Gauteng Department of Health Presentation to the national Health portfolio Committee

1

Gauteng Department of Health Presentation to the national Health portfolio

Committee

23 August 2005

Presented by Dr A Rahman (Acting HOD)

and Ms T Majaja (CFO)

2

OverviewOverview

• Strategic overview

• Departmental achievements highlights and key priorities for the MTEF period

• Strategic Focus Areas

• Key Challenges

• Financial Highlights

• Conclusion

3

Strategic OverviewStrategic Overview

4

VisionVision

Health for a better life

5

MissionMission• The Gauteng Health Department aims to promote and protect

the health of our people, especially those most vulnerable to illness and injury

• Through innovative leadership and management we provide quality health services and strive to:

• Ensure a caring climate for service users

• Implement best practice health care strategies

• Create a positive work environment of staff

• Provide excellent and appropriate training for health workers

• Listen to, and communicate with our communities and staff

• Establish management systems for effective decision making

• Forge partnerships with others

• Obtain the greatest benefit from public monies

6

Mission (continued)Mission (continued)

• Our work is reflected in the enhanced well being of our clients and staff, the social and economic development of our province and a more just society

7

Health Strategic GoalsHealth Strategic Goals

• Promote health, prevent and manage illnesses or conditions with emphasis on poverty, lifestyle, trauma and violence and psychosocial factors

• Effective implementation of the comprehensive HIV and AIDS strategy

• Strengthen the district health system and provide caring, responsive and quality health services at all levels

• Implement the people’s contract through effective leadership and governance

• Become a leader in human resource development and management for health

• Operate smarter and invest in health technology, communication and management information systems

8

2004/05 and 2005/06 12004/05 and 2005/06 1stst quarter quarter achievements Highlightsachievements Highlights

andand

Key priorities for the MTEF Key priorities for the MTEF priod priod (2006-09)(2006-09)

9

Goal 1:Goal 1: Promote health, prevent and manage illnesses or Promote health, prevent and manage illnesses or conditions with emphasis on poverty, lifestyle, trauma and conditions with emphasis on poverty, lifestyle, trauma and

violence and psychosocial factorsviolence and psychosocial factors

• Health promotion implementation framework approved and health promoters trained

• Mindset Health Channel launched and 58 sites operational (DSTV channel 82)

• Provincial Infections Control initiative

10

Goal 1:Goal 1: Promote health, prevent and manage illnesses or Promote health, prevent and manage illnesses or conditions with emphasis on poverty, lifestyle, trauma conditions with emphasis on poverty, lifestyle, trauma

and violence and psychosocial factors cont…and violence and psychosocial factors cont…

• Bana Pele launched in June 2005

• Integrated management of childhood illnesses: important strategy for improving child health

• Mass immunisation campaign in 2004– 2 million doses of polio and measles

administered with overall 90% coverage in the first round

– Contribute to the goal of declaring South Africa ‘Polio-free’ by the year 2005

• 85% immunisation coverage first Quarter 2005/06

• WHO investigation and implementation of recommendations

11

Goal 1:Goal 1: Promote health, prevent and manage illnesses or Promote health, prevent and manage illnesses or conditions with emphasis on poverty, lifestyle, trauma conditions with emphasis on poverty, lifestyle, trauma

and violence and psychosocial factors cont…and violence and psychosocial factors cont…

• Youth friendly services increased from 34 in 2003/04 to 40 in 2005/06 financial year

• Youth Summit with 560

participants held in June 2005

• Launched third edition of Classroom Health Guide for Teachers as part of Bana Pele launched in June 2005

• More than 150 000 learners were screened for obstacles of learning– More than 2 000 received

spectacles

12

• 8 facilities accredited with WHO/UNICEF Baby Friendly Hospital Initiative in the province

• Vitamin A supplementation supplied to children and post-partum women in all facilities

• 1 695 crèches funded benefiting 58 219 children

Goal 1:Goal 1: Promote health, prevent and manage Promote health, prevent and manage illnesses or conditions with emphasis on poverty, illnesses or conditions with emphasis on poverty, lifestyle, trauma and violence and psychosocial lifestyle, trauma and violence and psychosocial

factors cont…factors cont…

13

• Maternal and neonatal clinical care unit established

• Perinatal Problem Identification Programme (PPIP) implemented at 20 sites in the province

• 17 Kangaroo Mother Care units operational in the province

• Campaign for Cervical and Breast cancer targeting farm areas conducted in October 2004

– Cervical Cancer screening increased from 24 204 in 2001/02 to 50 033 in 2004/05



14

• 53 health facilities provide post-exposure prophylaxis for HIV

– 56% of facilities provide 24 hour service

– Benefited 28 181 clients since the inception of the programme

• Provided 3 541 assistive devices in 2004/05

– 1 793 Wheelchairs increasing

– 1 244 Hearing aids

– 504 Artificial limbs



15

Key Priorities for the MTEF PeriodKey Priorities for the MTEF Period

• Implementation of strategies for reducing avoidable deaths Implementation of strategies for reducing avoidable deaths

• Maternal and Neonatal care unit implementing Maternal and Neonatal care unit implementing recommendations from the saving mothers’ reportrecommendations from the saving mothers’ report

• Health implementation of Bana Pele programme Health implementation of Bana Pele programme

• Interventions for Immunisation and Interventions for Immunisation and polio count-down for polio count-down for Gauteng and outcomesGauteng and outcomes



16

Key Priorities for the MTEF periodKey Priorities for the MTEF period

• Implementation of the WHO model for integrated diseases Implementation of the WHO model for integrated diseases surveillance and response surveillance and response

• Increasing TB cure rate Increasing TB cure rate – Provision of capacity, Provision of capacity, – HIV/TB collaboration HIV/TB collaboration – Provincialisation of TB bedsProvincialisation of TB beds

• Implementation of health promotion and prevention illnesses Implementation of health promotion and prevention illnesses – Non communicable diseases Non communicable diseases

– Healthy lifestylesHealthy lifestyles



17

Goal 2:Goal 2: Effective implementation of the Effective implementation of the comprehensive HIV and AIDS strategycomprehensive HIV and AIDS strategy

• HIV sero-prevalence rate among pregnant women in Gauteng shows 3% increase, from 29.6% in 2003, to 33.1% in 2004

• Syphilis rate decrease from .1% in 2003 to 0.9% in 2004

0

5

10

15

20

25

30

35

Gauteng HIV prevalence 6.4 12 15.5 17.1 22.5 23.9 29.4 29.8 31.6 29.6 33.1

Gauteng syphils prevalence 3.8 9.6 9.6 2.7 6 2.1 0.9

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

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• A joint health and treasury national task team was set up in September 2002 to investigate feasibility of introducing ART as a component of treatment – Report was presented to National Cabinet on 8th

August 2003• Request to compile a national operational

plan for implementation of comprehensive HIV and AIDS includingART programme

• Gauteng prepared a provincial operational plan aligned with the national plan

• Implementation of comprehensive HIV and AIDS including ART programme commenced on 1st April 2004 in 5 facilities

19


• Currently a comprehensive treatment and care programme, including anti-retroviral treatment (ART) implemented in 27 health facilities– More than 200 000 clients assessed– More than 20 000 on treatment – 1 078 health professional trained on

comprehensive HIV and AIDS including ARV in 2004/05

• 11 000 Philani food supplements for adults and 3 000 children distributed to patients with TB and HIV and AIDS in 2004/05

• No drug stock outs have been reported

20


Monitoring of side effects

• Pharmacovigilance system being implemented to monitor side effects from patients receiving ART– Out of more than 20 000 patients on

treatment since the inception of the programme approximately 75 patients experienced side effects such as

• Skin Rash, Diarrhoea, Anaemia;• Fatigue, Headache, Lactic

Acidosis, Loss of Weight/Appetite; • Abdominal pains, Nausea,

Vomiting; • Lipoatrophy, Peripheral

Neuropathy and IRS

• Training of monitoring and evaluation for comprehensive HIV and AIDS programme conducted in July 2005

21


Accredited facilities implementing comprehensive treatment andcare programme, including ART

• Johannesburg Metro (09) Sub-District– Johannesburg Hospital (TH) SUB 8 – Chris Hani Baragwanath Hospital (TH) SUB 10– Helen Joseph Hospital (RH) SUB 4– Coronation Hospital (RH) SUB 4– Discoverer Clinic (CHC) SUB 5 – Hillbrow (CHC) SUB 8– Lillian Ngoyi (CHC) SUB 10– Zola (CHC) SUB 6– Sizwe Tropical Disease Hospital (SP) SUB 7

22


• West Rand (03) Sub-district– Leratong Hospital (RH) Mogale City– Carletonville Hospital (DH) Mogale City– Khutsong Main (CHC) Mogale City

• Ekurhuleni Metro ( 06)– Natalspruit Hospital (RH) Ekurhuleni– Tembisa Hospital (RH) Ekurhuleni Far East – Rand Hospital (RH) Ekurhuleni Daveyton– Main (CHC) Ekurhuleni– Tambo Memorial Hospital (RH) Ekurhuleni – Pholosong Hospital (DH) Ekurhuleni


23


• Sedibeng District (05) Sub-District

– Sebokeng Hospital (RH) Emfuleni – Kopanong Hospital (DH) Emfuleni – Empilisweni Clinic (CHC) Emfuleni– Heidelberg Hospital (RH) Lesedi– Levai Mbata (CHC)

• Tshwane / Metsweding (04)

– Pretoria Academic Hospital (TH) Central) Tshwane – Kalafong Hospital (RH) Central) Tshwane – Dr George Mukhari Hospital (TH) North) Tshwane

– Laudium CHC South) Tshwane


24

Staffing for ART sites

HRM//Reg. Region A Region B Region C Total

Doctors 13 11 4 28

Nurses 25 14 9 48

Dietitians 9 8..5 4 21..5

Social Workers 11 9.5 5 25..5

Pharmacists 7..5 9 3 19..5

Proj.Managers. 6 7 3 16

Admin Clerk 10 7 4 21

Data Capturers 12 8 3 23


25


• Prevention of Mother to Child Transmission (PMTCT) implemented in 100% of hospitals and CHCs and 71% (144) of all other clinics

• Outcome of the PMTCT programme– Out of 112 490 women enrolled on the

programme from April to December 2004, 17 315 of these women received Nevirapine and 12 495 babies were born from these women

– Out of 12 355 babies who received Nevirapine, 1 427 babies were tested after 12 months and only 12% (171) of these babies tested HIV positive

26


• Voluntary Counselling and testing (VCT) sites increased from 202 sites in 2003 to 320 sites to date

• Average of 11 million male and distributed per month in 2005/06

• Average of 30 000 female condoms distributed per month in 2004/05 and 19 000 for 1st quarter

• Syndromic management of sexually transmitted infections implemented in 97% of health facilities

27


• Funded 132 NGOs for home based care and 236 hospice beds in 23 hospices– NGOs cared for 51 994

homebound patients– Cared for 2 854

terminally ill patients in hospices

28


Key Priorities for the MTEF period

• Reducing of HIV new infections focusing on prevention

• Expansion of sites for distribution of female condom

• Expansion of comprehensive HIV and AIDS including ARV to – 45 sites and 25 000 patients on treatment by March 2006

• Monitoring implementation of AIDS strategy including ARV programme

• Implementation of strategies to reduce the impact of HIV and AIDS in hospitals and clinics

• Implementation of step down beds

• Strengthening the HR capacity through partnerships and recruitment strategies

29

Goal 3:Goal 3: Strengthen the district health system and Strengthen the district health system and provide caring, responsive and quality health services provide caring, responsive and quality health services at all levelsat all levels

• Final draft of SLA with City of JHB

• Implementation of full clinic supervisory manual in each sub-districts

• Extension of hours in 65% of sub-districts

• Phola Park and Esangweni Maternity Midwife Obstetric Unit opened

• Monitoring of MOU’s and joint District Health Plans on quarterly basis

30


• EMS Public awareness campaign through radio

• 104 EMS vehicles replaced since 2004/05

• Trained ambulance staff attend more than 420 000 incidents and transport more than 430 000 patients in 2004/05

• 65% reduction in the surgical backlog since 2004/05– 670 Joint (hip and knee)– 582 cardiac– 208 spine– 4 398 cataract

31


• Stabilisation of selected hospitals that meet risk identification criteria– Standard criteria– Management support and intervention– Critical post filling– Equipment– Monitoring and evaluation

• Expansion of centres of excellence in the province– Breast disease services consolidated

at Helen Joseph hospital – New hand surgery unit at Chris Hani

Baragwanath in partneship with leading mining and engineering companies nearing completion

32


• New Mental Health Care Act implemented– Mental Health Review Boards

Operational

• 10 bed child and adolescent beds opened at Sterkfontein

• Implementation of Pharmacy Act– Rational Pharmacy Management Survey

completed and shows 27 hospitals are between 70% and 90% compliant

– Training of Pharmacist assistants, Doctors and nurses

33

Goal 3:Goal 3: Strengthen the district health system and Strengthen the district health system and provide caring, responsive and quality health provide caring, responsive and quality health services at all levels cont…services at all levels cont…

• Six hospitals fully accredited

• Complaints hotline functional 24 hours, including weekends and public holidays: 0800 203 886

• Continue to excel in the Premier’s Service Excellence Awards and others

– Won both the Gold and the Silver award for the Face of Government awards

– silver award for the Service Delivery Innovation award

• Best Practice and Batho Pele programme being implemented in four hospitals and all Tshwane Clinics

• Initiated staff satisfaction survey

34



• Implementation of the Service Improvement Plan with special focus on modernization of tertiary services

• Improving efficiency indicators

• Establishment of Gateway Clinics

• Primary Health Services– Changing model of primary health care service

provision– Provincialisation of District Health Services – Ensure optimal functioning and – Taking pressure from hospitals

35



• Extension of extended hours of service at sub district levels

• Provincialisation of Emergency Medical Services

• Implementation of the new National Health Act

• Implementation of quality assurance programme focusing on – Service excellence – Improving frontline services– Improving clinical care– Management accountability– Reduce the unequal power relations between service users

and providers i.e true meaning of Batho Pele– Accreditation of all facilities

36

Goal 4:Goal 4: Implement the people’s contract Implement the people’s contract through effective leadership and governancethrough effective leadership and governance

• All hospitals have functional hospital boards

• 1 000 Community Health Care workers trained and another 208 commenced training in May 2005

• Various partnerships e.g. – Sanofi Aventis and Sizwe hospital, TB free centre– Mining sector and hand unit at Chris Hani

Baragwanath– Italian cooperation in information systems– Mandela Foundation– Other

• Commended by Public Service Commission in State of the Public Service Report on community participation model

• MECs 28 sub- districts imbizos and visits

• MEC’s 14 monthly roving meetings in districts since April 2005

37

Goal 4:Goal 4: Implement the people’s contract Implement the people’s contract through effective leadership and governancethrough effective leadership and governance


• Rollout of the CEO training and development Rollout of the CEO training and development programme including training of middle programme including training of middle managersmanagers

• Improve functioning of community Improve functioning of community participation structuresparticipation structures

• Community health workers (CHW) expansion Community health workers (CHW) expansion programmeprogramme

• Building partnerships including Public Private Building partnerships including Public Private Partnerships (PPPs)Partnerships (PPPs)

• Ensuring compliance with the Pharmacy Act, Ensuring compliance with the Pharmacy Act, New Mental Health Act and New national ActNew Mental Health Act and New national Act

38

Goal 5:Goal 5: Become a leader in human resource Become a leader in human resource development and management for healthdevelopment and management for health

• Gauteng trains 1/3 of country’s doctors and 25% of country nurses

• 5 024 new employees in past year– Aggressive recruitment

drive through block advertisement

– Recruitment of retired nurses

0

1000

2000

3000

4000

5000

6000

GDH Attrition rate 2002/03-2004/05

Appointmnts 1307 2407 5024

Termination 3883 3753 3739

2002/2003 2003/2004 2004/2005

39


• 1 840 people in learnership/ internship programme 2004/05– 1 589 1st quarter 2005/06

• Uniform allowance implemented

• Launched wellness programme in 2004 being extended– 61% of staff participate in

provincial Employee Assistance Programme with 16% utilisation rate

40



• Ensure recruitment & training of personnel in line with the SIP Ensure recruitment & training of personnel in line with the SIP with emphasis on health professionalswith emphasis on health professionals

• Implementation of retention strategy focusing onImplementation of retention strategy focusing on

– Reducing attrition rate of doctors and nurses Reducing attrition rate of doctors and nurses

– Retention of community service professionalsRetention of community service professionals

• Increasing the production of nurses by 20% in each year of Increasing the production of nurses by 20% in each year of the MTEF periodthe MTEF period

• Building partnerships with Universities for Emergency Building partnerships with Universities for Emergency Medical Services and production of nurses Medical Services and production of nurses

41



• Expansion of teaching platform to include Family Medicine in Expansion of teaching platform to include Family Medicine in district health servicesdistrict health services

• Mainstreaming of Gender and Disability as part of the Employment Mainstreaming of Gender and Disability as part of the Employment Equity PlanEquity Plan

• 5 100 beneficiaries on Learneships and internships programme by 5 100 beneficiaries on Learneships and internships programme by 20092009

• Strengthening implementation of Performance Management SystemStrengthening implementation of Performance Management System

• Expansion of Employee Wellness ProgrammeExpansion of Employee Wellness Programme

• Strengthening capacity developmentStrengthening capacity development

42

Goal 6:Goal 6: Operate smarter and invest in health Operate smarter and invest in health technology, communication and management technology, communication and management information systemsinformation systems

• Came within budget in 2004/05

• Unqualified audit report for 2004/05 for medical supplies Depot

• 12.5% increase of revenue from previous year

• Implementation of BAUD Asset Management System

• Launched an internal newsletter addressing staff issues

43

Goal 6:Goal 6: Operate smarter and invest in health Operate smarter and invest in health technology, communication and technology, communication and management information systemsmanagement information systems

• Two PPP projects for procurement of equipment approved – New Pretoria Academic Hospital– New Radiation Oncology for Johannesburg

Hospital

• Bought or ordered more than R100 million worth of medical equipment– CT scanners at Johannesburg, Pretoria

Academic – Coronation, Sebokeng, Helen Joseph and

Kalafong hospitals – MRI scanners at Chris Hani Baragwanath,

Pretoria Academic and Johannesburg hospitals– Gamma cameras at Dr George Mukhari, Pretoria

Academic and Johannesburg hospitals– Radiological equipment at Pretoria Academic,

Far East Rand, Heidelburg, Tembisa and Mamelodi hospitals

– Linear accelerators at Pretoria Academic and Johannesburg hospitals

44



• Strengthen control and management of Budget and Strengthen control and management of Budget and Expenditure including conditional GrantsExpenditure including conditional Grants

• Strengthen institutional capacity on financial managementStrengthen institutional capacity on financial management

• Revenue collection policies and strategies Revenue collection policies and strategies

• CAPEX CAPEX – Revitalisation of health infrastructure Revitalisation of health infrastructure – Infrastructure improvement Infrastructure improvement – EquipmentEquipment– Strengthen monitoring of capital projects through SLA Strengthen monitoring of capital projects through SLA – Alignment of budget with expenditure for revitalisation and Alignment of budget with expenditure for revitalisation and

capital projectscapital projects

45



• Investigate , develop and implement models of PPP’s in Investigate , develop and implement models of PPP’s in accordance with prescribed BBBEE policesaccordance with prescribed BBBEE polices

• Implementation of the BBEE strategyImplementation of the BBEE strategy

• Monitoring and implementation of the Supply Chain Management Monitoring and implementation of the Supply Chain Management guidelinesguidelines

• Implementation of IM/IT strategy including Roll out MEDICOM to Implementation of IM/IT strategy including Roll out MEDICOM to other facilities other facilities

• Implementation of external and internal communication strategyImplementation of external and internal communication strategy

• Alignment of planning, implementation monitoring and evaluationAlignment of planning, implementation monitoring and evaluation

46

Strategic focus areasStrategic focus areas

47

• Signed SLAs with three Gauteng Anti-Tuberculosis Association (SANTA) hospitals and three Life Care hospitals (total of 6)

• Cure rate increased from 58% end of 2004/05 to 62.4% in 1st quarter of 2005/06

• TB Free Centre launched in partnership with National Department of Health, Sanofi-Avertis and Nelson Mandela Foundation in 2004 at Sizwe Hospital

• TB/HIV collaboration programme implemented in all sub-districts

Management of Tuberculosis (TB)Management of Tuberculosis (TB)

48

• 89% (35 330 ) of TB patients with DOTS support– 15 879 DOT patients in clinics– 20 642 DOT patients in the Community– 3 176 DOT patients at workplace– 4 367 DOT patients self supervised

• All sub districts have started using TB electronic register

• TB advocacy– Developed integrated social mobilisation and advocacy plan– Collaboration with all role players

• • Established TB focal point in all provincial hospitals

• Adherence to National TB control programme guidelines and protocols

Management of Tuberculosis Management of Tuberculosis (TB)(TB)

49

• Implementation of national policy guidelines and protocols in all facilities

• Availability of EDL chronic medication in all facilities

• Provision of fast queues for older patients in all community Health Centres

• Implement chronic registers for follow up of defaulting patients in all facilities

• Support groups established in all sub districts

• Conduct healthy lifestyles awareness campaigns annually

• Public Private Partneship with NGOs and pharmaceutical companies

Management of other chronic diseasesManagement of other chronic diseases

50

• Patients with Chronic Obstructive Airway Diseases are benefiting from Long term domiciliary oxygen therapy

• Flue Vaccine is made available to all state subsidies old age homes and to the facilities for the older persons and debilitating conditions

• Treated over 2.5 million patients with chronic conditions in 2004/05

• Sight restored to 8 221 people through cataract surgery in 2004/05

– 3297 from public hospitals– 207 for World Sight Day– 4 717 from private hospitals

Management of other chronic diseasesManagement of other chronic diseases

51

Scarce Skills Allowance - ProgressScarce Skills Allowance - Progress

• The scare skills allowance was implemented in the Gauteng Department of Health for medical doctors and dentists, nurse specialists with qualifications and allied health professionals in 2004 retrospective to 01 July 2003 according to the PSCBC Resolution 1 of 2004

• Currently a total number of 4 595 health professionals are receiving the allowance. Of these 2 679 are medical doctors, 679 nursing, 1 228 are allied professionals

• The total budget for 2005/ 06 is R109 000 000

• The effect of the implementation of this measure has been two fold – On the positive aspect, it has improved the morale of those

staff members who are receiving it and although it is still early to measure has brought some stability in the retention of staff

52

– Whilst recognising that not all health professionals should receive the allowance, there are however some unintended negative consequences which have demoralised staff

• Exclusion of primary Health Care nurses who form the cornerstone of the implementation of District Health Services

• Nurses who have worked for a long period of time in the specialties, for instance ICU and Theatre nurses have a wealth of experience and no qualifications

• Few categories who are rendering critical services nationally and are few in number, for instance

– physicists and medical orthortists and prosthetics

Scarce Skills Allowance -ProgressScarce Skills Allowance -Progress

53

Scarce Skills Allowance - ProposalScarce Skills Allowance - Proposal

• In addition– Industrial Technicians (currently seven in DoH

and in need of 35)– Oral Hygiene and Dental Therapists– Nurse Educators (Tutors)

• Conduct review of all Health professionals salary packages which would obviate the need for allowances

54

• 11 Projects regarded and funded as part of the Revitalisation Programme sofar until the middle of 2004– Mamelodi Hospital – Natalspruit Hospital– Germiston Hospital– New Daveyton Hospital– Dr George Mukhari Hospital– New Kruisfontein Hospital – Tembisa Hospital – Leratong Hospital – Sebokeng Hospital– Chris Hani Baragwanath Complex

• Chris Hani Baragwanath Hospital• Upgrading of Lenasia South CHC to a 200 bed Level 1 Hospital• New Zola Hospital

– Upgrading of Lilian Ngoyi CHC to Level 1 Hospital

• Due to underspending allocation of budget has been reduced subject to increase in expenditure for 2005/06

Hospital Revitalisation Hospital Revitalisation Process- BackgroundProcess- Background

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Hospital Revitalisation Hospital Revitalisation Process - BackgroundProcess - Background

• An audit was undertaken of the National Department of Health by the Auditor-General in 2004– Following the audit, the process regarding approval of

revitalisation projects was reviewed

• A directive was issued by National Department of Health for each province– to include only four active projects within the revitalisation grant

funding– to include a new project only when one of the four current

projects was completed– Business cases to be submitted and approved by the NDoH and

Treasury for inclusion of projects within the grant

56

Hospital Revitalisation ProcessHospital Revitalisation Process - - BackgroundBackground

• Analysis of business cases irto– provincial populations– drainage areas – provincial strategic overview

• Ensuring business cases address issues relating to organizational development, quality of care, health technology and monitoring and evaluation

• Prioritisation of projects, value for money, levels of care and analysis of health data

57

Hospital Revitalisation ProcessHospital Revitalisation Process –Projects –Projects for the MTEFfor the MTEF

• Submission of business cases– Chris Hani Baragwanath / CHB Level 1 Hospital (Lilian Ngoyi), Zola Level 1 Hospital (300

beds) – Natalspruit Hospital (760 beds) to replace the existing Natalspruit Hospital under risk due

to dolomite conditions on the site

• Upgrading and renovation of Mamelodi Hospital would constitute the fourth projects included in the revitalisation grant funding as the Mamelodi project was already approved under the hospital renovation and repair programme

• A business case has been submitted for Germiston Hospital – closely aligned with the Natalspruit Hospital revitalisation as services will be shared

between the two hospitals

• A business case has been submitted for Daveyton Hospital – currently no hospital facilities

• Business cases are being finalised for Tembisa and Sebokeng Hospitals – projects are currently underway but funded through provincial and national infrastructure

grant funding

• The business cases for Germiston Hospital and Daveyton Hospital were submitted at the end of June 2005 for consideration by the NDoH and Treasury

58

Hospital Revitalisation ProcessHospital Revitalisation Process - -Projects and TimelinesProjects and Timelines

PRIORITY PROJECT BUS. CASE TIME-LINE

1 MAMELODI APPROVED MAY 2005

27 MONTHS

2 ZOLA APPROVED APRIL 2006

24 MONTHS

3 NATALSPRUIT APPROVED JULY 2006

36 MONTHS

4 CHB LEVEL 1 (LILIAN NGOYI)

APPROVED APRIL 2006

24 MONTHS

5 CHB LEVEL 2 & 3 SUBMITTED BUT NOT APPROVED

ONGOING

10 YR PROJECT

59



6 GERMISTON SUBMITTED NOT YET APPROVED

JULY 2006

24 MONTHS

7 DAVEYTON SUBMITTED NOT YET APPROVED

SEPT 2006

24 MONTHS

8 TEMBISA END SEPT 2005 JAN 2006

36 MONTHS

9 SEBOKENG END SEPT

2005

JAN 2006

36 MONTHS

10 DIEPSLOOT END NOV

2005

APRIL 2006

24 MONTHS

60



11 KRUISFONTEIN TO BE SUBMITTED

APRIL 2006

24 MONTHS

12 ENNERDALE TO BE SUBMITTED

APRIL 2006

24 MONTHS

13 ZOLA 2 TO BE SUBMITTED

APRIL 2006

24 MONTHS

14 DR GEORGE MUKHARI

TO BE SUBMITTED

APRIL 2007

48 MONTHS

15 YUSUF DADOO TO BE SUBMITTED

APRIL 2007

24 MONTHS

61

Hospital Revitalisation ProcessHospital Revitalisation Process - -Estimated Project Costs Estimated Project Costs

HOSPITAL PROJECT BEDS BEDS ESTIMATEDCURREN PLANNED COST

• Mamelodi Refurbish 90 80 269,000• Zola New 300 310,000 • CHB 1 New 300 210,000 • Natalspruit New 784 760 630,000• Chris Hani 3 Refurbish 2,888 1,510 2,247,000 • Germiston Refurbish 128 300 300,000 • DaveytonNew 300 210,000 • Tembisa Refurbish 760 720 108,393 • Sebokeng Refurbish 860 800 50,095 • Diepsloot New 300 210,000 • Kruisfontein New 300 210,000• Ennerdale New 300 210,000 • Zola 2 New 300 210,000 • Dr George

Mukhari Refurbish 1,724 700 • Yusuf Dadoo Refurbish 151 300

62

ChallengesChallenges• Tuberculosis, child and women’s health

– HIV/AIDS requires ongoing vigilance, but programme performance excellent

• Batho Pele:

– Ensuring each patient experiences caring and responsive services

– Management accountability for quality

• Quality of clinical care– Risk management approach– Health professionals doing what we have been trained to

do

63

ChallengesChallenges• Waiting times

• Optimal functioning of the district health system– Redefinition of municipal health services to

environmental services– Extension of hours and taking pressure off

hospitals

• Emergency medical services

• Retention of professional staff

64

ChallengesChallenges• Capex: infrastructure acceleration and

equipment

• Management and leadership and development for improved care and outcomes

• Ensuring strategic plans are supported by service delivery and improvement plans

• Implementation of monitoring and evaluation framework

65

Financial HighlightsFinancial Highlights

66

Final Budget Allocation for 2005-2006Final Budget Allocation for 2005-2006Officical Budget Allocation

2003-2004 2004-2005 2005-2006 %inc 2006-2007 %change 2007-2008 %change

AdjustedFinal Adj

Bud 2004-05Final 8

February 2005from 2004-05 Adj Bud

from 2005-06

from 2006-07

NationalNational Tertiary Services Grant 1 679 760 1 727 736 1 760 465 1.89% 1 866 094 6.00% 1 959 399 5.00%

Health Professions Training and Development Grant 539 330 560 778 554 039 -1.20% 554 039 0.00% 581 741 5.00%

HIV/AIDS 64 288 134 231 185 048 37.86% 252 695 36.56% 265 330 5.00%

Integrated Nutrition Programme 74 273 10 307 11 333 9.95% 0 -100.00% 0 #DIV/0!

Hospital Management and Quality Improvement 29 125 20 776 18 510 -10.91% 19 621 6.00% 20 602 5.00%

Hospital Revitalisation (Capital) 87 939 155 126 17 955 -88.43% 148 664 727.98% 133 093 -10.47%

Pretoria Academic Hospital (Capital) 92 356 0 #DIV/0!

Infrastructure Grant (Capital) 47 160 66 458 73 955 11.28% 81 549 10.27% 81 225 -0.40%

Total National 2 614 231 2 675 412 2 621 305 -2.02% 2 922 662 11.50% 3 041 390 4.06%

Special Projects ProvincialInfrastructure Grant 583 624 647 822 647 822 0.00% 647 822 0.00% 647 822 0.00%

HIV/AIDS 76 424 141 300 250 000 76.93% 262 750 5.10% -100.00%

ICS 43 000 0 0 #DIV/0!

Function Shifts 1 059 (28 400) (29 961) 5.50% (31 460) 5.00% -100.00%

EMS and Inflation 100 000 125 000 150 000 20.00% 150 000 0.00% -100.00%

Personnel and NPNC 200 000 200 000 210 000 5.00% 210 000 0.00% -100.00%

NPNC Tertiary Hospitals 78 000 80 000 2.56% 100 000 25.00% -100.00%

NPNC Academic Hospitals 50 000 60 000 20.00% 70 000 16.67%

HIV/AIDS Operational costs impact 0 200 000 -100.00% #DIV/0!

Total Provincial 1 004 107 1 363 722 1 357 861 -0.43% 1 399 112 3.04% 717 822 -48.69%

Discretionary Discretionary / Equitable share

Normal 4 501 135 4 833 173 5 278 640 9.22% 5 577 780 5.67% 6 596 184 18.26%

Revenue Retention 46 669 71 533 -100.00% #DIV/0!

Total Discretionary 4 547 804 4 904 706 5 278 640 7.62% 5 577 780 5.67% 6 596 184 18.26%

Total Budget 8 166 142 8 943 840 9 257 806 3.51% 9 899 554 6.93% 10 355 396 4.60%

Conditional Grants

67

2005/06 Allocation: Conditional 2005/06 Allocation: Conditional

vs Discretionaryvs Discretionary

• National Conditional Grants– R2 821 305

• Provincial Special Projects

• – R 1 357 861

• Discretionary allocation– Amount - R5 278 640

• Total R9 257 806

68

Prioritisation within the indicative Prioritisation within the indicative allocationsallocations• National conditional grants consists of 28,31%

compared to 32,01% during 2004-05

• Fixed costs must be provided for first e.g.

– Staff costs (including ICS, pay progression, etc)+- 43000 staff

– Legislative requirements• Conditional Grants• Capital Projects

– IT Budgets and expenditure• Software licensing• SITA costs• GITOC costs

69

Alignment of budgets to strategic Alignment of budgets to strategic plansplans

• The following key priorities have been taken account of in the alignment of budget to strategic plans

• District Health Services-Allocation of above inflation rate of 8%

• Priority Programmes

• Effective implementation of the comprehensive HIV/AIDS strategy

• Increased nurse numbers accounted for in Programme 6.

• CAPEX

70

Budget allocation for 2005 - 2006Budget allocation for 2005 - 2006

Programme

Original

Budget

2004-05

Adjustment

Budget

2004-05Orig Budget

2005-06

%Varianc

e f rom

2004-05

(O-O)

%Varianc

e f rom

2004-05

(A-O)

% of total

budget

% of total

budget 04-05

1. Health Administration 220 800 257 836 267 090 20.96% 3.59% 2.88% 2.53%

2. District Health Services 2 012 090 1 972 643 2 351 981 16.89% 19.23% 25.35% 23.05%

3. Emergency Medical Services 280 600 295 600 309 772 10.40% 4.79% 3.34% 3.21%

4. Provincial Health Services 2 471 502 2 499 193 2 591 850 4.87% 3.71% 27.93% 28.31%

5. Central Hospitals 2 841 282 2 999 335 2 970 988 4.57% -0.95% 32.24% 32.54%

6. Health Training and Sciences 187 283 200 783 217 040 15.89% 8.10% 2.34% 2.15%

7. Health Care Support Services 98 771 89 771 96 000 -2.81% 6.94% 1.03% 1.13%

8. Health Facilities Management 618 679 628 679 453 085 -26.77% -27.93% 4.88% 7.09%

SubTotal 8 731 007 8 943 840 9 257 806 6.03% 3.51% 100.00% 100.00%

Total 8 731 007 8 943 840 9 257 806 6.03% 3.51% 100.00% 100.00%

71

Capital ExpenditureCapital Expenditure

• Strategies to improve capex spending

– Establish capex monitoring and evaluation capacity in health

– Clinic building and revitalisation programme and own capacity

– SLA with Works and improved monitoring – Financial monitoring– Explore PPP arrangements

• Day to Day Maintenance funds allocated to institutions

• R225 995 000 million budgeted for equipment

72

Conditional GrantsConditional Grants

73

2004-052004-05Conditional GrantsConditional Grants

• National Tertiary Grant• Health Professions Training and

Development Grant• Revitalisation Grant (Capital)• Provincial Infrastructure Grant (Capital)• HIV/AIDS Grant• Integrated Nutrition Grant• Hospital Quality and Management

Improvement Grant

74

Expenditure vs. BudgetExpenditure vs. Budget

Conditional Grants Budget Expenditure Variance % spentR'000 R'000 R'000 R'000

Health Professions Training and Development 560 778 560 778 0 100.00% HIV/ AIDS 134 231 134 000 231 99.83% Hospital Management and Quality Improvement 20 776 20 886 (110) 100.53% Hospital Revitalisation 155 126 61 204 93 922 39.45% Integrated Nutrition Programme 10 307 9 848 459 95.55% National Tertiary Services 1 727 736 1 727 736 0 100.00% Provincial Infrastructure 66 458 57 632 8 826 86.72%

2 675 412 2 572 084 103 328

Conditional Grant Status at end March 2005

75

Budget vs. expenditureBudget vs. expenditure

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

% spent 100.00% 99.83% 100.53% 39.45% 95.55% 100.00% 86.72%

% should be 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Health Professions Training and

HIV/ AIDSHospital

Management and Quality

Hospital Revitalisation

Integrated Nutrition

Programme

National Tertiary Services

Provincial Infrastructur

e

76

MonitoringMonitoring• Financial

– Monitoring done on different management levels– Compliance with reporting requirements

• Performance– Compliance with reporting requirements

• No qualification from Auditor General on conditional grants for 2003-04

• Will be further strengthened during 2005/6

77

ReportingReporting

• Financial Reporting– Report done on template provided by National Treasury

– Finalised and submitted every month on the dates stipulated by the DORA (15th of each month)

• Performance Report– Submitted quarterly as required

• Other ad hoc

78

Local GovernmentLocal Government

• Local Government (LG) provides Primary Health Care Services at LG clinics on an agency basis

• Provincial health provides funding.– Cash subsidy by means of transfer payments– Pharmaceuticals– Payments for the Cost of Laboratory tests

• Local Government reports monthly by means of a certificate.

79

ChallengesChallenges

• Accuracy and reliability of data

• Allocations do not take cross border flow of patients into consideration

• Range of eligible services provided at each institution exceed grant allocations

– Complex nature of Gauteng, means that some services e.g. renal dialysis provided by some regional hospitals which are not funded

– Psychiatric tertiary services not funded

80

RevenueRevenue• Primary source of revenue is patient fees

– Tariffs are determined by National Department of Health in consultation with Provinces

– Differentiated tariffs based on• different levels of care• income of patients

• Other revenue includes– Boarding fees– Revenue from reports– Meal fees– Parking, etc.

81

Local GovernmentLocal Government• Local Government (LG) provides Primary

Health Care Services at LG clinics on an agency basis

• Provincial health provides funding.– Cash subsidy by means of transfer payments– Pharmaceuticals– Payments for the Cost of Laboratory tests– Amounts to more than R221 million– Technical support (e.g. training)

• Higher than CPIX (8%) increase allocated for 2005-06

82

ConclusionConclusion• Reasonable budget in light of

context and risks/ pressures

• Value for money is health returns

• Equity paramount

• Participation and accountability

83

Thank YouThank You

Documents

Gauteng Department of Health Presentation to the national Health portfolio Committee