LIMPOPO DEPARTMENT OF HEALTH VOTE 7

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LIMPOPO DEPARTMENT OF HEALTH

VOTE 7 ANNUAL REPORT

2013/2014 FINANCIAL YEAR

2013/14 Annual Report

2 2013/14 Annual Report

Annual Report for 2013/14 Financial Year Vote 7: Limpopo Department of Health

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Contents

PART A: GENERAL INFORMATION .................................................................................. 4 1. DEPARTMENT GENERAL INFORMATION ..................................................................................... 5

2. LIST OF ABBREVIATIONS/ACRONYMS ......................................................................................... 6

3. FOREWORD BY THE MEC ............................................................................................................ 9

4. REPORT OF THE ACCOUNTING OFFICER ................................................................................... 11

5 STATEMENT OF RESPONSIBILITY AND CONFIRMATION OF ACCURACY FOR THE ANNUAL REPORT.................................................................................................................................................. 23

6 STRATEGIC OVERVIEW .............................................................................................................. 24

6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24

7 LEGISLATIVE AND OTHER MANDATES ...................................................................................... 24

8 ORGANISATIONAL STRUCTURE ................................................................................................. 27

9 ENTITIES REPORTING TO THE MEC ........................................................................................... 28

PART B: PERFORMANCE INFORMATION ....................................................................... 29 1. AUDITOR GENERAL’S REPORT: PREDETERMINED OBJECTIVES ................................................. 30

2. OVERVIEW OF DEPARTMENTAL PERFORMANCE ...................................................................... 30

2.1 Service Delivery Environment ........................................................................................... 30

2.2 Service Delivery Improvement Plan .................................................................................. 32

2.3 Organisational environment ............................................................................................. 35

2.4 Key policy developments and legislative changes ............................................................ 36

3 STRATEGIC OUTCOME ORIENTED GOALS ................................................................................. 36

4 PERFORMANCE INFORMATION BY PROGRAMME .................................................................... 40

4.1 Programme 1: Administration .......................................................................................... 40

4.2 PROGRAMME 2: DISTRICT HEALTH SERVICES ................................................................... 45

4.3 PROGRAMME 3: EMERGENCY MEDICAL SERVICES & PATIENT TRANSPORT SERVICES .... 63

4.4 PROGRAMME 4: PROVINCIAL HOSPITALS (REGIONAL AND SPECIALISED) ....................... 68

4.5 PROGRAMME 5: CENTRAL & TERTIARY HOSPITALS .......................................................... 73

4.6 PROGRAMME 6: HEALTH SCIENCES AND TRAINING ......................................................... 78

4.7 PROGRAMME 7: HEALTH CARE SUPPORT SERVICES ......................................................... 83

4.8 PROGRAMME 8: HEALTH FACILITY MANAGEMENT .......................................................... 87

5 TRANSFER PAYMENTS ............................................................................................................... 91


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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24























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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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5.1. Transfer payments to public entities ................................................................................ 91

5.2. Transfer payments to all organisations other than public entities ................................... 91

6 CONDITIONAL GRANTS ............................................................................................................. 93

6.1. Conditional grants and earmarked funds paid ................................................................. 93

6.2. Conditional grants and earmarked funds received ........................................................... 93

7 DONOR FUNDS ........................................................................................................................ 106

7.1. Donor Funds Received .................................................................................................... 106

8 CAPITAL INVESTMENT ............................................................................................................. 106

8.1. Capital investment, maintenance and asset management plan .................................... 106

PART C: GOVERNANCE ................................................................................................. 112 1. INTRODUCTION ....................................................................................................................... 113

2. RISK MANAGEMENT ................................................................................................................ 113

3. FRAUD AND CORRUPTION ...................................................................................................... 114

4. MINIMISING CONFLICT OF INTEREST ...................................................................................... 114

5. CODE OF CONDUCT ................................................................................................................. 115

6. HEALTH SAFETY AND ENVIRONMENTAL ISSUES ..................................................................... 115

7. PORTFOLIO COMMITTEES ....................................................................................................... 117

8. SCOPA RESOLUTIONS .............................................................................................................. 119

9. PRIOR MODIFICATIONS TO AUDIT REPORTS .......................................................................... 134

10. INTERNAL CONTROL UNIT ....................................................................................................... 136

11. INTERNAL AUDIT AND AUDIT COMMITTEES ........................................................................... 137

12. AUDIT COMMITTEE REPORT ................................................................................................... 143

PART D: HUMAN RESOURCE MANAGEMENT ............................................................. 146 1. INTRODUCTION ....................................................................................................................... 147

2. OVERVIEW OF HUMAN RESOURCES ....................................................................................... 147

3. HUMAN RESOURCES OVERSIGHT STATISTICS ......................................................................... 149

PART E: FINANCIAL INFORMATION.......................................................................... 19089 1. REPORT OF THE AUDITOR GENERAL ..................................................................................... 1910

2. ANNUAL FINANCIAL STATEMENTS .......................................................................................... 198

189

190

198



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24





















PART A:GENERAL INFORMATION



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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1. DEPARTMENT GENERAL INFORMATION

PHYSICAL ADDRESS 18 College Street

Polokwane

0699

POSTAL ADDRESS Private Bag X 9302

Polokwane

0700

TELEPHONE NUMBER/S 015 293 6000

FAX NUMBER 015 293 6211

EMAIL ADDRESS [email protected]

WEBSITE ADDRESS www.dhsd.limpopo.gov.za



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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2. LIST OF ABBREVIATIONS/ACRONYMS Acronym Definition

AC AUDIT COMMITTEE

AGSA AUDITOR GENERAL OF SOUTH AFRICA

AIDS ACQUIRED IMMUNO DEFICIENCY SYNDROME

ALOS AVERAGE LENGTH OF STAY

ANC ANTENATAL CARE

ART ANTI-RETROVIRAL THERAPY

ARV ANTI-RETROVIRAL

BBBEE BROAD BASED BLACK ECONOMIC EMPOWERMENT

CEO CHIEF EXECUTIVE OFFICER

CFO CHIEF FINANCIAL OFFICER

DHIS DISTRICT HEALTH INFORMATION SYSTEM

DORA DIVISION OF REVENUE ACT

DOT DIRECTLY OBSERVED TREATMENT

ECP EMERGENCY CARE PRACTITIONERS

EMS EMERGENCY MEDICAL SERVICES

ESMOE ESSENTIAL STEPS TO MANAGE OBSTETRIC EMERGENCIES

EU EUROPEAN UNION

HAART HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY

HAST HIV AND AIDS, STI AND TB

HCT HIV COUNSELLING AND TESTING

HCRW HEALTH CARE RISK WASTE

HDI HISTORICALLY DISADVANTAGED INDIVIDUAL

HIV HUMAN IMMUNO VIRUS

HOD HEAD OF DEPARTMENT



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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Acronym Definition

HPR HOSPITAL REVITILISATION PLAN

IMCI INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES

MEC MEMBER OF EXECUTIVE COUNCIL

MEDUNSA MEDICAL UNIVERSITY OF SOUTH AFRICA

MHCU MENTAL HEALTH CARE USER

MCWH MOTHER AND CHILD AND WOMEN’S HEALTH

MDR MULTIDRUG-RESISTANT

MTEF MEDIUM TERM EXPENDITURE FRAMEWORK

NHLS NATIONAL HEALTH LABORATORY SERVICE

NIMART NURSE INITIATED MANAGED ANTI-RETROVIRAL

NPO NON PROFIT ORGANISATION

NVP NEVIRAPINE

OPD OUT PATIENT DEPARTMENT

PDE PATIENT DAY EQUIVALENT

PFMA PUBLIC FINANCE MANAGEMENT ACT

PHC PRIMARY HEALTH CARE

PHIS PROVINCIAL HEALTH INFORMATION SYSTEM

PMTCT PREVENTION OF MOTHER TO CHILD TRANSMISSION

PPP PUBLIC PRIVATE PARTNERSHIPS

PVC PNEUMOCOCCAL CONJUGATE VACCINE

RV ROTA VIRUS

SASQAF SOUTH AFRICAN QUALITY ASSURANCE FRAMEWORK

SCM SUPPLY CHAIN MANAGEMENT

SDIP SERVICE DELIVERY IMPROVEMENT PLAN

SITA STATE INFORMATION TECHNOLOGY AGENCY

SMME SMALL MEDIUM AND MICRO ENTERPRISES

SMS SENIOR MANAGEMENT SERVICE



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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Acronym Definition

STI SEXUALLY TRANSMITTED INFECTIONS

TB TUBERCULOSIS

TR TREASURY REGULATIONS

UBUR USABLE BED UTILIZATION RATE

XDR EXTREME DRUG RESISTANT



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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3. FOREWORD BY THE MEC

Name: Mr Ishmael Kgetjepe Title: Member of Executive Council for Limpopo Department of Health

The year 2014 marks 20 years in which our country celebrates Democracy after hundreds of years of oppression. As the Department we also celebrate these 20 years of Democracy and the delivery of quality health care services to our communities. It is against this background that I present the 2013/14 annual report of the Department of Health, Limpopo, for the period 01 April 2013 to 31 March 2014, in compliance with Section 40 of the Public Finance Management Act, 1999 (Act No. 1 of 1999). The Constitution of the Republic of South Africa confers on us the responsibility of providing quality and accessible healthcare services. This requires of us to design and execute programmes geared towards ensuring universal access to quality and uninterrupted healthcare services by all our citizens regardless of their socio-economic conditions. This report provides progress on the 2013/14 annual performance plan as well as the overall departmental performance against the set targets for the financial year. It therefore gives a reflection on what has and what has not been achieved, and some of the underlying constraints to guide future planning. The Department will continue to prioritize interventions aimed at achieving the outputs defined in the Negotiated Service Delivery Agreement (NSDA) and also the National Development Plan for Outcome 2: A long and health life for all South Africans, namely, increasing life expectancy, decreasing maternal and child mortality, combating HIV and AIDS and decreasing the burden of disease from tuberculosis and strengthening health system effectiveness (output 4). During the financial year under review the Department made significant strides to achieve a number of outputs and outcomes, including the following:



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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Worked with key stakeholders to market and promote awareness about the NHI, and launched Facility Improvement Teams (FITs) to assess the status of health infrastructure and make proposals for the necessary improvements.

Accelerated access and provision of quality primary health care services by increasing the number of healthcare facilities rendering 24 hours services, improving the PHC facilities supervisory rate and increasing the resident doctor rate.

Intensified Maternal, Child and Women’s Health (MCWH) and Nutrition services by continuing to roll out the Integrated School Health Programme and increasing the immunisation coverage of children under 1 year.

Increased cervical screening coverage and intensified prevention and disease control through anti-malaria indoor residual spraying

Intensified the combating of HIV and AIDS and decreasing the burden of disease from Tuberculosis by testing more pregnant women for HIV, initiating patients on lifelong ART, recording improvement on HIV testing rate and TB treatment success rate.

Provided more accommodation units for health professionals and appointed suitably qualified CEOs for hospitals in the province.

The Department is committed to refocusing priorities to interventions aimed at making positive progress towards achieving its five-year strategic goals. In this respect, the following outcomes are targeted for the financial year 2014/15: Reduced morbidity and mortality as well as improved patient care Improved quality of and access to healthcare services Improved accountability on financial resources, which should result in well-funded and

managed healthcare services Improved realisation of the Department’s objectives

The Department recognises the contribution of all health sector stakeholders, including civil society, in the achievement of the progress reported in this annual performance report. Performance improvements were also made possible by the multitude of all categories of health workers in the sector, sometimes working under challenging conditions, especially in the rural and hard-to-reach parts of the province. I commend the dedicated and productive health workers and also implore those health workers whose work ethic, behaviour and conduct holds back sector progress, and appeal to them to improve. Notwithstanding all that we have planned to implement and achieve in 2014/15, it has to be borne in mind that there are variables that are and will always remain beyond the control of the Department due to the nature of the sector reforms, resource availability, capacity and other challenges confronting our healthcare system. However, I remain confident that through sound managerial and leadership practices, the support of all sector stakeholders, and building on the lessons drawn from previous financial years’ performance, we will achieve our set targets.



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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4. REPORT OF THE ACCOUNTING OFFICER Photo of Accounting Officer

Name: Dr Sipho Kabane

Title: Head of Department

4.1 Overview of the operations of the Department

The Department of health has in line with the electoral mandates and other related mandates been charged with the responsibility to ensure that the people of our province access better and quality health care services. Furthermore the Public Finance Management Act (PFMA) and other related legislation bestows on me as the accounting officer, the responsibility to account on an annual basis on both the progress made and the challenges encountered in the process of executing our service delivery plans pronounced in our Annual Performance Plan. In line with this responsibility and through this Annual Report, I hereby feel much honoured to present to all stakeholders the progress made by the Department in the Financial Year 2013/14 and the challenges encountered in the execution of these responsibilities whilst celebrating 20 years of our democracy in the Republic of South Africa

In line with the electoral mandates of ensuring that all our citizens access better and quality health care services, the department has during the 2013/14 financial year achieved amongst others the following:

In strengthening health system effectiveness: the Department engaged in Primary Health Care re-engineering process and valuable progress has been recorded in this regard. Appointed District Specialist Teams (DSTs) have been fully fledged and functional to ensure that quality of Primary Health Care services is delivered in all Districts as part of the re-engineering process.

Significant events for the Department In strengthening management and leadership, was the appointment of the new Accounting Officer, Acting Chief Financial Officer, two General Managers for financial Accounting and Budget & Revenue; Senior Managers Supply Chain Management, Asset Management and Risk Management. The Department further appointed 17 Chief Executive Officers (CEOs) resulting in 37 Hospital having CEOs as a way of strengthening strategic leadership and Hospital management.



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6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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The Department had put on the Cuban scholarship programme, 110 students as way

of strengthening labour force in the hospitals In order to improve health infrastructure in our facilities, the department completed 1

clinic and 1 EMS Station Vhembe District, Two (2) ten (10) single rooms staff accommodation completed in Letaba Hospital and Jane Furse Hospital and 1 theatre complex completed in WF Knobel Hospital.

In Increasing Life expectancy the Department ensured that 100% ARV sites are fully functional 92% DOT coverage and the utilisation of GenExpert machines to improve detection and early diagnosis of TB patients

The Department continued with the implementation of the NHI pilot in the Vhembe District. This led to the functionality of the 75 Ward Based Outreach Teams and 14 school health teams. The pilot site is also equipped with 3 mobile trucks which help in rendering dental, optometry and surgical services.

Although more work has been done to ensure achievement of targets set in the Annual Performance Plan, the Department faced challenges which include:

Shortage of staff and particularly health professionals Budgetary constraints Infrastructural challenges Shortage of drugs and surgical sundries

4.2 Overview of the financial results of the Department:

Table 1: Departmental receipts

Departmental receipts

2013/2014 2012/2013 Estimate Actual

Amount Collected

(Over)/Under Collection

Estimate

Actual Amount

Collected


R’000 R’000 R’000 R’000 R’000 R’000

Tax Receipts Casino taxes - - - - - - Horse racing taxes - - - - - - Liquor licences - - - - - - Motor vehicle licences

- - - - - -

Sale of goods and services other than capital assets

106,456

94,326

12,130

102,209

94,286

7,923

Transfers received - - - - - - Fines, penalties and forfeits

- - - - - -

Interest, dividends and rent on land

- 6,479

(6,479)

84

(84)

Sale of capital assets

3,552 4,732 (1,180) 3,383 8,209 (4,826)

Financial transactions in

10,700

16,022

(5,322)

8,306

27,993

(19,687)



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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Departmental receipts

2013/2014 2012/2013 Estimate Actual

Amount Collected


Estimate

Actual Amount

Collected


R’000 R’000 R’000 R’000 R’000 R’000

assets and liabilities Total 120,708 121,559 (851) 113,898 130,619 (16,721)

Collections for the period (per plans/target)

The Department has experienced a decline in the collection of patient fees revenue item mainly due to Road Accident Fund (RAF) specific claims documentation requirements. RAF claims constitute a major portion of all potential revenue due to the Department, hence the under-collection on sale of goods and services other than capital assets. The Department has engaged RAF and it has been agreed that the claims will be processed with the attachment of other alternative documentations.

The Department over-collected the overall targeted amount by R0.851 million or 0.7%. The over-collection was due to the interest earned on the funds held in transit for the purchase of the staff accommodation as well as the sales of capital assets. The auctions were more successful than targeted.

Tariff determination

Patient fees for both funded and non-funded patients are proposed by the National Uniform Patient Fees Schedule (UPFS) Committee and approved annually by the Minister of Health. Thereafter the MEC and the Provincial Treasury grant approvals to implement at the Provincial Institutions. The recent approval was granted for implementation by 01 July 2013. It is anticipated that the new Tariffs for 2014/15 will be implemented by 1 April 2014.

Other miscellaneous items are determined in terms of Treasury circulars and PSCB Resolutions. Currently the approval for miscellaneous fees revision has been granted by Treasury in September 2013 and is being implemented.

List of some free services rendered

Maternity services for patients not affiliated to any medical aid.

Male Medical Circumcision for all patients

Free primary health care services

Termination of Pregnancy

New sources of Revenue

No new sources of revenue has been identified for 2013/14 financial year



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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Table 2: Programme Expenditure

Programme Name

2013/14 2012/13

Final Appropriation

Actual Expenditure

(Over)/ Under Expenditure

Final Appropriation

Actual Expenditure

(Over)/Under Expenditure

R’000 R’000 R’000 R’000 R’000 R’000

1.ADMINISTRATION

273 500 272 626 874 241 793 239 987 1 806

2.DISTRICT HEALTH SERVICES

7 938 198 7 868 354 69 844 7 081 718 7 189 516

(107 798)

3.EMERGENCY SERVICES

522 723 522 004 719 490 030 489 932 98

4.PROVINCIAL HOSPITAL SERVICES

1 689 299 1 688 203 1 096 1 640 966 1 639 771

1 195

5.CENTRALISED HOSPITAL SERVICES

1 263 218 1 244 436 18 782 1 118 092 1 117 618

474

6.HEALTH SCIENCE AND TRAINING

438 888 432 315 6 573 418 913 391 905

27 008

7.HEALTH CARE SUPPORT SERVICES

754 976 754 035 941 629 977 650 244 (20 267)

8.HEALTH FACILITIES MANAGEMENT

600 168 355 889 244 279 1 187 034 1 111 023 76 011

TOTAL 13 480 970 13 137 862 343 108 12 808 523 12 829 996 (21 473)

General review of the state of financial affairs

The Department was allocated an amount of R13.5 billion for the year under review to provide health services in the province. A total amount of R13.1 billion (97.5%) was spent. This indicates an under-spending of R343.1 million as a result of under –spending in conditional grants.

Spending trends

Year Budget Expenditure (Over)/ under % Spent

% Growth

R’000 R’000 R’000

2009/2010 9 358 949 9 020 020 338 929 96,4% 13,5%

2010/2011 10 644 084 10 505 964 138 120 98,7% 16,5%

2011/2012 11 671 685 11 366 341 305 344 97,4% 8,2%

2012/2013 12 808 523 12 829 996 -21 473 100,2% 12,8%

2013/2014 13 480 970 13 137 862 343 108 97,5% 2,4%



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6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24






















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Reasons for under/over spending. The Department has underspent the budget by the R343.1m as per the following economic classifications: COMPENSATION OF EMPLOYEES (CoE): R16m (under)

The Department has under-spent the compensation of employee’s budget by R16 m. This is due to delays in appointment of staff within conditional grants and deferment of liabilities to 2014/15 in order to finance shortfall on goods and services within equitable share. GOODS AND SERVICES (G&S): R74.4m (under)

The under spending is mainly on Conditional Grants and earmarked funding. The main reasons for the under spending are expired National tenders for Male Medical Circumcision kits, delays in deliveries/invoicing by suppliers and legal dispute with implementing agent. A roll-over has been requested for committed amounts. Non Profit Institutions: R41.6m (under)

The under-spending was mostly due to delay in the submission of quarterly progress report by the NGOs resulting in the non-transfer of 4th quarter trenches. As well, the EPWP social sector grant underspent due to home-based carers not appointed because it was decided that the Department had over-supply of home-based carers compared to HIV and AIDS patients that need this service. Households: R6.4m (under) The under-spending was due to payments of leave gratuities that cannot be accurately budgeted as attrition such as resignations, deaths and transfer are unpredictable. Building and other fixed structures: R181.5m (under) The underspending of R181m in Buildings and Other Fixed Structure is due to the delay in the resolution of the Legal/contractual dispute between the Department and the then Implementing Agent that was settled only in August 2013. Roll-over has been requested for active and overlapping projects and adjustment of the projects plans thereof. Machinery and Equipment: R22.4m (under) The Department has underspent on equipment due to delays in procurement processes and the late delivery of medical equipment by suppliers especially in Infrastructure grants and National Tertiary Services grants. Impact on programmes and service delivery Machinery and equipment earmarked to be purchased in 2013/14 financial year was not procured due budget constraints and thereby impacting on service delivery.



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Contents







6.1 Vision ................................................................................................................................. 24

6.2 Mission .............................................................................................................................. 24

6.3 Values ................................................................................................................................ 24












4.1 Programme 1: Administration .

LIMPOPO DEPARTMENT OF HEALTH VOTE 7

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