SELECT COMMITTEE ON SOCIAL SERVICES

SELECT COMMITTEE ON SOCIAL SERVICES

PRESENTATION ON THE ANNUAL REPORT 2011/2012 OF THE NATIONAL DEPARTMENT OF

HEALTH

27 NOVEMBER 2012

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1. PURPOSE OF THE PRESENTATION

1. To reflect on key issues (highlights) from the Annual Report of the National Department of Health (DoH) for 2011/12.

2. To reflect both achievements and problem areas.

3. To reflect strategies for addressing constraints experienced – which are also outlined in the National DoH’s Annual Performance Plan for 2012/13.

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2. STRUCTURE OF THE PRESENTATION

I. National Health Systems Priorities

II. Review of Programme Performance - across all 6 Budget Programmes

III. Budget and Expenditure Per Programme

IV. Budget and Expenditure Per Economical Classification

V. Explanations of Material Variances

VI. Audit Outcomes

VII. Recommendations

VIII. Conditional Grant Expenditure

IX. Trading Entities and Public Entities

VIII. Conclusion

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3. NATIONAL HEALTH SYSTEM’S PRIORITIES (1)

The Negotiated Service Delivery Agreement (NSDA) 2010-2014 guided the work of the National DoH during the financial year 2011/12.

NSDA 2010-2014 is the implementation plan for Outcome 2 namely: “ A long and healthy life for all South Africans”

Four outputs required from the health sector in terms of the NSDA 2010-2014 are:

Increased Life Expectancy;

Reduction in Maternal and Child Mortality Rates

Combating HIV and AIDS and decreasing the burden of diseases from Tuberculosis

Strengthening Health System Effectiveness

These outputs are also consistent with the Health-related Millennium Development Goals (MDGs), which must be achieved by 2015.

The four outputs are also in harmony with the Health Sector’s 10 Point Plan for 2009-2014. 5

10 POINT PLAN 2009-2014 4 NSDA OUTPUTS 2010-2014

HEALTH RELATED MDGs 2000-2015

1. Provision of Strategic leadership and creation of a social compact for better health outcomes;

2. Implementation of National Health Insurance (NHI);

3. Improving the Quality of Health Services;

4. Overhauling the health care system

5. Improving Human Resources, Planning, Development and Management;

6. Revitalisation of infrastructure

7. Accelerated implementation of HIV and AIDS and Sexually Transmitted Infections National Strategic Plan, 2007-2011 and reduction of mortality due to TB and associated diseases;

8. Mass mobilisation for better health for the population;

9. Review of Drug Policy; and

10. Strengthening Research and Development

A. Increasing life expectancy;

B. Decreasing child and maternal mortality rates

C. Combating HIV and AIDS and STIs and decreasing the burden of disease from Tuberculosis

D. Enhancing health systems effectiveness

MDG Goal 4 MDG Goal 5

MDG Goal 6

3. NATIONAL HEALTH SYSTEM’S PRIORITIES (2)

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4. REVIEW OF PROGRAMME PERFORMANCE

4.1. PROGRAMME 1: ADMINISTRATION (1)

Achievements to date

National DoH obtained an Unqualified Audit Opinion from the AGSA for 2011/12.

This is the 2nd Unqualified Audit Opinion in three years.

Given that asset management was the basis for a qualified audit opinion for 2010/11, an Asset Management Plan was developed and effectively implemented by the DoH. A key challenge experienced, which was overcome, was the valuation of the asset register.

With respect to financial management amongst the Provincial DoHs, Only 4/9 Provinces overspent their budgets for 2011/12 – EC; GP; KZN &NC). Factors contributing to the projected over-expenditure were: prior year accruals; price increases; inadequate budget control, as well as underfunding of the health sector.

Provincial Financial Management Improvement plans were developed by all 9 Provinces, with technical support from National Treasury (TAU).

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4.1.PROGRAMME 1: ADMINISTRATION (2)

Challenges & Remedial Action

Implementation of the Provincial Financial Improvement Plans was constrained by inadequate human resource capacity and limited resources.

The National DoH solicited alternative funding from international development partners (donors) to assist Provinces.

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The 2010 National Antenatal (ANC) Sentinel HIV and Syphilis and Prevalence Survey Report was produced, in partnership with key stakeholders, and published. It was launched by the Minister of Health in November 2011.

A 20-year database of HIV prevalence amongst ANC attendees has now been established (1990-2010).

Data from the 2010 National Antenatal Sentinel HIV and Syphilis and Prevalence Survey will play a significant role in informing the programmatic responses of government, civil society and international development partners to HIV&AIDS.

Data collection for the 2011 National Antenatal Sentinel HIV and Syphilis and Prevalence Survey has been completed and data analysis has commenced.

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4.2. PROGRAMME 2: HEALTH PLANNING AND SYSTEMS ENABLEMENT (1)


A successful National Health Research Summit was convened in July 2011, under the auspices of the National Health Research Committee (NHRC) - A Ministerial Advisory Committee - to identify the strengths, weaknesses, opportunities and threats of health research, with a specific focus on the four (4) outputs of the NSDA 2010-2014.

The National Health Research Summit also aimed to identify the key priorities for strengthening health research, innovation and development over the next 3-5 years.

The Summit attracted diverse stakeholders from government departments, NGO’s, industry, research councils, professional organisations, academia and civil society.

A report on the Summit was published in the Lancet Journal in April 2012.

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An important M&E subsystem, the three-tier system for monitoring the provision of Antiretroviral therapy (ART) to people living with HIV and AIDS, first developed by the University of Cape Town and implemented in the Western Cape, was scaled up to other Provinces.

Tier 1 of the strategy consists of paper-based ART registers; Tier 2 entails the use of electronic registers in non-networked computers, while Tier 3 is the most advanced, as it entails development of a networked patient information system.

133 Master trainers were trained, and by the end of March 2012, a total of 890 sites had started implementing Tier 2 of the system.

The Health Data Advisory and Coordinating Committee (HDACC), established by the DG of Health in October 2010, to establish consensus on key health outcome indicators for RSA, produced its report for 2011/12.

HDACC produced revised estimates for Life Expectancy; Infant Mortality Ratio; Child Mortality Ratio and Maternal Mortality Ratio. 11



10 pilot sites for National Health Insurance (NHI) were identified and publicly launched. KZN Province identified an additional NHI pilot site.

NHI Conditional Grant Framework was approved by National Treasury.

The NHI grant provides funding for NHI pilot sites over the 2012/13 MTEF pilot sites.

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National DoH successfully facilitated the recruitment of 80 South African students to study medicine in Cuba, and this cohort group commenced with their medical training in Cuba in October 2011.

Medical students were from the following seven Provinces:

Eastern Cape (12);

Gauteng (10);

KwaZulu-Natal (12);

Limpopo (10);

Mpumalanga (12);

North West (12); and

Northern Cape (12).13



Auditor General of South Africa (AGSA) conducted an audit of performance information reported in the Annual Report of the National DoH for 2011/12.

AGSA expressed satisfaction in all material respects with the presentation and usefulness of the performance information, in accordance with the predetermined criteria.

AGSA acknowledged that leadership was provided for strengthening Health Information Systems as evidenced by the development of national policies for HIS and the production of draft SoPs.

However, AGSA identified major challenges with the reliability of data for 9 indicators for Programme 3 tested in 20 public health facilities in 8 Provinces.

National DoH developed a roadmap for strengthening HIS, which was adopted by the National Health Information Systems Committee of South Africa.

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Combating HIV & AIDS

A total of 617,147 new patients were put on Antiretroviral Treatment in 2011/12, compared to 418,677 in 2010/11

9,6 million South Africans accepted HIV Testing in 2011/12

A cumulative total of 20,2 million people have undergone HIV Testing since the launch of the HCT campaign by the President of RSA in April 2010.

A total of 6,353,000 female condoms were distributed, which exceeded the target of 6million.

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4.3. PROGRAMME 3: HIV & AIDS, TUBERCULOSIS AND MATERNAL, CHILD AND

WOMEN’S HEALTH (1)


Improving TB Management

A TB cure rate of 73,1% (for 2010) was achieved, against a target of 75%. This reflects an improving trend compared to the 71,1% cure rate recorded in 2010/11 (for 2009).

The TB defaulter rate has decreased from 7% in 2010/11 to 6,8% in 2011/12.

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4.3. PROGRAMME 3: HIV & AIDS, TURBERCULOSIS AND MATERNAL, CHILD AND



Improving Child Health

A national immunisation coverage rate (under 1 year) of 95,2% was achieved, against a target of 95%.

4% of babies tested Polymerase Chain Reaction (PCR) positive 6 weeks after birth (out of all babies tested), which reflects very good performance when compared to the target of 7,5%. The Medical Research Council (MRC) Prevention of Mother to Child Transmission Survey (PTMCT) survey reflected a transmission rate of 3,5%. The 2011/12 figure is 2,7%.

56,9% of Mothers and 57,8% Babies received post natal care within 6 days after delivery, against a target of 60%.

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4.3. PROGRAMME 3: HIV & AIDS, TURBERCULOSIS AND MATERNAL, CHILD AND WOMEN’S HEALTH (3)


Improving Maternal and Women’s Health

An antenatal care coverage (ANC) rate of 100.4% was recorded, consistent with the target of 100%. Denominator issues are being discussed with StatsSA.

40,2% of pregnant women presented to the health services before 20 weeks of pregnancy, which exceeded the 2011/12 target of 40%.

100,7% of pregnant women were tested for HIV, which was consistent with the set target.

89,3% of deliveries took place in health facilities, under the supervision of qualified health personnel. The target for 2011/12 was 90%.

A cervical cancer screening coverage rate of 55% was achieved, which exceeded the target of 52%.

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A total of 347,973 MMCs were conducted in 2011/12, against a target of 500,000. Provincial variations occurred, with KZN conducting the highest number of MMCs. While this was lower than the set target of 500,000, it reflected high levels of performance for a newly introduced HIV prevention programme

A total of 397,106,000 male condoms were distributed, against a target of 1 billion male condoms.

Key challenges included service providers being unable to deliver the numbers specified in the tender as a result of a global latex shortage; delays in the registration of approved service providers in Provinces, and legal action initiated against National Treasury.

A measles immunisation coverage rate (second dose) of 85,3% was achieved, against a target of 95%.

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4.3. PROGRAMME 3: HIV & AIDS, TURBERCULOSIS AND MATERNAL, CHILD AND



Nationally

HIV prevalence amongst antenatal attendees increased from 29,4% in 2009 to 30,2% in 2010, though this increase was not statistically significant.

Provincially

HIV prevalence rates amongst antenatal attendees increased in 7 Provinces between 2009 and 2010, with the exception of KZN and NW.

In KZN, HIV prevalence rates amongst antenatal attendees remained stable at 39,5% for both 2009 and 2010. For both years, KZN had the highest prevalence rates in the country.

The North West Province experienced a decline in HIV prevalence rates from 30.0% in 2009 to 29,6% in 2010.

The Western Cape Province had the lowest HIV prevalence rate in the country of 18,5%. This reflected an increase from the 16,9% recorded in 2009, but this is attributed to a larger sample size from this province in 2010.

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District level

The five districts that recorded the highest prevalence rate in the country amongst antenatal attendees, which were above 40%, were located in KZN namely: Umkhanyakude (41,9%); eThekwini (41,1%); uMgungundlovu (42,3%); iLembe (42,3%) and Ugu (41,1%).

The number of district recording HIV prevalence rates of between 30% and 40% increased from 14/52 in 2009 to 21/52 in 2010.

The Central Karoo District in the Western Cape had the lowest HIV prevalence rate of 0,8%.

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A PHC utilisation rate of 2,5 visits per person was achieved in 2011/12, against a target of 2,6 visits per person.

Vitamin A supplementation coverage rate among children aged 12-59 months was 43%, which exceeded the target of 40%.

A total of 337 ward-based PHC Teams were established, which exceeded manifold the target of 54 teams.

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4.4. PROGRAMME 4: PRIMARY HEALTH CARE SERVICES (PHC) (1)


National DoH commenced with the implementation of the Integrated Chronic Disease Management (ICDM) model in 41 facilities in three districts across three Provinces.

The ICDM aims to ensure the integrated management of chronic diseases, to enhance the quality, effectiveness and efficiency of services provided to people living with these conditions.

The ICDM is being implemented in the West Rand District (Gauteng Province); Ehlanzeni District (Mpumalanga Province) and Dr. Kenneth Kaunda District (North West Province). Facilities in the three districts have commenced with:

Scheduling of chronic care patients

Designating dedicated consulting rooms for chronic patients.

Implementing waiting time surveys

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The Department produced a Strategic Framework for the Prevention of Injury in South Africa, which incorporates a plan for response to violence.

The Strategic Framework for the Prevention of Injury in South Africa is an integrated and intersectoral strategy with 12 key objectives.

It was developed in collaboration with other key stakeholders included the Departments of Basic Education; Correctional Services; Justice and Constitutional Development; Social Development; Trade and Industry; Transport; academic and research institutions such as the Medical Research Council (MRC); University of KwaZulu-Natal; as well as civil society.

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District Hospitals achieved a Usable Bed Utilisation Rate (USBR) of 67,1% against a target of 70%.

Average length of stay in District hospitals was 4,3 days, against a target of 4 days.

A PHC supervision rate of 66,6% was recorded, against a target of 70%.

A review of Hospital Performance indicators was conducted by HST, and feedback was provided to Provincial DoHs.

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4.5. PROGRAMME 5: HOSPITALS, TERTIARY SERVICES AND WORKFORCE

DEVELOPMENT (1)


The National DoH produced a Health Workforce Strategy responsive to the service delivery platform and begun to mobilise resources for its implementation.

The National Health Workforce Strategy was launched on the 11th October 2011.

A strategy for rural health workforce was incorporated into the National Health Workforce Plan.

The development of Norms and standards for the Health Workforce for Primary Health Care and Secondary Health Care commenced.

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4.5. PROGRAMME 5: HOSPITALS, TERTIARY SERVICES AND WORKFORCE

DEVELOPMENT (2)


An audit of CHWs was completed, as part of the re-engineering of PHC. An M&E Plan (and tools) for Community-based services was produced in collaboration with the School of Public Health at UWC.

42 technicians were trained by Tshwane University of Technology to conduct health technology audits, especially on safety performance across Provinces.

An external service provider was appointed in November 2011, for the development of the Integrated Project Management Information System (PMIS). Operational roll-out of the system and training of the users commenced in the new financial year.

The Essential equipment list (EEL) was completed for different levels of health facilities (Clinics and Tertiary Hospitals). This exceeded the target for 2011/12, which was to finalise the EELs for Primary Health Care.

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Achievements to Date

National Health Amendment (NHA) Bill was tabled in Parliament following approval by Cabinet in 2011/12.

By March 2012, 90% of facilities (3,780) had undergone a baseline audit conducted by HST. The audit data has been validated.

Establishment of the new Pharmaceutical and Related Products Regulatory Authority (SAHPRA) was approved by Cabinet.

The draft Medicines and Related Substances Amendment Bill was published for comment for three months, expiring in June

2012. The Bill aims to strengthen transitional arrangements, including the regulation of foodstuffs, cosmetics, medical devices and in vitro diagnostics under SAHPRA and to improve the definition of medicines.

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4.6. PROGRAMME 6: HEALTH REGULATION AND COMPLIANCE MANAGEMENT (1)

Achievements to Date

The newer triple fixed dose combination generic antiretroviral medicines were finalised within 18 to 19 months, discounting the time taken by applicants to respond to questions. This has contributed to the timely access to newer technologies for managing HIV and AIDS, which in turn improves life expectancy.

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A key objective of the Department is to improve the registration of medicines, reduce the current backlog of registration and reduce the time to market.

During 2011/12, a total of 386 generics were registered within an average period of 34 months. The target for 2011/12 was 18 months.

A total of 34 New Chemical Entities (NCEs) were registered with an average period of 37 months. The target for 2011/12 was 18 months.

Challenges experienced by the Department included a lack of evaluators, both in-house and external. Technical experts were appointed for a

fixed period of time to assist in fast-tracking the registration of medicines.

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Only 40% of complaints from users of public health services were resolved within the set target of 25 days.

National DOH is dependent on Provincial Health Departments and other investigative authorities to investigate and report on the complaints.

A database of complaints has been established, which facilitates more effective monitoring of progress.

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5. BUDGET AND EXPENDITURE PER PROGRAMME (1)

Appropriation per programme 2011/12

APPROPRIATION STATEMENT Adjusted Appropriation

Shifting of Funds

Virement FinalAppropriation

ActualExpenditure

Variance Expenditureas % of

final appropriation

R'000 R'000 R'000 R'000 R'000 R'000 %

1. ADMINISTRATION

Current payment 349 476 (2 083) (18 700) 328 693 315 500 13 193 96,0%Transfers and subsidies 2 624 2 083 - 4 707 4 609 98 97,9%Payment for capital assets 9 541 - - 9 541 6 566 2 975 68,8%Payment for financial assets - - - - 308 (308)

361 641 - (18 700) 342 941 326 983 15 958

2. HEALTH PLANNING AND SYSTEMS ENABLEMENT

Current payment 160 291 (32) 5 872 166 131 152 592 13 539 91,9%Transfers and subsidies 440 32 8 815 9 287 8 686 601 93,5%Payment for capital assets 1 895 - - 1 895 673 1 222 35,5%Payment for financial assets - - - - 3 (3)

162 626 - 14 687 177 313 161 954 15 359

3. HIV & AIDS, TB & MATERNAL, CHILD & WOMENS HEALTH

Current payment 355 819 (3) (15 509) 340 307 257 031 83 276 75,5%Transfers and subsidies 7 672 773 3 409 7 673 185 7 667 790 5 395 99,9%Payment for capital assets 1 250 - - 1 250 791 459 63,3%Payment for financial assets - - - - 1 519 (1 519)

8 029 842 - (15 100) 8 014 742 7 927 131 87 611

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5. BUDGET AND EXPENDITURE PER PROGRAMME (2)

Appropriation per programme2011/12

APPROPRIATION STATEMENT Adjusted Appropriation

Shifting of Funds


ActualExpenditure

Variance Expenditureas % of

final appropriation

R'000 R'000 R'000 R'000 R'000 R'000 %4. PRIMARY HEALTH CARE

SERVICES

Current payment 124 947 - 23 613 148 560 129 818 18 742 87,4%Transfers and subsidies 593 022 - 500 593 522 592 383 1 139 99,8%Payment for capital assets 19 621 - - 19 621 19 268 353 98,2%Payment for financial assets - - - - 14 (14)

737 590 - 24 113 761 703 741 483 20 2205. HOSPITAL, TERTIARY

SERVICES & WORKFORCE DEVELOPMENT

Current payment 190 929 (23) (2 200) 188 706 98 610 90 096 52,3%Transfers and subsidies 15 959 440 23 - 15 959 463 15 958 663 800 100,0%Payment for capital assets 1 302 - - 1 302 147 1 155 11,3%Payment for financial assets - - - - - -

16 151 671 - (2 200) 16 149 471 16 057 420 92 0516. HEALTH REGULATION AND

COMPLIANCE MANAGEMENT

Current payment 156 255 (270) (2 800) 153 185 129 884 23 301 84,8%Transfers and subsidies 366 440 270 - 366 710 366 710 - 100, 0%Payment for capital assets 1 906 - - 1 906 1 275 631 66,9%Payment for financial assets - - - - 2 (2)

524 601 - (2 800) 521 801 497 871 23 930TOTAL 25 967 971 - - 25 967 971 25 712 842 255 129 99,0%

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6. BUDGET AND EXPENDITURE PER ECONOMICAL CLASSIFICATIONAppropriation per economic classification

2011/12Adjusted

Appropriation

Shifting of Funds


ActualExpenditure

Variance Expenditureas % of final

appropriation

R'000 R'000 R'000 R'000 R'000 R'000 %Current paymentsCompensation of employees 427 302 (2 134) - 425 168 409 702 15 466 96,4%

Goods and services 910 415 (277) (9 724) 900 414 673 733 226 681 74,8%

Transfers and subsidies Provinces and municipalities 24 034 782 - - 24 034 782 24 034 782 - 100,0%

Departmental agencies and accounts 361 207 - 5 815 367 022 367 022 - 100,0%

Universities and technikons 14 124 - 409 14 533 12 762 1 771 87,8%Public corporations and private enterprises -

Non-profit institutions 182 426 - 3 000 185 426 179 264 6 162 96,7%

Households 2 200 2 411 500 5 111 5 011 100 98,0%Gifts and Donations - - - - - - -

Payments for capital assets

Machinery & equipment 35 515 (134) - 35 381 28 587 6 794 110,4%Software and other intangible assets - 134 - 134 133 1 99,3%

Payments for financial assets - - - - 1 846 (1 846)

Total 25 967 971 - - 25 967 971 25 712 842 255 129 99,0%

7. EXPLANATIONS OF MATERIAL VARIANCES (1)

Per programme Final Appropriation

R’000

Actual Expenditure

R’000

Variance

R’000

Variance as % of Final

Appropriation

Administration 342 941 326 983 15 958 95%

The under-spending on capital can be ascribed to the fact that the supplier was unable to deliver the ordered IT equipment before year end. On Goods and Services the funds for the Health Statistics Publications, the Provincial Support Unit and Hospital Tariffs System Review could not be fully used.

Health Planning and System Enablement

177 313 161 954 15 359 91%

The under-expenditure is attributed to slow spending on the NHI funding received, as the legislative processes delayed the consultation processes. The Technical Policy and Planning Unit was mostly inactive and the panel of technical experts were only finalised close to year end.

HIV and AIDS, TB, MCWH

8 014 742 7 927 131 87 611 99%

Slight under-spending was due to the late finalisation of the national condom contract awarded by National Treasury and failure to appoint a communication consultant for HIV and AIDS.

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7. EXPLANATIONS OF MATERIAL VARIANCES (2)

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Per programme

Final Appropriation

R’000

Actual Expenditure

R’000

Variance

R’000

Variance as % of Final

Appropriation

Primary Health Care Services

761 703 741 483 20 220 97%

Under-spending was due to the late delivery of influenza vaccines.

Hospitals, Tertiary Services and Workforce Development

16 149 471 16 057 420 92 051 99%

Slight under-spending was due to the slow start of the Nursing Colleges project and the fact that the supplier for the Infrastructure Unit Support System did not invoice the Department before financial year end.

Health Regulation and Compliance Management

521 801 497 871 23 930 95%

Under-spending was due to the fact that the establishment of the Office of Standards of Compliance was not finalized before year end.

8. AUDIT OUTCOMES

Unqualified Audit Opinion for 2011/12.

Matters to be attended to:– Employees were appointed without following a proper process to verify the claims

made in their applications, in contravention of Public Service Regulation;– Not all senior managers signed performance agreements as required by Public

Service Regulation; – A human resource plan was not in place as required by Public Service Regulation;– NGO funding monitoring not adequate to ensure transfers made was applied for

intended purpose;– Conditional Grants monitoring of expenditure and non-financial information was not

adequate for HIG, HPTDG and NTSG as required by DORA;– Requirements and responsibilities for HIG not adhered to;– Transfer payments for HIV/Aids not made in accordance with approved payment

schedule;– Arrangements for HRG, FPG and HIV/Aids grant not adequately adhered to;– Business plans for FPG and HIV/Aids grant not approved prior to start of the

financial year

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9. RECOMMENDATIONS

Further improve coordination and communication with the AG (Continue with audit protocols and regular steering committee meetings to manage the audit process);

Implement strategy to address audit findings (especially HR, NGOs and Conditional Grants). For those that can be implemented immediately the Department needs to determine whether they require processes and policies;

Address future audit risks e.g. Inventory

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10. CONDITIONAL GRANT EXPENDITURE (1)

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GRANT ALLOCATION TRANSFER SPENT

National Tertiary ServicesDivision of

Revenue Act Roll Overs AdjustmentsTotal

AvailableActual

Transfer

Amount received by department

Amount spent by department

% of available

funds spent by dept

R'000 R'000 R'000 R'000 R'000 R'000 R'000 %

Eastern Cape 609 327 609 327 609 327 609 327 627 130 103%

Free State 715 204 715 204 715 204 715 204 714 496 100%

Gauteng 2 759 968 2 759 968 2 759 968 2 759 968 2 691 882 98%

Kwa-Zulu Natal 1 201 831 1 201 831 1 201 831 1 201 831 1 183 935 99%

Limpopo 267 314 267 314 267 314 267 314 253 450 95%

Mpumalanga 91 879 91 879 91 879 91 879 91 247 99%

Northern Cape 235 948 235 948 235 948 235 948 210 135 89%

North West 194 280 194 280 194 280 194 280 194 280 100%

Western Cape 1 973 127 1 973 127 1 973 127 1 973 127 1 970 931 100%

TOTAL 8 048 878 8 048 878 8 048 878 8 048 878 7 937 486 99%


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Comprehensive HIV & AIDSDivision of


AvailableActual

Transfer



% of available

funds spent by dept

R'000 R'000 R'000 R'000 R'000 R'000 R'000 %

Eastern Cape 864 173 864 173 864 173 864 173 871 327 101%

Free State 530 440 530 440 530 440 530 440 456 734 86%

Gauteng 1 620 673 1 620 673 1 620 673 1 620 673 1 722 028 106%

Kwa-Zulu Natal 1 889 427 1 889 427 1 889 427 1 889 427 1 926 504 102%

Limpopo 624 909 624 909 624 909 624 909 499 814 80%

Mpumalanga 490 366 490 366 490 366 490 366 417 730 85%

Northern Cape 212 923 212 923 212 923 212 923 181 356 85%

North West 599 437 599 437 599 437 599 437 556 458 93%

Western Cape 660 614 660 614 660 614 660 614 619 616 94%

TOTAL 7 492 962 7 492 962 7 492 962 7 492 962 7 251 567 97%


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Forensic Pathology ServicesDivision of


AvailableActual

Transfer



% of available

funds spent by dept

R'000 R'000 R'000 R'000 R'000 R'000 R'000 %

Eastern Cape 73 506 73 506 73 506 73 506 92 449 126%

Free State 39 451 39 451 39 451 39 451 38 475 98%

Gauteng 97 966 97 966 97 966 97 966 73 979 76%

Kwa-Zulu Natal 161 550 161 550 161 550 161 550 161 550 100%

Limpopo 42 308 42 308 42 308 42 308 37 819 89%

Mpumalanga 53 114 53 114 53 114 53 114 53 589 101%

Northern Cape 24 240 24 240 24 240 24 240 25 585 106%

North West 28 019 28 019 28 019 28 019 28 019 100%

Western Cape 70 226 70 226 70 226 70 226 75 204 107%

TOTAL 590 380 590 380 590 380 590 380 586 669 99%


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Hospital RevitilisationDivision of


AvailableActual

Transfer



% of available

funds spent by dept

R'000 R'000 R'000 R'000 R'000 R'000 R'000 %

Eastern Cape 382 048 29 000 411 048 411 048 411 048 556 585 135%

Free State 417 883 417 883 417 883 417 883 405 515 97%

Gauteng 801 965 55 500 857 465 857 465 857 465 793 312 93%

Kwa-Zulu Natal 547 698 547 698 547 698 547 698 613 406 112%

Limpopo 371 672 371 672 371 672 371 672 285 679 77%

Mpumalanga 356 557 356 557 356 557 356 557 295 843 83%

Northern Cape 406 892 406 892 406 892 406 892 398 000 98%

North West 370 074 370 074 370 074 370 074 364 423 98%

Western Cape 481 501 481 501 481 501 481 501 481 511 100%

TOTAL 4 136 290 84 500 4 220 790 4 220 790 4 220 790 4 194 274 99%


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Professional Training and Development

Division of Revenue Act Roll Overs Adjustments

Total Available

Actual Transfer



% of available

funds spent by dept

R'000 R'000 R'000 R'000 R'000 R'000 R'000 %

Eastern Cape 170 071 170 071 170 071 170 071 186 598 110%

Free State 124 444 124 444 124 444 124 444 138 825 112%

Gauteng 690 803 690 803 690 803 690 803 686 774 99%

Kwa-Zulu Natal 249 917 249 917 249 917 249 917 258 017 103%

Limpopo 99 730 99 730 99 730 99 730 106 186 106%

Mpumalanga 80 718 80 718 80 718 80 718 76 270 94%

Northern Cape 65 510 65 510 65 510 65 510 57 181 87%

North West 88 323 88 323 88 323 88 323 88 323 100%

Western Cape 407 794 407 794 407 794 407 794 407 794 100%

TOTAL 1 977 310 1 977 310 1 977 310 1 977 310 2 005 968 101%


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Health InfrastructureDivision of


AvailableActual

Transfer



% of available

funds spent by dept

R'000 R'000 R'000 R'000 R'000 R'000 R'000 %

Eastern Cape 299 754 510 300 264 300 264 300 264 328 912 110%

Free State 129 621 2 096 131 717 131 717 131 717 75 052 57%

Gauteng 142 694 142 694 142 694 142 694 136 957 96%

Kwa-Zulu Natal 358 471 358 471 358 471 358 471 364 758 102%

Limpopo 270 802 270 802 270 802 270 802 253 093 93%

Mpumalanga 146 368 146 368 146 368 146 368 129 152 88%

Northern Cape 89 501 89 501 89 501 89 501 104 891 117%

North West 145 466 145 466 145 466 145 466 136 695 94%

Western Cape 119 179 119 179 119 179 119 179 124 836 105%

TOTAL 1 701 856 2 606 1 704 462 1 704 462 1 704 462 1 654 346 97%

11. TRADING ENTITIES AND PUBLIC ENTITIES (1)

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Medical Research Council :

The Medical Research Council (MRC) undertakes scientific research on clinical and health systems issues;

Funding from the Department’s vote amounted to R 271,2 million in 2011/12;

There is close co-operation with the Department of Health in setting research priorities.


National Health Laboratory Services

The National Health Laboratory Service Act, Act No 37 of 2000 came into operation in May 2001;

The National Health Laboratory Service’s major source of funding will be the sale of analytical laboratory services to users such as Provincial Departments of Health, but it continues to receive a transfer from the National Department, which amounted to R82,1 million in 2011/12.

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Medical Schemes Council

The Medical Schemes Council regulates the Private Medical scheme industry in terms of the Medical Schemes Act (131 of 1998), and is funded mainly through levies on the industry in terms of the Council for Medical Schemes Levies Act (58 of 2000);

During 2011/12 the Department transferred R4,194 million to the Council.

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South African National Aids Council Trust (SANACT)

During the period under review the SANAT was dormant. SANAC itself operated as planned with its activities funded by the HIV and AIDS Cluster within the

National Department of Health.

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Mines and Works Compensation Fund

The Compensation Commissioner for Occupational Diseases is responsible for the payment of benefits to miners and ex-miners who have been certified to be suffering from lung-related diseases because of working conditions.

The Mines and Works Compensation Fund derives funding from levies (Mine Account, Works Account, Research Account, State Account) collected from controlled mines and works, as well as appropriations from Parliament.

Payments to beneficiaries are made in terms of the Occupational Diseases in Mines and Works Act (78 of 1973). The value of the fund for the CCOD amounts to R1,1 billion while the Department’s transfer payment amounting to R2,777 million for the year under review.

The entire financial system of the Compensation Commissioner for Occupational Diseases is being re-engineered.

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LIFE EXPECTANCY AND ADULT MORTALITY (OUTPUT 1)INDICATOR BASELINE PROGRESS TARGET 2014

2009 2010 2011Life expectancy

at birth: Total 56.5 58.1 60.0 58.5

(increase of 2 years)Life expectancy

at birth: Male54.0 55.5 57.2 56.0

(increase of 2 years)Life expectancy

at birth: Female

59.0 60.8 62.8 61.0 (increase of 2 years)

Adult mortality (45q15): Total

46% 43% 40% 43% (10% reduction)

Adult mortality (45q15): Male

52% 49% 46% 48% (10% reduction)

Adult mortality (45q15): Female

40% 37% 34% 37% (10% reduction)

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12. SOME GOOD NEWS … (1)

Source: Medical Research Council, Rapid Mortality Surveillance Report 2011

INDICATOR BASELINE PROGRESS TARGET 2014

2009 2010 2011MATERNAL AND CHILD MORTALITY (OUTPUT 2)INDICATOR BASELINE PROGRESS

2009 2010 2011 TARGET 2014

Under-5 Mortality Rate (U5MR) per 1 000 live-births

56 53 42 50 (10% reduction)

Infant Mortality Rate (IMR)per 1 000 live-births

40 37 30 36 (10% reduction)

Neonatal Mortality Rate (<28 days) per 1 000 live-births

14 13 14 12 (10% reduction)

INDICATOR 2008* 2009 2010*** TARGET 2014

Maternal Mortality Ratio (MMR) per 100,000 live-births

310 333 No data yet

WHO (300/100,000)

270 (reverse increasing

trend and achieve 10% reduction)51

12. SOME GOOD NEWS … (2)

Source: Medical Research Council, Rapid Mortality Surveillance Report 2011

13. CONCLUSION

Key milestones were achieved during the financial year 2011/12, in relation to the objectives and targets set in the National DoH Annual Performance Plan for this period.

The highlight of these is the improvement of financial management and the unqualified audit opinion for 2011/12.

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

Going forward the department will enhance the implementation of interventions to achieve the four outputs of the NSDA 2010-2014 namely:

Increased Life ExpectancyDecreasing maternal and child mortalityCombating HIV and AIDS and Decreasing the burden of diseases from TuberculosisStrengthening Health System Effectiveness.

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THANK YOU!

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