Budget Presentation

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Budget Presentation

• Northern Cape
• Province

Health Portfolio Committee Monday 7th June 2004
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Vision

• Our Vision is to provide excellent, holistic,
  people-centred and affordable health care in the
  Northern Cape

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Mission

• We are committed to achieving our vision through
  a decentralized, accountable, accessible and
  constantly improving health care system within
  available resources.
• Our caring, multi-skilled effective personnel
  will use evidence-based, informative health care
  and maturing partnerships for the benefit of our
  clients and patients.

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Review of2003 / 2004
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Deficit Analysis
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Deficit Analysis

• Clearing of suspense account
• Pharmaceuticals R 20994 m
• Works R 3492 m
• Backlog payments
• Inflation
• Food supplies
• Fuel
• Medicine
• Laboratory

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Expenditure by Programme
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Revenue
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Budget Allocation and Distribution
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Budget
  Adjusted Voted Medium-term Estimates Voted Medium-term Estimates Voted Medium-term Estimates Voted Medium-term Estimates
  appropriation Voted Medium-term Estimates Voted Medium-term Estimates Voted Medium-term Estimates Voted Medium-term Estimates
R'000 2003-04 2004-05   Increase 2005-06 2006-07
Equitable share 579,730 623,792 7.6 683,650 721,981
Conditional grants 179,146 190,565 6.4 225,662 264,729
Statutory Amount 771 784 1.7 839 839
Total revenue 759,647 815,141 7.3 910,151 987,549
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Programme Distribution
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Personnel vs Non Personnel
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Capital vs Current
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GFS Classification
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Conditional Grants
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Specific Budget Pressures
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Inter-Provincial Equity
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Inter-Provincial Equity

• Correction to 17 of provincial equitable share
  including own revenue would add to the Health
  coffers
• R 44960 million

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Health Sector Inflation

• Adjustment after currency slide of December 2001
• National task team investigated impact on health
  budgets
• Recommendation to Health Treasury 10x10
• Stores Livestock 22,7
• Equipment 29,2
• Prof Spec 13,25
• NC Health Department recommended adjustment was
  never received
• R 35 million

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Improved Access to Services

• Upgrading tertiary services at Kimberley
  Hospital R 36 million required
• Upgrading secondary services at Gordonia
  Hospital R 14 million required
• Equipping of district
• hospitals R 46 million required
• Clinics R 2 million required

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Emergency Medical Services

• Ambulance equipment
• Rescue equipment
• Human resources
• Amount Required
• R 15 million

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Other Pressures

• PRESSURE REQUIRED
• Assistive devices R 2,500m
• Nursing College R 10,000m
• Maintenance R 9,000m
• Health Promotion R 2,000m
• Cross boundary flows R 21,000m

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National Pressures
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Free Health Care for the Disabled

• Number of Disabled 40681
• Estimated 4.8 of population in Sept 2003
• Patient Day Equivalents (PDE) 9904
• PDE (in patient days) (outpatient visits/3)
• Cost per PDE R 1024
• Cost of treating disabled patients will require
  additional spending
• R 10180 million

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Anti-Retroviral Treatment
R 72800 million
IMPLEMENTATION COST OF YEAR 1 (2004 / 2005)
Strengthening
R43400 million
Human Resources
Training, etc.
R29400 million
Drugs and Lab costs

• Current funding R14,0 million
• Shortfall R58,8 million

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Rural Scarce Skill Allowance

• Costed impact R35,8 million
• Current funding R12,4 million
• Shortfall R23,4 million

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Programme 1ADMINISTRATION

• Office of the MEC
• Management

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Sub- programme 1.1 Office of the MEC

• Key Strategic Objectives
• To provide strategic political leadership
• To provide the administrative framework and
  support function to allow the MEC for Health to
  discharge his duties.
• To support public accountability and
  participation.

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Sub- Programme 1.2 Management

• Key Strategic Objectives
• To develop a strategic plan for the department
  and maintain the strategic direction
• To develop a financial plan for the department
  for the MTEF period
• To maintain a system of effective management of
  all departmental assets

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QUALITY ASSURANCE

• Conducts regular quality audits and responds with
  quality improvement plans
• Supports the fundamentals of Batho Pele
• Recent Awards
• Premiers Excellence Gold Award
• Cecila Makiwane
• Platinum

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Programme 2DISTRICT HEALTH SYSTEM

• District Management
• Priority Programmes
• Support Services

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Programme 2 District Health System

• District Priorities
• The Districts remain the area of primary service
  delivery
• Underlying strategies include
• Improving Access
• Improving Quality
• Ensuring minimum service package is available
  throughout

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• Other District Health challenges include
• To improve the nutritional status in the
  community
• To ensure the retention of Health Professionals,
  esp. prof nurses
• To raise the profile of mental health and
  substance abuse
• To ensure a 2 crew per EMS vehicle
• Ensure rational drug use of essential drug use at
  primary level
• To render quality care to all mothers and babies

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COMMUNICABLE DISEASES

• HCBC coverage in all districts
• HIV AIDS
• 155 professionals trained in ART, 300 in
  opportunistic infections management
• 116 VCT sites achieved and strategically placed
• HIV Prevalence rate stable
• (the slight decline not yet significant)
• TB undergoing review
• Disease surveillance continues
• Director Appointed
• 5 Sites accredited for ART

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MATERNAL, CHILD AND WOMENS HEALTH

• Roll out of youth friendly services in 3
  districts
• Collaboration of the youth and adolescent
  programme with other youth structures
• Implementation of IMCI at district level
• Improvement of maternal and pediatric health care
  services
• Establishment of a dedicated HIV and AIDS clinic
  at GDH for children

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HEALTH PROMOTION

• Launch of health promoting schools
• Monitoring for compliance of the tobacco
  legislation
• Monitoring of emerging diseases
• Dissemination of the results of the youth risk
  behavioral survey

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MENTAL HEALTH AND SUBSTANCE ABUSE

• Psychiatric services are being integrated at PHC
  level
• The establishment of psychiatric community based
  services in the province
• Started with the training of Mental health care
  providers at facility level

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REHABILIATION DISABILITY AND CHRONIC DISEASE

• The Northern Cape has the greatest number of
  cataract surgery tours in the country
• Assistive devices have been prioritized, to
  reduce waiting lists
• Access to services for chronic diseases in remote
  areas continues to increase

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INTEGRATED NUTRITION PROGRAMME

• Vitamin A supplementation is being implemented
  according to National guidelines
• Monitoring of menus at primary schools continues
• Establishing of food gardens at clinics and
  schools will progress in collaboration with the
  Dept of Agriculture

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ORAL HEALTH

• Plans are underway to ensure the full package of
  primary oral health services is delivered to
  rural and remote areas
• This includes projects to
• provide an appropriately trained and dedicated
  workforce
• ensure that rehabilitative services are provided
  to edentulous patients

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ENVIRONMENTAL HEALTH

• Involvement in Port Control is increasing in
  Kimberley and Upington
• Inspections are conducted at hazardous substance
  premises in compliance with legislation
• Support is given for follow up of contacts of
  some communicable diseases patients e.g.
  hepatitis

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PHARMACEUTICAL SERVICES

• Monitoring of tracer drugs to ensure optimal
  levels at all facilities on a weekly basis
• Use of stock cards in the absence of a
  computerized system
• Training of pharmaceutical assistants
• The implementation of the rural and scarce
  skills allowance for pharmacist

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INFORMATION MANAGEMENT

• A Ten Year Review has been completed internally
• Bi-annual Indicator Reviews were implemented as
  management tools
• KHC Nerve Centre supports Information Management
  at all Hospitals
• Training of PHC nurses in the software continues
  (DHIS, STI module, TB module)

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Programme 3EMERGENCY MEDICAL SERVICES
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• EMS Strategic Priorities
• The establishment of a two-crew Ambulance in all
  the major centres (De Aar, Springbok, Kuruman,
  Upington and Jan Kempdorp).
• Procurement of sufficient and appropriate
  vehicles to affect a 60 separation of
  Emergencies/Planned Patient Transport.
• Implementation of the three year vehicle
  replacement plan

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Programme 4PROVINCIAL HOSPITAL

• Kimberley Hospital

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• The Complex
• Kimberley Hospital
• West End Hospital
• KHC Rehabilitation Centre
• Services
• level 1, 2 and 3 services
• 35 beds for private patients
• Twinning
• Oxford-Radcliffe, England
• Chicago, USA
• France

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Tertiary Services Package

• Internal Medicine
• General Cardiology
• Dermatology
• Lipidiology
• Clinical Immuniology
• Clinical Hematology
• Intensive Care
• Burn Unit
• Colorectal Surgery
• General Surgery
• 11. Hepatobiliary Surgery
• Vascular Surgery
• Opthalmology
• Ear, Nose and Throat
• Neurosurgery

• 16. Orthopedic
• 17. Plastic Reconstructive Surgery
• 18. Accident Emergency
• 19. Neonatal ICU
• 20. Medical Oncology
• 21. Tertiary Oncology
• 22. Nephrology (Renal Dialysis)
• 23. Spinal Injury Management
• 24. Complex Radiology (CT Scan)

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KHC Objectives

• Improving secondary hospital outreach services
• Developing specialist tertiary services
• Valuing and respecting users of the services
• Valuing and developing staff
• Improving infrastructure and technology
• Making best use of human and financial resources

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Programme 5HEALTH SERVICES AND TRAINING
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• COURSES OFFERED
• Comprehensive course (4 years)
• Bridging course (2 years)
• Midwifery (1 year)
• Auxiliary Nursing (1 year)
• Primary Health Care (18 mths post basic)
• Community Nursing (18 mths post basic)

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• LEARNERSHIPS
• 300 professional nurses to commence training in
  January 2005
• 600 auxiliary nurses to start training in July
  2004
• 40 doctors to start training in Bloemfontein in
  January 2005

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• NURSE EDUCATORS
• 13 with at least a basic Degree / Chief
  Professional nurses level
• 1 Acting Principal post has been advertsised

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PROGRAMME IN TRAINING QUALIFIED
Diploma in General Nursing Science 162 45
Diploma in Midwifery 30 11
Diploma in Community Health Nursing 18/12 5 5
Diploma in General Nursing (Bridging course) 73 72
Diploma in Health Assessment, Treatment and Care 20 None
Certificate in Forensic Nursing 22 19
Certificate in Primary Clinical Care
Pupil Auxiliary Nursing 114 16
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Training Objectives

• Improve representation of disadvantaged groups
  and students of rural origin.
• To reduce attrition rate per course per year for
  formal training by main category
• To ensure capacity building for health managers

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Programme 6HEALTH CARE SUPPORT SERVICES
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Forensic Services

• CURRENT MANDATES
• Transfer medico-legal mortuaries from SAPS to
  DOH.
• Improve the quality of the forensic pathology
  services in the Province, by ensuring the prompt
  performance of medico-legal autopsies as and
  where required.

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3. Be available for Forensic pathology
consultation with / by other medical
practitioners, the courts of law, the provincial
office of the public prosecutor and other
relevant authorized stakeholders. 4. Arrange a
training programme for staff involved in the
service. 5. Sharing expertise with other
departments
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Engineering

• CURRENT PRIORITIES
• Appoint artisans at District Hospitals
• Identifying financial resources required for
  pro-active maintenance and replacement of all
  equipment

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Programme 7HEALTH FACILITIES MANAGEMENT
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Facilities Management

• CURRENT PRIORITIES
• A long term capital project plan inclusive of all
  facilities is being developed
• A service level agreement will be implemented
  between Public Works and the Department of
  Health.
• Improve the image of all facilities, starting
  with paint work immediately

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• Thank you