PRESENTATION TO NCOP SELECT COMMITTEE ON FINANCE

1
PRESENTATION TO NCOP SELECT COMMITTEE ON FINANCE

• SECOND QUARTER ENDING 30 SEPTEMBER 2005
• 2005-10-12

2
PURPOSE

• To provide information to the NCOP on
  performance of all conditional grants managed by
  the Department, and the details on achievements,
  challenges and remedial actions for the Quarter
  ending 30th September 2005.

3
OVERVIEW

• 6 CONDITIONAL GRANTS MANAGED BY DOH NW.
• CONSTITUTES 14 OF TOTAL BUDGET.
• NEEDS TO IMPROVE QUALITY OF BUSINESS PLANS FOR
  CONDITIONAL GRANTS.
• STRENGTHENING OF PROJECT MANAGEMENT IN RELATION
  TO CONDITIONAL GRANTS.
• IMPROVE CAPACITY FOR MONITORING AND EVALUATION.
• INFRASTRUCTURE DELIVERY MODEL AND POSSIBLE
  IMPACT.
• INTERVENTIONS IN RELATION TO THE ABOVE ARE BEEN
  PUT IN PLACE.

4
HIV and AIDS GRANT

• PURPOSE
• To enable the health sector to develop an
  effective response to HIV and AIDS as well as
  supporting the implementation of the National
  Operational Plan for Comprehensive HIV and AIDS
  Treatment and Care.

5
COPREHENSIVE HIV/AIDS
EXPENDITURE
6
COMPREHENSIVE HIV/AIDS (CONT)

• Expenditure grown by 40 from last month.
• Actual expenditure is at 43.26 as at 30
  September.

7
COMPREHENSIVE HIV/AIDS (CONT)

• Progress
• The adjustment for the budget of the
  Comprehensive Plan (ARV) sites has been done by
  the Budget section.
• The funds to the tune of R6, 815m from National
  Treasury were transferred and the cash flow made
  available was spent.
• There is availability of pharmaceuticals (ARV)
  and a growing number of professionals trained in
  CCMT.
• We have in the Province accredited six additional
  sites for provision of the comprehensive plan.

8
COMPREHENSIVE HIV/AIDS (CONT)

• Challenges
• The cash flow constraints especially with the
  payment of NGOs where we have to effect the
  quarterly payment but we only getting monthly
  cash.
• Cash flow constraints also makes it difficult for
  the Department of fast rack certain activities
  which could be done earlier than the planned.
  This matter will be resolved with National.

9
COMPREHENSIVE HIV/AIDS (CONT)

• Remedial Action
• Interaction between Province and NDoH to review
  the transfer schedule for HIV/AIDS Grants
  (Possible DORA implications).

10
HOSPITAL MANAGEMENT QUALITY IMPROVEMENT.

• PURPOSE
• To transform hospital management and improve
  quality of care in line with national policy.

11
HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT
EXPENDITURE
12
HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont)

• Expenditure has grown by 109 from last
  month(August).
• Actual expenditure is 34. 36 of the budget as at
  30 September.

13
HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont)

• Progress
• Staff has been appointed and maintained in
  Swartruggens hospital, in line with the business
  plan.
• Upgrading of Patient Administration And Billing
  System (PAAB) is going well.
• Governance structures (hospital boards etc) have
  been relaunched and are now been trained,
  (service provider has been appointed).
• A partnership with Cohsasa on Quality Improvement
  and hospital accreditation is ongoing. Two
  hospitals have already been accredited.
• There have been two training sessions in the
  implementation of the Clinic Supervision Manual.
• The final draft of the Hospital supervision
  manual is ready for submission for adoption by
  the Management Committee.

14
HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont)

• Challenges
• The training of governance structures is
  continuing and expenditure will reflect in the
  next quarter.
• Initial problems experienced in relation to a
  contract for the PAAB system with one of the
  service providers, now resolved.
• Strengthen Quality Assurance unit in terms human
  resource.
• Expenditure for Swartruggens hospital
  (Revitalisation site) benefiting from this grant
  is currently incurred under Equitable Share.
• The Cost Centre Accounting project plan is being
  revised for faster implementation.

15
HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont)

• Remedial Action
• The Business Plan is being amended to
  sufficiently cover for activities which have been
  under allocated or delayed.
• A team of three appointed to support areas that
  are showing poor spending.
• Journals are being passed to correct expenditure.

16
HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT.

• PURPOSE
• Support services to fund costs associated with
  training of health professionals and the
  development and recruitment of medical
  specialists in under-served provinces.
• To support and strengthen under postgraduate
  teaching and training processes in health
  facilities, and to enable shifting of teaching
  activities from central hospitals to regional and
  district hospitals.

17
HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT
EXPENDITURE
18
HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT
(cont)

• 53.98 has been spent to date.
• This grant is on target in terms of planned
  activities and ideal expenditure.

19
HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT
(cont)

• Progress
• The fund has been used to increase the intake of
  nursing trainees from 100 to 180.
• Community based education and problem based
  learning is unfolding well under this grant.
• Nurses, Doctors, Community Service Personnel,
  Interns and Healalth Support Staff have been
  trained in Emergency Courses, e.g. Advanced
  Trauma Life Support, Paediatric Advanced Life
  Support and Advanced Cardiac Life Support,
  Advanced Medical Life Support, and Advanced
  Orthopaedic and Basis Surgical Skills Courses.

20
HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT
(cont)

• Challenges
• The grant is on target .

21
INTEGRATED NUTRION PROGRAMME GRANT

• To implement integrated nutrition activities
  aimed at improving the nutritional status of
  South Africans, based on disease-specific
  nutrition support, treatment and counselling
  focus areas, which are dependant on information,
  human resources and financial and administrative
  systems.

22
INTEGRATED NUTRITION PROGRAMME
EXPENDITURE
23
INTEGRATED NUTRITION PROGRAMME (cont)

• Expenditure has increased by 34 from August.
• Performance is at 30.22 as at 30 September.

24
INTEGRATED NUTRITION PROGRAMME (cont)

• Progress
• There is adequate supply of road to health
  charts.
• The inputs for the budget adjustment have been
  finalised to re-align the budget to the Programme
  needs.
• One extra hospital declared baby friendly.

25
INTEGRATED NUTRITION PROGRAMME (cont)

• Challenges
• The funds for the second quarter from the
  National Treasury were only received on the 22nd
  August instead of 18th July.

26
INTEGRATED NUTRITION PROGRAMME (cont)

• Remedial Action
• The programme is showing potential to spend its
  entire budget. There is R2 M already that is
  being processed this week which will take
  expenditure to 45.3 to compared to a half year
  target of 50.
• Transfer schedule needs to be reviewed in
  consultation with National Department of Health.

27
HOSPITAL REVITILIZATION GRANT.

• To provide funding to enable provinces to plan,
  manage, modernise, rationalise and transform the
  infrastructure, health technology, organizational
  management development and monitoring and
  evaluation of hospitals in line with national
  policy objectives.

28
HOSPITAL REVITALIZATION
EXPENDITURE
29
HOSPITAL REVITALIZATION (cont)

• Expenditure has grown by 15. Although theres a
  15 growth, actual expenditure as a percentage of
  the budget is still at 22.53.

30
HOSPITAL REVITALIZATION (cont)

• Challenges
• Human Resource capacity both within and with
  implementing agents.
• Inadequate response by experienced contractors
  and empowered joint ventures.
• Incapacity of some consultants and small emerging
  contractors to handle projects with the required
  competencies.
• Tendering and procurement processes both
  internally and externally takes longer than
  expected.
• Infrastructure delivery model require review.

31
HOSPITAL REVITALIZATION (cont)

• Remedial Action
• Intervene on Tshwaragano business case (cross
  border municipality).
• Complete business cases for the entire province.
• Commence planning for priority areas.
• Review the implementing strategy and process
  thoroughly. e.g. MEC for Education is convinced a
  task team between Health, Education and Public
  Works.
• Discussion are underway with the Provincial
  Treasury for the amount to only be transferred to
  the Department during 2006/07 financial year.
• Review of the bottom structure to address human
  resource challenges.

32
NATIONAL TERTIARY SERVICES.

• To compensate provinces for the supra-provincial
  nature of tertiary services provision and spill
  over effects as well as providing strategic
  funding to enable provinces to plan, modernise,
  rationalise and transform the tertiary hospital
  service delivery platform in line with national
  policy objectives including improving access and
  equity.

33
National Tertiary Services
EXPENDITURE
34
National Tertiary Services (cont)

• Expenditure on this grant has grown by 34 from
  end of August.
• It stands 31.06 of the budget.

35
National Tertiary Services (cont)

• Progress
• The Programme has shown an improvement in its
  expenditure compared to the previous months,
  however this still needs more attention.
• Previously, only Klerksdorp hospital complex
  provided a wider range of tertiary services now
  Rustenburg and Mafikeng are expanding services.

36
National Tertiary Services (cont)

• Challenges
• Concluding the procurement process and receiving
  tertiary equipments for all the tertiary
  hospitals.
• Amending the specifications for CT Scans due to
  market demands led to the delay. Price of 16
  Slice CT scans came down, and we responded
  accordingly. NB For this year CT scans accounts
  for more than 29 of the NTSG budget.

37
National Tertiary Services (cont)

• Remedial Action
• Follow up on the finalisation of the contract of
  procuring hospital medical equipments expected to
  be concluded during October 2005.
• Once delivery of this equipment takes place,
  this will bring the expenditure to the expected
  level.

38
Malaria Cholera Prevention Grant

• PURPOSE
• For the sustenance of the programmes related with
  pushing back the frontiers of poverty and hunger
  among women, Aids victims and especially to
  provide equipment for the food gardens and in
  some instances provide stipend to volunteer
  garden workers.

39
Malaria Cholera Prevention Grant

• Progress
• A business plan has been developed and approved
  for the utilisation of the rollover amounting to
  R1,111,460. The funds are currently under the
  provincial contingency reserve fund. Treasury
  will be transferring the money to the Department
  the 10th October 2005 .

40
Malaria Cholera Prevention Grant

• Challenges
• This is a once off conditional grant resulting
  from the drought of 2004.
• The Programme has to ensure that the roll-out of
  the activities is expedited to ensure spending of
  funds only in relation to time affected largely
  by a rural Bophirima district.

41
Malaria Cholera Prevention Grant

• Remedial Action
• All line expenditure items to benefit from this
  grant have been identified e.g. pharmaceuticals,
  water tanks for clinics, food gardens and fencing
  for food gardens.

42
Medico Legal Mortuaries

• PURPOSE
• To facilitate the transfer of forensic pathology
  services from the South African Police Services
  (SAPS) to the Department of Health and provinces.

43
Medico Legal Mortuaries

• Progress
• The Programme has the costed operational plan for
  the year and the necessary staff structure has
  been finalised.
• All facilities have been audited and are in the
  process of being upgraded.

44
Medico Legal Mortuaries

• Challenges
• The funds from the conditional grant of the
  Programme are not available yet.
• The programme is presently having at its disposal
  its equitable share which is being used for the
  programme.

45
Medico Legal Mortuaries

• Remedial Action
• Funds will be transferred with effect from the
  1st October 2005. However, the actual transfer
  will be with effect from April 2006 into
  provincial coffers.

46
Expenditure on Equitable Share in relation to
pressures points

• Personnel we are at 51, and project over
  expenditure of R69m.( being addressed with
  provincial Treasury).
• Administration (Indicates pool vehicles transport
  costs including ambulances) we are at 65. (
  will review funding during Adjustment Estimates
  process).

47
Current Pressure Points (Economic
Classifications)

• Professional services (expected to be a pressure
  point as service expand waste management).
• Equipment (Expected to be a pressure point as we
  implement health technology audit
  recommendations).
• Uniform for nurses ( based on new agreement ).

48
Closure

• Thank you for listening