Select Committee on Social Services 22 October 2013pmg-assets.s3-website-eu-west-1.amazonaws.com/131022ndoh.pdfA total of 360 168 HIV positive patients received Isoniazid Preventive

1

Select

Committee

on

Social

Services

22 October

2013

Purpose of the Presentation

1. To reflect on key issues (highlights) from the Annual

Report of the National Department of Health (DoH) for

2012/13.

2. To reflect on strategies for addressing constraints

experienced – which are also outlined in the National

DoH’s Annual Performance Plan for 2013/14.

2

Structure of the Presentation

I. Vision and Mission

II. National Health Sector Priorities

III. Review of Programme Performance

IV. Human Resource Management

V. Budget and Expenditure Per Economical Classification

VI. Explanations of Material Variances

VII. Audit Outcomes

VIII.Conditional Grant Expenditure

IX. Conclusions

3

Vision 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.

4 4

National Health Sector Priorities

The major strategic framework for the work of the National Department of Health (NDoH) during 2012/13 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 2012/13.

5 5

Programme 1:

Administration and Corporate Services

Fiscal Environment

6

ProvinceAnticipated

opinion

Audit opinion

2011-12Movement

Eastern Cape Qualified Qualified

Free State Qualified Qualified

Gauteng Qualified Qualified

KwaZulu-Natal Qualified Qualified

Limpopo Disclaimer Disclaimer

Mpumalanga Qualified Qualified

Northern Cape Disclaimer Qualified

North West Qualified Unqualified

Western Cape Unqualified Unqualified

National Unqualified Unqualified

6

Province 2011/12 2012/13 Movement

Programme 1: Administration and Corporate Services

Appointment of Interns

Unemployed financial, ICT and Human Resources graduates were

appointed to support the financial management plans and improve

audit outcomes

7 7

PROVINCE HR FM ICT TOTAL

Eastern Cape 10 6 16 32

Free State 12 8 9 29

NDoH 13 12 15 41

Gauteng 33 44 37 115

Limpopo 7 24 20 51

Northern Cape 12 5 12 29

CCOD 6 11 13 13

North West 15 9 11 35

TOTAL 108 119 133 360

Programme 1:

Administration and Corporate Services

Revenue Management Model:

• Interns were instrumental for implementing a project to improve revenue management at Charlotte Maxeke Hospital. The objectives of the Project were: – To reduce Medicom backlog in the hospital, due to system down time, and

– To improve data quality by correcting errors in patient contact details.

• The entire backlog of patient admissions dating back to April 2012 was cleared.

• 400 patients were registered daily, and 400 patient files were checked daily to improve data accuracy.

• The Road Accident Fund and Medical Scheme receipt allocations were earmarked for correction. Through the project, a total of R36.5 million receipts (R14million - RAF and R21.5 million - Medical Schemes) were reconciled to their invoices.

• The billing backlog to April 2012 for support services was also cleared.

• This model is currently being further rolled out in 6 provinces namely Gauteng, Free State, Limpopo, Eastern Cape, Limpopo and Northern Cape,

8

Programme 2: NHI, Health Planning and

Systems Enablement

Norms and Standards have been developed in four key areas, namely:

Information Technology (IT) – Council for Scientific and Industrial

Research (CSIR) developed Normative Standards Framework –

subsequently adopted by National Health Council

Human Resources – Workload Indicators for Staffing Need (WISN)

model of WHO has been adopted and rolled out at PHC facilities in

health districts.

Quality – The National Health Act was amended and proclaimed in order

to establish an independent Office of Health Standards Compliance

(OHSC). This office has been established to improve quality of care. (see

Programme 6)

Infrastructure – 80% of Norms and Standards for health infrastructure

have been developed.

9

Programme 2: NHI, Health Planning and

Systems Enablement

• National eHealth Strategy has been approved by the National Health Council and Published during July 2012.

• eHealth Strategy has identified following strategic priority areas:

– Strategy and Leadership

– Stakeholder engagement

– Standards and Interoperability

– Governance and Regulation

– Investment, Affordability and Sustainability

– Benefits realisation

– Capacity and workforce

– eHealth Foundations

– Applications and tools to support health care delivery

– Monitoring and Evaluation

10

Programme 2: NHI, Health Planning &

Systems Enablement

National Health Insurance (NHI) - A number of Health service

innovations in preparation for NHI were rolled-out at 10 pilot districts:

1. The Ministerial road-shows in each of the NHI districts involved a

wide range of stakeholders;

2. NHI management structures have been established in 5 Provinces –

Mpumalanga, Limpopo, KwaZulu Natal, North West, Northern Cape

3. Workload Indicator of Staffing Norms (WISN) have been introduced

in all 10 pilot districts and have been completed to district level.

4. 945 Ward based Primary Health Care (PHC) outreach teams were

constituted;

5. 34 District clinical specialist teams (with at least 3 members) were

appointed;

11

NHI (cont...) 6. Draft White Paper on NHI was prepared. 7. Consultations are underway in line with Cabinet guidelines. 8. Independent assessment of 12 month implementation were

undertaken in the NHI pilot districts. 9. Health Facility Improvement Teams were established; and

12


Systems Enablement

12


Systems Enablement

In response to the findings of the Health Facilities Baseline Audit, Health Facility Improvement teams under the leadership of senior management form the National Department of Health was established for the following districts

– O.R. Tambo (Eastern Cape);

– Mangaung (Free State);

– Sedibeng (Gauteng);

– Zululand (KZN);

– Vhembe (Limpopo);

– Gert Sibande (Mpumalanga);

– Dr. K. Kaunda (North West); and

– Pixley ka Seme (Northern Cape).

– Zululand (KwaZulu-Natal)

• The Health Facility Improvement Teams supported the development of quality improvement plans for health facilities on these districts

• Approximately 1000 facilities were directly or indirectly supported through this initiative

13 13

Eastern Cape - Luthubeni Clinic Before

After

Roof of one of the consulting rooms. The sun shine through onto the examination couch

The roof was replaced Air conditioner installed Water connected inside the Facility

14

Eastern Cape - Maphuzi Clinic

15

Staff Accommodation Staff used Consulting rooms as accommodation

Water to the clinic from a community tap

Eastern Cape - Maphuzi

The Staff Accommodation was repaired and upgraded Facility again has 5 consulting rooms Water supply was connected and available inside the clinic

After

16

Free State - BAINSVLEI CLINIC

17

CEILING BEFORE CEILING AFTER

Gauteng - Parkhomes

Temba clinic

Dilopye clinic

Northern Cape - Kareeberg: Progress

Water tanks installed at Vanwyksvlei clinic New flooring at Vanwyksvlei clinic

Northern Cape - Douglas CHC

NHI (cont...) 10 . Educating the public and users of health services

• Over 84% of the population utilises the public health system • The Mindset patient/public broadcast channel is both an educational and a

compelling viewing experience incorporating: – drama – public service announcements – documentaries – interviews and discussions

• The Channel covers health education and promotion on HIV and AIDS, tuberculosis, child health, chronic conditions and underlying factors such as gender violence in multiple languages.

• Available every week day from 07h30 – 17h30

• Broadcasts into 600 public health facilities in RSA (June 2012)

• Some content is sourced (for free) from media partners: Soul City, USAID/JHHESA, CMT, Khomanani, Izwi Multimedia, etc

22


Systems Enablement

22

Programme 2: NHI, Health Planning & Systems Enablement

Reach of the Mindset Health Channel in NHI Districts

23

PROVINCE DISTRICT TOTAL POPULATION

TOTAL HEALTH FACILITIES

CURRENT MINDSET HEALTH REACH (%)

EASTERN CAPE OR TAMBO 1, 3 million 154 15 (10%) FREE STATE THABO

MOFUTSANYANE

832, 000 85 21 (19%)

GAUTENG TSHWANE 2,6 million 116 20 (17%) KWAZULU NATAL

UMZINYATHI 514, 000 56 3 (5.4%) UMGUNGUNDLOVU 1,06 million 74 4 (5.4%) AMAJUBA 514, 314 28 10 (35.7%)

LIMPOPO VHEMBE 1,3 million 128 6 (4.6%) MPUMALANGA GERT SIBANDE 944, 000 108 15 (14%) NORTHERN CAPE

PIXLEY KA SEME 192, 000 42 11 (26%)

NORTH WEST DR KENNETH KAUNDA 807, 000 48 12 (25%) WESTERN CAPE EDEN 558, 000 71 5 (7%) TOTAL 10,784 million 910 122 (12.6%)

23

Programme 2: NHI, Health Planning & Systems Enablement

24

Mindset Health Channel: Satellite Receiving Equipment Mindset Health TV Channel Computer based HCP training

24

Programme 3: HIV and AIDS, TB and

Maternal, Child and Women’s Health

HIV and AIDS Prevention is the mainstay of efforts to combat HIV and AIDS

o During 2012/13 a total of 422 262 medical male circumcisions were

conducted, which was 70.4% of the 600 000 target set for 2012/13; and

o A total of 8 978 177 people accepted HIV Counselling and Testing

during 2012/13. After the HCT campaign of 2010/11 the programme

was integrated into the routine health services and this resulted in a

decrease of South Africans participating which is expected with any

campaign. The HCT Campaign will again be implemented during

2013/14.

A total of 612 118 new patients were put on Antiretroviral Treatment,

which exceeded the 2012/13 target of 500 000 patients.

25



26

85.3% of TB patients were tested for HIV. Though this was an improvement from the 82.9% achieved in 2011/12,

74.1% of eligible TB/HIV co-infected patients received Cotrimaxozole

Prophylaxis Therapy (CTP) to prevent opportunistic infections. A TB cure rate of 73.8% (for 2011) was achieved, against a target of 80%. A total of 360 168 HIV positive patients received Isoniazid Preventive Therapy

(IPT) - to prevent latent TB from progressing to clinically apparent disease - compared to the target of 400 000 patients.

26



Maternal and Woman's Health

For Couple year protection rate the Department has exceeded the 2012/13 target of 35 %, and a performance of of 37% was achieved.

All public health facilities provided contraceptive services.

55.4% of women were screened for cervical cancer, this was 1.4% above the 2012/13 target of 54%. This improvement is linked to improved training of healthcare providers to take cervical swabs.

44% of pregnant women presented to the health services before 20 weeks of pregnancy, which was 6% lower than the 2012/13 target of 50%.

65.2% of Mothers and 66.2% of Babies received postnatal care within 6 days after delivery, against a target of 75%.

27

28 28


Maternal, Child and Women’s Health Maternal and Woman's Health cont...

98.2% of pregnant women were tested for HIV, which was consistent with the 2012/13 target of 98%.

81.6% antenatal clients were initiated on HAART, compared to the target of 85%, because initiation of HAART could only be done after CD4 counts were done and some women struggled to come back for the results and initiation.

2.5% of babies tested Polymerase Chain Reaction (PCR) positive 6 weeks after birth (out of all babies tested) against the 2012/13 target of 3%. The outcomes of this programme continued to show a downward trend. This implies that a much lower proportion of babies contracted HIV from their mothers at birth.

29

30



Child Health

National immunisation coverage of 94% was achieved,

which exceeded the 2012/13 target of 90%.

A total of 10354 Quintile 1 and 2 schools were visited by

school health teams to provide Integrated School Health

Programme (ISHP). The 2012/13 target was to visit 6454

Quintile 1 schools.

A total of 84 281 Grade 8 learners assessed using the ISHP

learner assessment, compared to the target of 65 100

learners.

31

32 32

EU Supported Project

1st Phase – Purchased 30 Mobiles – EU Branded

2nd Phase – Purchase 30 more mobiles for delivery in January 2013

Provincial Departments will be responsible for :

• Staff

• Maintenance

• Overheads

33



33



34

Integrated School Health Programme (ISHP)

• Bilateral between the Department of Education and Department of health

• Focus on quintile 1 and 2 schools (poorest schools)

• Developed an integrated school health programme

• A High-level launch took place on 11 October 2012

35



35

Programme 4: Primary Health Care Services

Re-engineering of PHC and District Health System

A PHC utilisation rate of 2.5 visits per person was achieved in

2012/13, against a target of 2.8 visits per person.

76% of fixed PHC facilities had monthly supervisory visits, against

the target of 80%. Supervision of PHC facilities was affected by a

lack of dedicated supervisors caused by shortages of staff.

51 District Health Plans (DHPs) were analysed and feedback

provided against the target of 52 DHPs – except one district in the

Western Cape.

36

37

Programme 4:

Primary Health Care Services

Three Streams for Reengineering of PHC

A total of 945 ward-based PHC outreach teams were established as part of the PHC re-engineering strategy, and exceeded the target of 500.

1114 at end September 2013 9896 CHWs have been trained on Phase 1 Module 2 training is starting in November 2013

Phase 1: Health Promotion, Nutrition, Maternal and Child health, HIV and TB

Phase 2 NCDs, Mental health, Youth, Older Persons, Substance Abuse and Violence

34 districts had at least 3 members of the District Clinical Specialist Teams appointed compared to the target of 10 districts.

School Health Services – reported under child health 38

39

Province Number of Ward Base PHC Outreach Teams - DHIS 30/3/2013

Eastern Cape 478

Gauteng 120

Free State 58

KwaZulu-Natal 46

Limpopo 75

Mpumalanga 20

Northern Cape 1

Northwest 147

Grand Total 945

Programme 4: Primary Health Care Services

Progress on DCST appointments by Specialty per Province

Speciality EC FS GP KZN LP MP NC NW WC Total

Advanced Midwife 6 5 4 8 1 3 5 5 1 38

Anaesthetist 0 0 2 0 0 0 0 0 6 8

Family Medicine 0 4 5 5 5 0 4 8 3 34

Obstetrician 1 3 5 2 1 1 0 4 4 21

Paediatrician 1 0 7 0 0 0 2 3 5 18

Paeds nurse 5 5 4 7 1 3 0 1 0 26

PHC nurse 7 5 5 9 5 3 2 3 1 40

Total 20 22 32 31 13 10 13 24 20 185

40

Districts with a Minimum of 3 DCST Members

Province Districts Number

EC A Nzo, Chris Hani, Nelson Mandela Metro, ORT 4

FS All 5

GP All 5

KZN EThekwini, ILembe, UGu ,UMgungundlovu, UMkhanyakude, uMzinyathi, Zululand

7

LP Capricorn, Vhembe, (more appointments in progress) 2

MP All 3

NC Frances Baard, John Taole, Pixley ka Seme 3

NW All 4

WC Cape Winelands, City of Cape Town, Eden, Overberg 4

Total 37

Programme 4:


Nutrition and Health Promotion

51% (278) of health facilities in which deliveries are done

were accredited as Mother Baby Friendly Initiative,

against the target of 55% (300).

Vitamin A supplementation coverage rate among

children aged 12-59 months was 42.8%, which was

marginally above the target of 42%.

Health Promotion Strategy is currently in draft form and

will be adopted in the 2013/14 financial year

42

43 43 43

Programme 4:


Environmental Health

Norms and standards for Environmental Health Services were

developed and finalised as per the planned target.

In compliance with the requirements of Chapter 3 of the National

Environmental Management Act (NEMA), the Department’s

Annual NEMA compliance Report was prepared and submitted.

A total of 27 ports of entry were assessed and found to be ready

for designation. Draft regulations were developed to effect

designation.

Malaria

The cumulative incidence for malaria cases of local origin was

0.18 per 1000 population at risk , compared to the target of 0.4

per 1000 population at risk. The cumulative incidence was 0.28

for the aggregate of local cases and cases of unknown origin,

compared to the target of 0.58 per 1000 population at risk. 44

Programme 4:


Non Communicable Diseases

Draft Legislation on alcohol advertising was prepared and consultation

processes were conducted.

Three districts of West Rand (Gauteng Province); Ehlanzeni

(Mpumalanga Province) and Dr. Kenneth Kaunda (North West Province)

are implementing the Integrated Chronic Care Management model as

planned – this programme is now scaled to include all the NHI Pilot

Districts.

Regulations on salt content in processed food were promulgated.

With regards to the Prevention of Blindness Strategy one of the three

targeted Provinces achieved the target for cataract surgery rate of 1500

per million population and two Provinces reached 80% of the target.

45

Programme 5: Hospital, Tertiary

Services and Workforce Development

Health Infrastructure Programme

32 projects prioritised through the Nursing College and

Schools Grant were funded for upgrade.

The infrastructure Project Maintenance Information System

was reconfigured, maintained and implemented.

Three National Progress review meetings were conducted to

monitor facilities funded through the Grants.

85 hospitals received funding for infrastructure maintenance

and upgrade from the Hospital Revitalisation Grant.

354 infrastructure projects were funded from the Health

Infrastructure Grant.

46

Programme 6: Health Regulation and

Compliance Management

Management and Governance of Public Entities

Bi-annual Public Health Entities governance and

management framework reports produced.

Quarterly Public Health Entities compliance reports

produced.

Forum for Statutory Health Professional Council

established and bi-annual reports submitted.

47

Programme 6: Health Regulation and

Compliance Management

Medicines Control Council (MCC) :

During 2012/13, a total of 706 generic medicines were registered. 224 were from

the backlog. The remaining 482 were registered within an average period of 34

months. The target for 2012/13 was 15 months.

A total of 21 Human New Chemical Entities were registered with an average

period of 36 months. The target for 2012/13 was 28 months.

Addressing backlog in medicines registration is affected by:

The non-availability of evaluators, both in-house and external;

The evaluators that were appointed were undergoing training;

Difficulty to attract specialist evaluators at rates paid; and

Delays by applicants in responding to MCC recommendations.

Draft amendments to legislation to enable transition of the MCC to South African

Health Products Regulatory Authority was submitted to Cabinet.

48

Programme 6: Health Regulation and Compliance Management

Office of Health Standards Compliance (OHSC)

National Health Amendment Bill on establishment on the Office of

Health Standards Compliance was processed by Parliament. This

was enacted on 2 September 2013.

Number of inspectors appointed to assess compliance of public

health facilities with core standards of care increased towards the

end of the financial year

87.5% of the 64 randomly selected public sector hospitals

conducted patient satisfaction surveys at least once per year. The

target was 90% of the 400 public sector hospitals.

57% of the complaints were resolved within 25 days against the

target of 75%.

6.2% (235) of facilities were fully assessed for compliance with six

core standards of care, against the target of 20% (800 facilities).

49

Human Resources Management

For the year under review, Human Resources oversight

and control mechanisms have improved in the areas of

developing check lists for recruitment processes, as well

as implementation of exit processes, to determine causes

of staff turnover.

One of the achievements in this area relates to the

development of the Human Resource Plan and the

reduction of the vacancy rate.

These control measures responded to the prior year's

audit findings.

50


The implementation of the new organisational structure began

on 1 April 2012.

The first phase of matching and placing employees on the

three-tiers of the structure (Director-General, Deputy

Directors-General and Chief Directors levels) has been

completed.

The second phase of the matching process (Director and

below) is in progress, which will allow for a greater alignment

of functions.

51 51


The Department has created a dedicated Performance Management

and Development System (PMDS) Unit at a Directorate level to

provide advisory and administrative support in ensuring linkages

between individual and organisational performance.

An electronic PMDS system has been implemented to minimise the

administrative burden of the process.

52

Human Resources Priorities for 2012 to

2014- NDOH

Priority 1: To manage the re-engineering of business

processes and systems in the Department.

Priority 2:To strengthen the organisational structure and

evaluation of staff utilisation in the Department.

Priority 3: To strengthen the capacity of employees in the

Department through HR development initiatives.

Priority 4: To enhance employee health and wellness in the

workplace.

Priority 5: To enforce the implementation and compliance of

Performance Management Development System in the

Department.

Priority 6: To implement Human Resources Strategic

Planning and Reporting.

53

BUDGET AND EXPENDITURE PER PROGRAMME

54

BUDGET AND EXPENDITURE PER PROGRAMME Continue

55

BUDGET AND EXPENDITURE PER PROGRAMME Continue

56

EXPLANATIONS OF MATERIAL VARIANCES Per programme Final

Appropriation R’000

Actual Expenditure

R’000

Variance

R’000

Variance as % of Final

Appropriation

Administration 402 434 390 478 11 956 96%

The underspending can be attributed to hardware for ICT solution which could not be ordered before financial year-end and the earmarked allocation for hospital tariffs could not be spent before year-end.

NHI, Health Planning and System Enablement

303 794 293 286 10 508 97%

Underspending can be attributed to earmarked funds for the Hospital re-imbursement tool not spent and an underspending on the travelling budget for the NHI & Health Financing sub programme.

HIV & AIDS, TB, Maternal and Child Health

9 230 346 9 165 474 64 872 99%

The transfer to SANAC was approved by National Treasury during the latter part of March 2013, leaving the Department with insufficient time to verify the banking details before transferring the funds. Outstanding invoices by GCIS for the Media campaign as well as outstanding condom invoices contributed to the underspending.

57

EXPLANATIONS OF MATERIAL VARIANCES Continue

Per programme Final Appropriation

R’000

Actual Expenditure

R’000

Variance

R’000

Variance as % of Final

Appropriation


113 842 105 362 8 480 93%

Underspending on the Goods and Services budget of Non-Communicable Diseases and the non-finalizing of the Round About Project.

Hospitals, Tertiary Services & Human Resource Development

17 423 129 17 398 756 24 373 100%

Health Regulation and Compliance Management

583 658 545 526 38 132 93%

Both the Subprogrammes for Office of Standards of Compliance and the Compensation for Occupational Diseases underspent on their respective Goods and Services budget.

58

AUDIT OUTCOME U Unqualified Audit Opinion for 2012/13.

Matters to be attended to:

– Due to internal controls not being fully implemented the department did not

have and maintain an effective and efficient system of internal control

regarding performance management. Key interventions include:

– Quarterly performance reports on Conditional Grants were not submitted

within 45 days after the end of each quarter to the National Treasury – This

has been addressed and Programme Managers are working closely with

Provinces to ensure timley submission of reports);

– Business plans for utilisation of the HIV and AIDS grant allocation made to all

provincial departments of health were not approved prior to the start of the

financial year – This has been addressed and all Business plans have been

signed prior to financial year and in terms of the framework.

59

AUDIT OUTCOME

U Unqualified Audit Opinion for 2012/13.

– Employees of the department performed remunerative work outside

their employment in the department without written permission.

– Annual leave taken by employees were not recorded in a timely

manner thereby ensuring that all leave is accounted for accurately and

in full.

– Employees of the department performed remunerative work outside

their employment in the department without written permission – HR

has instituted action against all the employees. National Treasury will

assist Departments to make available all the databases necessary to

properly control this situation

– Annual leave taken by employees were not recorded in a timely

manner thereby ensuring that all leave is accounted for accurately and

in full – All leave is now captured in line with prescripts from DPSA.

60

AUDIT PLANS

Audit plans to address findings have been developed

both for Performance Information as well as Financial

Regularity;

In addition the Department has identified a number of

additional audit risks and plans have been developed to

address these;

The protocol with the AG remains in place and a number

of close out and engagement meetings have been held.

61

Strengthening Internal Controls for Performance Information

Interventions Include : • Implementation of the electronic Tool (eTool) of the District Health Information

System (DHIS) across Provinces. This started in the 20 audited facilities in 2011/12, but the number of facilities has increased to approximately 120 facilities during 2012/13. It is planned that the eTool will be rolled-out to all facilities over a three year period.

• Uniform Facility Level implementation of the District Health Information Management System (DHIMS) Policy. The Facility Level Standard Operating Procedures (SOPs) were approved in November 2012. These SOPS outline the roles and responsibilities of facility-level personnel with regard to data management within facilities.

• Revision of the National Indicator Data Set (NIDS) 2013/14 to 2014/15 was completed and the final revised NIDS was approved. The revised NIDS includes validation rules at the level of indicator and data elements definitions.

• Linked to the revision of the NIDS a process has started to rationalise facility registers , which were identified as one of the contributing factors to the audit findings.

• All nine provinces and the NDoH have formulated plans to address the finding of the 2012/13 audit of Performance Information by the Auditor General (SA) and various strategies to improve the quality of Performance Information are discussed at the meetings of the National Health Information Systems Committee of South Africa (NHISSA). 62

CONDITIONAL GRANT EXPENDITURE

63

Summary of Conditional Grant Expenditure

Grant Total Available Amount Spent Variance (R'000) Variance (%)

NTSG 8 878 010 8 819 943 58 067 99.3%

HIV/Aids 8 762 848 8 807 986 -45 138 100.5%

Hospital Revitalisation 4 289 595 3 660 304 629 291 85.3%

HPTDG 2 076 176 2 078 025 -1 849 100.1%

Health Infrastructure 1 800 981 1 812 772 -11 791 100.7%

NHI 150 000 78 019 71 981 52.0%

NCSG 100 000 72 378 27 622 72.4%

AFCON 15 000 8 608 6 392 57.4%

Total 26 072 610 25 338 035 734 575 97.2%

CONDITIONAL GRANT EXPENDITURE NTSG

64

Provinces DORA Amount Spent % Expenditure over

budget Rand

Variance

Eastern Cape

682,445 668,149 98% 14,296

Free State

786,724 778,270 99% 8,454

Gauteng

3,044,567 3,044,567 100% 0

KwaZulu-Natal

1,323,114 1,324,487 100% -1,373

Limpopo

288,427 276,607 93% 11,820

Mpumalanga

91,879 91,879 100% 0

Northern Cape

266,621 260,666 98% 5,955

North West

211,765 192,850 91% 18,915

Western Cape

2,182,468 2,182,468 100% -

TOTALS 8,878,010 8,819,943 99% 58,067

CONDITIONAL GRANT EXPENDITURE HIV/AIDS

65


budget Rand Variance

Eastern Cape

1,060,852 1,110,315 105% -49,463

Free State

615,160 648,684 105% -33,524

Gauteng

1,901,293 1,905,215 100%

-3,922

KwaZulu-Natal

2,225,423 2,253,755 101% -28,332

Limpopo

713,432 634,889 89% 78,543

Mpumalanga

575,032 586,097 102% -11,065

Northern Cape

248,372 228,064 92% 20,308

North West

685,204 706,124 103% -20,920

Western Cape

738,080 734,843 100% 3,237

TOTALS 8,762,848 8,807,986 100.5% -45,138

CONDITIONAL GRANT EXPENDITURE

HIV/AIDS VARIANCE

66

Limpopo

• There were savings accrued due activities not carried out which are:

– Delays in recruitment of key personnel, Training through RTC,

Condoms & Computers

– A rollover request of R50,724 for NHLS has been made

Northern Cape

• There were commitments not paid in time for the financial year end

which amounted to R18, 132 million in the following:

– ARVs,Computers for TIER.net, NHLS , IEC Materials, Nutrition,

Stipends , NGO Conference, Condom Warehousing, Training

and Condoms, Test Kits & MMC consumables

CONDITIONAL GRANT EXPENDITURE HOSPITAL REVITE

67



Eastern Cape

402,679

414,544 103% -11,865

Free State

638,384

462,127 72% 176,257

Gauteng

795,439

411,137 52% 384,302

KwaZulu-Natal

586,605

586,542 100% 63

Limpopo

301,193

344,703 114% -43,510

Mpumalanga

300,000

240,821 80% 59,179

Northern Cape

346,083

366,207 106% -20,124

North West

423,127

392,610 93% 30,517

Western Cape

496,085

441,610 89% 54,475

TOTALS 4,289,595 3,660,301 85.3% 629,291

CONDITIONAL GRANT EXPENDITURE HOSPITAL REVITALISATION VARIANCES

68

Eastern Cape

• Storm water drainage for Dr. Mphehle is at the tender stage. The construction to start in 01/04/2013

• Construction of St. Elizabeth main building project will also start on 01/05/2013 and is anticipated to finish in 2016

• Madwaleni Hospital project is still at the planning stage;.

• St. Patrick’s hospital project at 50% with the construction work

• Fronteir hospital is still on the construction stage and the procurement of equipment has been started

• Cecilia Makiwane hospital project is also progressing well; phase 4 which is the construction of the main hospital is between 76 and 99% towards completion

• The Psychiatric hospital however is still at the design phase


69

Free State

• Additional funds granted by the National Treasury for the province to procure equipment for the completed new Ladybrand hospital and processes of procuring has already started

• Equipment for Trompsburg is also being procured

• Boitumelo hospital project is still underway with the remaining two contracts 10 and 12

Contract 10 which is the construction of the casualty, laboratory and physiotherapy is at 55% towards completion and

Contract 12 which is the kitchen and the ablution rooms has just started with construction and is still below 25% with regards to progress..


70

Gauteng

• Natalspruit hospital project is progressing well and the construction of the main hospital is between 79 and 99% towards completion

• Zola Hospital is near completion however, the targeted completion date of 01/02/2013 was not reached due to delays encountered by the contractor

• Germiston hospital, now called Bertha Gxowa hospital is on the retention phase and the procurement of equipment is near completion

• Chris Hani Baragwanath hospital project which covered the Accident, Emergency and Trauma (AE&T); OPD; Radiography and Pharmacy is completed and on the retention stage


71

Limpopo

• The construction of the administration block, patient

admission department and transport control unit in

Letaba hospital have been completed and are on

retention. Other parts of the hospital building are at 96%

towards completion

• Maphutha Malatji hospital – the demolishing of existing

buildings and stores have been completed as well as

administration block, gateway clinic, gate house and

external works

• Other hospital projects that are still on construction are

Thabamoopo, Thabazimbi and the gateway clinic in Jane

Furse hospital.


72

Mpumalanga

• Ermelo there are new projects that have been identified and are in the design stages

• Rob Ferreira hospital - the construction of maternity section, heli-pad, ring road and kitchen are all completed and on retention

• Themba hospital:

– the construction of laboratory, wellness clinic, general wards, have all been completed

– The construction of children’s wards, male and female surgical wards, ICU/HCU, trauma unit and orthopedic unit is progressing well


73

North West

• Moses Kotane and Vryburg hospitals are completed; the

province is currently addressing maintenance issues.

• Brits hospital is also near completion with the

construction of the main hospital. Staff accommodation

project on the other-hand is still on the tender stage

• The construction of Bophelong Psychiatric hospital is

progressing well, at 25%


74

Western Cape

• TC Newman CHC, Worcester phases 3 and 4;

Vredenburg hospital phase 2A, Phase 2B is still under

construction and progress below 25% towards

completion and anticipated completion date is

31/03/2015

• The construction of Mitchell’s Plain hospital laundry is

near completion and progress is about 95%. The

planned completion date was 31/03/2013 but the date

has been extended to 01/05/2013

CONDITIONAL GRANT EXPENDITURE HPTDG

75



Eastern Cape

178,730

172,934 97% 5,796

Free State

130,930

143,946 110% -13,016

Gauteng

725,310

725,310 100% -

KwaZulu-Natal

261,860

261,860 100% -

Limpopo

103,913

92,307 89% 11,606

Mpumalanga

85,208

86,090 101% -882

Northern Cape

68,583

73,936 108% -5,353

North West

93,522

93,522 100% -

Western Cape

428,120

428,120 100% -

TOTALS 2,076,176 2,078,025 100% -1,849

CONDITIONAL GRANT EXPENDITURE HPTDG VARIANCES

76

Eastern Cape

• There was a problem with the MOU whereby the

Walter Sisulu University failed to produce audited

annual financial statements on numerous occasions,

which has resulted in not all the transfers made

CONDITIONAL GRANT EXPENDITURE HEALTH INFRASTRUCTURE

77


budget Rand

Variance

Eastern Cape

258,862

306,177 118% -47,315

Free State

139,073

81,950 59% 57,123

Gauteng

110,361

110,361 100% -

KwaZulu-Natal

573,367

572,520 100% 847

Limpopo

267,888

266,729 100% 1,159

Mpumalanga

108,971

114,394 105% -5,423

Northern Cape

98,258

110,038 112%

--11,780

North West

112,790

121,622 108% -8,832

Western Cape

131,411

128,981 98% 2,430

TOTALS 1,800,981 1,812,772 100.7% -11,791

CONDITIONAL GRANT EXPENDITURE HEALTH INFRASTRUCTURE VARIANCES

78

Free State

• There are 57 projects funded from this grant with 14 at retention stage

Western Cape

• A total of 23 projects were completed and are at retention stage.

CONDITIONAL GRANT EXPENDITURE NHI

79



Eastern Cape

11,500

8,093 70% 3,407

Free State

16,500

9,337 57% 7,163

Gauteng

31,500

8,066 26% 23,434

KwaZulu-Natal

33,000

16,127 49% 16,873

Limpopo

11,500

4,118 36% 7,382

Mpumalanga

11,500

5,570 48% 5,930

Northern Cape

11,500

8,005 70% 3,495

North West

11,500

8,818 77% 2,682

Western Cape

11,500

9,885 86% 1,615

TOTALS 150,000 78,019 52% 71,981

CONDITIONAL GRANT EXPENDITURE NHI VARIANCES

80

• Supply Chain Management processes within the

districts and at Provincial level;

• Limited availability of equipment ordered via

transversal tenders;

• Inadequate availability of third party contractors to

undertake some of the approved activities

CONDITIONAL GRANT EXPENDITURE NHI VARIANCES - COMMITMENTS

81

PROVINCE COMMITMENTS

EC 3 229 000.00

FS 7 163 000.00

GP 12 026 000.00

LP 6 382 000.00

KZN 14 949 000.00

MPU 325 000.00

NC 1 578 000.00

NW 2 083 765.00

WC 1 615 000.00

NATIONAL 49 350 765.00

CONDITIONAL GRANT EXPENDITURE NCSG

82



Eastern Cape

14,660

12,394 85% 2,266

Free State

9,160

3,265 36% 5,895

Gauteng

12,480

7,702 62% 4,778

KwaZulu-Natal

16,480

16,480 100% -

Limpopo

12,400

11,777 95% 623

Mpumalanga

9,740

5,391 55% 4,349

Northern Cape

6,080

977 16% 5,103

North West

8,680

8,680 100% -

Western Cape

10,320

5,712 55% 4,608

TOTALS 100 000 72,378 72% 27,622

CONDITIONAL GRANT EXPENDITURE NCSG VARIANCES

83

Limpopo

• The Giyani Nursing college project of installing fence has been completed and handed over to the department

• 2 projects are still on construction and will be carried over to the next financial year

Mpumalanga

• 1 project has been completed and is at retention,

• 1 on tender and these projects will be carried over to 2013/14 financial year

Northern Cape

• The province was allocated R6 million and spent less than a million on a project that is still at the tender stage

Western Cape

• The province managed to complete 3 projects by end of the 4th quarter. One project is still under construction and four are on the design phase.

CONDITIONAL GRANT EXPENDITURE NCSG VARIANCES

84

Eastern Cape

• 5 projects are still on the early stages of construction and

will be completed in the 2013/14 financial year

Free State

• Two projects are still on the design stages and will start

with construction in the 2013/14 financial year.

• Spending was very poor due to slow progress in the

planning of these two projects

Gauteng

• Bonalesedi, Garankuwa and SG Lourens are on the

planning phases

• Ann Latsky Nursing College under construction

CONDITIONAL GRANT EXPENDITURE AFCON

85


budget Rand

Variance

Eastern Cape 3,000 2,353 78% 647

Gauteng 3,000 0 0% 3,000

KwaZulu-Natal 3,000 1,672 56% 1,328

Mpumalanga 3,000 3,000 100% 0

North West 3,000 1,583 53% 1,417

TOTALS 15,000 8,608 57% 6,392

Conclusions

Key milestones were achieved during the financial year

2012/13, 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 2013/14.

86

Documents

Select Committee on Social Services 22 October 2013pmg-assets.s3-website-eu-west-1.amazonaws.com/131022ndoh.pdfA total of 360 168 HIV positive patients received Isoniazid Preventive