portfolio committee 2014/15: quarter 4 performance director general june 2015

PORTFOLIO COMMITTEE

2014/15: QUARTER 4 PERFORMANCE

Director General

June 2015

PurposePresent Progress Report on the Annual Performance Plan 2014/15. The report is presented by the following programmes:

1.Programme 1 : Administration2.Programme 2: Health Planning and Systems Enablement3.Programme 3: HIV & AIDS, TB and MCWH4.Programme 4: PHC Services5.Programme 5: Hospitals, Tertiary Services and Workforce Development6.Programme 6: Health Regulation and Compliance Management

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The Department Annual Performance Plan is designed to deliver on the MTSF commitments, namely:

Sub-outcome 1: Universal Health coverage progressively achieved through implementation of National Health InsuranceSub-outcome 2: Improved quality of health careSub-outcome 3. Implement the re-engineering of Primary Health CareSub-outcome 4: Reduced health care costsSub-outcome 5: Improved human resources for healthSub-outcome 6: Improved health management and leadershipSub-outcome 7: Improved health facility planning and infrastructure deliverySub-outcome 8: HIV & AIDS and Tuberculosis prevented and successfully managedSub-outcome 9: Maternal, infant and child mortality reducedSub-outcome 10 : Efficient Health Management Information System developed and implemented for improved decision making

Medium Term Strategic Framework (MTSF) 2014-2019

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Progress Report

PROGRAMME 1 : ADMINISTRATION

Programme 1: Administration

Strategic Objective Indicator Annual Target Actual performance

Ensure effective financial management and accountability by improving audit outcomes

Audit opinion from Auditor-General

UnqualifiedAudit Opinion

Annual Target to be reported at the end of

Audit process

Audit opinion from Auditor-General for Provincial Departments of Health

3 Unqualified audit opinions Annual Target to be reported at the end of

Audit process

Number of provinces that submit reports against defined set of non-negotiable items on a monthly basis

9 9 provinces submitted signed off reports

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Programme 1: Administration Strategic Objective Indicator Target Actual performance

Develop and implement the ICT Governance framework by focusing on the business continuity plan (BCP) inclusive of a disaster recovery plan (DRP)

Develop and Implement Business Continuity Plan inclusive of a disaster recovery plan.

Information Communication and Technology continuity plan inclusive of disaster recovery plan (DRP) finalized and approved.

The Information Communication and Technology service continuity plan approved to ensure that the department can continue with critical functions in case of disaster.

Provide support for effective communication by developing an integrated communication strategy and implementation plan

Develop an integrated communication strategy and implementation plan

Communication Strategy finalized and approved

Communication Strategy finalized and approved. Communication Strategy include: healthy lifestyle, TB, HIV and AIDS, Safe Sex, Diabetes, consumption of salt, teenage pregnancy reproductive health and rights etc.

Internal Communication Guidelines developed and approved Departmental Language Policy drafted and approved

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Strategic Objective Indicator Target Actual performance

Ensure efficient and responsive Human Resource Services through the implementation of efficient recruitment processes and responsive Human Resource support programme

Average Turnaround times for recruitment processes.

Target:turnaround time will be 4 months

Q4: 37.5 % of vacant posts were filled within 5 months

Provide support for effective communication by developing an integrated communication strategy and implementation plan

Develop and Implement Employee wellness programme that comply with Public Service Regulations (PSR) and Employee Health and Wellness Strategic Framework.

Target:All 4 EHW Pillars for improved employee well being and productivity implemented

All 4 EHW Pillars implemented

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Strategic Objective

Indicator Annual Target Actual performance

Provide leadership in the health sector by integrating all health sector plans

Develop and implement a framework for Integrated Health Service Plans at all levels of the health sector

1 National APP and 9 Provincial APPs developed according to guidelines.

Draft Framework for integrated health service plans developed

The Framework for integrated Health Service Plans was developed and implemented at National and Provincial DoH.

Review Provincial Annual Performance Plans

9 Provincial APPs analysed and feedback provided.

9 Provincial APPs reviewed and feedback provided

9 Provincial APPs were reviewed and feedback was provided

Establishment of fora for consultation of stakeholders on identified legislation, regulations and policy processes

Number of fora for consultation established

1 National and 9 Provincial fora established

1 National and four provincial consultative fora convened- Gauteng, KwaZulu-Natal, North West and Limpopo


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Progress Report

PROGRAMME 2 : HEALTH PLANNING AND SYSTEMS ENABLEMENT

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Achieve Universal Health Coverage through the phased implementation of the National Health Insurance(NHIimplementation ofthe National HealthInsurance (NHI).

Legislation for NHI Draft NHI Bill gazetted for public consultation

The Draft White Paper for the NHI Bill has been revised and prepared for submission to Cabinet

Piloting of NHI in selected districts across the country.

Q4 Target:Monitoring and evaluation performance meetings and site visits for quarter 4 conducted for all 10 NHI pilot sites

NHI - M&E visits held in 10 districts

Q4 Target:Consolidated quarter 4 performance report for 2014/15 prepared

Consolidated quarter 4 report prepared

Programme 2: National Health Insurance, Health Planning and Systems

Enablement

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Achieve Universal Health Coverage through the phased implementation of the National Health Insurance(NHIimplementation ofthe National HealthInsurance (NHI).

Establishment of the National Health Insurance Fund

Phase 1 of the implementation of NHI initiated through:Creation of a Project Management team established and various activities for the "shadow process" of the NHI Fund initiatedFunding Modality for the National Health Insurance Fund including budget reallocation for the district primary health care (PHC) personal health services developed

The Department and the National Treasury have continued liaisons to finalise the sections in the White Paper on NHI that speak to financing arrangements. Treasury has also drafted a paper titled " Financing National Health Insurance(NHI) in South Africa". Not published as yet


Enablement

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Regulate health care in the private sector legislating methodologies for calculating fees.

Revise and legislate methodology for the determination of the dispensing fee.

Systematic survey for the dispensing fee completed for 2015/16 cycle

The revised dispensing fee regulation was published on 13th March 2015.


Enablement

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Strategic Objective

Indicator Target Actual performance

Implement a transparent pricing system for medicines

Revise and legislate methodology for the determination of the logistics fee.

Revise the instruction document on how to calculate the Logistics Fee for 2015/16

The revised logistics fee regulation calculation was published.

Publish revised SEP adjustment methodology

Implementation of the gazette 2014/15 Annual Price Adjustment.

The 2014/2015 Annual Single Exit Price Adjustment was implemented


Enablement

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Strategic Objective

Indicator Target Actual performance

Improve Management and control of pharmaceutical services

Percentage of the PHC Essential Medicines List (EML) and Standard treatment Guidelines (STGs) reviewed

Q4 : Review 100% of PHC EML/STG Annual Target:Review 100% Primary Healthcare EML/STG & publish 2014 edition

Q4: 100%

Percentage of the Hospital Level Paediatric Essential Medicines List (EML) and Standard treatment Guidelines (STGs) reviewed

Q4: Review 20% of Hospital Level Paediatric EML/STGAnnual Target: Review 20% Hospital Level Paediatric EML/STG

Q4: 24%

Percentage of the Hospital Level Adult Essential Medicines List (EML) and Standard treatment Guidelines (STGs) reviewed

Q3: Review 50% of Hospital Level Adult EML/STGAnnual Target:Review 50% of Hospital Level Adult EML/STG

Q4: 36%


Enablement

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Improve Management and control of pharmaceutical services

Number of medicines review reports approved by the NELMC for inclusion in the tertiary EML

Q4: Complete 3 medicine reviewsAnnual : Complete 12 medicine reviews for Tertiary Level & update list

Q4: 12 (cumulative)

Central chronic medicine dispensing and distribution.

Number of Districts implementing centralised chronic medicine dispensing & distribution

Q4:75% of facilities in 10 NHI districtsAnnual Target: Implemented in all 10 NHI pilot districts

Q4: 77% of facilities in all ten pilot NHI districtsTen NHI districts have implemented the centralised chronic medicine dispensing & distribution system.

Strengthen revenue collection by incentivizing central hospital to increase their revenue collection

Develop and implement a revenue retention model

Q4: Present the findings to the CFOF and NT/PTAnnual Target: Present at the NHC TAC meeting

Revenue retention model developed. During the past three financial years 2012/13 to 2014/15, a total revenue amounting to R1.3 billion was collected by 13 hospitals. During the 2014/15 financial year the total revenue collected was R450,609,000.00.


Enablement

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Strategic Objective


Develop Business and Enterprise architecture for eHealth

Develop a complete System design for a National Integrated Patient based information system

Business architecture for a National Integrated Patient Based Information System developed

Progress made with the reference implementation of architecture in the 700 PHC facilities in 10 NHI District

•Distributed and installed 3337 computers and facility Local Area Network Equipments•Beta Testing of an integrated information package in 50 PHC FacilitiesInternet ConnectivityDeployment of web based Health Patient Registration SystemDeployment of Web Based District Health Information System Patient Administration reform inclusive of paper-based data collection tools, standardized patient files and filing system•Assessment of all PHC Patient Information System inclusive of the Private Sector against functionalities of the Interoperability Norms and Standards and Costs.


Enablement


Establish a National Health Research Observatory.

Functional Health Research Observatory

Concept paper for the establishment of the National Health Observatory approved

Concept Paper consisting of a proposal and business plan on NHRO has been established. The National Health Research Database (NHRD) which is part of NHRO is being rolled out to provinces

Develop and implement an integrated monitoring andevaluation plan alignedto health outcomes and outputs contained in the Health Sector Strategy

Develop and implement Integrated monitoring andevaluation plan.

Monitoring and evaluation plan for health developed.

Final Draft M&E Strategy Plan submitted

Establish a coordinated disease surveillance system for Notifiable Medical conditions (NMC).

Develop and implement a strategy and plan for the integration of disease surveillance systems for NMC.

Draft strategy for the integration of disease surveillance systems for NMC developed.

Emergency Operations Centre for disease surveillance has been established at NCID


Enablement

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Strategic Objective


Monitor HIV prevalence Annual National HIV Antenatal Prevalence Survey.

2013 National Antenatal Sentinel HIV and Herpes Simplex Type 2 prevalence in South Africa

Final 2013 National Antenatal Sentinel HIV Survey report prepared and submitted

Domestication of international treaties Implementation of multilateral cooperation on areas of mutual and measurable benefit

Implement International treaties or multilateral frameworks.

International treaties or multilateral frameworks implemented

Implementation of provisions of IHR (2005) and WHO-FCTC. Monitored the implementation of four cross border projects of the SADC HIV and AIDS Fund. Participated in multilateral health fora: World Health Assembly, World Health Organization-Africa region, World Economic Forum, 136 Executive Board Meeting of WHO, World Innovation Summit for Health - Doha, Qatar; Economist's Pharma 2015 Conference – UK, Sixteenth World Conference on Tobacco in Abu Dhabi, African Union and SADC Ministerial meetings.


Enablement

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Strategic Objective

Indicator Annual Target

Actual performance

Domestication of international treaties Implementation of multilateral cooperation on areas of mutual and measurable benefit

Implement International treaties or multilateral frameworks.

International treaties or multilateral frameworks implemented

Provided humanitarian assistance in response to Ebola virus disease outbreak in Guinea, Sierra Leone & Liberia, Provided financial assistance for the recruitment of Cuban doctors to provide health services in Sierra Leone. Established a knowledge and information sharing platform on various areas of collaboration with Botswana, Uganda, Namibia and Ghana. Continue to provide scholarship assistance for South African students to Cuba for medical training. Mobilized resources for SA health system with United Nations Industrial Development Organization. Handover Ceremony of an Obstetric Ambulance by Turkey. Release of the additional variable tranches for the Primary Health Care Sector Policy Support Programme


Enablement

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Strategic Objective


Implementation of bilateral cooperation on areas of mutual and measurable benefit

Number of Bilateral projects implemented

Two strategic bilateral projects implemented

A number of activities were pursued within the ambit of bilateral projects:

1.South African Malaria team visited Botswana to strengthen cross border collaboration and share information and experiences on malaria during 16 to 20 February 2015. An implementation plan was developed between Waterberg District and Bobirwa District and establishment of a cross border committee to coordinate the implementation plan.2. Two teams of South African volunteers consisting of seven and 26 volunteers were sent to Sierra Leone for humanitarian assistance on EBOLA virus disease. Further humanitarian assistance included shipment of food, medicines, motorbikes and ambulances to Guinea, Sierra Leone and Liberia as part of South African response to Ebola virus disease outbreak. 3. Approval was granted to conduct training for Malaria Programme Managers from Comoros in the first quarter of 2015/16. 4. NDoH delegation participated in the SA Week and the 14th SA-EU Joint Cooperation Council (JCC. Facilitated SA-EU Health Dialog Video Conference.


Enablement

Strategic Objective


Implementation of bilateral cooperation on areas of mutual and measurable benefit

Number of Bilateral projects implemented

Two strategic bilateral projects implemented

A number of activities were pursued within the ambit of bilateral projects:

• Mou between the Federal Department of Home Affairs (Swissmedic) and Republic of South Africa (MCC).

•MoU between NDoH by Deputy Registrar: MCC and North West University by Vice Rector: Teaching and Learning

•Contractual agreement between United Nations Industrial Development Organization, and the North -West University, Potchefstroom Campus, Second 2014 ODA Planning Forum.


Enablement

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Progress Report

PROGRAMME 3 : HIV AND AIDS, TUBERCULOSIS , MATERNAL, CHILD AND

WOMEN’S HEALTH

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

Health Strategic Objective Indicator Target Actual performance

To scale up combinationof prevention interventionsto reduce new infections

Number of HIV test client 15-49 years

Q4: 2 500 000 Q4: 2,352,440

9 566 097(Apr 2014-Mar 2015)

Number of Medical Male circumcisions performed

Q4: 250 000 Q4: 84,475

508,404 (Apr 2014-Mar 2015)

Increase the numbers of HIV positive people who are managed so that they do not contract opportunistic infections especially TB and who receive antiretroviral therapy when needed.

Total clients remaining on ART (TROA) at the end of the month

Q4: 3 000 000 Q4: 3,103, 902(Apr 2014-Mar2015)

TB/HIV co-infected client initiated on ART rate

Q4: 64% 73.7%(Apr 2014-Mar 2015)

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


Improve the effectiveness and efficiency of the routine TB control programme to increase the identification of TB patients; to ensure that these take and complete their treatmentof Tuberculosis

TB new client treatment success rate

82% Annual: 82.5%

TB (new pulmonary) treatment defaulter rate

6% Annual 5.7%

Number of trained TB tracing coordinators

Annual: 25 Annual: 7

TB Death Rate Q4:6% Annual: 4.8%

To improve the functioning of the MDR-TB control programme including earlier initiation and decentralised treatment

Number of professional nurses trained to initiate MDR-TB treatment

Annual : 25 120 (Overachievement due to additional global fund money, acceleration of the decentralised implementation model)

Number of hospitals assessed according to the Treatment Criteria

Annual: 50 Annual 50

TB MDR confirmed treatment initiation rate

Annual: 60% Annual: 82.9%

TB MDR treatment success rate

Annual: 42% Annual: 48%

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


Ensure that all correctional services facilities have appropriate services and that inmates all have access to TB and HIV diagnosis and treatment services and care

Percentage of correctional services centres conducting routine TB screening

Annual: 50% Annual: 90%

Number of Correctional Services Management areas with risk assessments undertaken

Annual:20 Annual: 29

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Health


To reduce the maternal mortality ratio to under 100 per 100 000 live births.

Antenatal 1st visit before 20 weeks rate

Q4: 65%Annual:65%

Q4: 55.2%53.9% (Apr 2014-March 2015)

Mother postnatal visit within 6 days rate

Q4: 80%Annual:80%

Q4: 74.4%74.3% (Apr 2014-Mar 2015)

Maternal mortality in facility ratio (annualised)

Annual: 100 per 100 000 live births (annual)

Annual: 132.5

To reduce the neonatal mortality rate to under 6 per 1000 live births.

Inpatient Neonatal death rate (annualized)

Q4: 10.3 per1000 Live BirthsAnnual: 10 per 1000 Live Births

Q4: 12.7Annual: 12.8

To improve access to sexual and reproductive health services by expanding the availability of contraceptives.

Couple year protection rate 55% Q4:46.5%52.7% (Apr 2014-Mar 2015)

Cervical cancer screening coverage 60% Q4:56%54.5% (Apr 2014-Mar2015)

HPV 1st dose coverage 70% 91.8%

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Health

Strategic Objective Indicator TargetActual performance

Expand the PMTCT coverage to pregnant women by ensuring all HIV positive Antenatal clients are placed on ARVs and reducing the positivity rate to below 1%.

Antenatal client initiated on ART rate.

Q4: 93%Annual: 93%

Q4: 93.8%91.2% (Apr 2014-march 2015)

Infant 1st PCR test positive around 6 weeks rate.

1.8% Q4: 1.5%1.5% (Apr 2014-March 2015)

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Health


To reduce under-five mortality rate to less than 23 per 1,000 live births by promoting early childhood development

Child under 5 years diarrhoea case fatality rate

3.5% (1 775/45 880)

Q4:3.3%3.3% (Apr 2014-Mar 2015)

Child under 5 years severe acute malnutrition case fatality rate

8% Q4:11.2%11.6% (Apr 2014-Mar2015)

Confirmed measles case incidence per million total population

<5/1,000,000 1.19 per 1, 000, 000(Apr 2014-Mar2015)

To contribute to health and wellbeing of learners by screening for health barriers to learning

Immunisation coverage under 1 year (annualised)

90% Q4: 96.5%90% (Apr 2014-Mar2015)

DTaP-IPV/Hib 3 - Measles 1st dose drop-out rate

7% Q4: -5.9%2.1% (Apr 2014-Mar 2015)

Measles 2nd dose coverage (annualised)

82% Q4: 86.5%82.8% (Apr 2014-Mar 2015)

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Health

Strategic Objective

IndicatorQuarter Three Target

Actual performance

To contribute to health and wellbeing of learners by screening for health barriers to learning

School Grade 1 screening coverage (annualised)

28% Q4: 12.7%

23.2% (Apr 2014-Mar 2015)

School Grade 8 screening coverage (annualised)

12% Q4: 5.8%

8.6% (Apr 2014-Mar2015)

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Progress Report

PROGRAMME 4 : PRIMARY HEALTH CARE SERVICES

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Programme 4: Primary Health Care Services


Improve district governance and strengthen management and leadership of the district health system.

Number of primary health care facilities with functional clinic committees/ district hospital boards.

Implementation plan approved.

The implementation plan forms part of the approved Ideal Clinic scale-up plan

The Ideal clinic software was developed as the M & E system to measure functionality of clinic committees

Monitoring and evaluation system developed.

Number of districts with uniform management structures for primary health care facilities.

Uniform management structures for PHC facilities approved and resources secured.

The WISN process and normative guidelines for PHC facilities have been completed

Establish an intersectoral forum that will plan and oversee the implementation of interventions across all sectors.

Establish National Health Commission.

Key government departments, civil society and other key stakeholders consulted on the establishment of the intersectoral forum.

The Department collaborates with other government departments on a range of matters affecting social determinant of health. The establishment of the formal forum will be guided by the National Health Commission.

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Improve access to community based PHC services and quality of services at primary health care facilities.

Number of primary health care clinics in the 52 districts that qualify as Ideal Clinics.

Roll out plan approved and resourced.

The roll out plan has been approved and costed. The NHC pledged the resources required to scale –up all clinics to Ideal Clinics within the next three years.

Number of functional WBPHCOTs

Q4:1500 functional WBPHCOTs

Annual: 1500

Q4: 1748 ( March 2015)

Ensure that the Port Health services are rendered in line with the International Health Regulations

Number of Ports of Entry that are compliant with the International Health Regulations

20 ports of entry compliant with the International Health Regulations

44 ports of entry compliant with the International Health Regulations

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Strategic Objective


Improve environmental health services in all 52 districts and metropolitan municipalities in the country.

Number of municipalities that meet environmental health norms and standards in executing their environmental health functions.

Environmental Health strategy developed

Environmental Health

strategy developed.

Ensure compliance with Health Waste management regulations.

Health Care waste management regulations finalised

Health Care waste management regulations finalized


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Programme 4: Primary Health Care ServicesStrategic Objective Indicator Target Actual performance

Reduce risk factors and improve management for Non-Communicable Diseases (NCDS) by implementing the Strategic Plan for NCDs 2012-2017

% reduction in obesity in men and women

10 % reduction over a five year period from 65% for obese women and 31% for men

This will be measured during the South African Demographic and Health Survey to be conducted in 2015

Number of people counseled and screened for high blood pressure

Q4: 500 000Annual: 500 000

Q4: 169 418

Currently not in the routine data management systems but have been included for 2015/16 onward reporting. Delays in receiving data from provinces (by the lack of sign off) and partners. A database of non-government or private sector organizations is required for incorporation to the DHIS for 2015/16 reporting

Number of people counseled and screened for raised blood glucose levels

Q4: 500 000

Annual: 500 000

Q4 :147 562

Currently not in the routine data management systems but have been included for 2015/16 onward reporting. Delays in receiving data from provinces (by the lack of sign off) and partners. A database of non-government or private sector organizations is required for incorporation to the DHIS for 2015/16 reporting

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Improve access to and quality of mental health services in South Africa

Percentage people screened for mental disorders

Information system and baseline established

Data elements for patients screened for mental disorders were included in the rationalized PHC registers and DHIS

25 % of 16.5% (prevalence) people screened and tested for mental disorders

Survey indicator

Percentage of people treated for mental disorders

Information system and baseline established

Data elements for patients screened for mental disorders were included in the rationalized PHC registers and DHIS

25 % of 16.5% (prevalence) people screened and tested for mental disorders

Survey indicator

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Eliminate Malaria by 2018, so that there is zero local cases of malaria in South Africa

Reduce the local transmission of malaria cases to 0 per 1000 population at risk

0.3 malaria cases per 1000 population at risk.

0.82 malaria cases per 1000 population at risk

Number of malaria endemic districts reporting malaria cases within 24 hours of diagnosis

3 malaria endemic districts reporting malaria cases within 24 hours of diagnosis.

There are 10 affected districts, only 1 malaria endemic district reported malaria cases within 24 hours of diagnosis. clinicians do not report Malaria cases within 24 hours of diagnosing; the districts that were targeted are Enhlanzeni, Uthungulu and Umkhanyakude.

A mobile phone sms application is being piloted in the three districts to improve reporting times. This will be scaled up to the 10 affected districts in the 2015/16 financial year.

Improve South Africa’s response with regard to Influenza prevention and control

Number of high risk population covered by the seasonal influenza vaccination

750 000 high risk individuals covered with seasonal influenza vaccination.

837 645 high risk individuals vaccinated (Annual Target was reached)


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Strategic Objective


Improve access to disability and rehabilitation services through the implementation of the framework and model for rehabilitation and disability services

Number of Districts implementing the framework and model for rehabilitation services

Model approved and costed Draft model developedand ready for discussion with stakeholders and presentation to the National Health Council

Cataract Surgery Rate 1 500 operations per million un-insured population

985 operations per million un-insured populationThe annual target on cataract surgery has not been achieved due systemic challenges encountered (i.e. lack of ophthalmologists, medical officers, theatre nurses and consumables) in delivery of eye services in facilities. Provinces have been encouraged to give more theatre time and ensure equipment and consumables are available. Possible cooperation with private sector is being investigated.

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Ensure access to and efficient effective delivery of quality Emergency Medical Services (EMS).

Number of provinces that are compliant with the EMS regulations.

Draft EMS Regulations developed.

Regulations finalised and gazetted

Review EMS Response Time monitoring system.

Review pre-hospital EMS response times indicators and finalise definitions.

EMS indicators reviewed and finalized in September 2014 as part of the National Indicator Data Set review

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Strategic Objective


To improve Forensic Chemistry Laboratory turnaround times for blood, alcoholic, toxicology and food samples.

Median waiting time for blood alcohol results.

Baseline established: 6 months

Q4: 2.3 months for all 3 FCLs

Turnaround times of toxicology tests and reports.

Baseline established:12 months

Q4: 2.6 months for all 3 FCLs

Turnaround times of food products tests and reports.

Baseline established: 60 days for persishables

Q4: 56 days

Turnaround times of food products tests and reports.

Baseline established: 120 days for non-perishables

Q4: 102 days

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Progress Report

PROGRAMME 5 : HOSPITALS, TERTIARY SERVICES AND WORKFORCE DEVELOPMENT

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Programme 5: Hospitals, Tertiary Services and Workforce Development


Increase capacity of central hospitals to strengthen local decision making and accountability to facilitate semi-autonomy of 10 central hospitals.

No. of central hospital with reformed management and governance structures as per the prescripts.

Policy on Governance developed

Draft policy on governance for central hospitals submitted for review by Legal Services

Ensure equitable access to tertiary service through implementation of the National Tertiary services plan.

Number of gazetted hospitals providing the full package of Tertiary1 Services.

Annual: 2 gazetted tertiary hospitals providing the full package of Tertiary 1 services.

Six monthly =1

3 (March 2015)

Ensure quality health care by improving compliance with National Core Standards at all Central, Tertiary, Regional and Specialised.

% compliance with extreme and vital measures of the National Core Standards all Central, Tertiary, Regional and Specialised Hospitals.

100% compliance with extreme and vital measures of the National Core Standards in 5 Central Hospitals.

3 Central Hospitals

Steve Biko, Inkosi Albert Luthuli, and Groote Schuur

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Strategic Objective


Develop health workforce staffing norms and standards

Develop guidelines for HRH norms and standards using the Workload Indicators for Staffing Heeds (WISN) methodology from WHO

Draft guidelines for PHC- HR norms and standards available

Staffing norms and standards for Clinics and CHCs developed.Implementation guideline developed

Ensure that the number, distribution, quality and standard of health facilities are in compliance with norms and standards

Number of RTC's established

3 RTCs established 4 RTCs established and functional in Mpumalanga, Limpopo, Gauteng and North West

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Improve quality of Nursing training and practice by ensuring that all Nursing colleges are accredited to offer the new Nursing qualification

Number of public nursing colleges accredited to offer the new nursing qualification

5 public nursing colleges accredited to offer the new nursing qualification

0 public nursing colleges accredited as consultation and discussions on accreditation still ongoing

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Improve quality of health infrastructure in South Africa by ensuring all new health facilities are compliant with health facility norms and standards.

Percentage of facilities that comply with gazetted infrastructure Norms & Standards.

100% of new facilities compliant from date of gazetting.

From the date of gazetting, the clinical brief and business cases all 15 facilities (100%) comply with gazetted infrastructure Norms & Standards.

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Progress Report

PROGRAMME 6 : HEALTH REGULATION AND COMPLIANCE MANAGEMENT

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Programme 6: Health regulations and Compliance Management


Regulate Complementary and Alternative Medicines (CAMS), Medical Devices, Invitro Diagnostics and African Traditional Medicines in South Africa.

Regulate Complementary and Alternative Medicines (CAMS), Medical Devices, Invitro Diagnostics and African Traditional Medicines.

CAMS for Oncology, Cardiovascular Diseases, HIV/AIDS and Diabetes Regulated.

MCC published Guidelines on Medical Devices & IVDs. CAMS Regulations: published new definition MCC publish guidelines on Vitamins and Minerals.

Ten CAMS applications under review

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Improve the efficiency of the Regulator through restructuring by establishing South African Health Product Regulation Authority (SAHPRA) as a public entity.

Establish SAHPRA as a public entity.

Medicines and Related Substances Amendment Bill drafted

Bill going through parliamentary processes. Public hearings of the Portfolio Committee on Health on proposed Amendment Bill completed

Strengthen food safety through expanding testing capabilities for adulterants (colourants, protein, and allergens

Develop and establish MOUs with food testing institutions to enable testing for adulterants in food products

Consultations and two draft MOUs with testing institutions

Consultations ongoing to establish the extent of the capacity and capabilities to conduct testing of food samples.

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Strategic Objective

Indicator Quarter Three Target

Actual performance

Improve registration of response times for antiretroviral, oncology, TB medicines and vaccines used to treat high burden diseases.

Percentage of prioritised medicines (antiretroviral, oncology, TB medicines and vaccines) registered within 22 Months for New Chemical Entities (NCEs), and 15 months for multisource medicines.

67% of all prioritised medicines registered within 22 months (NCEs) and 15 months (multisource medicines).

NCEs: no priority products; TB: none Generics: ARV(4)= 2 average 25 moths & 2 backlog average 62.5 m months ; Oncology(5)= 2 average 17months & 3 backlog average 55 months; Others generics: (54) average 44.6 months; 27 averaged 30 months & backlog 27 averaged 59 months

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Strategic Objective Indicator Six monthly / Annual Target

Actual performance

Improve oversight and Corporate Governance practices by reviewing the Governance Framework and Implementation Plan biennially.

Develop and Implement Governance Framework and Implementation Plan for Public Entities and Statutory Councils.

Approved Governance Framework and Implementation Plan.

Governance Framework and Implementation Plan developed

Functional governance structures established.

Six monthly :Public entities governance and compliance report produced

Annual: Fully constituted Boards/ Councils for health entities and statutory councils of the Department

The Public Entities and Statutory Health Professional Councils Governance structures were fully functional throughout the reporting

period.

Traditional Health Practitioners Act reviewed

Proposed amendments to the Traditional Health Practitioners Act.

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Enhance governance and management by establishing all committees at the CCOD/MBOD.

Audit opinion from the Auditor-General for CCOD.

Governance structures enhanced to improve audit outcome.

Governance structures were enhanced by convening regular meetings of the Audit and Risk Committee

Establish occupational health services within the public health system.

Number of provinces with occupational health services within their facilities.

Establishment of one occupational health service in one health facility in each of Eastern Cape and Gauteng provinces.

One occupational health service facility established in Eastern Cape and Gauteng province

Provide for coordinated disease and injury surveillance and research by establishing National Public Health Institute of South Africa (NAPHISA).

Establish National Public Health Institutes of South Africa (NAPHISA).

Conceptual framework and Business case for NAPHISA approved.

Conceptual framework document and business case for NAPHISA developed

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Strategic Objective Indicator Quarter Three & Annual Target

Actual performance

To monitor the existence of and progress on annual and regular plans that addresses breaches of quality, safety and compliance in all public sector establishments addresses breaches of quality, safety and compliance in all public sector establishments.

Percentage of Health Establishments that have developed an annual Quality Improvement Plan based on OHSC inspections

Annual : 45% 63%

To improve the acceptability, quality and safety of health services by increasing user and community feedback and involvement.

Patient satisfaction surveys rate.

70% 49%

Patient satisfaction rate Determine Baseline

70%

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Financial Performance

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Summary per Programme

Subprogramme

Actual

Expenditure as on 31

March 2015

Funds Available % Spent

Original Budget

Adjusted Budget

R'000 R0'00 R'000 R'000

ADMINISTRATION

399 721

397 721

386 476

11 245 97.17%NATIONAL HEALTH INSURANCE, HEALTH PLANNING & SYSTEM ENABLEMENT

621 252

628 156

316 667

311 489 50.41%

HIV & AIDS, TB, MATERNAL & CHILD HEALTH

13 049 923

13 049 923

13 027 910

22 013 99.83%

PRIMARY HEALTH CARE SERVICES

93 515

102 545

102 355

190 99.81%

HOSPITALS, TERTIARY HEALTH SERVICES & HUMAN RESOURCE DEVELOPMENT

18 925 780

18 810 607

18 482 048

328 559 98.25%

HEALTH REGULATION & COMPLIANCE MANAGEMENT

865 284

911 618

839 199

72 419 92.06%

TOTAL

33 955 475

33 900 570

33 154 655

745 915 97.80%

53

Summary per Economical Classification

Economic Classification

Actual


March 2015


Original Budget

Adjusted Budget

R'000 R0'00 R'000 R'000

Compensation of Employees

597 203

612 133

608 140 3

993 99.35%

Goods and Services

1 406

374

1 521 697

1 054

071 467

626 69.27%

Transfers

30 916

363

31 264 936

31 263

725 1

211 100.00%

Capital

1 035

535

501 804

227 786 274

018 45.39%

Losses

-

-

933 (933)

TOTAL

33 955

475

33 900 570

33 154

655 745

915 97.80%54


Subprogramme

Actual

Expenditure as on 31 March

2015

Funds Available % Spent Original Budget

Adjusted Budget

R'000 R0'00 R'000 R'000

MINISTRY 31 046 29 146 28 851

295 98.99%

MANAGEMENT 26 458 22 928 20 885

2 043 91.09%

CORPORATE SERVICES 184 647 180 177 178 331

1 846 98.98%

OFFICE ACCOMMODATION 105 825 110 525 110 449

76 99.93%

FINANCIAL MANAGEMENT 51 745 54 945 47 960

6 985 87.29%

TOTAL 399 721 397 721 386 476

11 245 97.17%

55



Actual


March 2015


Original Budget

Adjusted Budget

R'000 R0'00 R'000 R'000

Compensation of Employees

161 600

169 100

167 468

1 632 99.03%

Goods and Services

230 830

221 330

214 353

6 977 96.85%

Transfers

1 397

1 397

2 150

(753) 153.90%

Capital

5 894

5 894

2 322

3 572 39.40%

Losses

-

-

183

(183)

TOTAL

399 721

397 721

386 476

11 245 97.17%

56

Reasons for variances: Programme 1 Goods & services:Invoices for the Auditor-General, DIRCO and State Attorney were not received timeously to be paid before year end. Transfer payments: Leave gratuity payments will be adjusted by means of virement at the end of the financial year. Capital payments: The replacement of the Minister's and Deputy Minister's vehicles did not take place before the end of the financial year.

57

Programme 2: National Health Insurance, Health Planning and System Enablement

Subprogramme

Actual

Expenditure as on 31 March 2015

Funds Available % Spent Original Budget Adjusted Budget

R'000 R0'00 R'000 R'000

OFFICE OF THE DDG 2 989 1 647

331 1 316 20.10%

TECHNICAL POLICY & PLANNING 2 084 3 426

1 314 2 112 38.35%HEALTH INFORMATION MANAGEMENT, MONITORING & EVALUATION 53 725 60 629

38 933 21 696 64.22%

SECTOR-WIDE PROCUREMENT 22 987 22 987

24 347 (1 360) 105.92%HEALTH FINANCING & NATIONAL HEALTH INSURANCE 487 210 487 210

177 446 309 764 36.42%

INTERNATIONAL HEALTH & DEVELOPMENT 52 257 52 257

74 296 (22 039) 142.17%

TOTAL 621 252 628 156 316 667 311 489 50.41%

58

Programme 2: National Health Insurance, Health Planning and System Enablement


Actual


2015


R'000 R0'00 R'000 R'000Compensation of Employees 67 193 67 193 85 263 (18 070) 126.89%

Goods and Services 476 637 467 914 139 458 328 456 29.80%

Transfers 75 000 90 627 90 878 (251) 100.28%

Capital 2 422 2 422 1 012 1 410 41.78%

Losses - - 56 (56)

TOTAL 621 252 628 156 316 667 311 489 50.41%

59

Reasons for variances: Programme 2: Compensation of employees: Budget pressure due to appointment of a Health Attaché in Cuba and cost of living expenditure for officials at the missions that is much higher than budgeted for. Goods & Services: • The recruitment of the Health Practitioners at the NHI pilot hospitals is slower than anticipated. • The SA Health & Demographic Survey budget of R 30 million, which was received as a special allocation for this purpose, was requested to be rolled-over to the 2015/16 financial year

60

Programme 3: HIV and AIDS, TB, Maternal and Child Health

Subprogramme

Actual Expenditure as on 31 March 2015


R'000 R0'00 R'000 R'000

OFFICE OF THE DDG 3 609 3 609 4 225 (616) 117.07%

HIV & AIDS 12 784 418 12 784 418 12 782 033 2 385 99.98%

TUBERCULOSIS 26 442 26 442 21 783 4 659 82.38%WOMEN'S MATERNAL & REPRODUCTIVE HEALTH 17 058 17 058 12 422 4 636 72.82%

CHILD, YOUTH & SCHOOL HEALTH 218 396 218 396 207 447 10 949 94.99%

TOTAL 13 049 923 13 049 923 13 027 910 22 013 99.83%

61

Programme 3: HIV and AIDS, TB, Maternal and Child Health




R'000 R0'00 R'000 R'000

Compensation of Employees 64 404 64 404 65 285 (881) 101.37%


Transfers 12 515 080 12 515 080 12 510 961 4 119 99.97%

Capital 12 227 12 227 531 11 696 4.34%

Losses - - 560 (560)

TOTAL 13 049 923 13 049 923 13 027 910 22 013 99.83%

62

Reasons for variances: Programme 3: Payments for capital assets: The fridges for the Human Papilloma Virus Vaccines are still to be procured due to the lengthy tender procedures to be followed.

63


Subprogramme

Actual


2015


Adjusted Budget

R'000 R0'00 R'000 R'000OFFICE OF THE DDG 3 007 3 007 2 834 173 94.25%DISTRICT SERVICES & ENVIRONMENTAL HEALTH 25 762 23 674 25 790 (2 116) 108.94%COMMUNICABLE DISEASES 13 553 22 498 23 366 (868) 103.86%NON-COMMUNICABLE DISEASES 25 718 25 718 25 282 436 98.30%HEALTH PROMOTION & NUTRITION 21 768 21 768 18 353 3 415 84.31%VIOLENCE, TRAUMA & EMS 3 707 5 880 6 730 (850) 114.46%TOTAL 93 515 102 545 102 355 190 99.81%

64



Actual


2015


Adjusted Budget

R'000 R0'00 R'000 R'000Compensation of Employees 50 567 52 740 57 087 (4 347) 108.24%


Transfers 4 438 7 446 7 557 (111) 101.49%

Capital 1 474 4 115 3 989 126 96.94%

Losses - - 35 (35)

TOTAL 93 515 102 545 102 355 190 99.81%

65

Reasons for variances: Programme 4: Compensation of employees: Over expenditure is due to the appointment of 25 Environmental Health Practitioners due to the Ebola Virus response. Goods and services: • The project on Regulatory Impact Assessment on the Control of Marketing Alcohol Beverages Bill is not finalized yet.• The printing of the Road-to-Health booklets could not be finalized before year-end. Transfers and subsidies:• The transfer of funds to the National Kidney Foundation could not be processed due to difficulties experienced with the banking details. The amount of R 350,000 is requested to be rolled-over to the 2015/16 financial year.• Leave gratuity payments will be adjusted by means of virement at the end of the financial year.

66

Programme 5: Hospitals, Tertiary Health Services and HR Development

Subprogramme



Adjusted Budget

R'000 R0'00 R'000 R'000

OFFICE OF THE DDG 3 570

3 570 4 191 (621) 117.39%HEALTH FACILITIES INFRA-STRUCTURE MANAGEMENT 6 275 300

6 122 100 5 807 614 314 486 94.86%

TERTIARY HEALTH CARE PLANNING & POLICY 10 171 405

10 171 405 10 172 223 (818) 100.01%

HOSPITAL MANAGEMENT 5 426

5 426 4 583 843 84.46%HUMAN RESOURCES FOR HEALTH 2 344 652

2 382 679 2 380 818 1 861 99.92%

NURSING SERVICES 2 531

2 531 2 563 (32) 101.26%FORENSIC CHEMISTRY LABORATORIES 122 896

122 896 110 056 12 840 89.55%

TOTAL 18 925 780

18 810 607 18 482 048 328 559 98.25%

67

Programme 5: Hospitals, Tertiary Health Services and HR Development


Actual Expenditure

as on 31 March 2015Funds

Available % Spent

Original Budget Adjusted Budget

R'000 R0'00 R'000 R'000

Compensation of Employees 104 722 102 549 100 047

2 502 97.56%

Goods and Services 81 224 222 483 133 195

89 288 59.87%

Transfers 17 730 004 18 032 204 18 032 536

(332) 100.00%

Capital 1 009 830 453 371 216 217 237 154 47.69%

Losses - - 53

(53)

TOTAL 18 925 780 18 810 607 18 482 048 328 559 98.25%

68

Reasons for variances: Programme 5: Compensation of Employees:Some vacant posts were not filled during the year. Goods and services: An amount of R 86 million for the refurbishment of clinics managed by COEGA and the Development Bank of SA was not spent before year-end. Payments for capital assets: • Tenders for specialized laboratory equipment were awarded, but not all orders were received and / or being paid before year end.• The construction of new clinics and relocatable doctor consulting rooms involve outside partners to procure needs. This is also the case for the refurbishment of older clinics.

69

Programme 6: Health Regulation and Compliance Management

Subprogramme

Actual


March 2015


Original Budget

Adjusted Budget

R'000 R0'00 R'000 R'000

OFFICE OF THE DDG

4 127 4 127

3 758 369 91.06%

FOOD CONTROL

7 512 7 512

6 871 641 91.47%PHARMACEUTICAL TRADE & PRODUCT REGULATION

96 248 121 748

102 429 19 319 84.13%

PUBLIC ENTITIES MANAGEMENT 592 532 620 270

619 408 862 99.86%

OFFICE OF STANDARDS COMPLIANCE

108 953 102 049

60 107 41 942 58.90%

COMPENSATION COMMISSIONER FOR OCCUPATIONAL DISEASES & OCCUPATIONAL HEALTH

55 912 55 912

46 626 9 286 83.39%

TOTAL 865 284 911 618

839 199 72 419 92.06%

70

Programme 6: Health Regulation and Compliance Management


Actual


March 2015


R'000 R0'00 R'000 R'000Compensation of Employees 148 717 156 147

132 990 23 157 85.17%

Goods and Services 122 435 113 514

82 805 30 709 72.95%

Transfers 590 444 618 182 619 643 (1 461) 100.24%

Capital 3 688 23 775

3 715 20 060 15.63%

Losses - -

46 (46)

TOTAL 865

284 911 618 839 199 72 419 92.06%

71

Reasons for variances: Programme 6 Compensation of employees:The recruitment of officials for the OHSC and SAPHRA is taking longer than expected. Goods & services:Additional funds of R8,3m were received during the Adjustments Budget for the set-up of SAPHRA. Due to the short period of time before year-end, not all processes could be finalized. Capital Expenditure:R9,77m was received during the Adjustments Budget to upgrade the IT system in anticipation of the SAPHRA establishment during 2015. The tender was issued.

72

PRE AUDITED CONDITIONAL GRANTS EXPENDITURE FOR 2014/15 FY

FINANCE BRANCH

HEALTH SECTOR: CONDITIONAL GRANTS

73

As at end March 2015, aggregate CG pre-audited spending is at 98.4% or R30.3 bn against total adjusted budget of R30.8 bn

increased spending of 1.4% or R2.9 bn compared to the same period in the previous year (97% or R27.2 bn) however, overall spending is below the target by 1.6% or R489 mil (under spending)

Main contributors to under spending are:• NHI spending 71.8%• Health Facility Revitalization Grant spending 94.8%

Grants spending within the norm: HPTDG, NTSG and HIV and AIDS spent 100%, 99.4% and 99.1% respectively

Introduction

74

OVERALL EXPENDITURE PER GRANT(Schedule 4 and 5 grants)

Grant Name

Original Budget

National Adjustments

Provincial Roll-overs

Adjusted Budget

Actual Transfers

Actual Transfers as % of

Adjusted budget Expenditure

Budget Available

% Spent of Budget

Transfers Received

% of Transfers Received

Not Transferred

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

Health Professions Training and Development Grant 2,321,788 - 1,386 2,323,174 2,321,788 99.9% 2,323,128 46 100.0% 2,290,077 98.6% 31,711 National Tertiary Services Grant 10,168,235 - 22,823 10,191,058 10,168,233 99.8% 10,133,029 58,029 99.4% 10,193,433 100.2% (25,200) Comprehensive HIV and AIDS Grant 12,311,322 - 38,603 12,349,925 12,311,322 99.7% 12,244,548 105,377 99.1% 12,269,503 99.7% 41,819 Health Facility Revitalisation Grant 5,239,981 262,000 331,086 5,833,067 5,501,981 94.3% 5,532,643 300,424 94.8% 5,821,273 105.8% (319,292) National Health Insurance Grant 70,000 6,956 11,648 88,604 76,956 86.9% 63,605 24,999 71.8% 74,509 96.8% 2,447 TOTAL 30,111,326 268,956 405,546 30,785,828 30,380,280 98.7% 30,296,953 488,875 98.4% 30,648,795 100.9% (268,515)

BUDGET NATIONAL TRANSFERS EXPENDITURE PROVINCIAL TRANSFERS

75

Health Professions Training and Development Grant

Province Original Budget



Adjusted Budget

Actual Transfers

Actual Transfers as

% of Adjusted budget Expenditure

Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Eastern Cape 199,874 - 1,386 201,260 199,874 99.3% 201,226 34 100.0% 201,226 100.7% (1,352) Free State 146,419 - - 146,419 146,419 100.0% 146,419 - 100.0% 146,419 100.0% - Gauteng 811,114 - - 811,114 811,114 100.0% 811,114 - 100.0% 811,114 100.0% - Kwazulu-Natal 292,837 - - 292,837 292,837 100.0% 292,837 - 100.0% 292,837 100.0% - Limpopo 116,206 - - 116,206 116,206 100.0% 116,206 - 100.0% 83,143 71.5% 33,063 Mpumalanga 95,288 - - 95,288 95,288 100.0% 95,276 12 100.0% 95,288 100.0% - Northern Cape 76,697 - - 76,697 76,697 100.0% 76,697 - 100.0% 76,697 100.0% - North West 104,586 - - 104,586 104,586 100.0% 104,586 - 100.0% 104,586 100.0% - Western Cape 478,767 - - 478,767 478,767 100.0% 478,767 - 100.0% 478,767 100.0% - TOTAL 2,321,788 - 1,386 2,323,174 2,321,788 99.9% 2,323,128 46 100.0% 2,290,077 98.6% 31,711


76

National Tertiary Services Grant

Province

Original Budget



Adjusted Budget

Actual Transfers

Actual Transfers

as % of Adjusted budget Expenditure

Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Eastern Cape 786 007 - 10 334 796 341 786 007 98.7% 758 755 595 115 95.3% 758 755 96.5% 27 252 Free State 898 091 - - 898 091 898 091 100.0% 898 036 55 100.0% 898 090 100.0% 1 Gauteng 3 493 891 - - 3 493 891 3 493 891 100.0% 3 493 853 38 100.0% 3 493 853 100.0% 38 Kwazulu-Natal 1 496 427 - - 1 496 427 1 496 427 100.0% 1 496 407 20 100.0% 1 496 427 100.0% 0 Limpopo 323 158 - 7 556 330 714 323 158 97.7% 330 568 146 100.0% 370 714 114.7% (47 556) Mpumalanga 97 116 - 4 933 102 049 97 116 95.2% 93 833 8 216 91.9% 102 049 105.1% (4 933) Northern Cape 298 727 - - 298 727 298 727 100.0% 291 526 7 201 97.6% 298 727 100.0% (1) North West 237 264 - - 237 264 237 264 100.0% 232 497 4 767 98.0% 237 264 100.0% - Western Cape 2 537 554 - - 2 537 554 2 537 554 100.0% 2 537 554 - 100.0% 2 537 554 100.0% - TOTAL 10 168 235 - 22 823 10 191 058 10 168 233 99.8% 10 133 029 58 029 99.4% 10 193 433 100.2% (25 200)

EXPENDITURE PROVINCIAL TRANSFERSBUDGET NATIONAL TRANSFERS

77

Comprehensive HIV and AIDS




Adjusted Budget

Actual Transfers

Actual Transfers as


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Eastern Cape 1,449,237 - - 1,449,237 1,449,237 100.0% 1,431,296 17,941 98.8% 1,431,296 98.8% 17,941 Free State 843,026 - 5,050 848,076 843,026 99.4% 847,635 441 99.9% 848,126 100.6% (5,100) Gauteng 2,632,578 - - 2,632,578 2,632,578 100.0% 2,583,230 49,348 98.1% 2,583,230 98.1% 49,348 Kwazulu-Natal 3,257,992 - - 3,257,992 3,257,992 100.0% 3,257,968 24 100.0% 3,257,992 100.0% - Limpopo 978,132 - 20,370 998,502 978,132 98.0% 962,845 35,657 96.4% 998,502 102.1% (20,370) Mpumalanga 818,836 - - 818,836 818,836 100.0% 818,839 (3) 100.0% 818,836 100.0% - Northern Cape 342,789 - 13,183 355,972 342,789 96.3% 354,004 1,968 99.4% 342,789 100.0% - North West 936,938 - - 936,938 936,938 100.0% 936,938 - 100.0% 936,938 100.0% - Western Cape 1,051,794 - - 1,051,794 1,051,794 100.0% 1,051,793 1 100.0% 1,051,794 100.0% - TOTAL 12,311,322 - 38,603 12,349,925 12,311,322 99.7% 12,244,548 105,377 99.1% 12,269,503 99.7% 41,819


78

Health Facility Revitalisation Grant




Adjusted Budget

Actual Transfers

Actual Transfers as


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Eastern Cape 599,231 - - 599,231 599,231 100.0% 587,426 11,805 98.0% 587,426 98.0% 11,805 Free State 448,962 18,000 136,489 603,451 466,962 77.4% 580,853 22,598 96.3% 603,451 129.2% (136,489) Gauteng 671,033 - 81,667 752,700 671,033 89.2% 752,711 (11) 100.0% 752,711 112.2% (81,678) Kwazulu-Natal 1,162,469 200,000 - 1,362,469 1,362,469 100.0% 1,362,469 - 100.0% 1,362,469 100.0% - Limpopo 467,442 - 1,230 468,672 467,442 99.7% 462,938 5,734 98.8% 468,672 100.3% (1,230) Mpumalanga 343,509 - - 343,509 343,509 100.0% 271,516 71,993 79.0% 343,509 100.0% - Northern Cape 421,428 30,000 13,482 464,910 451,428 97.1% 395,519 69,391 85.1% 464,910 103.0% (13,482) North West 486,121 14,000 17,156 517,277 500,121 96.7% 499,456 17,821 96.6% 517,277 103.4% (17,156) Western Cape 639,786 - 81,062 720,848 639,786 88.8% 619,755 101,093 86.0% 720,848 112.7% (81,062) TOTAL 5,239,981 262,000 331,086 5,833,067 5,501,981 94.3% 5,532,643 300,424 94.8% 5,821,273 105.8% (319,292)


79

National Health Insurance




Adjusted Budget

Actual Transfers

Actual Transfers as


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Eastern Cape 7,000 - 1,049 8,049 7,000 87.0% 1,819 6,230 22.6% 1,819 26.0% 5,181 Free State 7,000 - 7,000 7,000 100.0% 6,959 41 99.4% 7,000 100.0% - Gauteng 7,000 - 3,281 10,281 7,000 68.1% 5,660 4,621 55.1% 5,660 80.9% 1,340 Kwazulu-Natal 14,000 - 5,848 19,848 14,000 70.5% 18,126 1,722 91.3% 19,848 141.8% (5,848) Limpopo 7,000 - 700 7,700 7,000 90.9% 7,178 522 93.2% 7,700 110.0% (700) Mpumalanga 7,000 - 770 7,770 7,000 90.1% 3,286 4,484 42.3% 7,770 111.0% (770) Northern Cape 7,000 - - 7,000 7,000 100.0% 3,975 3,025 56.8% 7,000 100.0% - North West 7,000 - - 7,000 7,000 100.0% 5,890 1,110 84.1% 7,000 100.0% - Western Cape 7,000 6,956 - 13,956 13,956 100.0% 10,712 3,244 76.8% 10,712 76.8% 3,244 TOTAL 70,000 6,956 11,648 88,604 76,956 86.9% 63,605 24,999 71.8% 74,509 96.8% 2,447


80

National Health Grant (Schedule 6)

Grant Name Adjusted Budget

Expenditure Budget Available

% Spent of

Budget

R'000 R'000 R'000 %

HPV Vaccine 200 000 189 489 10 511 95%

Health Facility Revite Grant 604 862 267 516 337 346 44%

NHI-Indirect Grant 388 044 82 261 305 783 21%

Total 1 192 906 539 266 653 640 45%

81

OVERALL EXPENDITURE PER PROVINCE

Grant Name Original Budget National

Adjustments Provincial Roll-overs

Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Eastern Cape 3 041 349 - 12 769 3 054 118 3 041 349 99.6% 2 980 522 73 596 97.6% 2 980 522 98.0% 60 827 Free State 2 343 498 18 000 141 539 2 503 037 2 361 498 94.3% 2 479 902 23 135 99.1% 2 503 086 106.0% (141 589) Gauteng 7 615 616 - 84 948 7 700 564 7 615 616 98.9% 7 646 568 53 996 99.3% 7 646 568 100.4% (30 952) Kwazulu-Natal 6 223 725 200 000 5 848 6 429 573 6 423 725 99.9% 6 427 807 1 766 100.0% 6 429 573 100.1% (5 848) Limpopo 1 891 938 - 29 856 1 921 794 1 891 938 98.4% 1 879 735 42 059 97.8% 1 928 731 101.9% (36 793) Mpumalanga 1 361 749 - 5 703 1 367 452 1 361 749 99.6% 1 282 750 84 702 93.8% 1 367 452 100.4% (5 703) Northern Cape 1 146 641 30 000 26 665 1 203 306 1 176 641 97.8% 1 121 721 81 585 93.2% 1 190 123 101.1% (13 483) North West 1 771 909 14 000 17 156 1 803 065 1 785 909 99.0% 1 779 367 23 698 98.7% 1 803 065 101.0% (17 156) Western Cape 4 714 901 6 956 81 062 4 802 919 4 721 857 98.3% 4 698 581 104 338 97.8% 4 799 675 101.6% (77 818) TOTAL 30 111 326 268 956 405 546 30 785 828 30 380 280 98.7% 30 296 953 488 875 98.4% 30 648 795 100.9% (268 515)


82

EASTERN CAPE



Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Health Professions Training and Development Grant 199 874 - 1 386 201 260 199 874 99.3% 201 226 34 100.0% 201 226 100.7% (1 352) National Tertiary Services Grant 786 007 - 10 334 796 341 786 007 98.7% 758 755 37 586 95.3% 758 755 96.5% 27 252 Comprehensive HIV and AIDS Grant 1 449 237 - - 1 449 237 1 449 237 100.0% 1 431 296 17 941 98.8% 1 431 296 98.8% 17 941 Health Facility Revitalisation Grant 599 231 - - 599 231 599 231 100.0% 587 426 11 805 98.0% 587 426 98.0% 11 805 National Health Insurance Grant 7 000 - 1 049 8 049 7 000 87.0% 1 819 6 230 22.6% 1 819 26.0% 5 181 TOTAL 3 041 349 - 12 769 3 054 118 3 041 349 99.6% 2 980 522 73 596 97.6% 2 980 522 98.0% 60 827

EXPENDITURE BUDGET PROVINCIAL TRANSFERS NATIONAL TRANSFERS

83

VARIANCES – EASTERN CAPE

GRANT REASONS FOR VARIANCES REMEDIAL STEPS

HPTDG • Budget fully spent • None

NTSG • Procurement challenges on CAPEX • Rollover request submitted

HIV/ AIDS

• Slow spending on Goods & Services and lengthy processing of capital contracts

• Rollover request submitted

HFRG • Procurement challenge for diagnostic equipment and furniture


NHI • Challenge in the implementation of key objectives of BP• Management challenges at EC Pilot District


84

FREE STATE



Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Health Professions Training and Development Grant 146 419 - - 146 419 146 419 100.0% 146 419 - 100.0% 146 419 100.0% - National Tertiary Services Grant 898 091 - - 898 091 898 091 100.0% 898 036 55 100.0% 898 090 100.0% 1 Comprehensive HIV and AIDS Grant 843 026 - 5 050 848 076 843 026 99.4% 847 635 441 99.9% 848 126 100.6% (5 100) Health Facility Revitalisation Grant 448 962 18 000 136 489 603 451 466 962 77.4% 580 853 22 598 96.3% 603 451 129.2% (136 489) National Health Insurance Grant 7 000 - - 7 000 7 000 100.0% 6 959 41 99.4% 7 000 100.0% - TOTAL 2 343 498 18 000 141 539 2 503 037 2 361 498 94.3% 2 479 902 23 135 99.1% 2 503 086 106.0% (141 589)

BUDGET NATIONAL TRANSFERS PROVINCIAL TRANSFERS EXPENDITURE

85

VARIANCES – FREE STATE



NTSG • Budget fully spent • None

HIV/ AIDS

• Spending is within acceptable norm • None

HFRG • Inability to fill vacant posts – scarce skills • Surrender the unspent funds

NHI • Spending is within acceptable norm • None

86

GAUTENG



Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Health Professions Training and Development Grant 811 114 - - 811 114 811 114 100.0% 811 114 - 100.0% 811 114 100.0% - National Tertiary Services Grant 3 493 891 - - 3 493 891 3 493 891 100.0% 3 493 853 38 100.0% 3 493 853 100.0% 38 Comprehensive HIV and AIDS Grant 2 632 578 - - 2 632 578 2 632 578 100.0% 2 583 230 49 348 98.1% 2 583 230 98.1% 49 348 Health Facility Revitalisation Grant 671 033 - 81 667 752 700 671 033 89.2% 752 711 (11) 100.0% 752 711 112.2% (81 678) National Health Insurance Grant 7 000 - 3 281 10 281 7 000 68.1% 5 660 4 621 55.1% 5 660 80.9% 1 340 TOTAL 7 615 616 - 84 948 7 700 564 7 615 616 98.9% 7 646 568 53 996 99.3% 7 646 568 100.4% (30 952)

PROVINCIAL TRANSFERSBUDGET

NATIONAL TRANSFERS EXPENDITURE

87

VARIANCES – GAUTENG




HIV/ AIDS

• Late appointments of WBOT leaders • Surrender the unspent funds – R48 mil

HFRG • Budget fully spent • None

NHI • Delays in the appointment of SP for NHI impact, WBOT study not concluded


88

KWAZULU-NATAL



Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Health Professions Training and Development Grant 292 837 - - 292 837 292 837 100.0% 292 837 - 100.0% 292 837 100.0% - National Tertiary Services Grant 1 496 427 - - 1 496 427 1 496 427 100.0% 1 496 407 20 100.0% 1 496 427 100.0% 0 Comprehensive HIV and AIDS Grant 3 257 992 - - 3 257 992 3 257 992 100.0% 3 257 968 24 100.0% 3 257 992 100.0% - Health Facility Revitalisation Grant 1 162 469 200 000 - 1 362 469 1 362 469 100.0% 1 362 469 - 100.0% 1 362 469 100.0% - National Health Insurance Grant 14 000 - 5 848 19 848 14 000 70.5% 18 126 1 722 91.3% 19 848 141.8% (5 848) TOTAL 6 223 725 200 000 5 848 6 429 573 6 423 725 99.9% 6 427 807 1 766 100.0% 6 429 573 100.1% (5 848)

NATIONAL TRANSFERS EXPENDITURE PROVINCIAL TRANSFERS

BUDGET

89

VARIANCES – KWAZULU-NATAL




HIV/ AIDS

• Budget fully spent • None

HFRG • Budget fully spent • None

NHI • Delays with specification for impact assessments


90

LIMPOPO



Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Health Professions Training and Development Grant 116 206 - - 116 206 116 206 100.0% 116 206 - 100.0% 83 143 71.5% 33 063 National Tertiary Services Grant 323 158 - 7 556 330 714 323 158 97.7% 330 568 146 100.0% 370 714 114.7% (47 556) Comprehensive HIV and AIDS Grant 978 132 - 20 370 998 502 978 132 98.0% 962 845 35 657 96.4% 998 502 102.1% (20 370) Health Facility Revitalisation Grant 467 442 - 1 230 468 672 467 442 99.7% 462 938 5 734 98.8% 468 672 100.3% (1 230) National Health Insurance Grant 7 000 - 700 7 700 7 000 90.9% 7 178 522 93.2% 7 700 110.0% (700) TOTAL 1 891 938 - 29 856 1 921 794 1 891 938 98.4% 1 879 735 42 059 97.8% 1 928 731 101.9% (36 793)

EXPENDITURE BUDGET NATIONAL TRANSFERS PROVINCIAL TRANSFERS

91

VARIANCES – LIMPOPO




HIV/ AIDS

• Outstanding supplier deliveries • Follow up in next financial year.

HFRG • Spending is within acceptable norm

• None

NHI • Delays in delivering of consultation desks


92

MPUMALANGA



Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Health Professions Training and Development Grant 95 288 - - 95 288 95 288 100.0% 95 276 12 100.0% 95 288 100.0% - National Tertiary Services Grant 97 116 - 4 933 102 049 97 116 95.2% 93 833 8 216 91.9% 102 049 105.1% (4 933) Comprehensive HIV and AIDS Grant 818 836 - - 818 836 818 836 100.0% 818 839 (3) 100.0% 818 836 100.0% - Health Facility Revitalisation Grant 343 509 - - 343 509 343 509 100.0% 271 516 71 993 79.0% 343 509 100.0% - National Health Insurance Grant 7 000 - 770 7 770 7 000 90.1% 3 286 4 484 42.3% 7 770 111.0% (770) TOTAL 1 361 749 - 5 703 1 367 452 1 361 749 99.6% 1 282 750 84 702 93.8% 1 367 452 100.4% (5 703)


93

VARIANCES – MPUMALANGA


HPTDG • Grant fully spent • None

NTSG • Supply Chain Management challenges – tender delays for equipment

• Rollover not requested as equipment was not committed.

HIV/ AIDS

• Grant fully spent • None

HFRG • Non receiving of final accounts for completed projects from DPW


NHI • Delays with specification for impact assessments

• Rollover not requested as budget was not committed.

94

NORTHERN CAPE



Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Health Professions Training and Development Grant 76 697 - - 76 697 76 697 100.0% 76 697 - 100.0% 76 697 100.0% - National Tertiary Services Grant 298 727 - - 298 727 298 727 100.0% 291 526 7 201 97.6% 298 727 100.0% (1) Comprehensive HIV and AIDS Grant 342 789 - 13 183 355 972 342 789 96.3% 354 004 1 968 99.4% 342 789 100.0% - Health Facility Revitalisation Grant 421 428 30 000 13 482 464 910 451 428 97.1% 395 519 69 391 85.1% 464 910 103.0% (13 482) National Health Insurance Grant 7 000 - - 7 000 7 000 100.0% 3 975 3 025 56.8% 7 000 100.0% - TOTAL 1 146 641 30 000 26 665 1 203 306 1 176 641 97.8% 1 121 721 81 585 93.2% 1 190 123 101.1% (13 483)

EXPENDITURE PROVINCIAL TRANSFERSBUDGET NATIONAL TRANSFERS

95

VARIANCES – NORTHERN CAPE



NTSG • Non completion of high care unit at Kimberly Hospital


HIV/ AIDS

• Spending within acceptable norm • Rollover request submitted

HFRG • Change of main contractor at Kimberly Mental Hospital• Delays in construction of Kagung Clinic and Port Nolloth CHC


NHI • Delays in tender process to install satelite connectivity of 29 PHC facilities at Pixley Ka Seme• Delays in appointment of NPI Manager

• Rollover not request as budget was not committed.

97

NORTH WEST



Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Health Professions Training and Development Grant 104 586 - - 104 586 104 586 100.0% 104 586 - 100.0% 104 586 100.0% - National Tertiary Services Grant 237 264 - - 237 264 237 264 100.0% 232 497 4 767 98.0% 237 264 100.0% - Comprehensive HIV and AIDS Grant 936 938 - - 936 938 936 938 100.0% 936 938 - 100.0% 936 938 100.0% - Health Facility Revitalisation Grant 486 121 14 000 17 156 517 277 500 121 96.7% 499 456 17 821 96.6% 517 277 103.4% (17 156) National Health Insurance Grant 7 000 - - 7 000 7 000 100.0% 5 890 1 110 84.1% 7 000 100.0% - TOTAL 1 771 909 14 000 17 156 1 803 065 1 785 909 99.0% 1 779 367 23 698 98.7% 1 803 065 101.0% (17 156)


98

VARIANCES – NORTH WEST



NTSG • Spending within target norm • None

HIV/ AIDS


HFRG • Invoices could not be processed before year end due to system availability


NHI • Non delivery of uniforms • Rollover request not submitted as budget is on goods and services

99

WESTERN CAPE



Adjusted Budget

Actual Transfers

Actual Transfers


Budget Available

% Spent of Budget

Transfers Received


Not Transferred

R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000 % R'000 Health Professions Training and Development Grant 478 767 - - 478 767 478 767 100.0% 478 767 - 100.0% 478 767 100.0% - National Tertiary Services Grant 2 537 554 - - 2 537 554 2 537 554 100.0% 2 537 554 - 100.0% 2 537 554 100.0% - Comprehensive HIV and AIDS Grant 1 051 794 - - 1 051 794 1 051 794 100.0% 1 051 793 1 100.0% 1 051 794 100.0% - Health Facility Revitalisation Grant 639 786 - 81 062 720 848 639 786 88.8% 619 755 101 093 86.0% 720 848 112.7% (81 062) National Health Insurance Grant 7 000 6 956 - 13 956 13 956 100.0% 10 712 3 244 76.8% 10 712 76.8% 3 244 TOTAL 4 714 901 6 956 81 062 4 802 919 4 721 857 98.3% 4 698 581 104 338 97.8% 4 799 675 101.6% (77 818)


100

VARIANCES – WESTERN CAPE



NTSG • Grant fully spent • None

HIV/ AIDS


HFRG • Slow progress on sites • Rollover request submitted

NHI • Printing of PACK CCW training material committed but not delivered


101

Provincial Rollovers Submitted to Treasury - Conditional Grants

101

Provinces

Health Professions Training and Development

Grant

National Tertiary Services

Grant

Comprehensive HIV and AIDS

Grant

Health Facility Revitalisation

GrantNational Health Insurance Grant Total

EC - 36,381 10,382 11,862 1,115 59,740

FS - - - 21,595 - 21,595

GT - - - 3,002 3,002

KZN - - - 6,393 6,393

LP - - 29,353 - 469 29,822

MP - - - 72,132 - 72,132

NC - 5,785 1,205 69,021 - 76,011

NW - - - 17,888 - 17,888 WC - - - 67,052 695 67,747

Total - 42,166 40,940 259,550 14,699 354,330

102

Overall improvement in spending and compliance and Tighten monitoring and evaluation both at national and provincial level.

Conclusion

103

The End

104

portfolio committee 2014/15: quarter 4 performance director general june 2015

Documents

health planning

improved health management

health regulation

technology continuity

information communication

universal health coverage

effective communication

audit outcomes audit