presentation to the standing committee on appropriations 2015/16: quarter one performance director...

PRESENTATION TO THE STANDING COMMITTEE ON APPROPRIATIONS

2015/16: QUARTER ONE PERFORMANCE

Director General

02 SEPTEMBER 2015

NATIONAL DEPARTMENT OF HEALTH

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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Total Targets in the Annual Performance Plan of 2015/16

Programmes Quarterly Targets

6 monthlyTargets

Annual Targets

Total targets

Programme 1 5 2 5 12

Programme 2 16 15 31

Programme 3 28 17 45

Programme 4 1 25 26

Programme 5 3 24 27

Programme 6 15 1 16

Total 69 2 86 157

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Progress Report

PROGRAMME 1 : ADMINISTRATION

Programme 1: Administration

Strategic Objective

Indicator Annual Target Actual performance

Performance Rating

Ensure effective financial management and accountability by improving audit outcomes

Audit opinion from Auditor-General

Annual Target: UnqualifiedAudit Opinion

NDoH obtained unqualified Audit

Achieved

Audit opinion from Auditor-General for Provincial Departments of Health

Annual target: 3 Unqualified audit opinions

3 Unqualified audit opinions for 2014/15 for Western Cape, Limpopo and North West

Achieved

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

Annual target: 9 7 (out of 9) provinces submitted signed off reports.

Partially achieved

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Strategic Objective Indicator Target Actual performance Performance Rating

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

Average Turnaround times for recruitment processes

Bi-annual Target: Average recruitment process turnaround time will be 4 months

2% (2/98) were filled within four months as per FOSAD target 7% (7/98)of the vacant posts were filled within six months as Public Service Regulation of 2001 and

This is a bi-annual target. Figures will be consolidated end of 2nd and 4th quarters

NDoH vacancy rate Bi-Annual target: 5%

5% Achieved. Same above

Percentage of Senior Managers that have entered into Performance Agreements with their supervisors

Annual target: 98%

95% Achieved.

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Programme 1: Administration Strategic Objective Indicator Quarter Target Actual performance Performance Rating

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

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

Quarter target: EHW induction programme to Port Health employees

Induction Schedule drawn to resume in July 2015 and meeting held with Environmental Health

Partially Achieved

Fully implement the Departmental Information Communication Technology (ICT) Service Continuity Plan by the 31st of March 2018

Establish ability to access domain services outside the NDoH premises

Quarter target: Enter into a BCM agreement with SITA for transversal systems.

BCM agreement with SITA for transversal systems approved and signed

Achieved

Quarter target: Ascertain the implications of duplicating all the existing domain in a DR site.

The requirements to duplicate the domain services were established

Achieved

Quarter target: Procure hardware for Domain services DR site.

First draft of the integrated communication strategiy and implementation plan, which includes a draft tool kit has been developed for consultations

Partially Achieved

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

Develop an integrated communication strategy and implementation plan

Annual Target: Communication Toolkit developed to integrate messages

1. A guide on writing a communication strategy for public health campaigns developed. 2. A guide to writing the Ministry's Persuasive Speeches 3.Communication strategy/plan guide (events specific)4. MBOD and CCOD Communication strategy/plan and fact sheet for Project Ku-Riha

Partially achieved: Annual target

A National Health Litigation Strategy development and implemented

Develop National Health Litigation Strategy

Quarter Target: The matter tabled for discussion in the National Legal Forum

There is a declaration emanating from the medico legal summit held on the 09-10 March 2015.

Partially achieved


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Progress Report

PROGRAMME 2 : HEALTH PLANNING AND SYSTEMS ENABLEMENT

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Strategic Objective Indicator Target Actual performance

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

White Paper on NHI

Annual Target: Finalise and publish White Paper on NHI

Draft White Paper has been prepared and is available for use in consultation purposes with National Treasury.

Partially achieved

Legislation for NHI Annual Target: Publication of the White Paper

The draft NHI Bill has been prepared.

Partially achieved

Establishment of the National Health Insurance Fund

Quarter target: Funding Modality for the National Health Insurance Fund including budget reallocation for the district primary health care (PHC)

The draft concept document on the NHI Fund is available.

Partially achieved

Review Annual dispensing fee

Annual target: Review of the 2015/16 dispensing fee in determining the 2016/17 maximum dispensing fee

The Draft dispensing fee for Pharmacists was published on 15 June 2015.

Partially achieved

Programme 2: National Health Insurance, Health Planning and Systems

Enablement

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Strategic Objective

Indicator Target Actual performance Performance Rating

Publish & implement Single Exit Price Adjustments Annually.

Annual Target: SEPA adjustment for 2015

Draft SEPA developed for publication in gazette in Q2.

Partially achieved

Strengthen revenue collection by incentivizing hospitals to maximise revenue generation

Develop and implement a Revenue Retention Model (RRM) at central hospitals

Quarter Target Conduct a comparative analysis of the WC and FS Revenue Retention Model

Comparative analysis of Revenue Retention Models concluded.

Achieved

Develop regulations pertaining to Uniform Patient Fee Schedule

Annual Target: UPFS regulations gazetted and implemented

Draft regulations developed Partially Achieved

Develop a Central Repository for the funded and unfunded patients

Quarter Target: Consultation with Council for Medical Schemes (CMS)

Consulted with the CMS regarding the draft specifications and data required.

Achieved


Enablement

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Strategic Objective

Indicator Target Actual performance

Improve Management and control of pharmaceutical services

Percentage of the review process of PHC Essential Medicines List (EML) and Standard treatment Guidelines (STGs) completed

Annual Target: 20%

5% Partially achieved : annual target

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

Annual Target: 50%

28% Partially achieved : annual target

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

Annual Target: 100%

46% Partially achieved annual target

Number of medicines review for the Tertiary & Quaternary EML

Quarter Target : 3 reviews

3 reviews Achieved


Enablement

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Enablement

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Strategic Objective


Performance Rating

Establish a national stock management surveillance centre to improve medicine availability

Implement an Electronic system for the early detection of stock outs of medicines at hospitals

Quarter target : Site assessment completed in 10 central hospitals

Site assessment completed in 6 central hospitals. The remaining four suite assessments done in quarter two

Partially achieved :

Implement an Electronic system for the early detection of stock outs of medicines at PHC facilities

Quarter target : Electronic stock management system functional in 750 PHC facilities

Electronic stock management system functional in 750 PHC facilities

Achieved

Establish a national surveillance centre to monitor medicine availability

Quarter target : Business Plan for National surveillance centre developed and approved (quarter target)

Draft Business Plan for National surveillance centre developed.

Partially achieved

Strategic Objective


Improve contracting and supply of medicines

Establish Provincial Control Towers for the management of direct delivery of medicines

Quarter Target: Project plan of the rollout of control tower developed for Eastern Cape and Free State Established

Project plan developed to implement FS and EC control towers.

Achieved

Number of patients receiving medicines through the centralised chronic medicine dispensing & distribution system

Quarter Target: 275,000 patients

210, 840patients

Partially Achieved

Contracts are available at least 8 weeks prior to expiration of outgoing tender

Quarter Target: 100% of contract expiring in Q1 have been renewed at least 8 weeks prior to expiration.

Nil contract expired in the Quarter 1.

Review Criteria for the approval of Pharmacy Licences

Quarter Target: Review of the Criteria for the approval of Pharmacy licences

Criteria for the approval of Pharmacy licences reviewed

Achieved


Enablement

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Strategic Objective


Implement the Strategy to address antimicrobial resistance (AMR)

Implement the National AMR strategy

Quarter Target: Development of Terms of Reference.

Terms of Reference developed.

Achieved

Regulate African Traditional Practitioners

Establish Council for Traditional Practitioners

Quarter Target: Advert placed for appointment of Council for Traditional Practitioners and Registrar

Approval for advert finalised Partially Achieved


Enablement

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Strategic Objective


Implement eHealth Strategy of South Africa through the development of the system design of patient information systems and implementation

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

Quarter targets: Shared infrastructure to host Health Information Exchange established

Shared Infrastructure established for hosting Health Information Exchange

Developed and tested integration between HPRS and Tier.net.

Achieved

Number of PHC health facilities with required IT Hardware for the reference implementation eHealth project

Quarter targets: 350 PHC Facilities receiving new IT Hardware

NDoH has received quotations for seeking funding approval from National Treasury for the procurement of equipment from the Infrastructure grant.

Not Achieved

Number of health facilities implementing improved patient administration and web based information systems

Quarter targets: 175 Facilities implementing improved patient administration and web based information system

50 PHC Facilities implemented the patient administration systems due to unavailability of required network connectivity in facilities

Not Achieved


Enablement

Strategic Objective Indicator Annual Target Actual performance Performance Rating

Develop and implement a national research strategic plan

National health research plan developed and implemented

Annual target: National Health Research strategic plan approved

Draft 2 of the National Research Strategy document was produced after consultation with international reviewers.

Partially Achieved: Annual target

Develop and implement an integrated monitoring and evaluation plan aligned to health outcomes and outputs contained in the Health Sector Strategy

Integrated monitoring and evaluation plan implemented.

Annual target: Fully defined comprehensive list of indicators and data elements approved

Lists of international and other indicators have been identified


At least one national evaluation conducted

Branches engaged on identification of evaluations to be conducted


Number of Provincial Annual Performance Plans (APPs) aligned to the National Health System Priorities

Annual target: 9 Provincial APPs reviewed and feedback provided to ensure health sector plans are aligned to the National Health System (NHS) Priorities

The Department reviewed provincial APPs in second and third quarters of 2015/16 financial year


Implement Patient Quality of care survey tool.

Annual target: Patient Quality of care survey tool tested & piloted

The survey tool for out-patients/primary health care facilities has been field-tested.


Conduct a National Survey to measure Patient Quality of care

Annual targetA national survey conducted to measure patient quality of care at all PHC facilities

National survey will be conducted once database and protocol has been finalised and provincial training in this regard has taken place.



Enablement

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Strategic Objective

Indicator Annual Target

Actual performance

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

Number of International treaties and multilateral frameworks implemented

Annual Target: 3 international treaties and multilateral frameworks implemented

The Memorandum of Understanding between South Africa and African Union on contributing resources to support EBOLA Outbreak in West Africa was signed on the 15th June 2015. South Africa is currently implementing one (1) cross border project of Phase two (II) of the SADC HIV and AIDS Trust Fund. The project is: Strengthening and consolidating the engagement of Religious leaders living with HIV to promote positive health, Dignity and Prevention. Facilitated the SADC HIV and AIDS Trust fund payment of R3 792 802.18 for 2015/16.


Implementation of bilateral cooperation on areas of mutual and measurable benefit.

Number of Bilateral projects implemented.

Annual Target: 5 strategic bilateral projects implemented

During 31 March to 3 April 2015, a delegation from the Ministry of Health of Zanzibar visited South Africa to share experiences on port health services. The visit resulted in the development of Programme of Action (PoA) on port health services as well as work plan to implement the PoA. During 4 to 15 May 2015, Coordinated visit to South Africa by the delegation from Ministry of Health and Social Welfare of Tanzania visited South Africa to share information and experiences on how new emerging issues in Antiretroviral Therapy (ART) are implemented at community level. The visit resulted in sharing of information and best practices on new emerging issues in ART.



Enablement

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A total of 50 facilities had internet connectivityagainst the first quarter one target of 175 PHC facilities. In order to address the challenge is unavailability of broad band connectivity in PHC facilities that will enable implemented the web-based patient administration systems; NDoH is actively working with Department of Telecommunications and Postal Services (DTPS) to address this challenge broadband internet connectivity in primary health care facilities of the NHI Pilot districts, as announced by the Minister of DTPS in his budget speech.

Mechanisms to fast-track performance

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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 Performance

Rating

To scale up combination of prevention interventions to reduce new infections

Number of HIV test client 15-49 years

Quarter Target: 2.5 million

2,600,316 Achieved

Number of Medical Male circumcisions performed

Quarter Target: 250 000

137 640 (including MMCs performance by doctors in traditional settings and in the private sector).

Partially achieved

Male Condoms Distributed Quarter Target: 175 million

181, 252, 919 Achieved

Female Condoms Distributed

Quarter Target: 4.125 million

5, 211, 220 Achieved

Increase the numbers of HIV positive people on ARVs

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

Quarter target: 3.2 million

3,053,294 Achieved

Develop and implement the HIV Counselling and Testing (HCT) policy

Annual target: HCT policy finalised and approved

The draft policy document has been prepared

Achieved:

Monitor implementation of the HIV and AIDS Programme

Quarter target: Quarterly report developed

Final quarter one report available end of July 2015. Annual report 2014/16 available

Partially achieved

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

Strategic Objective


Develop and implement HIV prevention strategy

Annual Target: Strategy Developed and Approved and produce 9 provincial reports on its implementation

Latest draft of the HIV prevention strategy has been prepared

Partially achieved: annual target

Develop and implement adherence guidelines for health programmes

Annual target: Guidelines developed and approved and produce 9 provincial reports on its implementation

It will be implemented from quarter two

Facilitate development of district plans to support NDoH male and female condom distribution strategy

Annual Target: 52 district distribution plans for male and female condoms developed and implemented with 9 provincial progress reports

A draft plan is available for Gert Sibande. The plan is being finalised.

Partially achieved: annual target

Monitor the implementation of the HIV and AIDS Conditional grant

Quarter Target: Quarterly HIV conditional grant reports produced

Final quarter one report was available for quarter one data. It was consolidated and submitted as per DORA timelines.

Partially Achieved

Annual Target : Annual HIV Conditional Grant Report produced

Annual Evaluation report for 2014/15 produced

Achieved

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Strategic Objective Indicator Annual Target Actual performance

Performance Rating

Undertake a massive TB screening campaign

TB client 5 years and older screened at health facilities for TB symptoms rate

Annual Target: 50% 28.5% Partially achieved: Annual target

Percentage of inmates screened for TB annually

Annual Target: 75% 72.7% Achieved: Annual targets

Percentage of mines providing routine TB screening

Annual Target: 60% 83.2% achieved: Annual target

Number of community members in 6 Peri mining districts screened for TB

Annual Target: 462 000

329,448 Partially achieved: Annual target

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Strategic Objective Indicator Annual Target

Actual performance

Performance Rating

Improve Access to treatment

TB client 5 years and older initiated on treatment rate

Annual target: 85%

94.6% achieved: Annual targets

TB Rifampicin Resistant clients treatment initiation rate

80% 76.6% Partially achieved: Annual targets

Strengthen patient retention in treatment and care

TB new client treatment success rate

Annual target: 83%

79.9% Partially achieved: Annual target

TB client loss to follow up rate Annual target: 5%


TB client death Rate Annual target: 6%


TB/HIV Co-infection TB/HIV co-infected client on ART rate

Annual target: 75%

74.4% achieved: Annual target

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Strategic Objective Indicator Annual Target

Actual performance

Strengthen patient retention in treatment and care

TB MDR client loss to follow up rate

Annual Target: 16%


TB MDR client death Rate Annual Target: 15%

22.8% Annual Target

TB MDR treatment success rate

Annual Target: 55%


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Health

Strategic Objective

Indicator Quarter TargetActual performance

Performance Rating

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

Antenatal 1st visit before 20 weeks rate

Quarter target: 55% 54.3% Achieved

Mother postnatal visit within 6 days rate

Quarter target: 80% 70.9% Partially Achieved

Maternal mortality in facility ratio (annualised)

Quarter target: 123 per 100000 live births

115.6 per 100 000 live births

Achieved

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

Inpatient Neonatal death rate (annualized)

Quarter target: 11.5 per 1000 Live Births

13.5 per 1000 live births. Mortality tends to be higher in the first quarter compared to other quarters

Not achieved:

Monitor implementation of Maternal, Neonatal and Woman’s health programmes using the standardised dashboard reports

Quarter target: Quarterly report produced with feedback provided to each provincial DoH

Quarterly Dashboard report for 2014/15 shared with provinces on 9 July 2015

Achieved

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Health

Strategic Objective Indicator TargetActual performance

Performance Rating

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

Annual target: 88% 91.6% Achieved

Infant 1st PCR test positive around six week rate

Quarter Target : 1.8% 1.6% Achieved

Develop provincial reports to track progress on the eliminations of mother-to-child transmission of HIV

Quarter Target: Conduct stocktaking workshops in all 3 provinces to monitor and evaluate progress towards elimination

Stocktaking workshops will be conducted in quarter tw

Not achieved

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

Couple year protection rate Quarter Target: 60% 44.7% Partially Achieved

Cervical cancer screening coverage

Quarter Target: 55% 51.8% Partially Achieved

Develop Training manual for the implantation of Contraception and Fertility Planning (CFP) Policy

Quarter Target: Target: Draft CFP training manual

Final draft 0 was piloted during master training in June 2015

Develop Pharmacovigilance system for adverse events for contraceptive implants

Quarter Target: Pharmacovigilance information system implementation plan drafted

Pharmacovigilance form distributed to province in January 2015

Develop cervical cancer control Policy

Quarter Target: Consultative process with relevant stake holders intitiated

Consultative meeting was held.

Achieved

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Health Strategic Objective

Indicator TargetActual performance

Develop breast cancer Policy

Quarter Target: Consultative process with relevant Stakeholders completed, and situational analysis completed

Consultative meeting was held with technical group participants on 10 July 2015, and the report was finalised in July 2015

Partially achieved

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

Quarter Target: 3.25% 2.7% Achieved

Child under 5 years pneumonia case fatality rate

Quarter Target: 3% 1.9% Achieved

Child under 5 years severe acute malnutrition case fatality rate

Quarter Target: 10% 10.9% Partially Achieved

Confirmed measles case incidence per million total population

Annual Target: <3/1,000,000 0.171/1,000,000 population

Achieved : Annual Target

Immunisation coverage under 1 year (annualised)

Quarter Target: ≥90% 90.7% Achieved

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Health Strategic Objective


Contribute to health and wellbeing of learners by screening for health barriers to learning

School Grade 1 screening coverage (annualised)

Annual Target 25%

42% Achieved: Annual target

School Grade 8 screening coverage (annualised)

Annual Target 10%

16% Achieved: Annual target

To protect girl learners against cervical cancer

HPV 1st dose coverage Annual target: 80%

Vaccinations to be administered in the second and fourth quarters

HPV 2nd dose coverage Annual target: 80%

Vaccinations to be administered in the second and fourth quarters

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•NDoH will strengthen data management systems for collection of data on medical male circumcisions conducted outside public health facilities to ensure that all MMCs conducted are reported on

•The stocktaking workshops on PMTCT were postponed in Q1 to implement birth PCR testing; all 9 provincial stocktaking workshops will be completed in Q2 and Q3

•To address the high neonatal death rate in Q1, data inaccuracies will be addressed urgently (hospitals reported deaths but no deliveries); training of master trainers in management of sick and small babies has commenced – training to be cascaded in all provinces; NDOH to monitor implementation of provincial newborn care plans

•To address the high TB MDR client death rate the NDOH is developing a mhealth based tracing system which links the lab diagnosis to patient tracers to close the gap between diagnosis and initiation on treatment; expansion of access to new TB medication (bedaquiline and lineozoid) should improve treatment outcomes


Progress Report

PROGRAMME 4 : PRIMARY HEALTH CARE SERVICES

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Programme 4: Primary Health Care ServicesStrategic Objective

Indicator Annual Target Actual performance Performance Rating

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

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

Annual target: 15 Districts with uniform management structures.

Currently evaluating to determine existing management structures

Partially achieved : Annual target

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

Annual target: 1000 health care facilities with functional clinic committees.

1209 Clinics with functional clinic committees


Improve access to community based PHC services

Number of functional WBPHCOTs

Annual target; 2000 functional WBPHCOTs

1740 functional WBPHCOTs Partially achieved : Annual target

Improve quality of services at primary health care facilities

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

Annual target; 500 primary health care facilities in the 52 districts qualify as Ideal Clinics

Preparatory work underway in facilities; 1234 clinics assessed during first quarter1 PHC clinic qualified as ideal clinic out of


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Programme 4: Primary Health Care Services

Strategic Objective

Indicator Annual Target Actual performancePerformance Rating

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.

Annual target: 20 Municipalities meet environmental health norms and standards in executing their environmental health functions

Audits of the municipalities have been completed. In process of analyzing data to determine compliance


Hand hygiene campaign rolled out in all nine (9) provinces

Annual target: A national hand hygiene strategy developed

First draft completed. It is in circulation for comment


Ensure compliance with Health Waste management regulations

Annual target: Health care risk waste regulations finalised and tools for audit implementation developed

Health care risk waste regulations approved by the Minister. In process of developing audit tool


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

Establish National Health Commission

Annual target: Operating framework for National Health Commission developed

Draft framework is ready. Will present this to executive management in the second quarter


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Strategic Objective

Indicator Annual and Quarter Target

Actual performance Performance Rating

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

Number of National government Departments oriented on the National guide for healthy meal provision in the workplace

Annual target: 20 National Departments

The draft National guide for healthy meal provision in the workplace has been developed and circulated for comment.


Regulations relating to Labelling and packaging of tobacco products and smoking indoor and outdoor public places developed

Annual target: Tobacco Act amended

First draft submitted to Legal Services for onward submission to State Legal Advisors. Meeting held to review State Law advisors inputs on 22 May 15


Awareness on risk factors relating to excessive salt intake, excessive sugar intake, physical inactivity and , alcohol related harm created

Annual target: Content of campaign finalised and ready for implementation

In process of awarding a tender for the content development in cooperation with programme 3 managers


Random Monitoring of salt content in foodstuffs conducted

Annual Target :Random samples from each of 13 regulated food category tested, reported on and corrective action taken

Obtained agreement from laboratories on how testing will be done and a budget drawn up.

Not achieved


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Strategic Objective


Number of people screened for high blood pressure as part of comprehensive health screening

Annual target: 8 million people screened for high blood pressure

2 468 177 Achieved : Annual target

Annual target: 8 million people screened for raised blood glucose levels

1 4113 541 Partially achieved : Annual target

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

Percentage people screened for mental disorders

Annual target; 28 % of 16.5% (prevalence) people screened for mental disorders

290690 out of 664000 annual target


Percentage of people treated for mental disorders

Annual target: 28 % of 16.5% (prevalence) people screened for mental disorders

16 504 out of 66400 annual target


Percentage of mental health inpatient units attached to designated district and regional hospitals

Annual target: 16% of mental health inpatient units attached to designated district and regional hospitals

38/274 (14%) of mental health inpatient units attached to general hospitals are under planning and construction



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Strategic Objective Indicator Annual Target Actual performance

Performance Rating

Mental health teams established in each district

Annual target: Strategy for establishment of specialist mental health teams approved by the TAC NHC

Draft Strategy is being circulated for comment


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

Annual target: Resources allocated for the approved Framework and Model

Framework has been approved by NHC. Costing is in progress


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Strategic Objective Indicator Annual and Quarter Target

Actual performance

Prevent avoidable blindness

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

217 per million un-insured population


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

Malaria incidence per 1000 population at risk

Quarter Target: 0.2 malaria cases per 1000 population at risk (quarter)

0.055 (533 confirmed local cases)

Achieved

Number of districts targeted for malaria elimination reporting malaria cases within 24 hours of diagnosis

Annual target: 5 malaria targeted districts reporting malaria cases within 24 hours of diagnosis

10% of malaria cases in 1 district reported within 24 hours


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Actual performance

Strengthen preparedness and core response capacities for public health emergencies in line with International Health Regulations

Number of Provincial Outbreak Teams capacitated to respond to zoonotic, infectious and food-borne disease outbreaks

Annual target: 9 Provincial Outbreak Teams capacitated to respond to zoonotic, infectious and food-borne disease outbreaks

Held a workshop planning meeting on 8 May.Submission for training approved.


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

Number of high risk population covered by the seasonal influenza vaccination

Annual target: 800 000 high risk individuals covered with seasonal influenza vaccination

513718 vaccines administered to high risk individuals


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

A strategy and plan for the integration of disease surveillance systems for NMC Develop and implemented

Annual target: Strategy for the integration of disease surveillance systems for NMC approved and implementation plans developed

A list of stakeholders to be consulted in the drafting of the strategy compiled and meeting arranged


Conduct Annual National HIV Antenatal Prevalence Survey

Annual National HIV Antenatal Prevalence Survey conducted

Annual target: 2015 National HIV prevalence report produced

Submission prepared for the 2015 survey to be conducted in the third quarter of 2015


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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

Number of central hospital with full delegated authority

Annual target: 10 central hospitals with full delegated authority

Task team on delegation framework for central hospitals established and two meetings held to prepare hospitals


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

Number of Hospitals that comply fully with the National Core Standards

Annual target: Full compliance with the National Core Standards in 8 Central hospitals and 5 Tertiary Hospitals

3 Central hospitals (Steve Biko, Groote Schuur and Tygerberg Hospitals) fully complied with the National Core Standard in 2014/15


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 target additional tertiary hospitals (Pietersburg, Frere, Kimberley and Ngwelezana) providing the full package of Tertiary 1 services

Public Health Registrar appointed to finalise tertiary services planPlan of action developed by the National Hospital Coordinating Committee


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Strategic Objective


Improve quality of health infrastructure in South Africa

Number of facilities maintained, repaired and/or refurbished in NHI Districts

Annual target: 198 facilities

Refurbishment in process of 23 Clinics in the Eastern Cape. In tendering process of appointment of contractors & Professional Services Providers for maintenance.


Number of facilities maintained, repaired and/or refurbished outside NHI pilot Districts

Annual target: 310 facilities

188 facilities in Renovations, Rehabilitation or Refurbishments phase.


Number of clinics and Community Health Centres constructed or revitalised

Annual target: 35 9 Clinics & 3 CHC's in handover phase


Number of hospitals constructed or revitalised

Annual target: 2 8 Hospitals in handover phase Partially achieved : Annual target

Number of new facilities that comply with gazetted infrastructure Norms & Standards

Annual target: 37 new facilities

8 new facilities under construction with the In-kind Grant


Develop a Infrastructure Monitoring System

Annual target: Infrastructure Monitoring System fully developed and tabled at NHC

Monitoring systems has been developed


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Strategic Objective


Develop and implement health workforce staffing norms and standards

Develop guidelines for HRH norms and standards using the WISN methodology

Annual target; Guidelines for HRH Norms for District and specialised hospitals developed.

Unpacking of activities leading to production of staffing norms for district and specialised hospitals


Number of facilities benchmarked against PHC staffing normative guidelines

Annual target; 1000 About 508 facilities have started with the process of benchmarking against PHC staffing normative guides based on the implementation Guideline in 6 out of 9 provinces

Achieved : Annual target

Annual target: Tertiary, Regional and Central Hospital managers oriented on WISN tool and methodology

Orientation workshops held with provincial representatives

Partially achieved

Number of RTC's established Annual target: 5RTCs established

5 RTCs established Achieved: Annual Target

44


Strategic Objective


Professionalise Nursing training and Practice implementation of the objectives of the Nursing Strategy

Public nursing colleges offering new nursing programmes (in line with National Qualifications Framework)

Quarter Target: A national policy for nursing education developed in the context of bedside training

Components of the national nursing education policy have been defined

Partially achieved

Develop a Nursing and Midwifery educators' training and development programme

Quarter Target: A Nursing and midwifery educators’ training and development programme developed

Audit of capacity of nurse educators completed

Achieved

Develop a standardised Nursing leadership structure for Provincial DoH

Quarter target: Provincial Nursing structures to give authority over nursing and midwifery services tabled at NHC

Recommended structures for authority for nursing at provincial levels identified and reviewed

Partially achieved

45


Strategic Objective


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

Number of provinces that are compliant with the EMS regulations.

Annual target: EMS Regulations and compliance checklist gazetted for implementation.

Circulation of the Gazetted Regulations.


Publish Policy on education and training of EMS Personnel published for implementation

Annual target: Policy on education and training of EMS Personnel published.

The draft policy was presented and approved at the NHC TAC. The migration plan to operationalise the policy was drafted


Develop regulations for Emergency Care Centres

Annual target: Regulations on Emergency Care Centres Drafted

Draft regulations completed Partially achieved: Annual target

Publish Regulations for EMS in Mass Gatherings

Annual target: EMS regulations in mass gatherings published for public comment and implementation

Final draft document prepared


46

Programme 5: Hospitals, Tertiary Services and Workforce DevelopmentStrategic Objective


To eliminate the backlog of blood alcohol and toxicology tests by 2016

Number of Blood Alcohol reports produced

Annual target: 120 000 28,656 Partially achieved: Annual target

Number of Toxicology reports produced

Annual target: 4500 583 Partially achieved: Annual target

To provide food analysis services

Number of food tests performed.

Annual target: 4000 3417 Partially achieved: Annual target

Develop a monitoring system to effectively measure turnaround time of tests conducted at Forensic Chemistry Laboratories

Annual target: A standardised workflow and monitoring system developed for all 3 tests and implemented at 4 forensic chemistry laboratories

A draft standardised workflow and monitoring system has been prepared


47

Programme 5: Hospitals, Tertiary Services and Workforce DevelopmentStrategic Objective


Regulations for the Rendering of Forensic Pathology Services promulgated

Annual Target: Regulations on for the Rendering of Forensic Pathology Services reviewed and Published for public comments

NFPSC meeting held on 25 March 2015 agreed to review the regulations under priority 1 item


Publish Scope of Practice Guidelines for the rendering of Forensic Pathology Services

Annual target: Review and Finalise the Scope of Practice Guidelines for the rendering of Forensic Pathology Services and Publish for Implementation

NFPSC meeting held on 25 March 2015 agreed to review the scope of practice under priority 1 item. Questionnaire developed for provinces to gather information on what scope of practice is done by the FPO's


Number of Health Facilities that are designated to render services for the management of sexual and related offences

Annual target: 60 additional facilities designated

Mpumalanga province identified 4 new designated facilities. Western Cape province identified 7 new designated facilities


48

Progress Report

PROGRAMME 6 : HEALTH REGULATION AND COMPLIANCE MANAGEMENT

49

Programme 6: Health regulations and Compliance Management


Actual performance

Performance Rating

Establish the South African Health Product Regulation Authority (SAHPRA)

Establish SAHPRA as a public entity

Annual target: SAHPRA Act (Bill 6 of 2014) Promulgated , and transitional plan from MCC to SAHPRA developed

Finalized corrections to the Bill as per directive of Portfolio Committee of Health

Partially Achieved

Establish Institute of Regulatory Science (IRS)

Institute of Regulatory Science (IRS) providing training

Quarter target: Project team appointed

Project team appointed

Achieved

Regulate Medical devices, IVDs, cosmetics and expand on regulation of Complementary and Alternative Medicines (CAMS)

Quarter Target: Evaluate stakeholder comments on Medical Devices and IVDs and CAMs Regulations in-house • Cosmetics: None

Evaluated stakeholders comments and prepared new set of Medical Device and IVD Regulations

Achieved

Improve registration turnaround times of ARV’s, TB, oncology and vaccines to treat and prevent high burden of diseases

Quarter Target: 15 % of priority medicines registered NCE = 36 month; Generics = 28 month

13%(88 human medicines registered of which 7 were priority medicines)

Partially achieved

50


Strategic Objective Indicator Quarter Target Actual performance Performance Rating

Establish a MOU with Department of Agriculture, Fisheries and Forestry’s (DAFF)`

Quarter Target: Identify tests to be carried out by internal and external laboratories

Tests identified to be carried out on foodstuffs for internal and external laboratories

Achieved

Develop Regulations for Cosmetic products

Quarter Target: Prepare draft Cosmetic regulations

Cosmetic Regulations prepared

Achieved

To develop the policy and legislative framework for occupational health and compensation

Review occupational health legislative framework

Quarter Target: Report on occupational health policy framework

Policy document drafted. Achieved

To establish an occupational health cluster

Occupational health cluster established and functional

Quarter Target: Document on structure, organogram and activities of the occupational health cluster

No structure and organogram document developed until NAPHISA structure finalised

Not achieved

51


Strategic Objective Indicator Target Actual performance

To provide occupational health and compensation services through the development of One Stop Service centres in provinces

Number of provinces with One Stop Service Centres to deliver occupational health and compensation services

Quarter target :1 preparatory meeting with stakeholders and role-players in Northern Cape

3 preparatory meetings have been hosted in Northern Cape and 1 in Limpopo

Achieved

To establish the National Public Health Institutes of South Africa (NAPHISA) for disease and injury surveillance

Develop legal framework to establish National Public Health Institutes of South Africa (NAPHISA)

Quarter target: Finalise legislative framework for NAPHISA

Legislative framework being reviewed with legal section and includes amendments to NHLS Act

Partially achieved

Number of applications certified at MBOD as compensable disease claims

Quarter target: 1500

1137 Partially achieved

Number of compensable disease claims paid by CCOD other than pensioners

Quarter target: 500 447 partially achieved

52


Strategic Objective


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

Number of Health entities’ and Statutory Health professional Councils with fully functional and compliant to good Governance practices (structures, Finance, HR , Supply Chain Management policies) and also respond to health sector priorities

Quarter target: Checklists for measuring functionality of health entities and professional councils developed and consulted

Draft Checklist for Entities to include specific internal control system circulated for input.

Partially Achieved

Develop and implement a performance management system for board members

Quarter target: Standardised performance management system for board members drafted and circulated for consultation

Draft performance assessment system for board members developed.

Partially Achieved

Number of newly appointed boards inducted and trained

Quarter target: None Call for nominations for candidates for the new term of Office of the Professional Boards of the HPCSA published. The panel to consider and make recommendations for appointment has been appointed by the Minister.

Partially Achieved

53

Programme 6: Health regulations and Compliance ManagementStrategic Objective

Indicator Quarter Target Actual performance Performance Rating

Develop and implement Dashboard to monitor entities performance and compliance to legislative prescripts

Quarter target: 3 Dashboards developed and piloted (1 per entity or statutory council)

Dashboard developed for NHLS, SAMRC and CMS finalized

Achieved

Develop a reporting template to enable feedback to the executive authority

Quarter target: Standardised reporting template drafted and circulated for consultation

Reporting template developed, presented and circulated to Departmental representatives serving on Boards/Councils

Achieved

54

Document on structure, organogram and activities of the occupational health cluster have not been finalised until the structure of NAPHISA is finalised.

Registration turnaround times of ARV’s, TB, oncology and vaccines to be improvoed through training of additional evaluators, propose prioritisation of existing applications based on public health needs.


55

Summary of Quarter One 2015/16 APP Performance

Programmes Quarterly Targets

Total Achieved

Total Partially Achieved

Total Not Achieved

Programme 1 5 2 3 0



Programme 4 1 1

Programme 5 4 1 2


Total 70 32 31 6

56

FIRST QUARTER EXPENDITURE 2015/16

57

Background

Quarterly performance briefings for the Committee.

The Department of Health recorded an expenditure of R8.70 billion or 23.9% of an allocation of R36.47 billion at the end of the first quarter of the 2015/16 financial year. The table below explains the financial performance for each programme.

58

Financial Performance per programme

Programme

R million Outcomes CommentsMain

Appropriation

Available budget

April to June expenditure

April to June

percentage spent

Reasons for

variances

1. Administration 386 476 457 078 457 078 135 307 29,60% Note 12. National Health Insurance, Health Planning and Systems Enablement 316 667 587 807 587 807 95 418 16,23% Note 23. HIV and AIDS, Tuberculosis, Maternal an Child Health 13 027 910 14 442 144 14 442 144 3 370 520 23,34% Note 34. Primary Health Care Services 102 355 225 005 225 005 45 766 20,34% Note 45. Hospitals, Tertiary Health Services and Human Resource Development 18 482 048 19 159 065 19 159 065 4 650 918 24,28% Note 56. Health Regulation and Compliance Management 839 199 1 596 919 1 596 919 395 098 24,74% Note 6Total 33 154 655 36 468 018 36 468 018 8 693 027 23,84%

Economic Classification

Current payments 1 662 362 2 351 547 2 351 547 397 294 16,90%Compensation of Employees 608 140 772 088 772 088 177 325 22,97%

Goods and Services 1 054 222 1 579 459 1 579 459 219 969 13,93% Note 7Interest and Rent on Land 0 0 0 0Total transfers and subsidies 31 263 725 33 448 493 33 448 493 8 243 332 24,64%Payments for capital assets 227 635 667 978 667 978 52 273 7,83% Note 8Payments for Financial Assets 933 0 0 128Total 33 154 655 36 468 018 36 468 018 8 693 027 23,84%

2014/15 2015/16

59

Note 1 – Programme 1 - Administration

The outstanding invoices for office accommodation for the 2014/15 financial year were processed during the first quarter of 2015/16;The renewal of the IT-related licences is due in the fourth quarter of the year;The maintenance of Civitas' security equipment amounting to R4million is scheduled to take place during November 2015;Electronic boards, digital recording equipment and other capital assets were ordered but not yet received and paid.

Reasons for variances

60

60

Note 2 – Programme 2 – National Health Insurance, Health Planning and Systems Enablement

NHI Direct Grant spending low due to:• As per operational plans the SCM processes were planned to be

finalised by end of Quarter 1 – Improvements have been in recorded in quarter 2 with spending at

16%;– Procurement plans have been delayed in many pilot districts;– Capacity constraints continue to plague some of the pilot districts; – Some districts have low levels of financial delegations;– Delays by appointed suppliers to deliver key equipment/kits for

the MWBOTs for which contracts have already been awarded.

Reasons for variances

Note 2 – Programme 2 – National Health Insurance, Health Planning and Systems Enablement

The tender for the printing and publication of the Essential Medicines List will be paid in the second quarter of the year;The planned publication of the STG of PHC could not be finalized during the 1st quarter due to a delay in the contracting of a printing service provider;The appointment of Health Practitioners at the NHI pilot sites is complete and it is expected that the expenditure increase accordingly;Contract for mid-level workers not finalized during the 1st quarter.

Reasons for variances - Continue

Note 3 – Programme 3 – HIV and Aids, TB, Maternal and Child Health

The National TB Meeting was postponed from May until September 2015 as the provinces were developing district improvements plans to implement the 90,90,90 targets for HIV and TB;

There were delays in printing the Saving Mothers Report (softcopies of the report have been distributed);

Payment for the printing of the TB Patient Treatment Cards has not been effected as less than half the order has been delivered. Payment will be made once the full order has been delivered.


63

Note 4 – Programme 4 – Primary Health Care 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 is not finalized;The development of clinical guidelines on Management of Co-morbidity Psychiatric and Substance Abuse is taking longer than expected;Developing procurement processes and guidelines in line with PFMA requirements to be finalised.


64

64


Note 5 – Programme 5 – Hospital, Tertiary Services and Human Resource Development

Liquid chromatography systems, nitrogen analyser and LIMS server are not yet delivered. Delivery expected in 2nd quarter;

Construction of new clinics and relocatable doctor consulting rooms ongoing. See progress on PICC expectations.

65


Note 6 – Programme 6 – Health Regulation and Compliance Management

File servers and steel shelving was ordered for MCC but not delivered during the 1st quarter.

Note 7 – Goods and Services Goods and Services expenditure is R219,9 million or 13,9% of the budget of R1,5 billion.

Spending on the Human Papilloma Virus vaccines did not occur in Q1 because the vaccine is administered in two years each calendar year - the first dose is administered in February/March and the second dose in August/September.

The South African Demographic Health Survey is running over three financial years. The first payments to this project are anticipated to flow in the latter half of the year;


67

Note 7 – Goods and Services

The printing of the Tuberculosis Pamphlets in Braille has been delayed because of the poor quality of the format and layout (not approved by the Society for the Blind), the procurement will be done through the Society to ensure compliance with quality standards.

WHO membership fees will be paid in the 4th quarter.


68


Note 8 – Payment of Capital Assets

The renewal of the IT-related licences is due in the fourth quarter of the year;File servers and steel shelving was ordered for MCC but not delivered during the 1st quarter;The maintenance of Civitas' security equipment amounting to R4million is scheduled to take place during November 2015;Electronic boards, digital recording equipment and other assets were ordered but not yet received and paid;Liquid chromatography systems, nitrogen analyser and LIMS server are not yet delivered. Delivery expected in 2nd quarter;Construction of new clinics and relocatable doctor consulting rooms ongoing (PICC progress).

69

Conditional Grants expenditure as at 30 June 2015:

Total CG spending is at 22.6 % or R7.2 bn against total original budget of R31.8 bn. The overall spending of the Provinces is not on par with the current norm of 25%. The major contributors to under spending are:

• National Health Insurance Grant (6.5%)• Health Facility Revitalisation Grant (19%)

HPTDG, NTSG & CHIV/AIDS spent within the acceptable norm at 26.1%, 24.0% and 22.5% respectively.

CONDITIONAL GRANTS

70

Expenditure Summary Per Grant(Schedule 4 and 5 grants)

Grant Name

Original Budget

Expenditur

e

% Spent of

Budget

Transfers per

Payment Schedule

Transfers per % of Payment Schedule

Transfers Received

by province

% of Transfers Received

Original Budget

Expenditur

e

% Spent

of Budget

Original Budget Expenditure

% Spent

of Budget

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

Health Professions Training and Development Grant 2,374,722 620,146 26.1% 593,685 100% 581,065 97.9% 2,321,788 566,844 24.4% 2,190,366 413,339 18.9%

National Tertiary Services Grant 10,398,034 2,491,682 24.0% 2,599,512 100% 2,492,607 95.9% 10,168,235 2,428,525 23.9% 9,620,357 1,944,062 20.2%

Comprehensive HIV&AIDS Grant 13,737,312 3,087,004 22.5% 3,340,119 100% 3,120,521 93.4% 12,311,322 2,491,939 20.2% 10,533,886 2,175,374 20.7%Health Facility Revitalis. Grant 5,275,762 1,000,862 19.0% 1,346,182 100% 1,230,107 91.4% 5,239,981 892,553 17.0% 5,123,542 727,288 14.2%National Health Insurance Grant 72,042 4,701 6.5% 14,400 100% 8,944 62.1% 70,000 8,806 12.6% 48,500 14,688 30.3%

TOTAL 31,857,872 7,204,395 22.6% 7,893,898 100% 7,433,244 94.2% 30,111,326 6,388,667 21.2% 27,516,651 5,274,751 19.2%

2015/16 2014/15 2013/14

Budget vs Expenditure Transfers Budget vs Expenditure Budget vs Expenditure

71

Health Professions Training Grant

Province


% Spent of

Budget

Transfers per Payment

Schedule


Transfers Received



% Spent of

Budget Original Budget Expenditure

% Spent

of Budget

R'000 R'000 % R'000 % R'000 % R'000 R'000 % R'000 R'000 %Eastern Cape 204,431 37,608 18.4% 51,108 100% 37,608 73.6% 199,874 35,025 17.5% 188,560 11,026 5.8%Free State 149,757 28,586 19.1% 37,440 100% 28,436 76.0% 146,419 35,731 24.4% 138,131 31,921 23.1%Gauteng 829,606 227,567 27.4% 207,402 100% 227,567 109.7% 811,114 223,558 27.6% 765,202 90,579 11.8%Kwazulu-Natal 299,514 81,105 27.1% 74,880 100% 74,880 100.0% 292,837 73,209 25.0% 276,262 69,066 25.0%Limpopo 118,856 37,750 31.8% 29,715 100% 29,715 100.0% 116,206 14,907 12.8% 109,628 43,529 39.7%Mpumalanga 97,460 26,219 26.9% 24,366 100% 20,622 84.6% 95,288 16,097 16.9% 89,894 11,169 12.4%Northern Cape 78,446 29,053 37.0% 19,611 100% 13,074 66.7% 76,697 21,128 27.5% 72,356 18,740 25.9%North West 106,970 29,837 27.9% 26,742 100% 26,742 100.0% 104,586 27,498 26.3% 98,666 24,392 24.7%Western Cape 489,682 122,421 25.0% 122,421 100% 122,421 100.0% 478,767 119,691 25.0% 451,667 112,917 25.0%TOTAL 2,374,722 620,146 26.1% 593,685 100% 581,065 97.9% 2,321,788 566,844 24.4% 2,190,366 413,339 18.9%

Budget vs Expenditure

2014/15

Transfers Budget vs Expenditure

2015/16


2013/14

72

Health Professions Training Grant

Overall spending has improved this financial year from 18.9% (2013/14) and 24.4% (2014/15) to 26.1% and is within the norm. All provinces spent within the acceptable norm with the exception of EC and FS that spent 18.4% and 19.1% respectively. The under spending for the two provinces is attributed to:

Delays in recruitment process for Registrars Dual registrar intake (January and July intake)

73

National Tertiary Services Grant

Province


% Spent of

Budget


Schedule


Transfers Received



% Spent of


% Spent

of Budget

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

Eastern Cape 803,770 264,646 32.9% 200,943 100% 200,943 100.0% 786,007 151,450 19.3% 743,621 149,483 20.1%Free State 918,387 226,992 24.7% 229,596 100% 226,987 98.9% 898,091 262,658 29.2% 849,661 183,540 21.6%Gauteng 3,572,852 818,493 22.9% 893,214 100% 818,493 91.6% 3,493,891 755,732 21.6% 3,305,931 693,237 21.0%Kwazulu-Natal 1,530,246 303,207 19.8% 382,563 100% 382,563 100.0% 1,496,427 394,573 26.4% 1,415,731 139,622 9.9%Limpopo 330,462 72,591 22.0% 82,614 100% 82,614 100.0% 323,158 70,010 21.7% 305,732 58,914 19.3%Mpumalanga 99,311 17,771 17.9% 24,828 100% 21,776 87.7% 97,116 22,888 23.6% 91,879 10,350 11.3%Northern Cape 305,478 83,167 27.2% 76,368 100% 50,912 66.7% 298,727 88,304 29.6% 282,618 76,100 26.9%North West 242,626 57,153 23.6% 60,657 100% 60,657 100.0% 237,264 44,747 18.9% 224,470 41,755 18.6%Western Cape 2,594,902 647,662 25.0% 648,729 100% 647,662 99.8% 2,537,554 638,163 25.1% 2,400,714 591,061 24.6%

TOTAL 10,398,034 2,491,682 24.0% 2,599,512 100% 2,492,607 95.9% 10,168,235 2,428,525 23.9% 9,620,357 1,944,062 20.2%

2014/15 2015/16


2013/14

74

National Tertiary Services Grant

Overall spending has improved this financial year from 20.2% (2013/14) and 23.9% (2014/15) to 24.0% and is within the acceptable norm. All provinces spent within the acceptable norm with the exception of LP, MP and KZN that spent 22.0% and 17.9% and 19.8% respectively. The under spending for the three provinces is attributed to:

PERSAL linkages Expenditure for salary adjustment not yet effected. Delays in supply chain management processes (changing from quotation to contract for pharmaceuticals) Delays on supplier delivery.

75

Comprehensive HIV/AIDS Grant

Province


% Spent of

Budget


Schedule


Transfers Received



% Spent of


% Spent

of Budget

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

Eastern Cape 1,577,065 398,044 25.2% 387,834 100% 372,635 96.1% 1,449,237 254,374 17.6% 1,273,296 304,944 23.9%Free State 911,946 141,674 15.5% 197,047 100% 141,284 71.7% 843,026 118,254 14.0% 742,984 169,255 22.8%Gauteng 2,928,300 654,110 22.3% 732,075 100% 654,110 89.4% 2,632,578 654,926 24.9% 2,258,483 379,940 16.8%Kwazulu-Natal 3,813,094 1,013,397 26.6% 880,734 100% 880,734 100.0% 3,257,992 668,277 20.5% 2,652,072 705,444 26.6%Limpopo 1,056,975 182,987 17.3% 276,234 100% 276,234 100.0% 978,132 126,387 12.9% 861,143 56,938 6.6%Mpumalanga 927,214 194,533 21.0% 242,186 100% 242,186 100.0% 818,836 216,808 26.5% 690,591 180,718 26.2%Northern Cape 371,253 64,546 17.4% 95,193 100% 63,462 66.7% 342,789 83,339 24.3% 302,468 47,606 15.7%North West 1,012,984 201,082 19.9% 253,246 100% 253,245 100.0% 936,938 173,545 18.5% 825,302 169,761 20.6%Western Cape 1,138,481 236,631 20.8% 275,570 100% 236,631 85.9% 1,051,794 196,029 18.6% 927,547 160,768 17.3%

TOTAL 13,737,312 3,087,004 22.5% 3,340,119 100% 3,120,521 93.4% 12,311,322 2,491,939 20.2% 10,533,886 2,175,374 20.7%

2014/15


2013/14


2015/16

Transfers Budget vs Expenditure

76

Comprehensive HIV/AIDS Grant

Overall spending has improved this financial year from 20.7% (2013/14) and 20.2% (2014/15) to 22.5% and is within the acceptable norm. All provinces spent below the norm with the exception of EC and KZN that spent 25.2% and 26.6% respectively. The under spending is attributed to:

Centralized delegations at Provincial Treasury. Delays in recruitment processes and supplier delivery lead time (condoms). Late submission of invoices by suppliers. Moratorium on filling of posts Outstanding accruals for key accounts (NHLS, condoms and drugs).

77

Health Facility Revitalisation Grant

Province


% Spent of

Budget


Schedule


Transfers Received



% Spent of


% Spent

of Budget

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

Eastern Cape 592,073 90,991 15.4% 152,055 100% 90,991 59.8% 599,231 64,582 10.8% 562,792 73,278 13.0%Free State 564,950 80,971 14.3% 108,907 100% 80,972 74.3% 448,962 101,848 22.7% 538,962 69,121 12.8%Gauteng 313,630 90,649 28.9% 78,408 100% 90,649 115.6% 671,033 57,781 8.6% 771,033 79,073 10.3%Kwazulu-Natal 1,229,775 271,396 22.1% 352,786 100% 352,786 100.0% 1,162,469 233,015 20.0% 962,469 186,826 19.4%Limpopo 194,256 72,383 37.3% 48,564 100% 48,564 100.0% 467,442 69,202 14.8% 457,442 2,564 0.6%Mpumalanga 287,942 48,247 16.8% 71,986 100% 71,986 100.0% 343,509 34,926 10.2% 283,509 76,495 27.0%Northern Cape 593,590 97,975 16.5% 113,200 100% 113,200 100.0% 421,428 84,306 20.0% 421,428 119,862 28.4%North West 695,404 124,393 17.9% 257,102 100% 257,102 100.0% 486,121 141,516 29.1% 496,121 54,864 11.1%Western Cape 804,142 123,857 15.4% 163,174 100% 123,857 75.9% 639,786 105,377 16.5% 629,786 65,205 10.4%

TOTAL 5,275,762 1,000,862 19.0% 1,346,182 100% 1,230,107 91.4% 5,239,981 892,553 17.0% 5,123,542 727,288 14.2%

Budget vs Expenditure Budget vs Expenditure

2013/14 2015/16 2014/15

Budget vs Expenditure Transfers

78

Health Facility Revitalisation Grant

Overall spending has improved this financial year from 14.2% (2013/14) & 17% (2014/15) to 19.0% and is below the norm. All provinces spent below the norm with the exception of GP and LP that spent 28.9% and 37.3% respectively. The under spending is attributed to:

Slow SCM processes (tender processes). Centralised delegations at provincial treasury. Poor performance of contractors. Inability to attract scarce skills – some projects not initiated. Cancellation of contracts and sourcing of new contractor.

79

National Health Insurance Grant

Province


% Spent of

Budget


Schedule


Transfers Received



% Spent of


% Spent

of Budget

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

Eastern Cape 7,206 91 1.3% 1,440 100% 91 6.3% 7,000 1,097 15.7% 4,850 2,193 45.2%Free State 7,204 176 2.4% 1,440 100% 231 16.0% 7,000 2 0.0% 4,850 552 11.4%Gauteng 7,204 313 4.3% 1,440 100% 313 21.7% 7,000 3,174 45.3% 4,850 3,013 62.1%Kwazulu-Natal 14,408 640 4.4% 2,880 100% 2,880 100.0% 14,000 592 4.2% 9,700 4,921 50.7%Limpopo 7,204 657 9.1% 1,440 100% 1,440 100.0% 7,000 449 6.4% 4,850 1,538 31.7%Mpumalanga 7,204 218 3.0% 1,440 100% 325 22.6% 7,000 1,113 15.9% 4,850 - 0.0%Northern Cape 7,204 995 13.8% 1,440 100% 960 66.7% 7,000 698 10.0% 4,850 1,373 28.3%North West 7,204 347 4.8% 1,440 100% 1,440 100.0% 7,000 381 5.4% 4,850 158 3.3%Western Cape 7,204 1,264 17.5% 1,440 100% 1,264 87.8% 7,000 1,300 18.6% 4,850 940 19.4%

TOTAL 72,042 4,701 6.5% 14,400 100% 8,944 62.1% 70,000 8,806 12.6% 48,500 14,688 30.3%

2015/16 2014/15 2013/14


80

National Health Insurance GrantNHI Direct Grant spending low due to:

• As per operational plans the SCM processes were planned to be finalised by end of Quarter 1 – Improvements have been in recorded in quarter 2 with spending

sitting at 16%– Procurement plans have been delayed in many pilot districts– Capacity constraints continue to plague some of the pilot districts – Some districts have low levels of financial delegations– Delays by appointed suppliers to deliver key equipment/kits for

the MWBOTs for which contracts have already been awarded

80

National Health Grant(Schedule 6 – Indirect Grant)

Component Budget Expenditure Commitment % Spent

National Health Insurance 298,100 53,919 83,618 18

Health Practitioners contracting 228,100 50,661 83,422 22 CCMDD 70,000 3,258 196 5

Health Facility Revitalisation 913,176 97,760 117,924 11 Human Papillomavirus 200,000 14,643 54,585 7 Total 1,709,376 220,241 339,745 13

82

INTRODUCTION TO PROGRESS (PICC SUMMARIZED REPORT) AND CASH FLOW ANALYSIS –IN KIND GRANT 2015/16 F/Y-Q1

In-Kind budget = R913 m, 146 multi and single Projects

Delays due to new approach to Ideal Clinics

Delays due to magnitude of procurement process

Several innovative initiatives

Contract for mid-level workers not finalized during the 1st quarter.

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Progress on In Kind Grant projects (PICC summarized report) Q1

Program Allocated Budget

2015/16 F/Y

Number of projects contractually committed as at

July 2015-2015/16 F/Y

Progress

Business cases, Clinical and technical briefs have been prepared along with final design of all 8 clinics in EC approved by EC province and NDoH.

All 8 in EC are under construction The Business cases, Clinical and Technical briefs and concept design of 5 clinics in LP and 3 in FS have been prepared and approved by the relevant provinces and NDoH and currently they are at final design and documentation stage and construction to start in Nov. 2015

Business cases, Clinical and technical briefs for 4 of the CHCs have been prepared and approved by the MP and NDoH and are at final design stage-To go on Construction by Nov. 2015

The fifth one is at concept design stage and construction to start in Dec. 2015 12 in EC all at construction stage. 16 in LP all at construction stage 6 in FS all at construction stage 22 in MP all at construction stage 5 in WC all at construction stage

The whole program to be completed by the end of current F/Y

The Business cases, clinical briefs and technical briefs of 2 hospitals in EC and 3 Hospital in LP and 1 in FS have been prepared by the Infrastructure Unit in conjunction with the relevant provinces and all have been approved by those provinces, while the one of the GP hospital is being prepared and land for it has been identified.

The Hospital Housing in Siloam of LP is at construction stage

It is planned to start the construction of the, two hospitals in EC in November 2016, 1 in GP in April 2017, 1 in FS in April 2016, Siloam hospital in December 2015, the other 2 in LP in April 2017

Ideal Clinic building R218 559 411 16 clinics (8 in EC, 3 in FS and 5 in LP)

Community Health Centers building

R 5000 000 5 Community Health Centers in MP

Doctors Consulting room building

R 147 749 641 61 Doctors consulting rooms in NHI areas where the space shortage is critical to functionality

Hospital Building R117 493 239 8 Hospitals (2 in EC, 3 in LP, 1 in FS and 1 in GP and I hospital housing project)

84

Progress on In Kind Grant projects (PICC summarized report) Q1


2015/16 F/Y

Number of projects contractually committed as at

July 2015-2015/16 F/Y

Progress

Business cases, Clinical and technical briefs have been prepared along with final design of all 8 clinics in EC approved by EC province and NDoH.

All 8 in EC are under construction The Business cases, Clinical and Technical briefs and concept design of 5 clinics in LP and 3 in FS have been prepared and approved by the relevant provinces and NDoH and currently they are at final design and documentation stage and construction to start in Nov. 2015

Business cases, Clinical and technical briefs for 4 of the CHCs have been prepared and approved by the MP and NDoH and are at final design stage-To go on Construction by Nov. 2015

The fifth one is at concept design stage and construction to start in Dec. 2015 12 in EC all at construction stage. 16 in LP all at construction stage 6 in FS all at construction stage 22 in MP all at construction stage 5 in WC all at construction stage

The whole program to be completed by the end of current F/Y

The Business cases, clinical briefs and technical briefs of 2 hospitals in EC and 3 Hospital in LP and 1 in FS have been prepared by the Infrastructure Unit in conjunction with the relevant provinces and all have been approved by those provinces, while the one of the GP hospital is being prepared and land for it has been identified.

The Hospital Housing in Siloam of LP is at construction stage

It is planned to start the construction of the, two hospitals in EC in November 2016, 1 in GP in April 2017, 1 in FS in April 2016, Siloam hospital in December 2015, the other 2 in LP in April 2017

Ideal Clinic building R218 559 411 16 clinics (8 in EC, 3 in FS and 5 in LP)

Community Health Centers building

R 5000 000 5 Community Health Centers in MP

Doctors Consulting room building

R 147 749 641 61 Doctors consulting rooms in NHI areas where the space shortage is critical to functionality

Hospital Building R117 493 239 8 Hospitals (2 in EC, 3 in LP, 1 in FS and 1 in GP and I hospital housing project)

85

Progress on In Kind Grant projects(PICC summarized report) Q1


2015/16 F/Y

Number of projects contractually

committed as at July 2015-2015/16 F/Y

Progress

Business cases, Clinical and technical briefs have been prepared along with final design of all 8 Extent of the work: Limpopo Academic Hospital (LAH), Dr George Mukhari Hospital (DGMH) and King Edward VIII Hospital(KE8H)

Total Estimated value of the works: LAH:R4 162 467 968, DGMH:R5 550 182 205, KE8H:R11 627 798 550, Total: R21 340 448 723

Program duration and Cash Flow projection: LAH: Construction, April 2016- Completion, Nov. 2020, DGMH and KE8H, Construction, May 2017- Completion, Dec. 2021, with average annual budget requirement of R724M, R832M and R1.744 B respectively-Pending capital financial availability

Phase 1 covering the planning and design of these projects to start in current F/Y, this can be provided under In Kind Grant allocation in the current F/Y

It is planned to establish the “Project Office” under the Infrastructure Unit Strategic Support (IUSS) program phase 2 to enrich the process. It is essential to activate this office in the current F/Y to oversee the development of the 3 mega projects to comply with the implementation schedule

The PSPs appointed for the condition assessment of the 840 facilities have already covered 400 clinics and busy with the documentation of the condition assessment reports and preparation of Bills of quantities. A target of 40 clinics report and BOQ per week has been set as from the week of the 10th

Aug. 2015. The first 40 has been submitted as at 13 Aug.2015

o Currently maintenance contractors are busy in 23 clinics in EC while the site handing over for balance of 17 is in progress under DBSA as the Implementing Agent-Total Value R110 M. In F/Y 2014/15 they completed the maintenance program in 103 clinics in all NHI districts.

Currently the department appointed 11 contractors and 3 PSPs for removal of Asbestos cement ceilings (55 clinics and 4 CHCs), Improving water supply and sanitation (89 clinics and 2 CHCs) as well as security fencing (8 clinics and 1 CHC) which will be followed by other maintenance works in those facilities- Total value R120 M

o The PSP for maintenance contracts for Edendale Hospital in KZN has been appointed and tender documentation for the appointment of the contractor will follow-Total estimated value R240 M

o The CPM for the maintenance contract for Dihlabeng hospital in FS has been appointed by the CDC the project IA and it is expected to have the contractor on site by December 2015. Total Estimated value of contract is R 100 M

o The PSP for the maintenance contract of Knysna hospital in WC has already been appointed by the province. Tender documentation for this contract is being prepared by NDoH for appointment of the contractor-Total Estimated cost R20 M

3 mega Projects R 0.000 3 Mega hospitals in GP, KZN and LP

Maintenance program in NHI Districts including the maintenance and revitalization of Nursing Education Institutions

R 323 027 384 200 Facilities

86

Progress on In Kind Grant Projects (PICC summarized report) Q1


2015/16 F/Y

Number of projects contractually

committed as at July 2015-2015/16 F/Y

Progress

Business cases, Clinical and technical briefs have been prepared along with final design of all 8 Extent of the work: Limpopo Academic Hospital (LAH), Dr George Mukhari Hospital (DGMH) and SCM Support R 6 000 000 Covering all In Kind Grant projects

1 Firm has been appointed to support the procurement process of the health infrastructure projects for three years started in F/Y 2014/15 Currently there are 24 Built environment professionals and support staff assisting the department to perform its oversight roles and responsibilities at provincial projects Funded by Health Facility Revitalization Grant (HFRG)-In the process of extension as from end March 2016 when current contract is expired. Also developing the Maintenance strategy and plans for the Health facilities in the country.

Currently 17 In Loco Monitors (Built Environment Professionals) appointed for critical provincial projects as well as the In Kind Projects for quality and quantity control and risk management-3 years as from F/Y 2014/15

Project Management Information System Support in Place

10 Year Infrastructure Plan

R 4 346 325 Full Plan At advance stage

Total R 913 176 000

Projects Oversight support (PMSU) and Major project Residence staff

R 91 000 000 Covering all provinces and In Kind Grant Projects

3 mega Projects R 0.000 3 Mega hospitals in GP,

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DOCTOR’S CONSULTING ROOMS

IDEAL CLINIC

COMMUNITY HEALTHCARE CENTRES

HOSPITAL BUILDING PROGRAMME

NURSING EDUCATION INSTITUTION (COLLEGES)

MAINTENANCE

PROFESSIONAL AND TECHNICAL SUPPORT

IN-KIND TOTAL

• Low road: Expenditure amounts to R860m (potential under spending of R53m)

• High road: Expenditure amounts to R1 348m (potential over spending of R435m)

• Low road: Expenditure amounts to R860m (potential under spending of R53m)

• High road: Expenditure amounts to R1 348m (potential over spending of R435m)

1. Monthly statistics on late payments relating to the 2014/2016 financial year are as follows:

SUPPLIER PAYMENT PERIOD

Month Number of invoices paid late Value of invoices paid late

April 2015 1 R 24, 307.08

May 2015 1 R 129, 418.00

June 2015 0 0

July 2015 0 0

Total 2 R 153, 725.08

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2. The results can be attributed to the following actions; A circular under signature of the DG was distributed to all

NDOH staff to raise the awareness of invoices being paid within 30 days;

Monthly letters are being issued for signature of the DG to units responsible for late payments;

Orders are not being placed if bank details of service providers are not active on the system;

Funding are being confirmed before placing orders.


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3. The department is currently in process of procuring an invoice tracking system after funding was secured which

will further contribute in an reduction in late payments. The invoice tracking system will be used as an early warning system to flag all invoices reaching a preset number of days (e.g. 14 days).

4. It is trusted that the abovementioned input will suffice.

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The End

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presentation to the standing committee on appropriations 2015/16: quarter one performance director...

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