,934 98,97098,970 154.00 %154.00 %

Hospital rehabilitationHospital rehabilitation

90,751 90,751 116,354116,354 28.21 %28.21 %

Integrated Nutrition Integrated Nutrition ProgrammeProgramme

172,465 172,465 23,93323,933 - 86.12 %- 86.12 %

Hospital Management Hospital Management ImprovementImprovement

14,553 14,553 19,52919,529 34.19 %34.19 %

TotalTotal

592,080 592,080 628,286628,286 6.11 %6.11 %

4242

ProgrammeProgramme Budget (R’000)Budget (R’000)

ARV Roll-outARV Roll-out 40,77740,777

Prevention Prevention 33,68833,688

TreatmentTreatment 32,55632,556

ManagementManagement 4,1184,118

Centre of ExcellenceCentre of Excellence 6,0286,028

Social MobilizationSocial Mobilization 14,80314,803

TOTALTOTAL 131,970131,970

HIV/Aids Budget 2004/05HIV/Aids Budget 2004/05

4343

Standard item Standard item classificationclassification

AdjustedAdjustedAppropriatioAppropriatio

nn

ActualActualExpenditureExpenditure

SavingsSavings(Excess)(Excess) ExpendituExpenditu

re as % of re as % of revised revised

allocationallocation  

R'000R'000 R'000R'000 R'000R'000

PersonnelPersonnel 2,846,9582,846,958 2,815,6732,815,673 31,28531,285 9999

AdministrativeAdministrative 225,488225,488 219,150219,150 6,3386,338 9797

InventoriesInventories 569,141569,141 558,506558,506 10,63510,635 9898

EquipmentEquipment 108,467108,467 97,78297,782 10,68510,685 9090

Land and buildingsLand and buildings 417,084417,084 466,800466,800

(49,716)(49,716) 112112

Professional and Professional and special servicesspecial services 298,501298,501 346,779346,779

(48,278)(48,278) 116116

Transfer paymentsTransfer payments 643,841643,841 735,595735,595

(91,754)(91,754) 114114

Total Total

5,111,782 5,111,782

5,242,146 5,242,146

(130,364)(130,364) 103103

2003/04 Expenditure analysis2003/04 Expenditure analysis

4444

2003/04 Variance analysis by programme2003/04 Variance analysis by programme

ProgrammeProgramme 2003/042003/04 2003/042003/04 VarianceVariance

   BUDGETBUDGET (Estimate)(Estimate)

Health AdministrationHealth Administration 218,478218,478 215,110 215,110 3,3683,368

District Health ServicesDistrict Health Services 2,333,8812,333,881 2,518,346 2,518,346 (184,465)(184,465)

Emergency Medical Emergency Medical ServicesServices 229,683229,683

194,488 194,488 35,19535,195

Provincial Hospital Provincial Hospital ServicesServices 1,731,7821,731,782

1,699,485 1,699,485 32,29732,297

Health Sciences and Health Sciences and TrainingTraining 159,409159,409

122,884 122,884 36,52536,525

Health Care Support Health Care Support ServicesServices 27,28827,288

23,027 23,027 4,2614,261

Health Facilities Health Facilities ManagementManagement 411,261411,261

468,806 468,806 (57,545)(57,545)

TotalTotal 5,111,7825,111,782 5,242,146 5,242,146 (130,364)(130,364)

4545

ProgrammeProgramme BUDGETBUDGET %%

1. Health Administration1. Health Administration 260,586260,586 4.824.822. District Health Services2. District Health Services 2,684,1022,684,102 49.6149.6111

3. Emergency Medical Services3. Emergency Medical Services 65,36565,365 1.211.2111

4. Provincial Hospital Services4. Provincial Hospital Services 1,703,2441,703,244 31.4831.4811

5. Central Hospital Services5. Central Hospital Services 00 006. Health Sciences and Training6. Health Sciences and Training 163,526163,526 3.023.027. Health Care Support Services7. Health Care Support Services 21,60721,607 0.400.408. Health Facilities Dev & Maint8. Health Facilities Dev & Maint 511,864511,864 9.469.46TOTALTOTAL 5,410,2945,410,294

Programme Distribution Programme Distribution 2004/052004/05

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EXPENDITURE AMOUNT EXPENDITURE AMOUNT PER CAPITAPER CAPITA

Expenditure per capita for the Eastern Cape Department of Health Expenditure per capita for the Eastern Cape Department of Health 2003/042003/04

PopulationPopulation 6,436,7636,436,76311   

Per capita Per capita (total Budget)(total Budget)

R814.41R814.41 Per Capita Per Capita (Excluding (Excluding Conditional Conditional GrantsGrants

R725.51R725.51

In terms of the Inter Governmental Fiscal Review (IGFR) 2003 this province at R769.00 received the third lowest per capita allocation in South Africa.

(1) Census data 2001

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Programme AnalysisProgramme Analysis

The proportion of the budget The proportion of the budget transferred to Local Government transferred to Local Government • 2.8 % was transferred.2.8 % was transferred.

The total amount for donor funding The total amount for donor funding was was • Approx. R26 million in kind where the Approx. R26 million in kind where the

USAID sponsored the Equity Project who USAID sponsored the Equity Project who rendered technical support and training.rendered technical support and training.

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Proportion of the Budget spent on Proportion of the Budget spent on District Health Services:District Health Services:• R 2,684,102 or 49.6 %R 2,684,102 or 49.6 %

Proportion of the Budget spent on Proportion of the Budget spent on Community Health Services and Community Health Services and Primary Health ServicesPrimary Health Services• R 1,200,057 or 22.18 % which is 45% of R 1,200,057 or 22.18 % which is 45% of

District Health Services budgetDistrict Health Services budget

Programme Analysis (cont) Programme Analysis (cont) R’000R’000

4949

Cost PressuresCost Pressures

Transport management R37m shortTransport management R37m short Laboratory services R44m shortLaboratory services R44m short Land and buildings especially Land and buildings especially

maintenance R43m shortmaintenance R43m short Nutrition budget of R23m not enough Nutrition budget of R23m not enough

to cover patients with HIV and TBto cover patients with HIV and TB

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7. CONCLUSION7. CONCLUSION

Various restructuring programs have been put in place, and Various restructuring programs have been put in place, and now we are in a process to deepen implementation.now we are in a process to deepen implementation.

We have started the roll-out of the Plan and we will increase We have started the roll-out of the Plan and we will increase the pace and capacity to absorb the demandthe pace and capacity to absorb the demand

We are continuously seized with the challenge to increase We are continuously seized with the challenge to increase the access and thereby drastically reducing the morbidity the access and thereby drastically reducing the morbidity and mortality, and any other curable diseasesand mortality, and any other curable diseases

Even though significant improvements have been made on Even though significant improvements have been made on PPTV it remains a challengePPTV it remains a challenge

Demand for services continues to outweigh our resourcesDemand for services continues to outweigh our resources We remain committed to strengthen our links with partners We remain committed to strengthen our links with partners

in civil societyin civil society

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WE ARE READY TO DELIVER WE ARE READY TO DELIVER

ENKOSI!!!ENKOSI!!!