PRESENTATION OF THE NATIONAL DEPARTMENT OF HEALTH’S

ANNUAL REPORT FOR 2005/06

PORTFOLIO COMMITTEE ON HEALTH

CAPE TOWN

29 MAY 2007

2

1. FLOW OF PRESENTATION

VISION & MISSION

LEGISLATIVE MANDATES

KEY PRIORITIES OF THE NATIONAL HEALTH SYSTEM (NHS)

FOR 2004-2009

SUMMARY OF ACHIEVEMENTS & CHALLENGES PER BUDGET PROGRAMME, COMPARING PROGRESS BETWEEN 2004/05 AND 2005/06

BUDGET AND EXPENDITURE REPORT

KEY PRIORITIES AS REFLECTED IN THE NDOH STRATEGIC PLANS FOR 2006/07-2008/09 AND 2007/08-2009/10

CONCLUSIONS

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2. VISION & MISSION

VISION

AN ACCESSIBLE, CARING AND HIGH QUALITY HEALTH SYSTEM

MISSION

TO IMPROVE HEALTH STATUS THROUGH PREVENTION OF ILLNESS & DISEASE AND THROUGH THE PROMOTION OF HEALTHY LIFESTYLES AND TO CONSISTENTLY IMPROVE THE HEALTH CARE DELIVERY SYSTEM BY FOCUSING ON ACCESS, EQUITY, EFFICIENCY, QUALITY AND SUSTAINABILITY

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3. LEGISLATIVE MANDATES

51 ACTS MENTIONED IN THE NDOH ANNUAL REPORT 2005/06 INCLUDING:

THE CONSTITUTION OF THE REPUBLIC NATIONAL HEALTH ACT OF 2003 PUBLIC FINANCE MANAGEMENT ACT OF 1999 NURSING ACT OF 2005 MEDICINES & RELATED SUBSTANCES ACT MEDICAL SCHEMES ACT OF 1998 TOBACCO PRODUCTS CONTROL AMENDMENT

ACT OF 1999

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4. BUDGET PROGRAMME STRUCTURE OF THE NDOH IN 2005/06

PROGRAMME 1: ADMINISTRATION

PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

PROGRAMME 3: HEALTH SERVICE DELIVERY

PROGRAMME 4: HUMAN RESOURCES

NB. BUDGET PROGRAMME STRUCTURE CHANGED BETWEEN 2004/05 AND 2005/06, WITH PROGRAMMES SUCH AS DISTRICTS AND DEVELOPMENT AND HIER MOVING FROM PROGRAMME 2 TO PROGRAMME 3

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5. KEY NHS PRIORITIES FOR 2004-2009

1. IMPROVE GOVERNANCE & MANAGEMENT OF THE NHS

2. PROMOTE HEALTHY LIFESTYLES

3. CONTRIBUTE TOWARDS HUMAN DIGNITY BY IMPROVING QUALITY OF CARE

4. IMPROVE MANAGEMENT OF COMMUNICABLE & NON-COMMUNICABLE DISEASES

5. STRENGTHEN PHC, EMS AND HOSPITAL SERVICE DELIVERY SYSTEMS

6. STRENGTHEN SUPPORT SERVICES

7. HUMAN RESOURCE PLANNING, MANAGEMENT AND DEVELOPMENT

8. PLANNING, BUDGETING AND MONITORING & EVALUATION

9. PREPARATION AND IMPLEMENTATION OF LEGISLATION

10. STRENGTHEN INTERNATIONAL RELATIONS

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6. SUMMARY OF ACHIEVEMENTS

6.1. PROGRAMME 1: ADMINISTRATION

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

DEVELOPMENT OF HEALTH LEGISLATION

8 BILLS PROCESSED DURING 2004/05. NATIONAL HEALTH ACT OF 2003 ALSO SIGNED INTO LAW

5 BILLS PROCESSED DURING 2005/06

STRENGTHENING COMMUNICATION WITH PROVINCIAL & NATIONAL STAKEHOLDERS

NATIONAL CONSULTATIVE HEALTH FORUM (NCHF) HOSTED IN DECEMBER 2005

RANGE OF PUBLICATIONS PRODUCED

NCHF HOSTED IN MAY 2006

18 MINISTERIAL IZIMBIZO HELD

RANGE OF PUBLICATIONS PRODUCED

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6. SUMMARY OF ACHIEVEMENTS

6.1. PROGRAMME 1: ADMINISTRATION

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

STRENGTHENING HEALTH SECTOR PLANNING

PROVINCIAL ANNUAL PERFORMANCE PLANS (APPs) FOR 2005/06 REVIEWED

ANNUAL REPORTS

FOR 2004/05 REVIEWED

DISTRICT HEALTH PLANNING (DHP) GUIDELINES REVISED BY MARCH 2005

APPs FOR 2006/07 AND ANNUAL REPORTS FOR 2005/06 REVIEWED

8/9 PROVINCES PRODUCED SERVICE TRANSFORMATION PLANS (STPs) FOR 2007/08

DHP GUIDELINES PUBLISHED BY JULY 2005 AND USED BY 53 DISTRICTS TO DEVELOP DISTRICT PLANS FOR 2006/07.

DESPITE GOOD PROGRESS, QUALITY OF MOST DHPs NEEDS FURTHER STRENGTHENING.

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6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

EXPANSION OF THE IMPLEMENTATION OF INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) STRATEGY

ALL 53 DISTRICTS IMPLEMENTING IMCI

IMCI CASCADED TO 136 OF 284 LOCAL MUNICIPALITIES (EXPANDED TO SUB-DISTRICTS)

TRAINING OF HEALTH WORKERS IN THE IMCI STRATEGY

64% OF HEALTH WORKERS PROVIDING SERVICES TO CHILDREN TRAINED IN IMCI

60% OF THOSE WHO PROVIDE SERVICES TO CHILDREN TRAINED IN IMCI

IMPROVING IMMUNISATION COVERAGE

NATIONAL IMMUNISATION COVERAGE OF 82% ATTAINED

NATIONAL IMMUNISATION COVERAGE OF 82% ATTAINED

IMPROVING IMMUNISATION COVERAGE AT DISTRICT LEVEL

37/53 DISTRICTS (69%) OF DISTRICTS HAVE MORE THAN 80% IMMUNISATION COVERAGE

12/53 DISTRICTS (23%) OF DISTRICTS HAVE MORE THAN 90% IMMUNISATION COVERAGE

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6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

NATIONAL DOH ACHIEVEMENTS

JECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

EXPANSION OF SCHOOL HEALTH SERVICES

30% OF PROVINCES WITH 100% OF DISTRICTS PROVIDING PHASE 1 OF SCHOOL SERVICES

72% OF DISTRICTS PROVIDE PHASE 1 OF SCHOOL HEALTH SERVICES

IMPROVING WOMEN’S ACCESS TO CHOICE ON TERMINATION OF PREGNANCY (CTOP) SERVICES

55% OF APPROVED FACILITIES PROVIDED CTOP

60% OF APPROVED FACILITIES PROVIDED CTOP

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6. SUMMARY OF ACHIEVEMENTS6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

STRENGTHENING PREVENTION OF HIV AND STIs

347 MILLION MALE CONDOMS AND OVER 1 MILLION FEMALE CONDOMS DISTRIBUTED

413 MILLION MALE CONDOMS & OVER 2 MILLION FEMALE CONDOMS DISTRIBUTED

EXPANSION OF VOLUNTARY COUNSELLING AND TESTING (VCT) AND PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) SERVICES

80% OF PUBLIC HEALTH FACILITIES OFFERED VCT

60% OFFERED PMTCT

88% OF FACILITIES OFFERED VCT

87% OFFERED PMTCT

EXPANDING THE COMPREHENSIVE PLAN FOR HIV &AIDS CARE, TREATMENT AND MANAGEMENT (CCMT)

139 CCMT SITES ESTABLISHED

210 CCMT SITES ESTABLISHED

65% OF PEOPLE LIVING WITH HIV&AIDS, TB AND OTHER CONDITIONS PROVIDED WITH NUTRITIONAL SUPPORT

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6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

STRENGTHENING TB CONTROL

50/53 HEALTH DISTRICTS IMPLEMENTING DOTS STRATEGY

53/53 HEALTH DISTRICTS IMPLEMENTING DOTS STRATEGY

TB SMEAR CONVERSION RATE OF 61% ATTAINED

(TARGET 70%)

TB SMEAR CONVERSION RATE OF 62.8% ATTAINED (TARGET 70%)

10.3% OF TB PATIENTS DEFAULTING PATIENTS

9.9% OF TB PATIENTS DEFAULTING PATIENTS

TB CURE RATE OF 50.8% ATTAINED

(TARGET = 65%)

TB CURE RATE OF 56.2% ATTAINED (TARGET = 65%)

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6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

ENHANCING COLLABORATION WITH NGOs IN CURBING HIV AND AIDS

74 NGOs FUNDED WITH CLOSE MONITORING

ABOUT 70 NGOs FUNDED WITH CLOSE MONITORING

EXPANDING INTERNATIONAL HEALTH RELATIONS

DIVERSE BILATERAL AND TRILATERAL AGREEMENTS WERE SIGNED INCLUDING THOSE WITH IRAN, RWANDA, MALI, INDIA AND BRAZIL

DIVERSE BILATERAL AND TRILATERAL AGREEMENTS WERE SIGNED INCLUDING: PROGRAMME OF ACTION WITH DRC AND NIGERIA ON TRADITIONAL MEDICINE; 24 CONTRACTS FOR RECRUITMENT OF IRANIAN DOCTORS; THROUGH DFID, UK GOVERNMENT PROVIDED R90 MILLION FOR THE COMPREHENSIVE PLAN FOR HIV AND AIDS; SA-CHINA MOU; ETC.

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6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

IMPROVING ACCESS TO SAFE AND AFFORDABLE MEDICINES

100% OF NEW PHARMACIES LICENSED IN LINE WITH THE NEW PHARMACY ACT

70% OF PHARMACY LICENCES ISSUED AGAINST APPLICATIONS RECEIVED

APPROPRIATE DISPENSING FEE PUBLISHED BUT UNDER CHALLENGE

MEDICINE PRICING REGULATIONS REVIEWED

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6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

STRENGTHENING MALARIA CONTROL

9 PROVINCES WITH EPIDEMIC PREPAREDNESS AND INTEGRATED RESPONSE FUNCTIONS

9 PROVINCES WITH EPIDEMIC PREPAREDNESS AND INTEGRATED RESPONSE (EPR) FUNCTIONS

EPR GUIDELINES FINALISED AND USED BY PROVINCES

ALL 3 MALARIA AFFECTED PROVINCES (KWAZULU-NATAL, LIMPOPO & MPUMALANGA) IMPLEMENTED RECOMMENDATIONS FROM THE ROLL BACK MALARIA STRATEGY

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6. SUMMARY OF ACHIEVEMENTS

6.3. PROGRAMME 3: HEALTH SERVICE DELIVERY

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

INCREASING ACCESS TO AND UTILISATION OF PHC SERVICES

PHC UTILISATION RATE OF 2.1. VISITS

PHC UTILISATION RATE OF 2.2 VISITS

35/53 DISTRICTS PROVIDE A FULL BASKET OF PHC SERVICES

48/53 DISTRICTS PROVIDE A FULL BASKET OF PHC SERVICES

PHC HEADCOUNT OF 97, 993, 394 ATTAINED IN 2004/05

PHC HEADCOUNT OF

101,758,377 ATTAINED IN 2005/6

PHC SUPERVISION RATE OF 60% ATTAINED

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6. SUMMARY OF ACHIEVEMENTS

6.3. PROGRAMME 3: HEALTH SERVICE DELIVERY

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

EXPANSION OF THE HOSPITAL REVITALISATION PROGRAMME

3 HOSPITALS COMPLETED NAMELY:

(CALVINIA & COLESBURG IN THE NORTHERN CAPE; PIET RETIEF IN MPUMALANGA)

5 HOSPITALS COMPLETED

NAMELY: (LEBOWAKGOMO &

JANE FURSE IN LIMPOPO; MARY THERESA IN THE EASTERN CAPE; GEORGE HOSPITAL IN WESTERN CAPE & SWARTRUGGENS IN THE NORTH WEST)

11% OF HOSPITALS ARE PART OF THE HOSPITAL REVITALISATION PROGRAMME

12% OF HOSPITALS ARE PART OF THE HOSPITAL REVITALISATION PROGRAMME (I.E. 46 HOSPITALS)

DELEGATION OF AUTHORITY TO

HOSPITAL MANAGERS 

ALL 9 PROVINCES DELEGATED AUTHORITY TO HOSPITAL CEOs

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6. SUMMARY OF ACHIEVEMENTS

6.3. PROGRAMME 3: HEALTH SERVICE DELIVERY

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

EXPANDING ACCESS TO TELEMEDICINE

12% OF HOSPITALS HAVE TELEMEDICINE FACILITIES

ADDITIONAL TELEMEDICINE SITES ESTABLISHED IN EC & MP

TRANSFER OF FORENSIC LABS AND MORTUARIES TO PROVINCIAL DOHs

8 PROVINCIAL BUSINESS PLANS DEVELOPED FOR THE TRANSFER OF FORENSIC LABS AND MORTUARIES FROM SAPS TO DOHs

TRANSFER OF FORENSIC LABS AND MORTUARIES TO DOHs COMPLETED

EXPANSION OF THE CATARACT SURGERY PROJECT

CATARACT SURGERY RATE OF 1039 OPERATIONS PER MILLION PEOPLE ATTAINED (TARGET 950 PER MILLION)

CATARACT SURGERY RATE OF 1030 OPERATIONS PER MILLION PEOPLE ATTAINED (TARGET 1000 PER MILLION)

NATIONAL HEALTH REPORTS PUBLISHED

ANTENATAL SURVEY; SADHS; CONFIDENTIAL INQUIRIES INTO MATERNAL DEATHS

UNGASS REPORT COMPLETED;

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6. SUMMARY OF ACHIEVEMENTS

6.4. PROGRAMME 4: HUMAN RESOURCES MANAGEMENT

NATIONAL DOH OBJECTIVES AND INTERVENTIONS

ACHIEVEMENTS

2004/05 2005/06

DEVELOPMENT OF A NATIONAL HUMAN RESOURCES (HR) FOR HEALTH PLAN

DRAFT HR PLAN DEVELOPED AND CONSULTATION PROCESS COMPLETED

HR PLAN LAUNCHED IN APRIL 2006

TRAINING OF HEALTH WORKERS TO IMPLEMENT THE COMPREHENSIVE PLAN FOR HIV &AIDS CARE, TREATMENT AND MANAGEMENT (CCMT)

MORE THAN 9 000 HEALTH WORKERS TRAINED TO IMPLEMENT THE CCMT

11 958 HEALTH WORKERS TRAINED IN THE IMPLEMENTATION OF CCMT (TARGET WAS 6 233)

EXPAND HEALTH SECTOR’S CONTRIBUTION TO THE EPWP PROGRAMME

CO-ORDINATION OF POLICY ON COMMUNITY CARE GIVERS WITH SOCIAL DEVELOPMENT COMPLETED

DRAFT REGULATIONS FOR CHWs DEVELOPED;

NATIONAL COMMUNITY HEALTH WORKER POLICY FRAMEWORK DEVELOPED

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7. CHALLENGES

POVERTY, UNEMPLOYMENT, LOW EDUCATION LEVELS, POOR TRANSPORT INFRASTRUCTURE, SOCIAL COHESION ISSUES

TRIPLE BURDEN OF DISEASE (COMMUNICABLE, NON-COMMUNICABLE, INJURIES AND TRAUMA)

LACK OF SUFFICIENT & SKILLED HUMAN RESOURCES FOR HEALTH (CLINICAL & MANAGEMENT LEVEL)

POOR HEALTH INFRASTRUCTURE

COMMUNITY MOBILISATION, PATIENT ADHERENCE ISSUES

8. BUDGET, EXPENDITURE AND AUDIT OUTCOMES FOR 2005/06

MR. F.G. MULLER (CFO)

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8.1. NATIONAL DEPARTMENT OF HEALTH

PROGRAMMES

Adjusted Estimate 2005/2006

R' 000

Actual 2005/2006

R' 000

DIFFERENCE 'R '000

PERCENTAGE %

Programme 1: Administration

Minister 843 837 6 0.71

Deputy Minister 685 680 5 0.73

Management 17,703 14,449 3,254 18.38

Corporate Services 116,677 113,596 3,081 2.64

S/Total Progm 1 Admin (excl Property Management ) 135,908 128,829 7,079 5.21

Property Management -

Total: Programme 1 135,908 128,829 7,079 5.21

Programme 2: Strategic Health Programmes

Maternal, Child and Women's Health 24,999 20,467 4,532 18.13

Medicines Regulatory Affairs 31,958 32,759 -801 -2.51

HIV and AIDS 137,359 144,950 -7,591 -5.53

Pharmaceutical Policy and Planning 30,649 21,462 9,187 29.97

Communicable Diseases 41,960 39,696 2,264 5.40

Total: Programme 2 266,925 259,334 7,591 2.84

BUDGET 2004 - 2008

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8.1. NATIONAL DEPARTMENT OF HEALTH

PROGRAMMES

Adjusted Estimate

2005/2006 R' 001

Actual 2005/2006

R' 000

DIFFERENCE 'R '000

PERCENTAGE %

Programme 3: Health Service Delivery

Non-communicable Diseases 47,777 41,401 6,376 13.35

Hospital Services 11,101 8,632 2,469 22.24

Health Economics 10,325 10,225 100 0.97

Health Information Research and Evaluation 33,199 31,529 1,670 5.03

PHC, Districts Health and Development 18,102 17,797 305 1.68

Office of the Standards of Compliance 11,627 11,579 48 0.41

Total: Programme 3 132,131 121,163 10,968 8.30

Programme 4: Human Resources

Human Resources 10,149 10,093 56 0.55

Bargaining Council and Employee Relations 5,835 3,097 2,738 46.92

International Health Liaison 40,238 18,834 21,404 53.19

Total: Programme 4 56,222 32,024 24,198 43.04

Total: Programmes 591,186 541,350 49,836 8.43

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8.2. NATIONAL DEPARTMENT OF HEALTH

PROGRAMMES

Adjusted Estimate

2005/2006 R' 001

Actual 2005/2006

R' 000 DIFFERENCE PERCENTAGE

Specificied Items:

Medical Research Council 179,304 179,304 - 0.00

Poverty Relief - - -

NHLS: (NICD) 32,267 32,267 - 0.00

NHLS: (NIOD) 27,949 27,949 - 0.00

Condom Purchases 108,000 62,000 46,000 42.59

Lovelife 37,000 36,999 1 0.00

Global Fund 15,400 13,000 2,400 15.58

Life Line 15,000 13,000 2,000 13.33

NGO Funding 52,314 49,745 2,569 4.91

Comprehensive Plan against HIV and AIDS 42,000 42,000 - 0.00

-

Total: Specifiec Items 509,234 456,264 52,970 10.40

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8.3. NATIONAL DEPARTMENT OF HEALTH

PROGRAMMES

Adjusted Estimate

2005/2006 R' 001

Actual 2005/2006

R' 000 DIFFERENCE PERCENTAGE

Conditional Grants:

Integrated Nutrition Programme 123,392 123,392

Comprehensive HIV and AIDS 1,150,108 1,150,108 - 0.00

Cholera Epidemic KwaZulu-Natal - - -

Drought Relief - - -

National Tertiary Services 4,709,386 4,709,386 - 0.00

Health Professions Training and Development 1,520,180 1,520,180 - 0.00

Hospital Revitalisation 1,105,427 1,105,427 - 0.00

Hospital Management and Quality Improvement 150,342 150,342 - 0.00

Forensic Pathology Services 93,606 93,606 - 0.00

Pretoria Academic - -

Total: Conditional Grants 8,852,441 8,852,441 - 0.00

TOTAL: NATIONAL DEPARTMENT OF HEALTH 9,952,861 9,850,055 102,806 1.03

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8.4. NATIONAL DEPARTMENT OF HEALTH

AUDIT OUTCOMES

1. Qualification – DORA

Reasons: Payments made prior to approval of

Business plans Difference between total amounts of

Business Plans and DORA applications Late and non submission of monthly

financial reports

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8.4. . NATIONAL DEPARTMENT OF HEALTH

1. Qualification – DORA (cont.)

Late and non submission of quarterly reports

Quarterly visits to provinces not always conducted

Appointment of monitoring staff happened late in the financial year.

28

8.5. NATIONAL DEPARTMENT OF HEALTH

2. Matters of Emphasis

Audit Committee – non functional Internal Audit – ineffective National Environmental Management Act –

non compliance, report not done Supply Chain Management Unit – not fully

operational.

29

9. KEY NHS PRIORITIES FOR 2006/07 & 2007/089

9.1. DEVELOP PROVINCIAL SERVICE TRANSFORMATION PLANS;

9.2. STRENGTHEN HUMAN RESOURCES;

9.3. IMPROVE QUALITY OF CARE;

9.4. STRENGTHEN INFRASTRUCTURE;

9.5. STRENGTHEN PRIORITY HEALTH PROGRAMMES

(HEALTHY LIFESTYLES, HIV PREVENTION, TB CRISIS MANAGEMENT, MCWH&N)

30

10. CONCLUSION

DESPITE MANY CHALLENGES THE DOH HAS SEEN PROGRESS IN HEALTH SERVICE DELIVERY IN 2005/06 (AND IN 2006/07)

WITH GUIDANCE FROM THE MINISTER AND DEPUTY MINISTER NDOH WILL WORK HARD TO ENSURE ACHIEVEMENT OF 2007/08 TARGETS

HOWEVER, CHANGES IN THE SOCIAL CONTEXTS IN WHICH OUR PEOPLE LIVE AND ADEQUATE RESOURCE AVAILABILITY FOR THE HEALTH SYSTEM (HUMAN RESOURCES & FINANCES) ARE KEY TO THE SUCCESSFUL IMPLEMENTATION OF THIS PLAN;

INTERSECTORAL COLLABORATION ACROSS GOVERNMENT AND WITH KEY STAKEHOLDERS ARE CRUCIAL;

ONCE THE MINISTER HAS TABLED THE ANNUAL REPORT FOR 2006/07 IN PARLIAMENT IN SEPTEMBER 2007, THE NATIONAL DOH WILL RETURN TO PRESENT IT TO THE PORTFOLIO COMMITTEE.