Presentation to the Select Committee on Finance

Dr. Ayanda NtsalubaDirector-General: Health

Conditional Grants

• Health oversees the following grants:– NTSG– HPTD– Hospital Revitalisation– Hospital management and quality improvement– HIV/AIDS– INP– Hospital Construction – Pretoria Academic– Medico-legal???

NTSG

• Purpose– Fund national tertiary services as identified and costed

by the NDoH• Allocation Mechanism

– A cost model is used that standardises the unit cost of each of the designated tertiary services.

– The level/quantity of tertiary services that each province provides is determined

– On the basis of the cost and quantity, the allocations for each province is determined

NTSG – trends

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

Eastern Cape Free State Gauteng KZN Limpopo Mpumalanga Northern Cape North West Western Cape

2002/032003/042004/052005/06

NTSG

• Conditions:– Key condition is the provision of Tertiary Services in

return for Funding– Monitoring mechanisms

• Quarterly submission of NTSG monitoring data via District Hospital Information System (DHIS)

– Measurable objectives/outputs• Improvement in management information in the befitting hospitals• Number of admissions, outpatients and day cases per specialised

service unit• Number of treated patients managed from outside each province

HPTD

• Purpose– Compensate provinces for service costs associated with

training• Allocation Mechanism

– HPT • Number of final year medical students• 4 provinces receive equal share of 10% of Grant

– Development component• Specialist and registrar population ratios for provinces without

medical schools (except KZN and Eastern Cape)

HPTD – trends

-

100,000

200,000

300,000

400,000

500,000

600,000

Eastern Cape Free State Gauteng KZN Limpopo Mpumalanga Northern Cape North West Western Cape

2002/032003/042004/052005/06

HPTD– Conditions

• Timely submission of monitoring information as agreed with national DOH.

– Monitoring mechanisms• Quarterly and annual reporting by provinces on number of students

enrolled by discipline• Quarterly and annual reporting by targeted provinces on achievement of

planned expansion of specialist and teaching infrastructure – Measurable objectives/ outputs

• Increase number and improve composition of health sciences students by province and institution

• Shift in the location of practical training placements by discipline to regional and district facilities\

• Expanded specialist and teaching infrastructure in target provinces

Hospital Revitalisation

• Purpose– to transform and modernise hospitals in line

with national policy and to achieve a sustainable infrastructure from which modern, equitable and sustainable services can be delivered

• Allocation– Allocations are based on projects comprised of

at least one hospital per province

Hospital Revitalisation – Trends

-

50,000

100,000

150,000

200,000

250,000

Eastern Cape Free State Gauteng KZN Limpopo Mpumalanga Northern Cape North West Western Cape

2002/032003/42004/52005/6

Hospital Revitalisation– Conditions

• Compliance with Integrated Health Planning Framework (IHPF) and monitoring and reporting requirements

• Compliance with provincial priorities for sustainable service delivery as identified in the provinces’ Strategic Position Statements (SPS)

– Monitoring mechanisms • Prescribed format and indicators in hospital and provincial

monitoring modules• Monthly reporting on project implementation progress and

expenditure to the national department– Measurable objectives/output

• Number of hospitals revitalised

Hospital Mx

• Purpose– to strengthen management in hospitals including the

development of management systems and structures • Allocation

– The grant accommodates funding, on a limited scale, of the existing activities/projects started in the 2001/2 financial year

– Allocations are based on the number of revitalisation projects

Hospital Mx – trends

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Eastern Cape Free State Gauteng KZN Limpopo Mpumalanga Northern Cape North West Western Cape

2002/032003/42004/52005/6

Hospital Mx

– Conditions • Business plans approved by HOD’s to be submitted before the

first payment.

– Monitoring mechanisms• Monthly and quarterly financial reports to be submitted in the

prescribed Treasury format.• Quarterly reports on progress against approved business plans

– Measurable objectives/ outputs• Demonstrable progress with the decentralisation and

improvement in msnagement capacity

HIV/AIDS

• Purpose– to enable the health sector to develop an effective

response to HIV/Aids epidemic • Allocation

– based on a few data sources and methodology, as the interventions cannot all fit within one approach. The following data sources inform the allocation resources.

• 2001 Antenatal HIV Prevalence Survey,• Estimated share of HIV+ births, • Share of reported rapes, • Estimated share of Aids cases

HIV/AIDS – trends

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

Eastern Cape Free State Gauteng KZN Limpopo Mpumalanga Northern Cape North West Western Cape

2002/032003/042004/052005/06

HIV/AIDS

– Conditions • The flow of first installments is subject to approval

of business plans• Quarterly monitoring returns to be submitted

– Monitoring mechanisms• Quarterly reporting of output in terms of the

monitoring framework established by national DOH

HIV/AIDS– Measurable objectives/ outputs

• Increased access to voluntary counseling and testing by 12,5 per cent of adult population aged between 15-49 years within three years, with specific targets for the youth and rural communities

• Number of health districts which have voluntary counseling and testing facilities

• Number of mothers receiving VCT and number of mother/baby pairs receiving PMTCT prophylaxis

• Number of home based care teams in operation, caseload and number of patient contacts

• Number of step-down facilities in operation, number of admissions and bed days

• Number of adults and children receiving PEP after sexual assault• Number of projects targeting commercial sex workers and number of sex

workers reached

INP

• Purpose• Improve the nutrition status of South African children; • Specifically to enhance active learning capacity and improve

school attendance in schools• Improve nutritional knowledge, perceptions, attitudes and

behavior amongst school learners, their parents and teachers

– Allocation• The INP conditional grant is distributed in total to the

provincial departments of health according to an Index of poverty

INP – trends

-

50,000

100,000

150,000

200,000

250,000

Eastern Cape Free State Gauteng KZN Limpopo Mpumalanga NorthernCape

North West Western Cape

2002/032003/042004/052005/06

INP– Conditions

• Access of funding through business plans• Use of funds only for approved purposes• Grant must be kept on separate responsibility and objective codes• Feeding in poor primary schools • Compliance with minimum norms and standards as determined by

policy and implementation guidelines– Monitoring mechanisms

• Provinces must report quarterly in terms of progress indicators• Provinces must report monthly in terms of financial indicators• Monitoring visits• Formal assessments

INP– Measurable objectives/ outputs

• Improve coverage of targeted primary school feeding from 86 per cent to 100 per cent

• Improve coverage of planned feeding days from 85 per cent to 100 per cent• Improve compliance with nutritional criteria for school feeding from 0 per cent

to 100 per cent• Decrease underweight, stunting and wasting in children from 10.3 per cent to 10

percent, 21.6 per cent to 20 per cent and 3.7 per cent to 2 per cent respectively• Increase provision of Road to Health Chart from 74.6 per cent to 85 per cent• Eliminate micronutrient deficiencies• Increase exclusive breastfeeding from 5 per cent to 10 per cent and

breastfeeding from 67.9 per cent to 70 per cent• Increase baby-friendly health facilities from 40 to 72 out of 480

Compliance with Grant and Problems

• Main areas of non-compliance, problems include:– Late submission of reports and business plans– Non-submission of reports – sometimes– Incorrect figures (when the next report is submitted the

previous months figures are amended).– Reports not signed by Financial Officer or Head of

Health– No explanation for deviations on spending patterns etc.

Improved Monitoring Capacity

• Significant investment in systems and people

• Able to better track progress• Improved national and provincial

communication