1 PRESENTATION TO THE NATIONAL PORTFOLIO COMMITTEE ON HEALTH 14 May 2002 9:00 – 10:00 NORTHERN...

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PRESENTATION TO THE NATIONAL PORTFOLIO COMMITTEE ON HEALTH

14 May 20029:00 – 10:00

NORTHERN NORTHERN PROVINCEPROVINCE

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Contents:Contents:

IntroductionIntroduction Expenditure Trends: 1999/00 – 2004/05Expenditure Trends: 1999/00 – 2004/05 Expenditure Trends: 2001/02 – 2004/05Expenditure Trends: 2001/02 – 2004/05 Achievements on Strategic Service Achievements on Strategic Service

AreasAreas Priorities for the 2002/03 Financial Year Priorities for the 2002/03 Financial Year

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DEMOGRAPHY

NP12.1%

WC9.7%

NC8.3%

MP6.9%

FS6.5%NC

2.1%KZN

20.7%

GP18.1%

EC15.5%

TOTAL POPULATION = 5.8 Million

(DWAF, CWSS Study, 2000)

89% OF THE POPULATION LIVE IN

RURAL AREAS.

54.3% 0F THE POPULATION ARE

WOMEN

36.9% 0F THE POPULATION AGED

LITERACY RATE FOR 20 YRS &

OLDER PEOPLE WAS 63.1 % IN 1996

46% UNEMPLOYMENT RATE

GDP CONTRIBUTION = 4.2 % IN

1996

6 DISTRICTS

44 HOSPITALS & 477 CLINICS

POPULATION DISTRIBUTION

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HEALTH STATUS HEALTH STATUS INDICATORSINDICATORS

MORTALITY RATES INFANT MORTALITY RATE DECREASED FROM 57 IN 1994 TO 37.2 PER 1 000 LIVE

BIRTHS IN 2001 UNDER FIVE MORTALITY RATE DECREASED FROM 83 IN 1994 TO 53 PER 1 000 LIVE

BIRTHS IN 2001 MATERNAL MORTALITY RATE = DROPPED FROM 53 TO 30 PER 100 000 LIVE BIRTHS

IN SAME PERIOD HIV PREVALENCE RATE INCREASED FROM 3.04 % IN 1994 TO 13.2 % IN 2001

MORBIDITY RATES REPORTED CASES OF TB = 40 PER 100 000 POPULATION REPORTED CASES OF MALARIA=65 PER 100 000 POPULATION REPORTED CASES OF TYPHOID = 1.7 PER 100 000 POPULATION REPORTED CASES OF MEASLES= 5.6 PER 100 000 POPULATION REPORTED CASES OF VIRAL HEPATITIS= 2.7 PER 100 000 POPULATION

NUTRITIONAL STATUS WASTING = CHANGED FROM 3.8 IN 1994 TO 7.5 IN 2001 STUNTING = CHANGED FROM 34.2 IN 1994 TO 23.1 % IN 2001 UNDER WEIGHT INCREASED FROM 10.4 TO 15.0 IN THE SAME PERIOD IMMUNISATIN COVERAGE INCRESED FROM 50 % IN 1994 TO 60 % IN 2001.

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VISIONVISION

““A CARING AND DEVELOPMENTAL A CARING AND DEVELOPMENTAL HEALTH AND WELFARE SYSTEM HEALTH AND WELFARE SYSTEM WHICH PROMOTES WELL BEING, WHICH PROMOTES WELL BEING, SELF RELIANCE AND A HUMAN SELF RELIANCE AND A HUMAN SOCIETY IN WHICH ALL PEOPLE IN SOCIETY IN WHICH ALL PEOPLE IN THE NORTHERN PROVINCE HAVE THE NORTHERN PROVINCE HAVE ACCESS TO AFFORDABLE AND ACCESS TO AFFORDABLE AND GOOD QUALITY SERVICES!”GOOD QUALITY SERVICES!”

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MISSION MISSION STATEMENT STATEMENT ‘‘THE DEPARTMENT IS COMMITTED TO THE DEPARTMENT IS COMMITTED TO

PROVIDING COMPREHENSIVE, PROVIDING COMPREHENSIVE, INTEGRATED AND EQUITABLE INTEGRATED AND EQUITABLE HEALTH AND WELFARE SERVICES HEALTH AND WELFARE SERVICES WHICH ARE SUSTAINABLE, COST WHICH ARE SUSTAINABLE, COST EFFECTIVE AND FOCUS ON THE EFFECTIVE AND FOCUS ON THE DEVELOPMENT OF HUMAN DEVELOPMENT OF HUMAN POTENTIAL IN PARTNERSHIP WITH POTENTIAL IN PARTNERSHIP WITH RELEVANT STAKEHOLDERS’ RELEVANT STAKEHOLDERS’

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Core FunctionsCore Functions· · Provide Provide RRegional and egional and SSpecialised hospital services pecialised hospital services && AAcademic cademic

Health ServicesHealth Services· Render and co-ordinate Medical Emergency Services · Render and co-ordinate Medical Emergency Services · · RRender Medico-legal services.ender Medico-legal services.· Quality control of all health services and facilities.· Quality control of all health services and facilities.· Formulate and implement provincial health policies, norms, · Formulate and implement provincial health policies, norms,

standards and legislation.standards and legislation.· · Develop & Manage District Health Services Develop & Manage District Health Services· Provide technical and logistical support to health districts.· Provide technical and logistical support to health districts.· Render specific provincial services programmes, e.g. TB · Render specific provincial services programmes, e.g. TB

programme.programme.· Provide non-personal health services.· Provide non-personal health services.· Provide and maintain· Provide and maintain Health Care Technologies. Health Care Technologies.• Research on, monitor and evaluate health services/programmes.Research on, monitor and evaluate health services/programmes.

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Strategic PrioritiesStrategic Priorities

• TB/STD/HIV/AIDS & other TB/STD/HIV/AIDS & other CCcommunicable diseasescommunicable diseases• Maternal, Child, Women, Youth & Adolescence HealthMaternal, Child, Women, Youth & Adolescence Health• Integrated Poverty AlleviationIntegrated Poverty Alleviation• Health Promotion Health Promotion • District Health Development & Primary Health CareDistrict Health Development & Primary Health Care• Hospital RevitalisationHospital Revitalisation• Health Planning, Logistics & Support ServicesHealth Planning, Logistics & Support Services• Quality of CareQuality of Care• Mental, Chronic, Disabilities & Geriatric HealthMental, Chronic, Disabilities & Geriatric Health• Communication, Collaboration & Community ParticipationCommunication, Collaboration & Community Participation. . • DeDeveloveloppment of a Medical School ment of a Medical School

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Summary of Expenditure & Estimates Summary of Expenditure & Estimates 1999 - 2004/051999 - 2004/05

ProgrammeProgramme 1999/001999/00

ActualActual2000/012000/01


Est.. Est.. actualactual

2002/032002/03

VotedVoted2003/042003/04

MTEFMTEF2004/052004/05

MTEFMTEF

Health Admin Health Admin 127,810127,810 170,337170,337 191,581191,581 189,477189,477 195,450195,450 201,733201,733

District HealthDistrict Health 1,249,4391,249,439 1,392,9911,392,991 1,476,9021,476,902 1,596,5261,596,526 1,728,8131,728,813 1,885,0111,885,011

Reg. & Special. Reg. & Special. HospitalsHospitals

514,152514,152 600,209600,209 631,042631,042 655,618655,618 687,172687,172 741,580741,580

Health SciencesHealth Sciences 58,89658,896 73,61773,617 98,31098,310 107,360107,360 118,026118,026 138,914138,914

Health Care Health Care SupportSupport

141,273141,273 165,190165,190 168,428168,428 178,370178,370 189,410189,410 201,476201,476

Health FacilitiesHealth Facilities 128,944128,944 163,516163,516 125,638125,638 186,072186,072 190,212190,212 225,701225,701

TotalTotal 2,220,5142,220,514 2,565,8602,565,860 2,718,9012,718,901 2,913,4222,913,422 3,109,0833,109,083 3,394,4153,394,415

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Summary of Expenditure & Estimates by Std Items 1999 – Summary of Expenditure & Estimates by Std Items 1999 – 2004/052004/05

Standard Item Standard Item 1999/001999/00 2000/012000/01 2001/02001/022

2002/032002/03 2003/02003/044

2004/052004/05

Personnel ExpenditurePersonnel Expenditure

Administrative Administrative Expendit. Expendit.

Stores & LivestockStores & Livestock

Equipment CurrentEquipment Current

Equipment Capital Equipment Capital

Land & Buildings: Land & Buildings: CurrentCurrent

Profess. & Special Profess. & Special Serv: CurServ: Cur

Prof. & Special Serv: Prof. & Special Serv: CaptCapt

Transfer Payment: Transfer Payment: CurrentCurrent

Transfer Payment: Transfer Payment: CapitalCapital

Miscellaneous Miscellaneous

1,505,0031,505,003

55,79755,797

251,488251,488

31,43531,435

10,69010,690

159,612159,612

127,736127,736

54,29454,294

1,2081,208

23,27223,272

1,626,2851,626,285

88,06288,062

283,467283,467

35,63535,635

76,99076,990

199,268199,268

150,860150,860

91,54991,549

13,77813,778

1,698,951,698,9566

1 1 03,24603,246

295,263295,263

43,85543,855

100,442100,442

8,0008,000

211,221211,221

140,638140,638

113,848 113,848

3,4323,432

1,876,3661,876,366

110,011110,011

312,230312,230

44,34044,340

74,59674,596

8,4048,404

229,272229,272

152,072152,072

106,000106,000

3,1313,131

2,048,432,048,4366

111,401111,401

325,420325,420

37,09337,093

74,01474,014

8,6408,640

236,435236,435

156,212156,212

108,000108,000

3,4323,432

2,186,9352,186,935

154,169154,169

378,572378,572

40,07940,079

69,15969,159

9,3329,332

249,036249,036

191,701191,701

112,000112,000

3,4323,432

Total CurrentTotal Current 2,080,902,080,9044

2,338,042,338,0444

2,477,82,477,82121

2,689,752,689,7544

2,878,82,878,85757

3,133,553,133,5555

Total Capital Total Capital 139,634139,634

227,850227,850

241,080241,080

223,668223,668

230,226230,226

260, 260, 860860

Total Standard Total Standard Items Items

2,220,532,220,5388

2,565,892,565,8944

2,718,92,718,90101

2, 2, 913,422913,422

3,109,03,109,08383

3,394,413,394,4155

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Equitable Share & Conditional Equitable Share & Conditional Grants Grants

RevenueRevenue

R’000R’000

99/0099/00



Est. Est. ActualActual

2002/032002/03


MTEFMTEF2004/052004/05

MTEFMTEF

Equitable Equitable ShareShare

ConditionConditionalal

Grants Grants

1,955,71,955,73939

264,77264,7755

2,287,472,287,4744

278,386278,386

2,384,552,384,5511

334,350334,350

2,573,072,573,0755

309,627309,627

2,758,702,758,7055

350,373350,373

2,993,882,993,8811

400,534400,534

TotalTotal

Revenue Revenue 2,220,52,220,51414

2,565,862,565,8600

2,718,902,718,9011

2,913,422,913,4222

3,109,083,109,0833

3,394,413,394,4155

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Departmental Revenue Collection 1999 – Departmental Revenue Collection 1999 – 2004/052004/05

RevenueRevenue

R’000R’0001999/001999/00

Actual Actual 2000/012000/01


Est. Est. Actual Actual

2002/032002/03


MTEFMTEF2004/052004/05

MTEFMTEF

Revenue Revenue

CurrentCurrent

Non-Tax Non-Tax RevenueRevenue

Capital Capital RevenueRevenue

--

35,35735,357

--

--

63,74263,742

--

--

48,20048,200

--

--

51,25751,257

--

--

54,42954,429

--

--

58,10058,100

--

Total Total RevenueRevenue 35,35735,357 63,74263,742 48,20048,200 51,25751,257 54,42954,429 58,10058,100

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Personnel v/s Non-Personnel Expenditure Personnel v/s Non-Personnel Expenditure TrendsTrends

ItemItem 1999/01999/000

2000/02000/011

2001/02001/022

2002/02002/033

2003/02003/044

2004/02004/055

Pers. Pers. Exp. Exp.

1,505,001,505,0033

1,626,281,626,2855

1,698,951,698,9566

1,876361,8763666

2,048,432,048,4366

2,186,932,186,9355

Non - PENon - PE 450,736450,736

661,189661,189

685,596685,596

696,709696,709

710,269710,269

806,946806,946

Cond. Cond. GNTSGNTS

264, 264, 775775

278,386278,386

334,350334,350

309,627309,627

350,373 350,373

400,534400,534

TOTALTOTAL 2,220,512,220,5144

2,565,862,565,8600

2,718,902,718,9011

2,913,422,913,4222

3,109,083,109,0833

3,394,413,394,4155

Non-Personnel Expenditure for service delivery items has been declining in real terms whilst nominal increase has been below inflation rate.

Nominal growth of Non-PE between 2000/01 and 2001/02 was 3.70 %

Nominal growth of Non – PE between 2001/02 and 2002/03 was 1.62 %

Nominal growth of Non – PE between 2002/03 and 2003/04 is 1.95 %

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Fiscal Equity IssuesFiscal Equity Issues

The Budget for PHC: The Budget for PHC: increased from 49.2 % in increased from 49.2 % in 1996/97 to 54.3 % in 2001/021996/97 to 54.3 % in 2001/02

Population served by Public Sector:Population served by Public Sector:• By 1999, NP had 92.4 % people without Medical Aids Cover.By 1999, NP had 92.4 % people without Medical Aids Cover.

Per capita Health Expenditure:Per capita Health Expenditure:• NP showed an average decline of – 15.7% from 1996 – 1999/00 NP showed an average decline of – 15.7% from 1996 – 1999/00 • NP is the second lowest.. By 1999, NP had NP is the second lowest.. By 1999, NP had R483R483/person, which /person, which

was about half of Gauteng’s was about half of Gauteng’s R913R913/person (SA Health Review, /person (SA Health Review, 2000)2000)

• By 1997, NP was spending By 1997, NP was spending R24/personR24/person on medicines on medicines compared to the National average of compared to the National average of R42R42/person/person & & currently NP spends currently NP spends R35.60/personR35.60/person which = which = 3 times less3 times less than that of Gauteng. than that of Gauteng.

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Fiscal Equity IssuesFiscal Equity Issues

Percentage Growth of the Health Budget:Percentage Growth of the Health Budget:• Has been consistently lower than National normHas been consistently lower than National norm• The department gets 16 % of the Social Cluster Budget compared The department gets 16 % of the Social Cluster Budget compared

to Education’s 44 % to Education’s 44 % • 16% is inflated as it includes Capital Works & is less than 19% 16% is inflated as it includes Capital Works & is less than 19% national national

averageaverage• The Budget shows The Budget shows nominal increasesnominal increases while in while in real termsreal terms it is it is

declining as the bulk goes to declining as the bulk goes to Personnel ExpenditurePersonnel Expenditure which which increased from 53.59 % in 1995/96 to 64.62 in 2001/02 increased from 53.59 % in 1995/96 to 64.62 in 2001/02 while actual while actual staff Numbers are declining staff Numbers are declining ((from 24085 in 1998/99 to 23 310 in from 24085 in 1998/99 to 23 310 in 2001/022001/02))

• The Actual growth is experienced in Conditional Grants.The Actual growth is experienced in Conditional Grants.• Equity within NP and between Provinces still need to Equity within NP and between Provinces still need to

improve as demonstrated by the above Tables & notes. improve as demonstrated by the above Tables & notes.

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SUMMARY OF BUDGET AND EXPENDITURE PER SUMMARY OF BUDGET AND EXPENDITURE PER PROGRAMME FOR 2001/02 TO 2004/05PROGRAMME FOR 2001/02 TO 2004/05

PROGRAMME BUDGET EXPENDITURE VARIANCES BUDGET BUDGET BUDGETFOR FOR FOR FOR FOR FOR

2001/02 2001/02 2001/02 2002/03 2003/04 2004/05

1 2 3 4 5 7 8

EXPENDITURE R'000 R'000 R'000 R'000 R'000 R'000

1. HEALTH ADMIN. 172,682 153,148 19,534 189,477 195,450 201,733

2. DISTRICT HEALTH SERV. 1,480,801 1,460,487 20,314 1,596,525 1,728,813 1,885,011

3. REG. & SPEC. HOSP 633,855 617,674 16,181 655,618 687,172 741,580

4. HEALTH SCIENCES 95,497 77,064 18,433 107,360 118,026 138,914

5. HEALTH CARE SUPPORT 183,428 176,237 7,191 178,370 189,410 201,476

6. HEALTH FAC, DEV. & M 152,638 179,919 -27,281 186,072 190,212 225,701

TOTAL EXPENDITURE 2,718,901 2,664,529 54,372 2,913,422 3,109,083 3,394,415

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SUMMARY OF BUDGET AND EXPENDITURE PER SUMMARY OF BUDGET AND EXPENDITURE PER STANDARD ITEM FOR 2001/02 TO 2004/05STANDARD ITEM FOR 2001/02 TO 2004/05

STANDARD ITEM BUDGET EXPENDITURE VARIANCES BUDGET BUDGET BUDGET

FOR FOR FOR FOR FOR FOR

2001/02 2001/02 2001/02 2002/03 2003/04 2004/05

1 2 3 4 5 7 8

EXPENDITURE R'000 R'000 R'000 R'000 R'000 R'000

1. PERSONNEL EXP. 1,719,530 1,737,623 -18,093 1,876,363 2,048,436 2,186,935

2. ADMINISTRATIVE 110,000 95,040 14,960 110,011 111,401 154,169

3. STORES & LIVESTOCK 296,900 273,619 23,281 312,230 325,420 378,572

4. EQUIPMENT 116,312 67,804 48,508 115,936 111,107 109,238

5. LAND & BUILDINGS 8,500 6,475 2,025 8,404 8,640 9,332

6. PROFESSIONAL SER 341,622 390,473 -48,851 381,344 392,647 440,737

7. TRANSFER PAY 124,657 92,578 32,079 106,000 108,000 112,000

8. MISCELLANEOUS 1,380 917 463 3,131 3,432 3,432

TOTAL EXPENDITURE 2,718,901 2,664,529 54,372 2,913,422 3,109,083 3,394,415

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REVENUE ESTIMATESREVENUE ESTIMATES

BUDGET COLLECTED VARIANCES BUDGET BUDGET BUDGETFOR FOR FOR FOR FOR FOR

DISCRIPTIONS 2001/02 2001/02 2001/02 2002/03 2003/04 2004/05

1 2 3 4 5 6 7EXPENDITURE R'000 R'000 R'000 R'000 R'000 R'000

1. HOSPITAL FEES 42,209 41,787 -422 40,492 42,910 46,317

2. OTHER SOURCES 15,000 16,235 1,235 10,765 11,219 11,783

TOTAL REVENUE 57,209 58,022 813 51,257 54,129 58,100

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CONDITIONAL GRANTSCONDITIONAL GRANTS

BUDGET EXPENDITURE VARIANCES BUDGET BUDGET BUDGETFOR FOR FOR FOR FOR FOR

DISCRIPTIONS 2001/02 2001/02 2001/02 2002/03 2003/04 2004/05

1 2 3 4 5 6 7EXPENDITURE R'000 R'000 R'000 R'000 R'000 R'000

1. Intergrated Nutrition Prog 124,331 103,539 20,792 106,032 106,032 112,394

2. Redistributive Grant 79,008 50,250 28,758 44,838 45,116 45,545

3. Training and Research 33,551 23,483 10,068 34,113 41,827 58,041

4. Hospital Rehabilitation Grant 88,000 82,179 5,821 92,000 96,140 101,908

5. HIV/AIDS 7,458 2,275 5,183 15,371 28,228 43,050

6. Improv. Financial Management 4,000 2,882 1,118 9,000 12,000 12,720

TOTAL EXPENDITURE 336,348 264,608 71,740 301,354 329,343 373,658

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Expenditure Variances Analysis for Expenditure Variances Analysis for 2001/022001/02

Programme 1: Health AdminProgramme 1: Health Admin

Savings of R19,534m accrued from Austerity Measures placed on Savings of R19,534m accrued from Austerity Measures placed on Non-Personnel & a moratorium on Appointment of Staff aimed at Non-Personnel & a moratorium on Appointment of Staff aimed at bailing out projected over-expenditure in Personnel Expenditure.bailing out projected over-expenditure in Personnel Expenditure.

Programme 2: District Health & PHCProgramme 2: District Health & PHC

Saving of R20,314m is due to late transfer of rollovers of Cond. Saving of R20,314m is due to late transfer of rollovers of Cond. Grants (CGs) & unspent Cond. Grants resulting from failure to get Grants (CGs) & unspent Cond. Grants resulting from failure to get Tenders out in time for delivery of goods & payment before the Tenders out in time for delivery of goods & payment before the end of the Financial Year (FY). end of the Financial Year (FY).

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Programme 3: Regional & Specialised Hospitals:Programme 3: Regional & Specialised Hospitals:

Saving of R16,181m is due to late transfer of rollovers of Saving of R16,181m is due to late transfer of rollovers of Cond. Grants (CGs) & unspent budgets resulting from failure Cond. Grants (CGs) & unspent budgets resulting from failure to get Tenders out in time for delivery of goods & payment to get Tenders out in time for delivery of goods & payment before the end of the Financial Year (FY). before the end of the Financial Year (FY).

Programme 4: Health Sciences ServicesProgramme 4: Health Sciences Services

Saving of R18,433m is due to late transfer of rollovers of Prof. Saving of R18,433m is due to late transfer of rollovers of Prof. Training & research Grant & unspent budgets resulting from Training & research Grant & unspent budgets resulting from failure to get Tenders out in time for delivery of goods & failure to get Tenders out in time for delivery of goods & payment before the end of the Financial Year (FY). payment before the end of the Financial Year (FY).

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Programme 5: Health Care Support ServicesProgramme 5: Health Care Support Services

Savings of R7,191m accrued due to the Tender Board failing to Savings of R7,191m accrued due to the Tender Board failing to approve Specifications for the EMS Vehicles. The Tender will now be re-approve Specifications for the EMS Vehicles. The Tender will now be re-advertised. advertised.

Programme 6: Health Facilities Development & Programme 6: Health Facilities Development & MaintenanceMaintenance

An over-expenditure of R27,281m occurred as a result of a process An over-expenditure of R27,281m occurred as a result of a process whereby the Provincial Treasury suspended an allocation of R27,404m whereby the Provincial Treasury suspended an allocation of R27,404m from the budget earmarked for Professional Services under this from the budget earmarked for Professional Services under this progreamme in order to ‘bail out’ budget pressures elsewhere in the progreamme in order to ‘bail out’ budget pressures elsewhere in the province. province.

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Revenue Collection:Revenue Collection: There is an under-collection (variance) of R422m in Patient Fees compared to There is an under-collection (variance) of R422m in Patient Fees compared to

a set target of R42,209m. The under-collection is related to late payment by a set target of R42,209m. The under-collection is related to late payment by Health Funders for private Patients & MVA Claims as the private patients are Health Funders for private Patients & MVA Claims as the private patients are the main pool of UPFS (New Hospital Tariffs). Other fees showed a variance of the main pool of UPFS (New Hospital Tariffs). Other fees showed a variance of R1,235m as they are from sources which the department is able to control. R1,235m as they are from sources which the department is able to control.

Conditional GrantsConditional Grants: : Saving accrued in all CGs are mainly due to:Saving accrued in all CGs are mainly due to:

Late arrival and delayed access to Conditional Grants.Late arrival and delayed access to Conditional Grants. Delays in Tender Processes especially Public Works Department & Delays in Tender Processes especially Public Works Department &

Tender Board delays in approving Specifications and Contracts.Tender Board delays in approving Specifications and Contracts. Delays lead to purchase orders being released late thus delaying Delays lead to purchase orders being released late thus delaying

delivery & payments of goods and services received before the end delivery & payments of goods and services received before the end of FY in March. of FY in March.

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Service Implications for the 2002/03 Service Implications for the 2002/03 BudgetBudget

HR Mx: HR Mx: there is a R117m shortfall & this will limit the filling of there is a R117m shortfall & this will limit the filling of critical Posts critical Posts

DHS: DHS: has a R190m short fall; limiting improvement of security at has a R190m short fall; limiting improvement of security at clinicsclinics

EMS: EMS: has a R61m shortfall; limiting purchase of EMS Vehicles & has a R61m shortfall; limiting purchase of EMS Vehicles & Expnasion of New Stations to Rural Districts.Expnasion of New Stations to Rural Districts.

Hospital Revitalisation & Clinic Upgrading: Hospital Revitalisation & Clinic Upgrading: Almost no Almost no Funds for New ProjectsFunds for New Projects

Pharmaceuticals: Pharmaceuticals: possibility of over-spending due to possibility of over-spending due to Opportunistic Infections related to HIV/AIDS & hiking prices of Opportunistic Infections related to HIV/AIDS & hiking prices of medicinesmedicines

Revenue Collection: Revenue Collection: need to strengthen PPP to attract need to strengthen PPP to attract

Private Patients & effective management of Debtors Book. Private Patients & effective management of Debtors Book.

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Achievements on Strategic Service Achievements on Strategic Service AreasAreas

Programme 1: Health AdministrationProgramme 1: Health Administration Draft HR, Master Fraud Prevention & Vehicle Replacement Plans are Draft HR, Master Fraud Prevention & Vehicle Replacement Plans are

in place. in place. Cost Centre Responsibility Managers have HR & Financial Cost Centre Responsibility Managers have HR & Financial

DelegationsDelegations Policies are being finalised for 8 identified areas Policies are being finalised for 8 identified areas Compliance with EEA: Compliance with EEA: have achieved ratios of male/female of 70/30 at have achieved ratios of male/female of 70/30 at

Sen. Mx.; 58/42 at Mid. Mx.; 23/77 at Supervisory and 42/58 at lower levels. Sen. Mx.; 58/42 at Mid. Mx.; 23/77 at Supervisory and 42/58 at lower levels.

Constraints/challenges: Constraints/challenges: Need more funding for: Need more funding for: R120m for Filling critical Posts- R120m for Filling critical Posts- Clinics & HospitalsClinics & Hospitals (approved posts = 37 906 & (approved posts = 37 906 &

61 % filed)61 % filed) R20m for Rank & Leg PromotionsR20m for Rank & Leg Promotions Creation of incentives for retaining Staff in Limpopo.Creation of incentives for retaining Staff in Limpopo. Training & retention of PHC Nurses, Doctors & Allied Health Professionals.Training & retention of PHC Nurses, Doctors & Allied Health Professionals.

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Programme 2: District Health Services & PHCProgramme 2: District Health Services & PHC Devolution: Consultation taking place with LG, DoH & other Devolution: Consultation taking place with LG, DoH & other stakeholders.stakeholders. 6 Health District have aligned their boundaries with those of the District Councils. 6 Health District have aligned their boundaries with those of the District Councils. The Budget for PHCThe Budget for PHC: increased from 49.2 % in 1996/97 to 54.3 % in 2001/02: increased from 49.2 % in 1996/97 to 54.3 % in 2001/02 Number of clinics has increased from 302 to 477; 160 clinics have been Number of clinics has increased from 302 to 477; 160 clinics have been

upgraded & 183 clinics offer 24 hour service while the rest offer 8 – 12 hours.upgraded & 183 clinics offer 24 hour service while the rest offer 8 – 12 hours. Clinics are being designated as Cost Centres to improve efficiency in careClinics are being designated as Cost Centres to improve efficiency in care TB Cure Rates have increased from 33 % in ‘94 to 57 % in 2001 TB Cure Rates have increased from 33 % in ‘94 to 57 % in 2001 TB Treatment Failure Rate has decreased from 5 % in ’94 to 1.1 % in 2001TB Treatment Failure Rate has decreased from 5 % in ’94 to 1.1 % in 2001 Routine Immunisation Coverage increased from 50 % in ’94 to 60 % in 2001Routine Immunisation Coverage increased from 50 % in ’94 to 60 % in 2001 Immunisation Campaigns: Polio = 91% ; Measles = 100% in 2001Immunisation Campaigns: Polio = 91% ; Measles = 100% in 2001 28 Institutions are doing TOP & 4 447 TOPs were done from 1997 – 200128 Institutions are doing TOP & 4 447 TOPs were done from 1997 – 2001 127 Clinics are implementing IMCI & 510 Nurses trained in IMCI Policy 127 Clinics are implementing IMCI & 510 Nurses trained in IMCI Policy

27


HIV/AIDS: HIV/AIDS: a Full Directorate has been established.a Full Directorate has been established. A Provincial AIDS Council has been formed; A Provincial AIDS Council has been formed; Districts areDistricts are

finalising theirs. finalising theirs.

Lessons are being learnt from the 2 PMTCT Pilot Sites for Lessons are being learnt from the 2 PMTCT Pilot Sites for future planningfuture planning

A Draft PMTCT Expansion Plan is under consideration by A Draft PMTCT Expansion Plan is under consideration by Management Management

Have hostedHave hosted the Ministerial Meeting to brief NP about recent the Ministerial Meeting to brief NP about recent Cabinet Decision Cabinet Decision on HIV/AIDS. Superintendents , Matrons & District on HIV/AIDS. Superintendents , Matrons & District Managers benefited from these Managers benefited from these inputsinputs

About 8 million Condoms were distributed in 2001/02About 8 million Condoms were distributed in 2001/02 Funding is discussed under Budget trends and Statistics Funding is discussed under Budget trends and Statistics

are shown are shown at the backat the back

28

PMTCT Data from August 2001 to PMTCT Data from August 2001 to March 2002March 2002

For both Mankweng & Siloam Pilot Sites:For both Mankweng & Siloam Pilot Sites:

Of the 7 047 Women who attended PMTCT Clinics, 3 Of the 7 047 Women who attended PMTCT Clinics, 3 273 (46 %) consented to Volnt. Counselling & 1 489 273 (46 %) consented to Volnt. Counselling & 1 489 (45 %) did Voluntary Testing(45 %) did Voluntary Testing

290 (19%) tested positive; 1 196 (80 %) tested negative290 (19%) tested positive; 1 196 (80 %) tested negative 1 196 had post – counselling; 72 Mothers received 1 196 had post – counselling; 72 Mothers received

Nevirapine;Nevirapine; Number of Live Births was 432 ; 75 babies were given Number of Live Births was 432 ; 75 babies were given

NevirapineNevirapine 42 mothers excluded breastfeeding and 45 excluded 42 mothers excluded breastfeeding and 45 excluded

Formula Feeding. Formula Feeding.

29


Impact of Nutrition Conditional Grant:Impact of Nutrition Conditional Grant: PSNP is accessed by 2 649 Schools & 1.17 million PSNP is accessed by 2 649 Schools & 1.17 million

children are benefiting from feeding schemes.children are benefiting from feeding schemes. 121 Poverty Alleviation Projects have been established121 Poverty Alleviation Projects have been established

Challenges/Constraints: Challenges/Constraints: Critical posts for Clinics to be filled & Devolution of Critical posts for Clinics to be filled & Devolution of

services services R89m needed to improve Security Services at Clinics.R89m needed to improve Security Services at Clinics. Transport for PHC ServicesTransport for PHC Services

30


Programme 3: Regional & Specialised Programme 3: Regional & Specialised Hospitals:Hospitals:

A Hospital Revitalisation Plan is being implemented to: A Hospital Revitalisation Plan is being implemented to: decentralise hospital management & improve quality of decentralise hospital management & improve quality of carecare

Hospital CEOs are being appointed. Community Service Hospital CEOs are being appointed. Community Service Health Professionals are improving access to servicesHealth Professionals are improving access to services

HIS: HIS: 38 Hospital have live Unicare Hosp. Information System38 Hospital have live Unicare Hosp. Information System

PPP: PPP: 6 Regional Hospital & few district hospital are ready to 6 Regional Hospital & few district hospital are ready to

admit Private Patientsadmit Private Patients RECONSTRUCTION AND REHABILITATION GRANTRECONSTRUCTION AND REHABILITATION GRANT

424 projects 424 projects to the value of R70,4m have been completed.to the value of R70,4m have been completed.

31


Training & Research Grant:Training & Research Grant: Skills of Health Professionals are being developedSkills of Health Professionals are being developed Research Projects are being initiated on various health issuesResearch Projects are being initiated on various health issues

Redistribution of Specialised Services Grant:Redistribution of Specialised Services Grant: Development of Tertiary Services is going wellDevelopment of Tertiary Services is going well HPCSA has accredited the Tertiary Complex for training of some HPCSA has accredited the Tertiary Complex for training of some

specialities specialities

Referrals of patients to Gauteng has decreased by 50 %.Referrals of patients to Gauteng has decreased by 50 %.

Constraints/Challenges: Constraints/Challenges: R42.2m needed to address Capital Works Backlogs R42.2m needed to address Capital Works Backlogs Need to focus on improving Quality of Services & Health Need to focus on improving Quality of Services & Health

Technology ManagementTechnology Management

32


Programme 4: Health Science ServicesProgramme 4: Health Science Services A full Nursing Directorate has been established to oversee quality of A full Nursing Directorate has been established to oversee quality of

servicesservices Former homelands Nursing Colleges have been rationalised into one.Former homelands Nursing Colleges have been rationalised into one. A NP College of EMS has been established for training Emergency A NP College of EMS has been established for training Emergency

Care StaffCare Staff 60 more new Ambulances, 11 Rescue Vehicles and 6 Response Cars 60 more new Ambulances, 11 Rescue Vehicles and 6 Response Cars

have been purchased in 2001/02. have been purchased in 2001/02.

Constraints/Challenges: Constraints/Challenges: Decentralisation of PHC Traininf from HSDU to other DistrictsDecentralisation of PHC Traininf from HSDU to other Districts Decentralisation of EMS Stations to Rural Sub-districtsDecentralisation of EMS Stations to Rural Sub-districts Find a solution to poor management of EMS Fleet. Find a solution to poor management of EMS Fleet.

33


Programme 5: Health Care Support ServicesProgramme 5: Health Care Support Services Procurement & distribution of medicines has been out-Procurement & distribution of medicines has been out-

sourced.sourced. Distribution by a central Depot ensures 95 % medicines Distribution by a central Depot ensures 95 % medicines

availability at hospitals.availability at hospitals. Presence of Community Service Professionals improve Presence of Community Service Professionals improve

access to services.access to services.Constraints/Challenges: Constraints/Challenges: Low Per Capita spending on Medicines.Low Per Capita spending on Medicines. Increased utilisation of medicines for HIV Opportunistic Increased utilisation of medicines for HIV Opportunistic

Infections.Infections. Recruitment & retention of Allied Health ProfessionalsRecruitment & retention of Allied Health Professionals Slow process for Rationalisatipn of Laboratory Services Slow process for Rationalisatipn of Laboratory Services

into the National Laboratory Organogram.into the National Laboratory Organogram.

34


Programme 6: Health Facilities Programme 6: Health Facilities Development Development

424 Hospital projects have been completed.424 Hospital projects have been completed. 160 Clinics have been upgraded160 Clinics have been upgraded

Constraints/Challenges:Constraints/Challenges: A backlog of 132 Clinics that need upgrading at 20 Clinics A backlog of 132 Clinics that need upgrading at 20 Clinics

costing about costing about R42m R42m per year.per year.

Completion of Phase II of Hospital Capital Projects Completion of Phase II of Hospital Capital Projects

35

HIV PREVALENCE FROM HIV PREVALENCE FROM 1990-20001990-2000

NORTHERN PROVINCE VERSUS NATIONAL HIV PREVALENCE

0.53 0.55

3.044.89

7.96 8.2

11.4 11.4313.2

7.57

10.44

14.1716.01

22.8 22.423.5

4.12.56

4.25

2.421.350.76

0

5

10

15

20

25

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

YEARS

PREV

ALE

NC

E

N PROV NATIONAL

36

ANNUAL ANTENATAL HIV ANNUAL ANTENATAL HIV SEROPREVALENCE SURVEY RESULTSSEROPREVALENCE SURVEY RESULTS

1998 vs 1999 Provincial HIV Prevalences

5.2

9.911.5

5.9

21.322.5 22.8

30

32.5

22.8

7.1

10.111.4

18 18

23.9

27.3 27.9

32.5

22.4

0

5

10

15

20

25

30

35

Provinces

% P

reva

lenc

e

1998

1999

37


2000 HIV/SYPHILIS SEROPREVALENCE SURVEY RESULTS BY REGION

16.317.5

14.3

15.9

10.3

11.9

10.3

13.2

0

2

4

6

8

10

12

14

16

18

20

REGIONS

% P

REV

ALE

NCE

38


1999 VS 2000 HIV PREVALENCE

11.210.5

11.3

9.1

5.6

12.6

13.7 13.6

0

2

4

6

8

10

12

14

16

NO EDUCATION GRADE 1-7 TGRADE 8-12 TERTIARY

% P

REV

ALE

NCE

1999 2000

39

ANNUAL ANTENATAL HIV SEROPREVALENCE SURVEY ANNUAL ANTENATAL HIV SEROPREVALENCE SURVEY RESULTSRESULTS

1999 vs 2000 HIV PREVALNCE BY REGION

11

16.1 16

14.3

9

7

9.6

11.4

1617.3

14.3

15.9

10.3

11.9

10.2

13.2

0

2

4

6

8

10

12

14

16

18

20

REGIONS

% P

REV

ALE

NCE

1999

2000

40

TERMINATION OF PREGNANCY TERMINATION OF PREGNANCY SERVICESSERVICES

419

929

18431924

0

500

1000

1500

2000

2500

1997 1998 1999 2000

41

TOP 5 PREVALENT DISEASESTOP 5 PREVALENT DISEASES

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

42

Priorities for 2002/03: Priorities for 2002/03: Program. 1Program. 1

Planned ActivitiesPlanned Activities Targets & Time Targets & Time FramesFrames

BudgetBudget

1. Identification of Policies needing 1. Identification of Policies needing Review & DevelopmentReview & Development

Complete Five Policies Complete Five Policies by the end of 2002by the end of 2002

2. Implementation of HR Skills 2. Implementation of HR Skills AuditsAudits

Complete by June 2002 Complete by June 2002 2m2m

3. Implementation of Fleet Audits3. Implementation of Fleet Audits Complete by June 2002 Complete by June 2002 15m15m

4. Development of Procurement 4. Development of Procurement GuidelinesGuidelines

To be completed August To be completed August 2002 2002

Implement Computirised Assets Implement Computirised Assets Mx. Mx.

To be completed by July To be completed by July 20022002

1m1m

Implementation of UPFS Tariffs Implementation of UPFS Tariffs Cover all Facilities by Cover all Facilities by end F Yend F Y

Development of Standards for Development of Standards for Customer CareCustomer Care

Publish Standards by Publish Standards by July 2002July 2002

0,5m0,5m

43


Planned ActivitiesPlanned Activities Targets & Time FramesTargets & Time Frames BudgetBudget

1. Implementation of 1. Implementation of HIV/AIDS/STIs/TB Public HIV/AIDS/STIs/TB Public Awareness Campaigns Awareness Campaigns

Reach 100% of targeted Reach 100% of targeted communities by the end communities by the end of 2002 of 2002

25m25m

2. Expansion of PMTCT to Reg. 2. Expansion of PMTCT to Reg. HospitalsHospitals

Complete rollout by March Complete rollout by March 2003 2003

3. Implementation of MCWH3. Implementation of MCWH All clinics to offer MCWH & All clinics to offer MCWH & 10 more Dist. Hosps. To 10 more Dist. Hosps. To offer TOPoffer TOP

303,000303,000

4. Strengthening of Health 4. Strengthening of Health PromotionPromotion

30 HP Campaigns by end 30 HP Campaigns by end of 2002of 2002

0,5m0,5m

5. Increase Clinics offering 24 5. Increase Clinics offering 24 hour Servicehour Service

200 Clinics to offer 24 h 200 Clinics to offer 24 h service by March 2003service by March 2003

202m202m

6. Review & Development of 6. Review & Development of DHS Devolution GuidelinesDHS Devolution Guidelines

Complete Devolution Complete Devolution Guidelines by end of Guidelines by end of October 2002October 2002

50,00050,000

7. Expansion of EMS to Rural 7. Expansion of EMS to Rural Districts Districts

Establish 3 extra EMS Establish 3 extra EMS Stations Stations

39m39m

44



1. Development of 1. Development of Infrastructure to improve Infrastructure to improve access to services access to services

Complete Phase II of capital Complete Phase II of capital Works by the end of Works by the end of 2002/032002/03

2. Implementation of a 2. Implementation of a Referral System at all levels of Referral System at all levels of carecare

20 % reduction of district 20 % reduction of district hospital patients at Reg. hospital patients at Reg. Hosps. End of 2002 Hosps. End of 2002

3. Improvement of Quality of 3. Improvement of Quality of CareCare

50 % reduction of referrals 50 % reduction of referrals to Gauteng; reduction of to Gauteng; reduction of Waiting Period to 3 Hours Waiting Period to 3 Hours Hospitals. End FY Hospitals. End FY

4. Adoption of 2 Hospitals as 4. Adoption of 2 Hospitals as Best Mx. Practice Models for Best Mx. Practice Models for province province

Province to support the 2 Province to support the 2 Hospitals throughout Hospitals throughout 2002/03 2002/03

100,000100,000

5. Finalise Appointment of 5. Finalise Appointment of Hosp. CEOsHosp. CEOs

Complete process by Complete process by August 2002 August 2002

6. Improvement of Health 6. Improvement of Health Technology Management in Technology Management in the Provincethe Province

Complete development of Complete development of Provincial HT Guidelines by Provincial HT Guidelines by end FYend FY

45



1. Provision of adequate Nursing 1. Provision of adequate Nursing Human Resources to address Human Resources to address the needsthe needs

Curriculum Documents for Curriculum Documents for Level 1 Study to Level 1 Study to implemented by March implemented by March 2003.2003.

Fully utilise the capacity of Fully utilise the capacity of the Nursing College by end the Nursing College by end of 2002 of 2002

52m52m

2. Increase of EMS Practitioners2. Increase of EMS Practitioners 72 candidates to 72 candidates to successfully complete successfully complete training by March 2003training by March 2003

4.5m4.5m

46



1. Implementation of 1. Implementation of Mechanisms to ensure adequate Mechanisms to ensure adequate availability of Medicines at all availability of Medicines at all Facilities at all timesFacilities at all times

Availability of EDLs to be Availability of EDLs to be as follows: at Central as follows: at Central Warehouse = 95 %; Warehouse = 95 %; Hospitals = 95 % & Clinics Hospitals = 95 % & Clinics = 95 % by March 2003= 95 % by March 2003

177m177m

2. Preparations for Community 2. Preparations for Community Service for Allied Health Service for Allied Health Professionals Professionals

All identified Health All identified Health Facilities to be ready for Facilities to be ready for deployment of Community deployment of Community Service Personnel by Service Personnel by December 2002. December 2002.

47


Planned ActivitiesPlanned Activities Targets & Time Targets & Time FramesFrames

BudgetBudget

1. Implementation of Clinic 1. Implementation of Clinic Upgrading PlanUpgrading Plan

20 clinics to be 20 clinics to be upgraded by March 2003 upgraded by March 2003

40m40m

2. Provision of reliable and quality 2. Provision of reliable and quality water and electricity supply to water and electricity supply to clinics clinics

40 clinics to have water 40 clinics to have water supply and 65 clinics to supply and 65 clinics to be electrified by March be electrified by March 20032003

3. Completion of Capital Works 3. Completion of Capital Works projectsprojects

Phase II Projects to be Phase II Projects to be completed by March completed by March 20032003

112m112m

4. Implementation of Facilities 4. Implementation of Facilities Maintenance PolicyMaintenance Policy

All facilities to be All facilities to be maintained by end of maintained by end of 2002/032002/03

34m34m

48

Requested v/s Actual Allocated Requested v/s Actual Allocated Budget For 2002/03 Financial Year Budget For 2002/03 Financial Year

BUDGET ITEMBUDGET ITEM 2001/022001/02

ADJUSTEDADJUSTED

R’000R’000

2002/032002/03

REQUESTEDREQUESTED

R’000R’000

2002/032002/03

ALLOCATEDALLOCATED

R’000R’000

2002/032002/03

VARIANCE VARIANCE

R’000R’000

Personnel Personnel Cond. Cond. GrantGrant

Equitable Equitable

Non-PersonNon-Person..

Cond. Cond. GrantGrant

Equitable Equitable

R1,666,809R1,666,809 R0R0

R1,666,809R1,666,809

R1,065,794R1,065,794 R336,348R336,348

R729,446R729,446

R1,993,002R1,993,002 R0R0

R1,993,002R1,993,002

R1,258,750R1,258,750 R287,695R287,695

R971,055R971,055

R1,876,366R1,876,366 R6,400R6,400

R1,869,966R1,869,966

R1,037757R1,037757 R289,954R289,954

R747,803 R747,803

R - R - 116,636116,636 R6,400R6,400

R – R – 123,036123,036

R – R – 220,993220,993 R2,259R2,259

R – R – 223,252 223,252

PersonnelPersonnel Cond. Cond. GrantGrant

Equitable Equitable

R2,732,603R2,732,603 R336,348R336,348

R2,396,255 R2,396,255

R3,251,752R3,251,752 R 287,695R 287,695

R2,964,057R2,964,057

R2,914,123R2,914,123

R296,354R296,354

R2,617,769R2,617,769

R – R – 337,629337,629 R8,659R8,659

R – R – 346,288346,288

49

THE ENDTHE END

I I

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1 PRESENTATION TO THE NATIONAL PORTFOLIO COMMITTEE ON HEALTH 14 May 2002 9:00 – 10:00 NORTHERN...

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