Hospital Revitalisation Program

Portfolio Committee24 August 2005Dr Thabo SibekoChief Director: Hospital ServicesGert SteynDirector: Hospital Revitalisation

Agenda

Vision Purpose of Hospital Revitalisation Grant Process Brief overview of HRP Grant Methodology of Allocations Challenges Achievements Progress/Expenditure on Grant DoRA Conditions Project Management Unit Delay of Transfers Current and New Projects Photos

Vision of Revitalised Hospital

Good fully operational physical condition Deliver appropriate services:

– to suit the population’s needs – levels of care provided

Appropriate management system operating with appropriate delegations.

Community structures to hold the hospitals accountable Appropriately equipped and resourced. Implementing and monitoring quality improvement programmes Equitable budget based on the population served and services

delivered.

Vision of Revitalised Hospital

Improve cost efficiency and effectiveness of hospitals

Have in place sustainable Planned Preventative Maintenance and replacement programmes supported by:

– appropriately qualified and trained staff – technical resources.

Implement all National policies. All health facilities will be part of a national health

service and will operate within a rationalised referral system network.

Project405 hospitals

Revitalise Hospitals

Quality

Province

NationalREVITALISATION OF PUBLIC

HOSPITALS

EMS

Project M anagem ent S tructure

Resource Group

Project (Com m issioning) Team

Local Steering Com m ittee

Provincial Steering Com m ittee

National Project Coordination Team

National Steering Com m ittee

Programme Management

Provide Technical Support

Overall provincial projects coordination and managementRegional/ Local Facilitation of Project Implementation process

Day to day management of project implementation activities

Political & Technical Guidance

Purpose of HRP Grant

Purpose– “To provide strategic funding to enable provinces

to plan, manage, modernise, rationalise and transform the infrastructure, health technology, organizational management and development and monitoring and evaluation of hospitals in line with national policy objectives”: DoRA Act 1 of 2005 Framework

Process

Provincial Responsibility– Do prioritisation of hospitals to be revitalised in Province.

Decisions to be made at provincial level– Submit business cases according to required format– Submit Project Implementation Plans according to required

format– Submit monthly financial and quarterly non-financial reports– Implement all components of the HRP

Process

National Health Responsibility– Prioritisation framework supplied, BUT province ultimately

responsible for prioritisation outcome. National provides guidance on using system.

– Provide framework (PIM) for business cases, Project Implementation Plans (PIP)

– Appraise and formally approve business cases and PIP’s– Collect and analyse monthly and quarterly reports, combine

into single report– Monitor and evaluate performance on site for all projects– Support provincial implementation

Business Cases

Provinces must submit business case to have project included in HRP

Business case consists of 2 areas1. Strategic Context containing:

Strategic plan of province on health service delivery in hospitals

Prioritisation of hospitals to be included based on:– Service delivery issues (Access to services, political risk, risk of

delays, and other areas the province identifies)– Financial issues (cost to correct, backlog of maintenance,

condition)

Business Cases

2. Priority Hospital Details with regard to site Size of hospital (beds by level of care) Specific details such as area per bed, cost per bed, admission rate, average

length of stay) Cost Period of Construction Operational cost Staffing plan Health technology plan Quality Assurance plan

Appraisal– National Department of Health appraises all business cases to ensure

strategic plan of province is adhered to and size, location, cost, sustainability and level of service adheres to National Guidelines

Brief Overview

MTEF AllocationProvince 2005/2006 2006/2007 2007/2008

Eastern Cape 157732 71666 102552

Free State 113082 128853 104360

Gauteng 17955 148664 133093

KwaZulu-Natal 128977 60940 81090

Limpopo 212918 123698 160690

Mpumalanga 57018 101032 117071

Northern Cape 69651 217464 234960

North West 98056 125493 106495

Western Cape 172038 202474 198987

TOTAL 1 027 427 1 180 284 1 239 298

Methodology of Allocation

Project/Needs based allocation Information utilised:

– Approved business cases– Expected cash flows per year (received from

provinces)– Number of active projects (currently minimum 4

due to funding constraints)

Methodology of Allocation

Process to obtain available funds figure:– 2004/2005 DORA allocation amount– ADD expected roll-over from 2003/2004– SUBTRACT Expected expenditure for 2004/2005– Result = Expected Roll-over into 2005/2006 +

DoRA allocation

Methodology of Allocation

Provinces supplied expected expenditure over MTEF period (information from business cases and Project Implementation Plans)

Expected Need calculated as follows:– Amount required for projects in provinces– The allocation puts provinces in a favourable

position where they will be able to spend the full allocation without having to cut on budget.

Methodology of Allocation

Allocation– Need LESS 2004/2005 roll-over indicates

2005/2006 allocation– Process is repeated into outer years to determine

allocation Allocation HEAVILY dependent on quality of

information and prioritisation received from provinces.

Challenges

Delays in appointing contractors on site (public works related issues) – ALL provinces reported various problems with public works

Public Works – Specific Examples:– Lebowakgomo, Jane Furse (LP) – Tenders closed in Aug 2004, contract

not yet awarded.– Contracts awarded to inefficient contractors – contractor awarded tender at

Jane Furse after contractor went 80% over contract at other site. (LP)– Contractor on 14 month contract at King George V was 6 months into

contract, but already 3 months behind. Appeal followed, appellant received contract. (KZN) – delayed by about 10 months

– Design/Architect/Engineers do not give input in design phase. Nothing from contractors questioned – “Everything goes” (NC)

– Large contracts awarded to small contractors – insufficient capacity, no capital to fund project, delays are inevitable. All provinces are troubled by this.

– Procurement: Extremely slow: 10 months to appoint completion contract at Frontier Hospital (EC)

– Lack of personnel to do quality checks on construction at regular intervals

Challenges

Provincial Capacity in Revitalisation– Appointing Revitalisation Managers is slow process– Most managers schooled in infrastructure – very little

capacity exists in Health Technology, Organisational Development and Quality Assurance.

Reporting/Communication to and from provinces are ineffective and unreliable. Recommendation will be made shortly to increase accuracy, compliance and reliability at limited cost. Web page reporting model to be designed that will result in a more accurate, efficient data and compliance of HRP

Achievements on Grant

Progress– 3 Hospitals finished:

Calvinia (NC) – 35 Beds, District, R35m Colesberg (NC) – 35 Beds, District, R35m Swartruggens (NW) – 28 Beds, District, R39m Piet Retief (MP) – 140 beds, District, R140m

– Hospitals to be completed in 2005/2006 George (WC) 276 Beds, Regional, R78m Eben Donges (WC) 315 Beds, Regional, R213m Lebowakgomo (LP) – 255 Beds, District, R105m Jane Furse (LP) – 252 Beds, District, R110m

– Hospitals to be completed in 2006/2007 Dilokong (LP) – 244 Beds, District, R134m Nkenshani (LP) – 290 Beds, District, R127m Vredenburg (WC) – 80 Beds, District, R58m Barkley West (NC) – 40 Beds, District, R40m

Expenditure on Grant

In 2004/2005– HRP spent 84% if KZN is excluded

*KZN requested to return the allocation due to extensive problems with Public Works

Division of Revenue Act (No. 7 of 2003)

Total expenditure to date

Roll Overs"000 "000 "000

EC 116,354 98,376 85% 17,978 FS 52,370 40,092 77% 12,278 GP 155,126 62,317 40% 92,809 KZN 178,054 LP 106,463 98,939 93% 7,524 MP 68,292 52,357 77% 15,935 NC 57,135 58,246 102% (1,111) NW 92,845 81,929 88% 10,916 WC 85,217 124,114 146% (38,897) Total (excluding KZN) 733,802 616,370 84%

911,856

Expenditure in %

Allocation

Province

DoRA Conditions

All new projects commencing in 2005/06 must have business cases and project implementation plans approved before funds can be released for such projects

Provincial strategic plans must include comprehensive hospital plans, which provide a framework in which business cases are subsequently developed

Adhere to the process of approval of business plans for the 2006 MTEF

DoRA Conditions

Adherence to monitoring requirements National Department to strengthen grant

management and capacity and business planning and reporting processes

Provincial departmental strategic plans for 2005/06 and over the MTEF to clearly indicate measurable objectives and performance targets as agreed with national department

Project Management Unit

Program Manager

Monitoring & EvaluationDeputy Director

Secretary

Organisational Development and Quality Improvement

Deputy Director

InfrastructureDeputy Director

Health TechnologyDeputy Director

Senior admin OfficerAdmin / Logistics

Administration Officer

FinanceAssistant DirectorTechnical Specialists – New Posts to

be filled

Reason of Delaying Transfer

Prov

2005/06 Business

Case2005 PIP (Due 15

March 05)Revised PIP (after appraisal by 18/04)

EC yes received (26/04) 28-AprFS no received (04/04) 25-AprGP yes received (11/04) 5-AprKZN yes received (12/04)LP yes received (01/04) 28-AprMP no received (05/04)NC yes received (07/04) 29-AprNW no received (12/04)

WC yes

received (31/03 Vredenburg, 01/04 George, 12/04 Eben Donges)

George 19/04, Vredenburg 25/04

Current and New projects

PROV Project name 2005/06 New Projects1. Frontier 5. St. Lucy's2. St. Elizabeth's3. Mary Theresa4. Rietvlei1. Boitumelo 3. National Hospital2. Pelonomi 4.Bethlehem (Dhilabaneng)1. Mamelodi 2. Zola

3. Natalspruit4 Chris Hani Bara level1

1. King George V 3. Dr. Pixley Seme2. Ngwelezane / Lower Umfolozi 4. Dr. John Dube

5. Hlabisa1. Lebowakgomo2. Jane Furse3. Dilokong4. Nkhensani

HOSPITAL REVITALIZATION PROGRAMME

LP

EC

FS

GP

KZN

Current and New projects

PROV Project name 2005/06 New Projects1. Piet Retief 5. New Nelspruit2. Themba3. Rob Ferreira4. Ermelo1. Colesburg 4. Upington (Gordonia)2. Calvinia 5. New Kimberly (start 3. Psychiatric (West End)6. Barkely West

7. De Aar2. Swartruggens 4. Tshwaragano1. Moreteletsi / George Stegmann5. Brits3. Vryburg1. Vredenburg 4. Paarl 2. George 5. Khayelitsha 3. Eben Donges

NW

WC

HOSPITAL REVITALIZATION PROGRAMME

MP

NC

Photos: Jane Furse (LP)

Old Revitalised

[PMG note: Graphics not included]

Photos: Dilokong (LP)

Old Revitalised

[PMG note: Graphics not included]

Photos: Swartruggens (NW) [PMG note: Graphics not included]

Photos: Colesberg (NC)

[PMG note: Graphics not included]

Making a movie is like trying to grill a steak by having a succession of people coming into a room and breathing on it.

Douglas Adams

Should progress in Revitalisation be as slow??

Thank You