NATIONAL DEPARTMENT OF HEALTH

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NATIONAL DEPARTMENT OF HEALTH

• PRESENTATION TO THE JOINT BUDGET COMMITTEE
• Presented by
• Mr TD Mseleku

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NATIONAL DEPARTMENT OF HEALTH
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NATIONAL DEPARTMENT OF HEALTH
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NATIONAL DEPARTMENT OF HEALTH

• Public Health Sector
• Budget growth acknowledged at 6-7
• IGFR figures specifically used to illustrate 2
  points
• Variances in growth per province
• Ranges from 3 (FS), 8.5(Limpopo)

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NATIONAL DEPARTMENT OF HEALTH

• Public Health Sector
• Per capita growth 4.8
• Population growth reduces budget growth by /- 1
• Variances in growth per province different
• Ranges from 2.4 (FS) to 7.8 (Mpumalanga)

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NATIONAL DEPARTMENT OF HEALTH

• Public Health Sector
• The Sector has 2 fast growing programmes, i.e.
  hospital revitalization (backlogs), HIV and AIDS
  (burden of disease)
• Should these two programmes be removed from the
  calculation, the balance of the budget grows at
  /-2

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NATIONAL DEPARTMENT OF HEALTH

• Public Health Sector
• Health can spend its allocations
• 2005/06 Sector spent 98 of allocation
• 2006/07 after ¾s spending on votes, operation
  and capex, in line with budget

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NATIONAL DEPARTMENT OF HEALTH
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NATIONAL DEPARTMENT OF HEALTH
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Hospital Revitalisation

• Budget Process

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Budget process

• Information requested from provinces in
  preparation of budget bid
• Total expected cash flows for the current 06/07
  financial year
• Infrastructure cash flows, collected from the
  Implementing Agents and the facility section of
  the respective departments of Health
• Whether or not consultants were appointed for a
  project
• Whether or not the construction tender was
  awarded for a project
• Organisational Development expected cash flows,
  after consultation with the provincial department
  and the affected hospitals.
• Quality assurance expected cash flows for each
  project after consultation with the affected
  hospitals
• Health Technology cash flows, after consultation
  with the provincial health technology staff.
• Grant Management has been added this funding
  will be used to fund the operational budget of
  the provincial Revitalisation Units.

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Budget Process
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Achievements

• Expenditure rate 86.3 against transfers at the
  end of January 2007
• Roll overs not taken into account due to late
  approval thereof.
• Increased compliance in reporting. No defaults
  on quarterly or financial reporting in last
  quarter.

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Challenges

• Funds allocated to Revitalisation only sufficient
  to spend on projects that have awarded tenders.
• Very little money available for planning
• Provincial roll overs of unspent funds approved
  too late in year to spend (Approved in December
  only)

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Calculation of actual allocations

• Only Awarded tenders taken into account
• No Fruitless expenditure
• Planning only budgeted for critical projects
• Projects where tenders were not awarded moved to
  outer years

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Discussion for table to follow

• Following table shows, per hospital, amounts
  allocated to provinces.
• NB!! Hospital allocation based on information
  received from provinces, done on consultative
  approach.
• Provinces still free to adjust the specific
  allocation to hospitals internally whilst staying
  inside the provincial allocation.
• Project Implementation Plans per project have
  been submitted that will indicate the activities
  and costs in the coming financial year for these
  projects.

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• HIV AND AIDS

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Back GroundCabinet approved the Operational Plan
for Comprehensive HIV AIDS Care. Management
and Treatment for S.A on the 19 March 2003.
Conditional Grant Budget is made to enable the
health sector to develop an effective response to
the HIV and AIDS epidemic and other matters.
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• The Conditional Grant Budget covers not only the
  ARV treatment but also the Enhance programs
  VCT,PMTCT, PEP, SDC, STI, HTA, RTCHBC.
• The budget has doubled from the financial year
  04/05 to 06/07 and this has led to the treatment
  of more than 245 106 patients on ARTs as shown
  below from only 28 393 in December 2004.

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Conditional Grants increment to Provinces 2006
2007 2009 2010
Comprehensive HIV AIDS Grant Projections
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• With only R300million additional budget and
  looking at the projected budget it is more likely
  that the Department wont be able to meet the
  target of more than 100 000 (07/08) new patients
  on treatment as well as keeping those already on
  treatment as shown on the table below.
• To reach as planned 573 000 patients by 2010 an
  additional budget of R765 000will be required on
  top of the current allocation of R2, 676,000
• With the increased number of Accredited
  Facilities and trained staff we are able to see
  more patients than planned

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Patients on ART
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Projected Patients on ART
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Skills Development Initiatives by National
Department of Health

• Focus on internal departmental issues and the
  health sector

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Coverage

• This short presentation covers
• The internal departmental skills development and,
• The approach taken to address the broader health
  sector
• Internal departmental approach in line with DPSA
  prescripts
• Health sector approach informed by the National
  Human Resources for Health Planning Framework

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Departmental Skills Development

• Development of support staff through ABET and
  bursaries to enhance their career paths to
  develop a culture of quality life long learning
  for all staff
• Total training budget for current financial year
  R4 131 00.00, budget for 07/08 is R5 036 520.00
• Project literacy engaged to train 38 ABET
  learners in numeracy and literacy in 2007 at cost
  of R175 000

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Departmental Bursaries and Fellowships

• Completely based on Work Skills Programme with
  local Skills Development Forum inputs
• Bursary cycle now includes career counseling
• Struggling learners are identified earlier
• Fellowships now aligned to strategic needs of DoH
• International fellowships in tropical medicine
  and forensic science being implemented
• New contracts being developed to remove
  depreciating contract values and equate work
  back periods to value of studies rather than
  duration

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Departmental Internship Programme

• To provide graduates with valuable work
  experience and skills to enhance their
  employability
• 125 interns employed by NDOH since inception and
  all secured jobs with either DoH, other
  government departments private sector
  organisations after training with NDoH

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External mentorship coaching

• New concept where selected employees who show
  exceptional success will be mentored or coached
  with limited placements in relevant private and
  public organisations for experiential learning
• Aims to grow talent and the programme will bring
  innovative approaches to doing business in public
  sector

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Sector Service delivery improvement by SMS

• Enhancement of capacity of SMS through programmes
  like Project Khaedu done through DPSA
  initiatives
• Capacity building initiatives for hospital
  managers through a French-funded programme which
  is jointly offered by University of KZN and WITS
  (71 in the programme)

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Sector Management Team Development

• Focus has changed from skilling individuals to
  instead skill teams
• It follows an action cycle which develops and
  maintains capacity
• Training within DoH is done using Belgian
  Technical Cooperation funding
• It is not qualification orientated but rather
  foundational, seeking to give managers on the job
  skills that they need to improve service delivery

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Addressing Health Sector

• NDoH (with DoE) currently engaged with health
  sciences education training institutions to
  address training production matters
• NDoH is engaging Statutory Health Professions
  Councils to address implementation of National
  HRH Plan (esp. linking CPD to performance
  management of clinicians)
• Funding is required to support increased
  production of health professionals improve
  remuneration

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Training of health professionals

• Skills development here take place within context
  of education training (under- post-graduate)
• Health sectors interns community service
  health professionals provide health care to all
  SA communities
• Skills development here is done through either
  specialisation or through Continuing Professional
  Development programmes (paid for by individual
  professionals)
• Major challenge in this area is retention of
  professionals within public health facilities
  low salaries driving professionals out of public
  health service

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Emergency Medical Services

• Plan to accelerate training of professional
  emergency medical personnel being implemented
• Objectives
• strengthen health system response to medical
  emergencies
• prepare for 2010 as part of governments
  responsibility
• Professionalise this category through accredited
  training

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Emergency Medical Services cont..

• Training of Emergency Care Technicians to
  commencing in 2007 target 1000 by 2010
• Registration of qualifications scope of
  practice being dealt with
• Funding obtained from Treasury
• There is need to ensure provision of emergency
  vehicles to enable provision of complete service

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Clinical Associates Programme

• Category being introduced as mid-level worker in
  medicine
• To deal with minor but important work free
  doctors to do carry out major responsibilities
  and procedures
• Will work at district hospital and Community
  Health Clinic level
• Education training to occur at university
  district hospital levels
• Focus will be on skills development to deal with
  common presenting medical problems refer to
  experienced senior staff (doctors nurses)

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Clinical Associates Programme cont..

• Process now at level where universities are
  applying to register programme with DoE
• Process managed at national level by a
  Ministerial Task Team

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Community Health Workers

• Community Health Worker policy adopted in 2004
  incorporated as part of EPWP
• Training now formalised, standardised nationally
  training manuals being produced by JUTA
  publishers
• Stipends have been standardised nationally
  employment is by NGOs
• CHWs operate at community home level
• National targets for training achieved in line
  with Social Cluster EPWP Programme of Action

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NATIONAL DEPARTMENT OF HEALTH
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NATIONAL DEPARTMENT OF HEALTH

• THE END