Presentation to the Portfolio Committee on Health 16 October 2013

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Presentation Presentation to the to the

Portfolio Portfolio Committee Committee on Health on Health

16 October 16 October 20132013

Purpose of the Presentation 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.

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Structure of the PresentationStructure of the Presentation

I. Vision and MissionII. National Health Sector PrioritiesIII. Review of Programme Performance IV. Human Resource ManagementV. Budget and Expenditure Per Economical ClassificationVI. Explanations of Material VariancesVII. Audit OutcomesVIII.Conditional Grant ExpenditureIX. Conclusions

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Vision and MissionVision and Mission

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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.

National Health Sector PrioritiesNational Health Sector Priorities

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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.

Programme 1: Programme 1: Administration and Corporate ServicesAdministration and Corporate Services

Fiscal Environment

National DoH obtained an unqualified audit opinion in 3 years.

Significant improved financial management both within the Department and the health sector. Even though 5 provinces were unqualified there has been some improvements as a result of an intervention from National. 2 provinces moved from a disclaimer to qualified and one from qualified to unqualified

Appointment of 371 unemployed financial, ICT and Human Resources graduates to support the financial management plans and improve audit

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Programme 1: Programme 1: Administration and Corporate ServicesAdministration and Corporate Services

Using Donor Funding 371 Unemployed Graduates worked over 12 months in the Intern Programme:

• Financial Management 125• Information Communication Technology 137• Human Resources management 109Revenue Management Model:• Interns were instrumental in the implementation of a project for improvement of

revenue management which was implemented in Charlotte Maxeke Hospital.• The objectives of the Project were to reduce Medicom backlog in the hospital, due

to system down time, and to increase data quality by correcting errors in patient contact details.

• The entire Medicom backlog of patient admissions dating back to April 2012 was cleared and 400 downtime patients were registered daily and 400 patient files were checked daily to ensure accurate data is captured on the system.

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

• The billing backlog to April 2012 for support services was cleared.• This model is now rolled out to 6 additional provinces.

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Programme 2: NHI, Health Planning and Programme 2: NHI, Health Planning and Systems EnablementSystems Enablement

Norms and Standards

Four norms and Standards were developed in key areas, namely: Information Technology (IT) Human Resources Quality Infrastructure

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Programme 2: NHI, Health Planning and Programme 2: NHI, Health Planning and Systems EnablementSystems Enablement

Norms and Standards

Four norms and Standards for Information Technology (IT) The IT work is premised on the eHealth Strategy for South

Africa was adopted in July 2012. The Council for Scientific and Industrial Research commenced

with the development of National Health Normative Standards for Interoperability.

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Programme 2: NHI, Health Planning & Programme 2: NHI, Health Planning & Systems EnablementSystems Enablement

National Health Insurance Health service innovations and preparation for NHI in 10

selected districts were rolled-out: The Ministerial road-shows in each of the NHI districts involved a wide

range of stakeholders; NHI management structures established by Provinces; Workload Indicator of Staffing Norms (WISN) were introduced; Ward based Primary Health Care outreach teams were constituted; District clinical specialist teams were launched; Health Facility Improvement Teams were established; and Independent assessment of 12 month implementation were

undertaken in the NHI pilot districts. Draft White Paper on NHI was prepared. Consultations are underway in line with Cabinet guidelines.

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Mindset Health ChannelMindset Health Channel

Mindset Health ChannelMindset Health ChannelEducating 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

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Reach of the Mindset Health Channel in NHI Districts

Reach of the Mindset Health Channel in NHI Districts

PROVINCE DISTRICT TOTAL POPULATION

TOTAL HEALTH

FACILITIES

CURRENT MINDSET HEALTH REACH (%)

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

MOFUTSANYANE832, 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%)

Mindset Health TV Channel Computer based HCP training

Mindset Health Channel: Satellite Receiving Equipment

Mindset Health Channel: Satellite Receiving Equipment

Programme 3: HIV and AIDS, TB and Programme 3: HIV and AIDS, TB and Maternal, Child and Women’s HealthMaternal, Child and Women’s Health

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

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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.


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%.

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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.

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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.

School Health ServicesSchool Health Services

• 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

School Health ServicesSchool Health Services

School Health ServicesSchool Health ServicesEU Supported Project1st Phase – Purchased 30 Mobiles – EU Branded2nd Phase – Purchase 30 more mobiles for delivery in January 2013Provincial Departments will be responsible for :• Staff• Maintenance• OverheadsIntersectoral Collaboration is a critical success factor. Sectors

include among others– Department of Rural Development– Presidency- War on Poverty– Department of Transport– Local Government – Water and Sanitation– Social Development

Programme 4: Programme 4: Primary Health Care Services Primary Health Care Services

Re-engineering of PHC and District Health System 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. 34 districts had at least 3 members of the District Clinical Specialist

Teams appointed compared to the target of 10 districts. The draft District Health Systems policy was developed. The draft Framework for addressing the social determinants of health was

developed. 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.

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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%.

The Integrated Health Promotion Strategy was not implemented as certain components of the Strategy required consultation with stakeholders.

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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.

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Re-engineering of PHC and District Health System There are three workstreams:

Municipal Ward-Based PHC Outreach Teams (6 members per team)

District Specialist teams

School Health teams

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Municipal Ward-Based PHC Outreach Teams

Teams established 945 at end March 2013 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, child health, HIV, TB

Phase 2 NCDs, Mental health, Youth, older persons, substance abuse, violence

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Province DHIS 30/5/2013

Eastern Cape 478Gauteng 120Free State 58KwaZulu-Natal 46Limpopo 75Mpumalanga 20Northern Cape 1Northwest 147Grand Total 945

Programme 4: Primary Health Care Services 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

20 22 32 31 13 10 13 24 20 185

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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

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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

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Programme 5: Hospital, Tertiary Programme 5: Hospital, Tertiary Services and Workforce DevelopmentServices and Workforce Development

Feasibility studies for 4 out of 7 Flagships Projects have been completed. Costing work is underway

Embarked on a process of development 46 norms and standards, guidelines and benchmarks on infrastructure

As at end March 2013, 69% were completed As at end of September 2013, 80% were completed

A National Infrastructure Plan based on health facility Planning have been developed

A project monitoring information system has been developed and is being cascaded to provincial departments of health for purposes of reporting on progress on infrastructure projects

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Programme 6: Health Regulation and Programme 6: Health Regulation and Compliance Management 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.

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Programme 6: Health Regulation and Programme 6: Health Regulation and Compliance Management Compliance Management

Medicines Control Council 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.

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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).

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Human Resources ManagementHuman Resources Management

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• 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.


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• 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.


• 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.

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Human Resources Priorities for 2012 to Human Resources Priorities for 2012 to 2014- NDOH2014- 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.

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BUDGET AND EXPENDITURE PER PROGRAMMEBUDGET AND EXPENDITURE PER PROGRAMME

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BUDGET AND EXPENDITURE PER PROGRAMMEBUDGET AND EXPENDITURE PER PROGRAMMEContinue

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BUDGET AND EXPENDITURE PER PROGRAMMEBUDGET AND EXPENDITURE PER PROGRAMMEContinue

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EXPLANATIONS OF MATERIAL VARIANCESEXPLANATIONS OF MATERIAL VARIANCESPer programme Final

AppropriationR’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.

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EXPLANATIONS OF MATERIAL VARIANCES EXPLANATIONS OF MATERIAL VARIANCES Continue

Per programme Final Appropriation

R’000

Actual Expenditure

R’000

Variance

R’000

Variance as % of Final

Appropriation

Primary Health Care Services

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.

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AUDIT OUTCOMEAUDIT 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;

– Quarterly performance reports on Conditional Grants were not submitted within 45 days after the end of each quarter to the National Treasury;

– 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.

– 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.

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AUDIT OUTCOMEAUDIT OUTCOME

Audit plans to address this 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.

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CONDITIONAL GRANT EXPENDITURECONDITIONAL GRANT EXPENDITURE

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Summary of Conditional Grant Expenditure

Grant Total Available Amount Spent Variance (R'000) Variance (%)NTSG 8 878 010 8 839 943 38 067 99.6%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 25 358 035 714 575 97.3%

CONDITIONAL GRANT EXPENDITURECONDITIONAL GRANT EXPENDITURENTSGNTSG

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Provinces Amount

Transferred Amount Spent % Expenditure over

budgetRand

Variance

Eastern Cape

682,445 668,149 95% 34,270

Free State

786,724 778,270 100% 8454

Gauteng

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

KwaZulu-Natal

1,323,114 1,324,487 100% -1373

Limpopo

288,427 276,607 96% 20,820

Mpumalanga

91,879 91,879 100%

-

Northern Cape

266,621 260,666 100% 17100

North West

211,765 192,850 91% 18,915

Western Cape

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

-

TOTALS 8,878,010 8,839,943 99% 38,067

CONDITIONAL GRANT EXPENDITURECONDITIONAL GRANT EXPENDITURENTSG VARIANCENTSG VARIANCE

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Eastern Cape• Delays in the procurement process of the three MRI

machines

Limpopo• Delays in the tendering processes of the CAT scan and

GAMMAR camera for nuclear medicines

North West• Delays in the procurement process one MRI machine for

Tshepong Hospital in Klerksdorp

CONDITIONAL GRANT EXPENDITURECONDITIONAL GRANT EXPENDITUREHIV/AIDSHIV/AIDS

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Provinces Amount


budgetRand

Variance

Eastern Cape

1,060,852 1,110,315 103.5% -41,178

Free State

615,160 648,684 99.5% 6,043

Gauteng

1,901,293 1,905,215 100.0%

-3922

KwaZulu-Natal

2,225,423 2,253,755 101.4% -28,332

Limpopo

713,432 634,889 82.7% 132,708

Mpumalanga

575,032 586,097 100.0%

-

Northern Cape

248,372 228,064 92.5% 20,308

North West

685,204 706,124 100.0% -

Western Cape

738,080 734,843 100.0% 3,237

TOTALS 8,762,848 8,807,986 100.5% -45138

CONDITIONAL GRANT EXPENDITURECONDITIONAL GRANT EXPENDITUREHIV/AIDS VARIANCEHIV/AIDS VARIANCE

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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 EXPENDITURECONDITIONAL GRANT EXPENDITUREHOSPITAL REVITEHOSPITAL REVITE

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Provinces Amount

Transferred Amount Spent % Expenditure over budget

Rand Variance

Eastern Cape

402,679

414,544 90% 45,629

Free State

638,384

462,127 71% 192,817

Gauteng

795,439

411,137 52% 384,302

KwaZulu-Natal

586,605

586,542 100% 63

Limpopo

301,193

344,703 92% 28,654

Mpumalanga

300,000

240,821 67% 118,750

Northern Cape

346,083

366,207 100% -1,227

North West

423,127

392,610 92% 34,974

Western Cape

496,085

441,610 88% 62,804

TOTALS 4,289,595 3,660,301 85.3% 629291

CONDITIONAL GRANT EXPENDITURECONDITIONAL GRANT EXPENDITUREHOSPITAL REVITALISATION VARIANCESHOSPITAL REVITALISATION VARIANCES

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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


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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..


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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


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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.


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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


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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%


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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 EXPENDITURECONDITIONAL GRANT EXPENDITUREHPTDGHPTDG

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Provinces Amount


budgetRand

Variance

Eastern Cape

178,730

172,934 94% 10,087

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

86,090 100% -253

Northern Cape

68,583 73,936 101% -1,034

North West

93,522

93,522 100% -

Western Cape

428,120

428,120 100% -

TOTALS 2,076,176 2,078,025 100% -1849

CONDITIONAL GRANT EXPENDITUREHPTDG VARIANCES

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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 EXPENDITURECONDITIONAL GRANT EXPENDITUREHEALTH INFRASTRUCTUREHEALTH INFRASTRUCTURE

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Provinces Amount


budget Rand

Variance

Eastern Cape

258,862

306,177 100% 537

Free State

139,073

81,950 45% 99,767

Gauteng

110,361

110,361 100%

-

KwaZulu-Natal

573,367

572,520 98% 12,847

Limpopo

267,888

266,729 100% 1,159

Mpumalanga

108,971

114,394 100% 98

Northern Cape

98,258

110,038 100%

-

North West

112,790

121,622 100% 45

Western Cape

131,411

128,981 96% 5,253

TOTALS 1,800,981 1,812,772 100.7% -11791

CONDITIONAL GRANT EXPENDITUREHEALTH INFRASTRUCTURE VARIANCES

62

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 EXPENDITURECONDITIONAL GRANT EXPENDITURENHINHI

63

Provinces Amount

Transferred Amount Spent % Expenditure

over budgetRand

Variance

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 EXPENDITURECONDITIONAL GRANT EXPENDITURENHI VARIANCESNHI VARIANCES

64

• 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 EXPENDITURECONDITIONAL GRANT EXPENDITURENCSGNCSG

65

Provinces Amount


over budgetRand

Variance

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 EXPENDITURECONDITIONAL GRANT EXPENDITURENCSG VARIANCESNCSG VARIANCES

66

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 yearMpumalanga• 1 project has been completed and is at retention, • 1 on tender and these projects will be carried over to 2013/14

financial yearNorthern 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 EXPENDITURECONDITIONAL GRANT EXPENDITURENCSG VARIANCESNCSG VARIANCES

67

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 EXPENDITURECONDITIONAL GRANT EXPENDITUREAFCONAFCON

68

Provinces BudgetAmount


over budgetRand

Variance

Eastern Cape 3000 3000 2353 78% 647

Free State

Gauteng 3000 3000 0 0% 3000

KwaZulu-Natal 3000 3000 1672 56% 1328

Limpopo

Mpumalanga 3000 3000 3000 100% 0

Northern Cape

North West 3000 3000 1583 53% 1417

Western Cape

TOTALS 15000 15000 8608 57% 6392

Conclusions 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 period46% of the planned targets for 2012/13 were fully

achieved. 56% of the targets were partially achieved.

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.

69

Presentation to the Portfolio Committee on Health 16 October 2013

Documents

Transcript of Presentation to the Portfolio Committee on Health 16 October 2013