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EASTERN CAPE DEPARTMENT OF HEALTH. Parliamentary Budget Hearings Tuesday, 08 June 2004. INDEX. Page 1.Overview3 2.Organisational Establishment4 3.Revised Service Delivery Model5-6 4.Where do we want to be7-9 - PowerPoint PPT Presentation
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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)
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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
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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!!!