Presentation to the Select Committee on Social Services Annual Performance Plan and Budget –...

Presentation to the Select Committee on Social Services

Annual Performance Plan and Budget – National Department of

Health 2013/14-2015/16

23 APRIL 2013

VISION AND MISSION

VISION

Long and healthy life for all South Africans

MISSION

To improve health status through the prevention of illnesses and the promotion of healthy lifestyles and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

2

MTEF PRIORITIES

The MTEF priorities of the Department is derived from:

10 Point Plan 2009-2014

Government’s outcome-based approach to service delivery. The Health sector is responsible for the achievement of Outcome 2 : A long and healthy life for all South Africans

Four outputs identified:– Output 1 : Increasing Life Expectancy– Output 2 : Decreasing Maternal and Child mortality– Output 3 : Combating HIV and AIDS and decrease the burden of disease from

Tuberculosis– Output 4 : Strengthening Health System’s Effectiveness

Millennium Development Goals 2000-2015

Health Goals from the National Development Plan 2030.

HEALTH SECTOR’s PRIORITIES

NATIONAL DEVELOPMENT PLAN:HEALTH

GOALS, INDICATORS AND ACTION POINTS

TOWARDS THE 2030 VISION

4 NSDA

OUTPUTS

2010-2014

10 POINT PLAN 2009-2014

HEALTH

RELATED

MDGs

2000-2015

1. Average male and female life expectancy at

birth increases to 70 years.

2. Progressively improve TB prevention and

cure

3. Reduce maternal, infant and child mortality

4. Significantly reduce prevalence of non-

communicable chronic diseases

5. Reduce injury accidents and violence by 50

percent from 2010 levels

6. Complete health systems reforms

7. Primary health care teams provide care to

families and communities

8. Universal health care coverage

9. Fill posts with skilled, committed and

competent individuals

1. Increasing life expectancy;

2. Decreasing child and

maternal mortality rates

3. Combating HIV and AIDS

and STIs and decreasing the

burden of disease from

Tuberculosis

4. Enhancing health systems

effectiveness

1. Provision of Strategic leadership and creation

of a social compact for better health outcomes

2. Implementation of National Health Insurance

(NHI);

3. Improving the Quality of Health Services;

4. Overhauling the health care system

5. Improving Human Resources, Planning,

Development and Management;

6. Revitalisation of infrastructure

7. Accelerated implementation of HIV and AIDS

and Sexually Transmitted Infections National

Strategic Plan, 2007-2011 and reduction of

mortality due to TB and associated diseases;

8. Mass mobilisation for better health for the

population

9. Review of Drug Policy; and

10. Strengthening Research and Development

MDG Goal 4

MDG Goal 5

MDG Goal 6

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2013/14 – 2015/16

Improve Life Expectancy by implementing following key strategies:

Expansion of the ARV coverageReduce new HIV infections.Reduce burden of TuberculosisReduce Maternal MortalityReduce Infant, Child and Youth morbidity and mortalityImprove collaboration and Reduce burden of Communicable and Non-communicable diseases.

Interventions for all of the above key strategies are outlined in the next slides

IMPROVE LIFE EXPECTANCY


Improved health system’s effectiveness by implementing following key areas: Improve quality of health services Re-engineering of Primary Health Care Functional District Health System Preparation for the implementation of the NHI Improve health workforce planning, management and

development. Efficient management of health technology Accelerate delivery of health infrastructure

Interventions for all of the above key areas are outlined in the next slides

IMPROVE HEALTH SYSTEMS EFFECTIVENESS

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2013/14 - 2015/16

REDUCE NEW HIV INFECTIONS

KEY INTERVENTIONS INCLUDE:

Conduct at least 600 000 Medical Male Circumcisions during 2013/14, this will increase to 1 000 000 during 2015/16.

Test at least 98% of all TB patients for HIV by 2015/16.

Increase contraceptive prevalence (couple year protection rate) from 32.5% during 2011/12 to at least 38% during 2015/16.

Expanded PMTCT Programme for pregnant women (to be outlined in the coming slide)


EXPAND THE ARV COVERAGE


Initiate at least 500 000 new clients on ARVs per annum.

Initiate at least 85% of all TB and HIV co infected patients on ARVs, with up to 97% by 2015/16.


EXPAND PMTCT PROGRAMME FOR HIV + PREGNANT WOMEN


Increase HIV+ pregnant women initiated on ARVs from 80.4% in 2011/12 to at least 97% in 2015/16

Reduce the proportion of HIV positive babies born to HIV positive mothers from 4% in 2011/12 to at least 2% by 2015/16


REDUCE MATERNAL MORTALITY


Increase the proportion of antenatal clients attending a health facility before 20 weeks from 40.2% in 2011/12 to at least 68% in 2015/16.

Increase the proportion of deliveries taking place in health facilities under the supervision of trained personnel in a public health facility from 89.3% in 2011/12 to at least 97% in 2015/16.

Increase the percentage of mothers and babies who receive post-natal care within 6 days of delivery from 56.9% in 2011/12 to at least 84% in 2015/16.


REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY


Maintain the percentage of children fully immunised under 1-year of age at minimum 90% throughout the MTEF period

Maintain the measles immunisation coverage rate of 90 % throughout the MTEF period

Expand the implementation of the Integrated School Health Programme

70% (9,666 of 13,809) of quintile 1 and 2 schools to benefit from the integrated School Health Programme (ISHP) during 2013/14, with up to 95% schools benefiting during 2015/16

9 666 schools translates to 297,000 Grade 1 learners and 80,200 Grade 8 learners benefitting from the ISHP during 2013/14.


REDUCE THE BURDEN OF TUBERCULOSIS

KEY INTERVENTIONS WILL INCLUDE:

Increase the TB cure rate from 73.1 % in 2011/12 to the WHO target of 85% by 2015/16.

Reduce the TB treatment defaulter rate from 6.8% in 2011/12 to less than 5% by 2015/16.

Reduce turnaround time of TB test results by increasing the number of tests conducted using the GeneXpert. Estimated 800 000 tests to be conducted using GeneXpert during 2013/14, increasing to 1m by 2015/16.


IMPROVE COLLABORATION BETWEEN TB AND HIV PROGRAMMES TO REDUCE THE CO-INFECTION BURDEN

KEY INTERVENTIONS WILL INCLUDE:

Increase the percentage of TB patients tested for HIV from 82.9% in 2011/12 to at least 98% in 2015/16

Increase the number of HIV positive patients that receive Isoniazid Preventative Therapy (IPT) from 360 168 patients in 2011/12 to at least 525 000 in 2015/16


STRENGTHEN MANAGEMENT OF NON-COMMUNCABLEDISEASES

KEY INTERVENTIONS:

Conduct public education campaign on salt reductions in line with published regulations

Expanding the chronic care model to 15 districts by 2015/16. Revision to the regulations of warning labels on alcohol products. Development and implement the Health Promotion strategy. Develop regulations for graphic health warnings on tobacco

products Establishment of the National Health Commission to develop and

implement an Intersectoral approach for the prevention of NCDs.


REDUCE THE BURDEN OF DISEASE FROM COMMUNICABLE DISEASES


Establish a National Public Health Institute to reform and strengthen the capacity of National Institute of Communicable Diseases (NICD) over the MTEF

Improve access to cataract surgery to at least 1 500 operations per million population in all 9 provinces.

Increase the cervical cancer screening coverage from 55% in 2011/12 to at least 60% by 2015/16

Decrease the incidence of Malaria from 0,58 cases per 1000 population in 2011/12 to at least 0.45 per 1000 population at risk in 2014/15, in keeping with the target to eliminate Malaria by 2018.


IMPROVE QUALITY OF HEALTH SERVICES


Improve complaint resolution by ensuring that at least 85% of all resolved complaints have a turnaround time within 25 days.

Develop and implement standardised protocol for conducting Patient Satisfaction surveys

Increase the number of districts supported by Facility Improvement Teams to 20.

Ensure gap assessment are conducted at all health facilities by 2015/16. (30% facilities to be assessed during 2013/14)

Fully establish Office of Health Standards Compliance by 2015/16.


RE- ENGINEERING OF PRIMARY HEALTH CARE

KEY INTERVENTIONS INCLUDE: Increase the number of municipal ward based primary health teams to 750 in

2013/14, 1000 in 2014/15 and 1500 in 2015/16 Improve access to primary health care services with an increased utilisation rate of

at least 3 visits by 2015/16. Expand the number of districts with the full complement of members of the District

Clinical Specialist teams to at least 20 Districts in 2013/14, up to 25 during 2015/16. Improve access and quality of PHC supervision.

Develop and implement a manual for capacity building for PHC supervisors and facility managers

Increase the monthly supervisor visit rate from 66.6% in 2011/12 to at least 85% in 2015/16 Implementation of Integrated School Health Programme

• School Health services refer to slide 11


IMPROVE HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPMENT

KEY INTERVENTIONS INCLUDE: Development and implementation of norms and standards for health

workforce planning. Increase the number of medical students registered at South African

Universities by at least 10% every year over the MTEF. This will increase the number of new students from 1800 in 2012/13 to at least 2395 in 2015/16.

Increase the number of hospital managers trained as per the training programme developed by the Academy for Leadership and Management in Health – 105 during 2013/14, 100 during 2014/15 and 100 during 2015/16


FUNCTIONAL DISTRICT HEALTH SYSTEM

KEY INTERVENTIONS INCLUDE: Develop and implement an Intersectoral Framework for addressing

the Social Determinants of Health A District Quarterly Review Guideline will be developed during

2013/14 to institutionalise district quarterly reviews Strengthen the disease outbreak response by establishing trained

disease outbreak teams in 20 districts by 2013/14. This intervention will be implemented in all 52 districts by 2015/16 financial year.

Revised District Health System strategy which is inclusive of a District Health Authority.


PREPARATION FOR THE IMPLEMENTATION OF NHI


Preparation of the legal framework for the establishment of the NHI2013/14 White Paper on NHI finalised and gazetted2014/15 NHI Bill tabled to parliament2015/16 Implementation of regulations

Develop a conceptual framework for the creation of the NHI Fund in 2013/14 with the first phase of implementation in 2014/15

Increase Revenue collection in Central Hospitals – 4 in 2013/14, 7 in 2014/15 and 10 in 2015/16

Contracting of the General Practitioners (GPs) and other health service providers.

2013/14 - 600 GPs contracted to work in 533 clinics in NHI Pilot Districts


EFFICIENT MANAGEMENT OF HEALTH CARE TECHNOLOGY


Continue with the implementation of the Health Technology Strategy

Publish Essential Equipment lists for all levels of care in 2013/14

Finalization of the standards for the use and maintenance of Health Care Technology


ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE

KEY INTERVENTIONS INCLUDE: Accelerate the delivery of health infrastructure through the following key

activities: During 2013/14 - Issue RFP, procure and sign agreement for Chris Hani Baragwanth. RFQ and RFP for Limpopo Academic Hospital. Completed feasibility studies for Dr G Mukhari, Nelson Mandela Academic

Hospital and King Edward VIII projects. Procure Transactional services for Mpumalanga Tertiary and Tygerberg

hospital projects Five of the seven planned tertiary hospitals (Nelson Mandela Academic (EC);

Chris Hani Baragwanath (GP); Dr. George Mukhari (GP); Limpopo Academic (LP); King Edward VIII (KZN)) would have commenced with construction by 2015/16.

RESOURCE ENVELOPE FOR IMPLEMENTING OF THE

NATIONAL DOH PLANS FOR 2013/14 to 2015/16

PROGRAMME ALLOCATIONS FOR 2013/14 - 2015/16

ProgrammesR’ million

12/13 13/14 14/15 15/16

Administration 403 411 425 450

National Health Insurance, health Planning and System Enablement

315 492 638 672

HIV/AIDS, TB, Maternal and Child Health

9,265 11,029 12,867 14,546

Primary Health Care Services 126 109 106 111

Hospital, Tertiary Health Services and Human Resource Development

17,351 17,911 19,073 19,903

Health Regulation and Compliance Management

597 754 816 1,002

Total Budget Allocation 28,057 30,706 33,925 36,684

ECONOMIC CLASSIFICATIONS ALLOCATIONS FOR 2013/14 TO 2014/15

Economic Classification 12/13 13/14 14/15 15/16

Compensation of Employees

486 538 568 597

Goods and Services 887 1,100 1,270 1,336Total Transfers & Subsidies

26,648 28,242 30,393 33,055

Payment of Capital Assets

36 826 1,694 1,696

Total 28,057 30,706 33,925 36,684

EXPENDITURE TRENDS

The Department’s expenditure grew from R19,2 billion in

2009/10 to R27,9 billion in 2012/13 at an average annual rate of

13,3 percent.

Over the Medium Term period, expenditure is expected to grow

to R36,7 billion, at an average annual rate of 9,4 percent.

The increase in both periods is driven largely by transfers to

provinces for the conditional grants, with the main increase

being on the HIV and AIDS and the introduction of NHI grant.

MEDIUM TERM ALLOCATION FOR 2013/14 – 2015/16

The Budget includes additional allocations of R800 million for 2015/16 for the scale up of the provision of antiretroviral treatment.

R100 million for 2014/15 and R384 million for 2015/16 to partly offset the decrease in funding over the medium term from the US President’s Emergency Plan for AIDS Relief (PEPFAR). This programme has contributed roughly R4 billion per year towards the South African national HIV and AIDS and tuberculosis response.

The amount is likely to decrease by 50 percent over the next five years.


R90 million, R100 million and R250 million for the Medical Research Council to strengthen its capabilities and infrastructure and to support partnership on high priority diseases, such as HIV and AIDS, tuberculosis and malaria, with development partners , such as Gates Foundation.

R15 million, R31,5 million and 31,5 million to strengthen the National Institute of Communicable Diseases and address the decrease in PEPFAR funding support

R30,1 million, R30 million and R30,3 million most of which comes from internal reprioritisation savings, for the infrastructure unit systems support programme, which provides capacity building support to the department and provinces.


R15 million in 2015/2016 for the South African National AIDS Council for HIV and AIDS programmes.

R22,1 million, R28,3 million and R41 million for improved conditions of service to cover high personnel costs.

R6 million in 2013/2014 for emergency medical services during the 2014 African Nations Championship.

The department expects to reprioritise R19,6 million, R37 million and R51,8 million over the medium term in non-core goods and services items.


Cabinet has approved reductions of R531 million over the medium term.

The three health infrastructure grant will be reduced due to slow spending and weaknesses in performance.

Reductions of R26 million (R11 million, R10 million and R5.2 million) over the MTEF period have been made to the National Health Insurance grant due to slow expenditure.

The department reviewed the staff establishment in 2010/11 to its human resources needs and the functions assigned in terms of the approved budget structure . The establishment is projected to increase moderately to strengthens skills and experience

INFRASTRUCTURE SPENDING

The three health infrastructure grant (Hospital Revitalisation, Health Infrastructure and Nursing Colleges and schools grants) have been consolidated into a single direct grant, called the Health Facility Revitalisation Grant with three windows.

It is envisioned that the new configuration will allow more flexibility to shift funds in between and ensure timely delivery of health infrastructure.

Spending on infrastructure increased from R3,2 billion in 2009/2010 to R5.8 billion in 2012/2013, and is expected to increase to R6,5 billion over the medium term.

The Health Facility Revitalisation Grant has been allocated R14,9 billion over the MTEF period (R5,1 billion, R4,7 billion and R5 billion).

INFRASTRUCTURE SPENDING

Infrastructure Spending continue

The new indirect schedule 6A grant has been established called National Health grant. This grant will have two components, one for National Health Insurance (NHI) and one for Health Facility Revitalisation grant.

The new National Health Grant contains a Health Facility Revitalisation component. This grant has been allocated R4.2 billion over the MTEF period (R807 million, R1,7 billion and R1,7 billion) and is a grant in kind to the provinces.

CONDITIONAL GRANTS ALLOCATIONS 2013/14 - 2015/16

Grant / Year 2013/14 2014/15 2015/16(R'000) (R'000) (R'000)

African Nations Championship Grant 6 000 0 0National Health Indirect Grant 1 098 025 2 099 862 2 119 755Of Which:National Health Insurance: Indirect Grant 291 000 420 000 443 803Health Facility Revitalisation: Indirect Grant 807 025 1 679 862 1 675 952National Tertiary Services Grant 9 620 357 10 168 235 10 635 974Comprehensive HIV/Aids Grant 10 533 886 12 311 322 13 957 043Health Facility Revitalisation Grant 5 123 542 4 738 837 4 987 920Health Professionals Training and Development Grant 2 190 366 2 321 788 2 428 590National Health Insurance Grant 48 500 70 000 73 967Total 28 620 676 31 710 044 34 203 249


Schedule 4 grants: specifying allocations to provinces to supplement the funding of programmes or functions funded from provincial budgets;

Transfer payments cannot be withheld based on non performance or compliance, however, the new Division of Revenue Grant allows a 5% withholding while interventions are put in place.

Grants included are: National Tertiary Services, Health Professions Training and Development.


Schedule 5 : specifying specific-purpose allocations to provinces.

Grants included are: HIV and AIDS Grant National Health Insurance Grant. Health Facilities Revitalisation Grant.

Schedule 5 grants may be withheld for non performance and or compliance. Interventions must also be put in place for compliance.

KEY SPECIFIC GRANT REFORMS IN NHI GRANT

• R291 million is allocated to the National Department:

1. R40 million is allocated for Diagnostic Related Groupers (DRG’s) for Central Hospitals

2. R251 million allocated for contracting of doctors (GPs)

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KEY SPECIFIC GRANT REFORMS IN HEALTH REVITALISATION

• Health Facility and Revitalisation Grant deals with selected projects managed at the National level that are related to upgrading of Nursing Colleges, Revitalisation and Health Infrastructure projects

• R807 million will be allocated to NDOH and is based on a project list

• Procurement of contractors for all the selected projects will be managed by National Department of Health

• Merging of Infrastructure grants into 1 grant with 3 sub components at Provincial level

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KEY SPECIFIC GRANT REFORMS IN HEALTH REVITALISATION

• R807 million will be allocated to NDOH and is based on a project list

• Distribution per Province as follows:

38

Provinces Budget % allocation versus budget

Eastern Cape 135 000 16.73

Free State 94 000 11.65Gauteng 102 000 12.64KwaZulu-Natal 58 000 7.19Limpopo 155 000 19.21Mpumalanga 106 123 13.15

Northern Cape 44 816 5.55North West 85 086 10.53Western Cape 27 000 3.35Total 807 025 100.00

2013 DIVISION OF REVENUE BILL SCHEDULES

Purpose of schedule 2012 DoRA numbering

2013 DoRB numbering

Supplementary Grants to Provinces 4 4A

Specific Purpose Grant to Provinces 5 5A

Allocations in-kind to Provinces 7 6A

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COMPREHENSIVE HIV AND AIDS GRANT (5A)


Eastern Cape 1 273 296 12.09

Free State 742 984 7.05

Gauteng 2 258 483 21.44KwaZulu-Natal 2 652 072 25.18Limpopo 861 143 8.17Mpumalanga 690 591 6.56

Northern Cape 302 468 2.87North West 825 302 7.83Western Cape 927 547 8.81Total 10 533 886 100.00

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NATIONAL HEALTH INSURANCE GRANT (5A)

Province District Name Allocation % allocation versus

budget

Easter cape OR Tambo District 4 850 000 10

Free State Thabo Mofutsanyana 4 850 000 10

Gauteng Tshwane District 4 850 000 10

KwaZulu-Natal uMzinyathi 4 850 000 10

KwaZulu-Natal uMgungundlovu 4 850 000 10Limpopo Vhembe District 4 850 000 10

Mpumalanga Gert Sibande District 4 850 000 10

Northern Cape Pixley ka Seme District 4 850 000 10

North West Dr Kenneth Kaunda District 4 850 000 10Western Cape Eden District 4 850 000 10TOTAL 48 500 000 100

41

NATIONAL TERTIARY SERVICES GRANT (4A)

Provinces Budget % allocation versus budgetEastern Cape 743 621 7.7%

Free State 849 661 8.8%

Gauteng 3 305 931 34.4%Kwa-Zulu Natal 1 415 731 14.7%Limpopo 305 732 3.2%Mpumalanga 91 879 1.0%

Northern Cape 282 618 2.9%North West 224 470 2.3%Western Cape 2 400 714 25.0%Total 9 620 357 100.0%

42

HEALTH PROFESSIONS TRAINING AND DEVELOPMENT GRANT (4A)



Free State 138 131 6.3Gauteng 765 202 34.9

KwaZulu-Natal 276 262 12.6

Limpopo 109 628 5.0

Mpumalanga 89 894 4.1

Northern Cape 72 356 3.3

North West 98 666 4.5

Western Cape 451 667 20.6

Total 2 190 366 100.0

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NATIONS CHAMPIONSHIP CONDITIONAL GRANTS (6A) ALLOCATED TO NDOH


Free-State 1 500 25

Northern-Cape 1 500 25

Limpopo 1 500 25

Western-Cape 1 500 25

Total 6 000 100

44

HOSPITAL REVITALISATION GRANT


Eastern Cape 336 719 9.0Free State 469 470 12.5

Gauteng 677 371 18.1

Kwa-Zulu Natal 560 104 14.9

Limpopo 230 211 6.1

Mpumalanga 225 000 6.0Northern Cape 331 274 8.8

North West 428 258 11.4


Total 3 751 933 100.0

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HEALTH INFRASTRUCTURE GRANT



Free State 67 250 5.2

Gauteng 86 816 6.7Kwa-Zulu Natal 373 969 28.9Limpopo 211 961 16.4Mpumalanga 58 509 4.5

Northern Cape 90 154 7.0North West 67 863 5.2Western Cape 122 296 9.4Total 1 295 634 100.0

46

NURSING COLLEGES AND SCHOOLS GRANT



Free State 1 242 1.6

Gauteng 6 846 9.0Kwa-Zulu Natal 28 396 37.4Limpopo 15 270 20.1Mpumalanga 0 0.0

Northern Cape 0 0.0North West 0 0.0Western Cape 13 964 18.4Total 75 975 100.0

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NATIONAL HEALTH GRANT (HRG, HIG AND NCSG COMBINED – 5A)

Provinces Budget % allocation versus budgetEastern Cape 562 792 11.0

Free State 538 962 10.5

Gauteng 771 033 15.0

Kwa-Zulu Natal 962 469 18.8

Limpopo 457 442 8.9

Mpumalanga 283 509 5.5

Northern Cape 421 428 8.2

North West 496 121 9.7


Total 5 123 542 100.0

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CONCLUSION

National DoH Annual Performance Plan 2013/14-2015/16 reflects interventions to improve the health system and health outcomes for all South Africans.

Achieving the health sector objectives will require fundamental reform of the health system in the country, which includes amongst others: focus on improved infrastructure; human resources for health and improved management capacity, including norms and

standards for staffing; accountability in planning and budgeting, as well as development of capacity and systems in financial management; health financing reform and reform of key strategic institutions.

The Department will continue to work towards improving healthcare equity, quality and access through the introduction of the National Health Insurance, and building human resource capacity in the health sector through various initiatives.

Thank You

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