Mpumalanga Department of Health report on Comprehensive HIV

Mpumalanga Department of Health report on Comprehensive HIV and Aids

and Revitalization Grants

PRESENTATION LAYOUT

• 2010 Budget allocation• Trends in Allocation and Expenditure• Trend in Expenditure for the 4th Quarter• Progress up to end of 4th quarter• Monitoring, Evaluation and Reporting • Challenges• Proposed solutions to challenges

2009/10 BUDGET ALLOCATION-HIV AND AIDS CONDITIONAL GRANT

Budget Allocation

Transfers schedule

R200,226,000 + R96,204,000 (Adjustment)= Total R 296,430,000 Adjusted 1st Transfer May 2009 R38,534,0002nd Transfer July 2009 R12,150,0003rd Transfer August 2009 R21,073,0004th Transfer October 2009 R13,000,0005th Transfer November 2009 R14,922,0006th Transfer December 2009 R35,000,0007th Transfer February 2010 R42,460,0008th Transfer March 2010 R119,282,000Total Transfers R 296,430,000

2009/10 BUDGET ALLOCATION-HIV AND AIDS CONDITIONAL GRANT

Actual Expenditure at 31 March 2010

Planned roll-over application

R 289,929,424

R 6,500,576

HIV AND AIDS CONDITIONAL GRANT : TRENDS IN EXPENDITURE UP TO THE END 2009-10

Financial Year Budget Allocation Actual Expenditure % Expenditure

2006/ 2007

2007/2008

2008/2009

2009/2010

R 110,709,000

R 121,190,000

R 177,419,000

R 296,430,000

R 110,709,000

R 121,190,000

R 186,622,602

R 289,929,424

100%

100%

105%

98%

HIV AND AIDS CONDITIONAL GRANT PROGRESS UP TO END 2009-10

KEY FOCUS AREA ANNUAL PLANNED OUTPUT

ACHIEVEMENTS UPTO END OF 2009-10

CCMT SERVICES 43 Facilities accredited 34 accredited

70 310 patients on ART 70 269 patients on ART (March)

18 post accreditation visits to be conducted.

24 post accreditation visits conducted.

12 mentorship visits to be conducted

16 mentorship visits conducted

HIV AND AIDS CONDITIONAL GRANT PROGRESS UP TO END OF 2009-10


ACHIEVEMENTS UPTO END OF 2009-10

Youth and Life Skills

PMTCT

15 Mayihlasele izazi girl child project sites established

15 Mayihlasele izazi girl child project sites established

100% coverage 100% coverage

90% testing rate 95% testing rate

15%Transmission rate 12% transmission rate



ACHIEVEMENTS UPTO END 2009-10

PMTCT

VCT

10 support groups established

19 support groups established

80% testing rate 86% testing rate

48 mentors placed 48 mentors placed

100% Coverage rate 100% Coverage rate




MPAC Provincial Strategic Plan and Monitoring and Evaluation adopted, printed and distributed

Provincial Strategic Plan and Monitoring and Evaluation Framework adopted.

4 MPAC sitting conducted 2 MPAC sitting conducted




CARE AND SUPPORT 2200 HBC care received stipend.

2437 HBC care received stipend.

1,584,000 home visits conducted

3,033,446 home visits conducted

2100 care kits purchased 1500 care kits purchased

9 step down care facilities established

6 step down care facilities established




CAPACITY ENHANCEMENT

4500 health care workers trained

4720 health care workers trained

4 clinical symposium conducted

4 clinical symposium conducted

MONITORING AND EVALUATION

• Monitoring and evaluation officials monitor and support the effective implementation of the programme on a Quarterly basis ( Post accreditation and Mentorship).

• Monitoring and Evaluation officials monitor the implementation of the programme by visiting the accredited facilities and submitting reports to the Provincial office for effective monitoring and providing adequate support to reach all the facilities.

• Monthly, Quarterly and Annual reports are compiled and sent to National Department of Health, National Treasury and the Provincial Treasury on financial and non-financial indicators.

HIV AND AIDS CONDITIONAL GRANT REASONS FOR UNDER-EXPENDITURE

• The system used in the province entails delivery of activities by the Department and payments processed utilising the equitable shares budget, there-after the Department claims the amount utilised from Provincial Treasury.

• One invoice was received after the cut of dates of payment ( 26 March 2010).

HIV AND AIDS CONDITIONAL GRANT CHALLENGES

• Increase in number of patients, average of 1,800 to 2,000 new intake monthly. Projected monthly intake 1,600.

• Budget increase not aligned to demand for the services.• Staff shortage affect the monitoring and evaluation of the delivery services.• Poor infrastructure hindering increase in the number of accredited facilities.• Slow process of accreditation of facilities by National Department of health

HIV AND AIDS CONDITIONAL GRANT PROPOSED SOLUTIONS TO CHALLENGES

• Budget allocation to be aligned to the demand of services.• Strengthen the monitoring and evaluation for programme.• Rehabilitation and upgrade of the facilities.• Train more health care workers.• Continuous support to home care givers in respect of stipend and care

kits.• Increasing Non medical VCT sites.

Mpumalanga Department of Health report on Hospital Revitalization Grants

Hospital Revitalization: Trends in allocation and expenditureFinancial Year

Budget Allocation

Amount Received

Actual Expenditure

% Expenditure

2006/ 2007

2007/2008

2008/2009

2009/2010

R58 477 000

R107 843 000

R244 444 000

R 498 159 000

R72 896 000

R89 883 000

R144 774 000

R304 444 000

R72 896 000

R72 895 000

R104 157 000

R343 743 057

100%

81%

72%

69%

Hospital Revitalization : Budget allocation cont….. Budget Allocation 2009/2010

Transfers 2009/2010

Actual Expenditure at 31 March 2010

Planned roll over application 2009/2010

R 304 441 000 + R193 718 000 (Roll over)= Total R498 718 000

R 304 441 000

R 343 743 000

R 153 500 000

Hospital Revitalization : Current projects and deliverablesRob Ferreira Hospital

Accumulative expenditure-R 217 208 000Budget allocation for 2009/10-R159 000 000

Status indicatorAchievedPartially Achieved

Not Achieved

PROJECT DESCRIPTION STATUS

Phase 2Completion of OPD, casualty, Pharmacy, Sinqobile (ARV) unit and Dental unit(contractor terminated, project implemented as part of phase 4)

Partially achieved

Phase 3Completion of Maternity unit, ring road and 3 guard housesFinal account Achieved

Phase 4 A1) Renovation of existing units. Construction of vehicle parking, waste storage area and ramps.2) Renovation of existing buildings for the establishment of rehabilitation centre, main stores, administration offices, crèche, cafeteria, Health Care Technology workshop and laboratory3) Upgrading of ICU and theatres4) Renovate the Imaging Dept, admin offices and new Paediatric ward

Achieved

Phase 4 BConstruction of trauma, day ward, helipad, private ward, administration

Partially Achieved

Hospital Revitalization : Current projects and deliverablesRob Ferreira Hospital cont…

Hospital Revitalization : Current projects and deliverables Rob Ferreira Hospital : PHASE II

Hospital Revitalization : Current projects and deliverables Rob Ferreira Hospital : PHASE III

Hospital Revitalization : Current projects and deliverables Rob Ferreira Hospital : Theatre

Hospital Revitalization : Current projects and deliverables Rob Ferreira Hospital : ICU

Hospital Revitalization : Current projects and deliverables Rob Ferreira Hospital : ICU

Hospital Revitalization :Ermelo Hospital

Accumulative expenditure-R 69 776 000Budget allocation-R 41 534 000

Status indicator

AchievedPartially Achieved

Not Achieved


Ermelo Hospital Phase 3 Completion of upgrading of casualty, OPD and Theatre Partially achieved

Phase 2B. Construction of 1x admin block, flats x 8 Achieved

Phase 3Completion of Psychiatric ward & EMS AchievedPhase 4Renovations of Maternity Ward and ICU, Achieved

Phase 4Construction of Paediatric ward Achieved

Phase 4Construction of Health support block Achieved

Hospital Revitalization :Ermelo Hospital cont…

ERMELO : TRAUMA UNIT

ERMELO : OPD

ERMELO : MATERNITY WARD

ERMELO : HEALTH SUPPORT BLOCK

ERMELO : PAEDIATRIC WARD

Hospital Revitalization : Themba Hospital

Accumulative expenditure-R 80 268 000Budget allocation-R 67 231 000

Status indicator

Achieved

Partially Achieved

Not Achieved


Construction of New Doctors AccommodationPartially achieved

Construction of Bambanani ARV clinic and 30 garages

Partially achievedRenovations and Upgrading of Psychiatric, Allied, Post natal and Chronic Wards

Partially achieved

Renovations of Ophthalmic ,Orthopedic, Female and Male Medical and Surgical wards

Partially achieved

Construction of New General Wards and CE Workshop

Partially achieved

Hospital Revitalization : Themba Hospital cont…

Themba Hospital DOCTOR’S ACCOMMODATION

THEMBA HOSPITAL GARAGES

Themba Hospital WARD 1 AND 2

Themba Hospital NEW GENERAL WARD

Themba Hospital BAMBANANI CLINIC

Hospital Revitalization grant : monitoring, evaluation and reporting for the financial year 2009/2010.

• The confirmation of the roll-over R 153 500 000 was conditionally approved in November 2009, subject to an audit of utilisations of funds. The audit was only conducted in January 2010,hence the office is still awaiting a final audit report.

• R 153 500 000 has since been withheld by National Treasury.

• An application for rollover of funds based on existing commitments incurred in the previous financial year has been made

Hospital Revitalization grant : monitoring, evaluation and reporting for the financial year 2009/2010 Cont:

The following appointments were made or planned to strengthen monitoring and evaluation:

80% of the HRP post structure has been filledDirector Filled-01\04\2009Infrastructure Manager Not filled- AdvertisedHealth Technology Manager Not filled -AdvertisedQA\OD Manager Filled-01\08\2009M&E Manager Not filled-not advertised3 Site project managers -filled 2x 01\08\2009


The following appointments were made or planned to strengthen monitoring and evaluation:

80% of the HRP post structure has been filled

Assistant Director filled-01\01\2010Site Electrical Engineering Technicians 3x Technicians appointed 01\09\2009

SecretaryFilled-01\06\2009Administrative officer Filled-01\09\2009


Department of Public Works, Roads and Transport as an implementing agent

Site project managers in each hospitalTechnical support

-Operational Support team-IDIP

Conducting quarterly reviews and site visits


Submission of reports totalling to 17 to the National Department of Health

-12 Monthly reports-4 Quarterly reports-Annual report

SITE VISITSMonthly Site visits by the HRP UnitNational Treasury visitSupport visits National Department of Health


Political Visits-Premier-Portfolio Committee-MEC & HOD

Monthly Steering committee meetingsMonthly Site and technical meetings with consultants

Hospital Revitalization grant : monitoring, evaluation and reporting for the financial year 2009/2010 cont…

• Reports required in compliance with DoRA have been submitted to the transfering Department (National Department of Health) monthly, quarterly and annually

• The provincial office received confirmation of receipt from the National Department of Health

HOSPITAL REVITALIZATION : HEALTH TECHNOLOGY

Equipment was procured from the previous quarters and only received during the 3rd quarter because of delays in handing over of projects .Training of staff for maintenance of equipment is on-going Equipment lists were submitted to National Department of Health

HOSPITAL REVITALIZATION :QUALITY ASSURANCE

Staff were trained on customer care and for change management Plans.Quality Assurance and Infection Control committees are in placeUnits are conducting own clinical audits

Hospital boards and Management team trained in November 2009

Hospital Revitalization : Organizational Development

Hospital board committees are in place and trained.Hospital organogram reviewed and motivation for filling of vacant posts done.Operational efficiency improved ( Strategic plan with 70 managers

from each facilities, 120 managers trained on finance for non finance managers, 500 nurses trained on the nursing process)

HOSPITAL REVITILIZATION CONDITIONAL GRANT : CHALLENGES

• Limited capacity to deliver health infrastructure by appointed contractors and consultants

• Inability to recruit and retain professional staff in relation to upgrade of services.

• Limited project management and planning skills.

HOSPITAL REVITILIZATION CONDITIONAL GRANT : PROPOSED SOLUTI0N TO CHALLENGES

• Recommendation of penalties to be levied on non performing contractors and consultants.

• Motivate for market related packages for professionals.

• Strengthen the capacity in respect of contract management and planning

THANKS

Documents

Mpumalanga Department of Health report on Comprehensive HIV