Presentation to the Portfolio Committee on Health 15 October 2014

Presentation to the Portfolio Committee on Presentation to the Portfolio Committee on HealthHealth

15 October 201415 October 2014

Structure of the PresentationStructure of the Presentation

I. Vision and Mission

II. National Development Plan

III. National Health Sector Priorities

IV. Programme Performance

V. Human Resource Management

VI. Financial Management

VII. Conclusion

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Vision and MissionVision and Mission

Vision

A long and healthy life for all South Africans.

Mission

To improve the health status through the prevention of illnesses and the promotion of healthy lifestyles and consistently to improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

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National Development Plan 2030

The Health Sector derives its vision and mandate from NDP 2030.

By 2030, South Africa should have: • Raised the life expectancy of South Africans to at least 70 years.

• Progressively improve TB prevention and cure.

• Reduced maternal, infant and child mortality.

• Significantly reduced prevalence of non-communicable diseases.

• Reduced injury, accidents and violence by 50 percent from 2010 levels.

• Completed health system reforms.

• Established primary healthcare teams to provide care to families and communities.

• Implement universal health coverage.

• Fill posts with skilled, committed and competent individuals.

National Development Plan 2030

The NDP also identifies a set of nine (9) priorities that highlight the key interventions required to achieve a more effective health system, which will contribute to the achievement of the desired outcomes. The priorities are as follows:

– Address the social determinants that affect health and diseases.

– Strengthen the health system.

– Improve health information systems.

– Prevent and reduce the disease burden and promote health.

– Finance universal healthcare coverage.

– Improve human resources in the health sector.

– Review management positions and appointments and strengthen accountability

mechanisms.

– Improve quality by using evidence.

– Development meaningful public-private partnerships.

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National Health Sector PrioritiesNational Health Sector Priorities

The major strategic framework for the work of the National Department of Health (NDoH) during 2013/14 was the Negotiated Service Delivery Agreement (NSDA) 2010 to 2014, which provides key strategies for accelerating progress towards the vision of “A Long and Healthy Life for all South Africans”.

The four outputs required from the health sector in terms of the NSDA are:(a) Increased life expectancy; (b) Reduction in maternal and child mortality rates;(c) Combating HIV and AIDS and decreasing the burden of disease from Tuberculosis; and(d) Strengthening health system effectiveness.

These outputs are interlinked. An effective and well-functioning health system is essential for the attainment of the desired improved health outcomes. The NSDA 2010 to 2014 informed the development, implementation and monitoring of the Annual Performance Plan (APP) of the NDoH for 2013/14.

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Programme Performance

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Programme 1: Administration Programme 2: National Health Insurance, Health Planning and

Systems Enablement Programme 3: HIV and AIDS, TB and Maternal and Child Health Programme 4: Primary Health Care Programme 5: Hospital, Tertiary Health Services and Human

Resource Development Programme 6: Health Regulation and Compliance Management

Programme 1

Administration

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Programme 1Programme 1

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• Performance management systems have been reviewed and aligned to

Department’s strategic direction.

• Vacancy rate was reduced to 4.34% which is below DPSA’s target of 10%.

• 103 out of 109 senior managers signed and timeously filed performance

agreements with DPSA.• The National Department of Health (NDoH) has for the last 3 consecutive

years obtained an “unqualified audit opinion” on external audit of the financial information by the Auditor-General (SA), including 2013/14 financial year.

• 7 out of 9 provinces had qualified audits. All provinces have developed

financial improvement plans.

Programme 2

National Health Insurance, Health Planning and Systems Enablement

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• The Department partnered with Council for Scientific and Industrial Research (CSIR) to develop Health Patient Registration System (HPRS) to establish a patient registry.

• There are 5 components of the system are People, Processes, Hardware, Software and Telecommunications

• The Department procured IT equipment (computers, printers and basic network equipment) for 700 clinics in NHI Pilot Districts during the 2013/14 financial year.

• The Department has supplied and installed equipment at 590 clinics in NHI Pilot Districts thus far.

Implementation of Patient-based Health Information Systems at PHC Facilities

Programme 2

HARDWARE AND NETWORK INSTALLATION

SOFTWARE INSTALLATION AND TRAINING

Broadband Connectivity is essential to implement the HPRS:• All Clinics in both KZN NHI Pilot Districts were connected during

the financial year.• The Department is working with Department of

Telecommunications and Postal Services (DTPS) to scale up connectivity to all clinics in NHI Districts through the SA Connect project.

The Department is also currently expanding the roll out of web-based District Health Information System (DHIS) daily data capture (DDC) where connectivity exist. Both HPRS and DHIS DDC will be scaled up to 700 clinics in NHI Pilot Districts.

Implementation of Patient-based Health Information Systems at PHC Facilities (continue...)

Programme 2

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Information Systems, Monitoring & Evaluation

• The Normative Standards Framework for eHealth for the public health sector was developed and approved. The eHealth Strategy seeks to ensure an Integrated National Patient-Based Information System.

• Electronic Register (TIER. Net) was implemented in 2754 health facilities.

• Rapid Mortality Surveillance was conducted by MRC and UCT School of Actuary Sciences to provide estimates for life expectancy, maternal and child mortality rates.

Programme 2

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Research• The Council for Scientific and Industrial Research (CSIR) undertook

an assessment of Patient Information Systems used in Primary Health Care settings to make recommendations for effective patient information system.

• Under the auspices of the National Health Research Council a National Health Research Database is being established.

• The National Health Research Scholars Programme which seeks to produce 1 000 PhD graduates in all fields of Health Sciences over the next 10 years, was expanded in 2013/14. 13 PhD candidates were enrolled in 2012/13; and 26 candidates enrolled in 2013/14.

Programme 2

Sector-wide Procurement

• An early warning system has been implemented to prevent stock-outs at facility level.

• A toll free line is also available to report low stock levels.

• In an effort to improve access and to decongest public facilities, work has started in NHI pilot districts whereby stable patients on chronic medicines are offered the opportunity to collect their chronic medicines at a point close to their homes or workplaces.

• To monitor the overall performance of the Provincial Pharmaceutical Services, a dashboard of key pharmaceutical indicators has been developed.

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Programme 2

Procurement Reforms: Total Impact 1-6

Programme 2

• Availability of drugs has improved from 58% to 73%

• Out of contract procurement decreased from 36% to 12%

• Buy-outs decreased by 26%

• Warehouse productivity has improved by 26% reducing the requirement for overtime as well additional hiring of staff

• Order processing time has been improved from pre project levels of 32 days on average to current levels of 11 days

• Cost of distribution has decreased by 27%

• Non Essential Medicine List orders reduced from 50% to 40%

• Backorders have reduced by 30%

Financial savings of over R150,000,000 have been achieved through the improved governance around procurement and contract

management.

Procurement Reforms Impact

Programme 2

National Health Insurance (NHI)

• The Department continued to implement the new re-engineered Primary Health Care (PHC) model for South Africa which consist of District Clinical Specialist Teams; Ward Based Primary Health Care Outreach Teams, the Integrated School Health Programme and the Contracting of General Practitioners to work in Primary Health Care Facilities.

• District Clinical Specialist Teams with at least three specialists were established in 46 of the 52 health districts.

• A total of 1 063 Municipal Ward Based Primary Health Care Outreach Teams (WBPHCOT) were established.

• 119 GPs were contracted for NHI.

• The various interventions implemented in the pilot districts focused on developing capacity in the area of monitoring and evaluation, supply chain management, and planning and strengthening the referral system.

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Programme 2

• In order to strengthen the school health programme launched in October 2012, the National Department of Health has purchased 60 mobiles which have been deployed and are being used in the NHI pilot districts

• A further 28 mobiles are currently on order for delivering in this financial year

Integrated School Health Programme

Programme 2

• 33 1668 medical male circumcision were performed• 6 688950 people aged 15-49 were tested for HIV• 662312 new clients were put on ARVs• Immunization coverage under 1 year reached 91.8%• 77. 5% of Antenatal clients initiated on ART• 89% of pregnant women delivered at facilities• TB cure rate at 75.9% • 88.7% of TB clients were tested for HIV

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1st AU International Maternal, Newborn & Child Health Conference

• Co-hosted with the AU and held in August 2013• Attended by Ministers and deputy Ministers from as well as officials

from more than 30 countries• The objective was to review progress in the implementation of the

Campaign on the accelerated reduction of maternal and child mortality (CARMMA)

• Recommendations from the conference were adopted by the joint AU/AFRO Health Ministers meeting held on 16-17 April 2014

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Programme 2

Strategies to Improve: National Health Insurance

(APP 2014/15)

• Installation of consulting rooms

• GPs programme for NHI

– Contracting

– Accurate documentation

– GP induction programme

• Expand from GP contracting to other health professionals

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Programme 2

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Strategies to Improve: Performance Data Quality• Implement web based District Health Information System to improve

data quality and timeliness of routine health information.• Strengthen the implementation of the District Health Management

Information System (DHMIS) Policy• Improve the quality of data collection tools at PHC Facilities

– Conclude the review of the National Indicator Data Set (NIDS) 2015-2017

– Develop and implement standardised guidelines for review of Provincial Indicator Data Set 2015-2017

– Rationalisation of PHC Registers Project• Integrate TB (ETR.net) and HIV (Tier.net) Health Information Systems• Accelerate the implementation of the eHealth strategy

Programme 2

Programme 3

HIV and AIDS, TB and Maternal and Child Health

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Programme 3 District -based Clinical Specialist Teams per Province

ProvinceAdvanced Midwife Anaesthetist

Family Physician Obstetrician

Paediatric Nurse Paediatrician PHC Nurse

Grand Total

Eastern Cape 8 1 1 7 3 7 27

Free State 5 4 2 5 5 21

Gauteng 5 1 5 5 5 4 5 30

KwaZulu-Natal 10 6 3 10 3 11 43

Limpopo 2 3 3 1 4 13

Mpumalanga 2 1 2 3 1 3 12

North West 4 4 3 2 2 4 19

Northern Cape 5 1 5 1 1 1 1 15

Western Cape 1 3 2 3 1 3 1 14

Grand Total 42 6 30 20 37 18 41 194

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Programme 3 Increasing Life Expectancy

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Source: Statistics South Africa, 2014

Programme 3 Declining Number of Deaths

Programme 3 Death Trends

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• The total number of deaths registered by Home Affairs was 480 476, which was a decline of 6,2% from the 512 310 deaths that occurred in 2011.

• The median age at death (age at which deaths occurred, indicating early or late mortality in the population) is increasing.

• From 2008 – 2011, the highest proportion of deaths occurred amongst young adults. However, the 2012 data show that the age profile of deaths in South Africa is starting to normalise, with the older age groups having a higher proportion of deaths than young adults.

Programme 3 Key mortality data (MRC &UCT)

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Programme 4

Primary Health Care

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Programme 4

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• PHC utilization rate is of 2.4 visits per person per annum was achieved

• A total of 1063 Municipal Ward Based Primary Health Care Outreach teams

established.

• “Ideal Clinic” initiative is being implemented in primary health care facility to

improve quality.

• National Environmental Health Policy was approved and published in the

Government Gazette for implementation.

• Malaria incidence reduced from 0.60 to 0.17 per 1000 .

• Infant & Young Child Feeding Policy was approved and published.

• A diagnostic & implementation of evaluation of Government Nutrition

Programme for under five years of age was undertaken.

Programme 5

Hospital, Tertiary Health Services and Human Resource Development

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Programme 5

• 2 638 students were registered for the first year of the medical

degree in South Africa (1756) and Cuba (882).

• A total of 88 doctors from Cuba were distributed to provinces

• 260 Hospital CEOs have undergone training to enhance the

management capacity of the public health sector

• A Public Health Enhancement Fund was created, jointly with the

private sector. R20 million from this fund was used to support

training of 100 medical students from disadvantaged backgrounds.

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9 898 Community Health Workers (CHWs) were trained on Phase One

Foundation Training. They have been placed in the Municipal Ward

Based Outreach Teams to support the PHC re-engineering process.

Programme 5

Human Resources for Health

• During 2013/14, the Workload Indicators for Staffing Need (WISN) model

from WHO was used to determine health workforce staffing requirements.

Staffing norms for clinics and community health centres were developed and

adopted as guidelines for implementation by National Health Council.

• A total of 75 521 health professionals and non-professional were trained in

programmes dealing with HIV and AIDS, STIs, TB and chronic disease

management.

• The National Department of Health enrolled 70 Forensic Interns out of a

pool of qualified but unemployed applicants.

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Programme 5

Health Infrastructure• In 2013/14:

– 842 projects at various stages of construction– 587 at planning stages– 39 handed over

• Infrastructure norms & standards being finalised with CSIR• Manual monitoring system converted into a web-based system• 14 hospitals revitalised through Health Facility Revitalisation Grant• 105 clinics being refurbished in NHI districts from the National Health

grant through DBSA FET college student initiative• 12 nursing education institutions upgrading process initiated

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Programme 5

Physical Progress in the MP Province

Ermelo Clinic (Gert Sibande) Lebohang Clinic (Gert Sibande)

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FS province

Mahaig Clinic (Thabo Mofutsanyane)

Tshirela Clinic (Thabo Mofutsanyane)

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Physical progress in the FS province

Bohlokong Clinic (Thabo Mofutsanyane)

Bluegumbosch Clinic (Thabo Mofutsanyane)

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Portchefstroom clinic close to completion

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Portchefstroom clinic furniture and medical equipment

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Human Resource Management

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Programme Number of permanent posts

Number of filled posts

Vacancy rate *1 Number of posts additional to the establishment *2

Administration 466 442 5.15% 9NHI, Health PLN & Sys Enablement 180 171 5.00% 10HIV & Aids, TB & Child Health 132 127 3.79% 9Primary Health Care Services 101 98 2.97% 3Hosp, Tertiary Ser & HR Dev 290 285 1.72% 83Health Regul & Compliance MNG 305 287 5.90% 20TOTAL 1474 1410 4.34% 134*1: (Number of permanent posts minus number of filled posts) divided by number of permanent posts multiplied by 100)

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Employment and Vacancies

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Employment Equity


Programme 6

Health Regulation and Compliance Management

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Programme 6

• Formalised the establishment of the Office of Health Standards Compliance (OHSC) as an

independent public entity. Approval of the National Health Amendment Act by Parliament

and its signing into law by the President, in July 2013. The proclamation of the National

Health Amendment Health Act (Act 12 of 2013) by the President of the Republic of South

Africa on 2nd September 2013 and inauguration of the Board in January 2014.

• “Mock” inspections in 582 facilities, thus exceeding the target of 567 and more than

doubling the number conducted in the previous year.

• A total of 1 928 health facilities conducted self-assessments and 868 facilities developed

annual Quality Improvement Plans.

• Improved management of patient complaints in preparation for the establishment of the

Health Standards Ombudsman, was supported through training in five provinces (reaching

1 221 officials) on a new in-house complaints management database and the revision of

the national complaints protocol.

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Financial Management

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ProgrammeAdjusted Budget Actual Expenditure

Over / Under Spent % Spent

R'000 R'000 R'000

ADMINISTRATION 405 505 363 960 41 545 89.8%

NATIONAL HEALTH INSURANCE, HEALTH PLANNING & SYSTEM ENABLEMENT 492 994 197 905 295 089 40.1%

HIV & AIDS, TB, MATERNAL & CHILD HEALTH 11 036 505 10 958 798 77 707 99.3%

PRIMARY HEALTH CARE SERVICES 100 960 88 199 12 761 87.4%

HOSPITALS, TERTIARY HEALTH SERVICES & HUMAN RESOURCE DEVELOPMENT 17 728 804 17 483 962 244 842 98.6%

HEALTH REGULATION & COMPLIANCE MANAGEMENT 763 413 732 273 31 140 95.9%

TOTAL 30 528 181 29 825 097 703 084 97.7%

EXPENDITURE PER PROGRAMME

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Reasons for Deviations (1)

Administration – Under spent due to late submission of invoices by GCIS and suppliers.

National Health Insurance, Health Planning & System Enablement – Under spent due to the slow take-off of the National Health Insurance Indirect Grant.

HIV & AIDS, TB, Maternal & Child Health – Delays in the procurement of condoms due to shortage of stock from suppliers and late deliveries.

Primary Health Care Services – Under spent due to slow implementation of project to strengthen the District Health Information

System.

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Reasons for Deviation (2)

Hospitals, Tertiary Health Services & Human Resource Development – Under spent due to late submission of invoices by Forensic Chemistry Laboratories and incomplete infrastructure projects funded through Health Facility Infrastructure Indirect Grant.

Health Regulation & Compliance Management – Under spent on Goods and Services under Pharmaceutical Trade & Product Regulation, Office of Health Standards Compliance and the Commissioner for Occupational Diseases.

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ECONOMIC CLASSIFICATION

Economic ClassificationAdjusted Budget Actual Expenditure

(Over) / Under Spent

% Spent

R'000 R'000 R'000

Compensation of Employees 556 900 555 318 1 582 99.7%

Goods and Services 1 034 395 633 369 401 026 61.2%

Transfers 28 465 818 28 461 386 4 432 99.9%

Capital 471 068 173 313 297 755 36.8%

Losses - 1 711 (1 711) 0.00%

TOTAL 30 528 181 29 825 097 703 084 97.7%

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Reasons for Deviation

Compensation of Employees and Transfers spent within the target norm.

Contributors to under spending Goods and Services – Slow take-off of the National Health

Insurance Indirect Grant and delays in delivery of condoms.

Capital – Incomplete infrastructure projects funded through Health Facility Infrastructure Indirect Grant.

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Conditional Grants

Overall Expenditure

To present Conditional Grants expenditure as at 31 March 2014.

Overall provincial CG spent 96% or R27 bn against total adjusted

budget inclusive of Provincial roll-overs of R28 bn.

resulted to under spending of 4% or R1 bn

major contributors to under spending are:

• NHI spent 80%

• HFRG spent 84%

HPTDG, NTSG and HIV and AIDS spent within the target

norm at 100%, 100% and 99% respectively.

Expenditure Summary Per Grant Benchmark 100%

PROVINCE

Grant Name

Original Budget (1)

National Adjustments (2)

Total National Budget (3 = 1+2)

Provincial Roll-overs (4)

Total Adjusted Budget (5 = 3+4)

Expenditure (6)

Budget Available (7 = 5-6)

% Spent of National Budget (as per AR) (8 = 6÷3)

% Spent of total Adjusted Budget (9 = 6÷5)

R'000 R'000 R'000 R'000 R'000 R'000 R'000 % %Health Professions Training and Development Grant 2 190 366 - 2 190 366 3 896 2 194 262 2 194 125 137 100% 100%National Tertiary Services Grant 9 620 357 - 9 620 357 72 215 9 692 572 9 656 647 35 925 100% 100%Comprehensive HIV and AIDS Grant 10 533 886 - 10 533 886 95 486 10 629 372 10 515 696 113 676 100% 99%Health Facility Revitalisation Grant 5 123 542 167 274 5 290 816 298 410 5 589 226 4 687 457 901 769 89% 84%National Health Insurance Grant 48 500 2 453 50 953 38 755 89 708 71 614 18 094 141% 80%TOTAL 27 516 651 169 727 27 686 378 508 762 28 195 140 27 125 539 1 069 601 98% 96%

BUDGET NATIONAL

EXPENDITURE

Health Professions Training and Development Grant

33,3%Benchmark

100%

PROVINCE

Grant Name

Original Budget (1)





Expenditure (6)




R'000 R'000 R'000 R'000 R'000 R'000 R'000 % %Eastern Cape 188 560 - 188 560 2 380 190 940 186 435 4 505 99% 98%Free State 138 131 - 138 131 - 138 131 138 029 102 100% 100%Gauteng 765 202 - 765 202 - 765 202 765 202 - 100% 100%Kwazulu-Natal 276 262 - 276 262 - 276 262 276 262 - 100% 100%Limpopo 109 628 - 109 628 1 516 111 144 110 584 560 101% 99%Mpumalanga 89 894 - 89 894 - 89 894 89 885 9 100% 100%Northern Cape 72 356 - 72 356 - 72 356 77 395 (5 039) 107% 107%North West 98 666 - 98 666 - 98 666 98 666 - 100% 100%Western Cape 451 667 - 451 667 - 451 667 451 667 - 100% 100%TOTAL 2 190 366 - 2 190 366 3 896 2 194 262 2 194 125 137 100% 100%

NATIONALBUDGET EXPENDITURE

National Tertiary Services Grant Benchmark 100%

PROVINCE

Grant Name

Original Budget (1)





Expenditure (6)




R'000 R'000 R'000 R'000 R'000 R'000 R'000 % %Eastern Cape 743 621 - 743 621 40 996 784 617 774 091 10 526 104% 99%Free State 849 661 - 849 661 - 849 661 849 636 25 100% 100%Gauteng 3 305 931 - 3 305 931 - 3 305 931 3 305 810 121 100% 100%Kwazulu-Natal 1 415 731 - 1 415 731 - 1 415 731 1 415 743 (12) 100% 100%Limpopo 305 732 - 305 732 12 304 318 036 303 916 14 120 99% 96%Mpumalanga 91 879 - 91 879 - 91 879 80 736 11 143 88% 88%Northern Cape 282 618 - 282 618 - 282 618 282 616 2 100% 100%North West 224 470 - 224 470 18 915 243 385 243 385 - 108% 100%Western Cape 2 400 714 - 2 400 714 - 2 400 714 2 400 714 - 100% 100%TOTAL 9 620 357 - 9 620 357 72 215 9 692 572 9 656 647 35 925 100% 100%


Reasons for Deviations

National Tertiary Services Grant:

•With exception of Limpopo and Mpumalanga all other provinces spent

within the target norm.

Limpopo

•Delay in the completion of installation of Cathlab resulted in under

spending on CAPEX.

Mpumalanga

•Delays in the delivery of medical equipment.

Comprehensive HIV and AIDS Grant Benchmark

100%

PROVINCE

Grant Name

Original Budget (1)





Expenditure (6)




R'000 R'000 R'000 R'000 R'000 R'000 R'000 % %Eastern Cape 1 273 296 - 1 273 296 26 080 1 299 376 1 299 292 84 102% 100%Free State 742 984 - 742 984 - 742 984 699 554 43 430 94% 94%Gauteng 2 258 483 - 2 258 483 - 2 258 483 2 258 483 - 100% 100%Kwazulu-Natal 2 652 072 - 2 652 072 - 2 652 072 2 651 997 75 100% 100%Limpopo 861 143 - 861 143 50 724 911 867 860 671 51 196 100% 94%Mpumalanga 690 591 - 690 591 - 690 591 690 591 - 100% 100%Northern Cape 302 468 - 302 468 18 682 321 150 302 259 18 891 100% 94%North West 825 302 - 825 302 - 825 302 825 302 - 100% 100%Western Cape 927 547 - 927 547 - 927 547 927 547 - 100% 100%TOTAL 10 533 886 - 10 533 886 95 486 10 629 372 10 515 696 113 676 100% 99%



Comprehensive HIV/AIDS Grant:

Free State

•Under spent due Provincial cash flow challenges experienced.

Limpopo

•Delays in delivery of condoms by suppliers.

Northern Cape

•Delays in the procurement of condoms due shortage of stock from

suppliers.

Health Facility Revitalisation Grant Benchmark 100%

PROVINCEGrant Name

Original Budget (1)





Expenditure (6)




R'000 R'000 R'000 R'000 R'000 R'000 R'000 % %Eastern Cape 562 792 - 562 792 6 264 569 056 568 745 311 101% 100%Free State 538 962 - 538 962 86 792 625 754 454 423 171 331 84% 73%Gauteng 771 033 - 771 033 73 205 844 238 473 799 370 439 61% 56%Kwazulu-Natal 962 469 110 062 1 072 531 - 1 072 531 1 072 529 2 100% 100%Limpopo 457 442 - 457 442 4 469 461 911 233 140 228 771 51% 50%Mpumalanga 283 509 212 283 721 22 712 306 433 304 315 2 118 107% 99%Northern Cape 421 428 57 000 478 428 5 103 483 531 452 952 30 579 95% 94%North West 496 121 - 496 121 34 702 530 823 513 667 17 156 104% 97%Western Cape 629 786 - 629 786 65 163 694 949 613 887 81 062 97% 88%TOTAL 5 123 542 167 274 5 290 816 298 410 5 589 226 4 687 457 901 769 89% 84%



Health Facility Revitalisation Grant:

Free State – Delays in allocation of land by the Municipality and prolonged

bid processes and appointment of new consultants between the

Department and FDC.

Gauteng – Delays in the appointment of contractors and delivery of

projects by Department of Infrastructure Development.

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Health Facility Revitalization Grant:

Limpopo – Late appointment of new implementing agent in the fourth

quarter

Northern Cape – Delay in finalising contract with implementing agents

Western Cape – Delays in awarding tenders and poor performance of

contractors on site

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National Health Insurance Grant Benchmark 100%

PROVINCE

Grant Name

Original Budget (1)





Expenditure (6)




R'000 R'000 R'000 R'000 R'000 R'000 R'000 % %Eastern Cape 4 850 - 4 850 2 376 7 226 5 941 1 285 122% 82%Free State 4 850 - 4 850 - 4 850 4 871 (21) 100% 100%Gauteng 4 850 - 4 850 12 026 16 876 13 559 3 317 280% 80%Kwazulu-Natal 9 700 - 9 700 14 949 24 649 15 520 9 129 160% 63%Limpopo 4 850 - 4 850 5 802 10 652 9 217 1 435 190% 87%Mpumalanga 4 850 - 4 850 - 4 850 3 739 1 111 77% 77%Northern Cape 4 850 - 4 850 1 578 6 428 6 528 (100) 135% 102%North West 4 850 - 4 850 2 024 6 874 6 874 - 142% 100%Western Cape 4 850 2 453 7 303 - 7 303 5 365 1 938 73% 73%TOTAL 48 500 2 453 50 953 38 755 89 708 71 614 18 094 141% 80%



National Health Insurance:

Under spending in EC, GP, KZN, LP, MP and WC are mainly due to:

• Late implementation of projects.

• Inefficiencies in SCM processes which led to delay in deliveries of

goods and services by Service Providers.

Overall Expenditure Per Province Benchmark 100%

PROVINCE

Grant Name

Original Budget (1)


Total National Budget (3= 1+2)


Total Adjusted Budget (5= 3+4)

Expenditure (6)

Budget Available (7=5-6)

% Spent of National Budget (as per AR) (8=6÷3)

% Spent of total Adjusted Budget (9= 6÷5)

R'000 R'000 R'000 R'000 R'000 R'000 R'000 % %Eastern Cape 2 773 119 - 2 773 119 78 096 2 851 215 2 834 504 16 711 102% 99%Free State 2 274 588 - 2 274 588 86 792 2 361 380 2 146 513 214 867 94% 91%Gauteng 7 105 499 - 7 105 499 85 231 7 190 730 6 816 853 373 877 96% 95%Kwazulu-Natal 5 316 234 110 062 5 426 296 14 949 5 441 245 5 432 051 9 194 100% 100%Limpopo 1 738 795 - 1 738 795 74 815 1 813 610 1 517 528 296 082 87% 84%Mpumalanga 1 160 723 212 1 160 935 22 712 1 183 647 1 169 266 14 381 101% 99%Northern Cape 1 083 720 57 000 1 140 720 25 363 1 166 083 1 121 750 44 333 98% 96%North West 1 649 409 - 1 649 409 55 641 1 705 050 1 687 894 17 156 102% 99%Western Cape 4 414 564 2 453 4 417 017 65 163 4 482 180 4 399 180 83 000 100% 98%TOTAL 27 516 651 169 727 27 686 378 508 762 28 195 140 27 125 539 1 069 601 98% 96%

BUDGET NATIONAL

EXPENDITURE

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Schedule 6 Conditional Grant

SCHEDULE 6A GRANT PERFORMANCE REPORT AS AT 31 MARCH 2014

Grants Budget (R'000)

Expenditure (R'000)

Commitments Budget

Available (R'000)

% Spent of Budget

Health Facility Revitalisation Grant - In Direct 440 025 182 692 33 312 257 333 42%National Health Insurance - In Direct 288 547 9 458 48 728 279 089 3%Total National Health Grant 728 572 192 150 82 040 536 422 49% African Nations Championship Grant 6 000 4 561 - 1 439 76%

TOTALS 734 572 196 711 82 040 537 861 27%

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Reasons for Deviations(Schedule 6)

Health Facility Revitalisation Grant - Indirect• Poor management of projects by implementing agents • Delays in awarding of tenders and appointment of contractors.

National Health Insurance• Under spending caused by challenges in attracting GPs across the country.• Submission of inaccurate and incomplete timesheets by GPs leading to delay in process of payments – service provider sourced to administer payroll system for GPs.

African Nations Championship (CHAN)• Failure to procure capital items by Western Cape province.

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ConclusionsConclusions

Key milestones were achieved during the financial year 2013/14, in relation to the objectives and targets set in the National DoH Annual Performance Plan for this period

Challenges were also experienced, which affected some areas of service delivery.

These challenges are addressed in the National DoH Annual Performance Plan for 2014/15.

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75

Thank You

Documents

Presentation to the Portfolio Committee on Health 15 October 2014