NATIONAL DEPARTMENT OF HEALTH National Health Insurance Grant
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Transcript of NATIONAL DEPARTMENT OF HEALTH National Health Insurance Grant
NATIONAL DEPARTMENT OF HEALTH
National Health Insurance GrantSelect Committee on Appropriations
Hearing on 3rd and 4th Quarter Expenditure 4th June 2013
Index
• Background
• Provincial Expenditure Summaries (IYM) – Q3 and Q4 figures (incl. Province specific challenges)– Total Grant Expenditure
• Summary of challenges impacting on Expenditure
• Monitoring and Evaluation matters
• Way Forward 2Select Committee on Appropriations_4 June 2013
Background
• R150 million allocated for 2012/13 FY– Each pilot District received R11.5 million
• Focus:– To test innovations that are necessary for the
implementation of NHI
– To undertake health system strengthening initiatives in identified Districts
– To provide strategic resources for supporting the pilot Districts in implementing selected health service delivery interventions
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Eastern CapeQ3 and Q4 Expenditure (R’000)
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Eastern Cape: Challenges
• Provincial office delayed notification of the availability of funds to the District
• District capacity constraints – Lack of key HR in essential categories;– Inadequate technical support
• Supply Chain hurdles – Delays in getting approvals
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Free StateQ3 and Q4 Expenditure (R’000)
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Free State: Challenges
• Reprioritisation of funds allocated to activities
• SCM hurdles
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GautengQ3 and Q4 Expenditure (R’000)
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Gauteng: Challenges
• No support/guidance from relevant officials at Provincial Office
• Significant hurdles in procurement processes
• Delays in getting information on budget codes – Staff shortages in key areas
• Lack of ability to employ staff on long term basis using NHI-CG funding e.g. clinical staff, sessional doctors, etc.
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KZNQ3 and Q4 Expenditure (R’000)
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KZN: Challenges • Structural administrative process
– Bureaucratic processes that hamper innovation
• The process for obtaining signatures needs to be streamlined – Huge delays at Provincial office
• Limited delegations to allow for activities to be undertaken– District level delegations very limited
• Significant Supply Chain hurdles– Lack of clarity regarding long delays in getting necessary
approvals 11Select Committee on Appropriations_4 June 2013
LimpopoQ3 and Q4 Expenditure (R’000)
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Limpopo: Challenges • Challenges around budget matters
– Inappropriate / incorrect budget coding
• SCM hurdles – Significant delays in getting approvals
• Challenges in identifying relevant providers to undertake some activities due to limited database
• Technical and administrative support from Province inadequate
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MpumalangaQ3 and Q4 Expenditure (R’000)
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Mpumalanga: Challenges
• Majority of the DHMT not appointed– Too many vacancies to undertake activities
• Non-existent / limited delegations to allow for activities to be undertaken– District level delegations very limited
• SCM hurdles impacting on key activities
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Northern CapeQ3 and Q4 Expenditure (R’000)
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Northern Cape: Challenges• Delays in Provincial Treasury providing information
regarding availability of funds
• SCM hurdles
• Significant delays in getting necessary approvals and lack of technical support in key areas
• Challenges in identifying relevant providers to undertake some activities due to limited database
• Contextual factors also impact on programme:
– Majority of key staff complement based in Kimberley
• DHMT has limited delegations 17Select Committee on Appropriations_4 June 2013
North WestQ3 and Q4 Expenditure (R’000)
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North West: Challenges• Incorrect capturing of budget at Provincial level
– District submitted an incorrect business plan to Provincial Treasury
• Poor prioritisation of allocated funding– Need to reprioritise to other activities
• Lack of technical support in key areas– Need Provincial NHI Coordinator– Challenges in identifying relevant providers to undertake
some activities due to limited database
• Inability to spend on Infrastructure i.e. clinics, motor vehicles, etc
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Western Cape Q3 and Q4 Expenditure (R’000)
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Western Cape: Challenges
• Delays in finalising business plan impacted on progress– Approval only granted in August 2012
• Encountered some challenges in undertaking work around Governance arrangements at Community level i.e. CHCs
– Delays in getting a supporting legal opinion on the exact roles, responsibilities and functioning of Clinic Committees
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Summary of Quarter 3 Expenditure(R’000)
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Summary of Quarter 4 Expenditure(R’000)
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DORA: Implementation
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NATIONAL HEALTH INSURANCE GRANT
Province
R thousand
Eastern Cape 11 500 11 500 11 500 11 500 8 093 100.0% 70.4% 8 093 3 407 3 229 Free State 16 500 16 500 16 500 16 500 9 337 100.0% 56.6% 9 337 7 163 7 163 Gauteng 31 500 31 500 31 500 31 500 8 066 100.0% 25.6% 8 066 23 434 12 026 KwaZulu-Natal 33 000 33 000 33 000 33 000 16 127 100.0% 48.9% 16 127 16 873 14 949 Limpopo 11 500 11 500 11 500 11 500 4 118 100.0% 35.8% 4 118 7 382 6 382 Mpumalanga 11 500 11 500 11 500 11 500 5 570 100.0% 48.4% 5 570 5 930 325 Northern Cape 11 500 11 500 11 500 11 500 8 005 100.0% 69.6% 8 005 3 495 1 578 North West 11 500 11 500 11 500 11 500 8 818 100.0% 76.7% 8 818 2 682 2 084 Western Cape 11 500 11 500 11 500 11 500 9 885 100.0% 86.0% 9 885 1 615 1 615 Total 150 000 150 000 150 000 150 000 78 019 100.0% 52.0% 78 019 71 981 49 351
Preliminary (over)/under
Roll-Overs Requested
Division of Revenue Act, 2012 (Act No.
5 of 2012)
Total availablePayment
Schedule: Year to date
Received by province:
Year to date
Provincial actual
payments
% Transferred of national allocation
% Actual payments
of total available
Preliminary outcome for
financial year
Total Expenditure by Province (%) (April 2012 – 31 March 2013)
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NHI-CG Provincial Commitments/Roll-Overs
2012/13 Financial Year
PROVINCETOTAL NHI-CG ALLOCATION COMMITMENTS
COMMITMENTS AS PERCENTAGE OF TOTAL BUDGET
EC 11 500 000.00 3 229 000.00 28.1
FS 16 500 000.00 7 163 000.00 43.4
GP 31 500 000.00 12 026 000.00 38.2
LP 11 500 000.00 6 382 000.00 55.5
KZN 33 000 000.00 14 949 000.00 45.3
MPU 11 500 000.00 325 000.00 2.8
NC 11 500 000.00 1 578 000.00 13.7
NW 11 500 000.00 2 083 765.00 18.1
WC 11 500 000.00 1 615 000.00 14.0
NATIONAL 150 000 000.00 49 350 765.00 32.9
Summary Challenges• Weak HR capacity in some Districts
• Weak Provincial technical support
• Delays in budgets being communicated to some pilot sites
– Incorrect budget capturing
• Significant Supply Chain management challenges in many Districts
• Lack of necessary delegations to perform outlined activities
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Monitoring and Evaluation Matters • Monitoring and Evaluation undertaken by Grant Management Unit
and Directorate: NHI– Financial, Health Economics and Monitoring and Evaluation skills
appointed
• All Provinces have submitted Month on Month financial data– Used to compile IYM data
• Quarterly reports and meetings with all sites – Mutually identified shortfalls and challenges;– Mutually identified “quick win” activities and interventions; – Expedited Expenditure on commitments in approved Business Plans– Assessed progress on operational plans
• Prioritisation process
• Focus on quality spending– Evidence gathering
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Way Forward (1) • Inherent underperformance in early part of the
2012/13 cycle:– NHC Intervention resulted in improvement in Q3 and Q4
• DORA framework to adjust the purpose, focus activities and funding allocations to Provinces:– Allows NDOH a stronger and more interventionist approach:– Influences the scope of work to be undertaken at National
and pilot site levels:– Changes in allocations across Districts
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Way Forward (2) • For 2013/14, the grant has been split into 2 components:
– Direct: District piloting (Schedule 5)– In-kind: GP contracting and Central Hospitals work (Schedule 6A)
• New focus areas: – Strengthening SCM;– Supporting the roll-out of PHC streams and their role within the District
referral system;– Strengthening District level Monitoring and Evaluation capacity
• Mobilised funding for appointment of Provincial NHI Coordinators:– Majority appointed to post;– Assist in coordination, project management and Monitoring and
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THANK YOU
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