THE BRIEFING TO PARLIAMENT STANDING COMMITTEE ON APPROPRIATION AND PORTFOLIO COMMITTEE ON HEALTH THE EFFECTIVE CO-ORDINATION AND ALIGNMENT OF NATIONAL AND PROVINCIAL SPHERES OF GOVERNMENT IN THE DELIVERY OF HEALTH SERVICES

PROCESS ALIGNMENT, CHALLENGES AND MEASURES TO STRENGTHEN THE ALIGNMENT

ALIGNMENT BETWEEN NATIONAL BUDGET PROCESSES AND THE PROVINCIAL PROCESSES The budgeting process of the department is based on the Provincial and National processes. In terms of these processes, there are a number of interactions between the Provincial Treasury & the National Treasury, & between the Provincial Treasury & PDoH, & amongst the Provincial Treasury, the National Treasury, the NDoH and the PDoH. These interactions takes form of either formal meetings or written communications. Departmentally, a budget policy exists which outlines the processes that must be followed when budget estimates are developed.

ALIGNMENT BETWEEN NATIONAL BUDGET PROCESSES AND THE PROVINCIAL PROCESSES These estimates are developed in conjunction with the strategic planning component of the department to ensure alignment with priorities of the department, to ensure alignment with priorities of the department. To ensure alignment with National priorities, the various interactions mentioned above, serve as amongst others, platform to integrate set priorities & allocated estimates. The process stated above is normally a formal Benchmarking exercises. The Health Sector, under the championship of NDoH, would lead the interactions with the treasuries to discuss priorities & allocations.

ALIGNMENT BETWEEN NATIONAL BUDGET PROCESSES AND THE PROVINCIAL PROCESSES Towards the end of the budgeting process, the NDoH also convenes benchmarking exercises to ensure that there is alignment in the budget priorities by all provincial DoH. The Ministerial Non negotiables is an example of a perfect fit of how the sector aligns the budget processes. Furthermore, within the provincial government itself, the Provincial EXCO under the leadership of the Premier, will convene several meetings ( budget lekgotla) to ensure the budgets of the departments are aligned to the provincial priorities & addresses province-specific needs. In the final analysis, the conclusion of both the National Treasury & NDoH in the past years on the budget of the PDoH has been positive.

CHALLENGES AND MEASURES TO STRENGTHEN THE ALIGNMENT With regard to processes between NDoH & PDoH, there are adequate measures in place, and these include processes related to target setting, allocation of budgets and time schedules. However, time schedules for planning is in most cases tight. This creates pressures with regard to synchronization of strategic planning and budgeting processes, especially at provincial level. Not all costing of healthcare services have been done or is available thus creating/resulting in certain instances, in ineffectively financing of policy priorities.

HEALTH INFORMATION SYSTEMS

ENSURING ALIGNMENT IN HIS Provincial Information and Research unit has representation in the National Health Information system of South Africa (NHISSA) which is a sub-committee of the Technical Advisory Committee of the National Health Council. The unit also gets represented in the national data alignment meetings as part of standardization of information management according to the DHMIS Policy 2011 The Free State department of health is implementing WebDHIS (DHIS 2) in line with national department of Health as part of the e-health strategy

ENSURING ALIGNMENT IN PHARMACEUTICAL SYSTEMS The PDoH uses the following systems for pharmaceuticals: RX solution – for stock control and dispensing (Various facilities) RX solution PMPU – for medical procurement (Medical Depot) Medsas Remote Demand Module – for ordering (Various facilities and medical depot) Medsas – payments and inventory management (Medical Depot) Medsas interfaces with BAS for payment purposes Patient management systems (PADS and sourced system) These systems are aligned within the department, that is among the facilities, Medical Depot and Head Office and not integrated with other National ICT systems.

ENSURING ALIGNMENT IN PHARMACEUTICAL SYSTEMS VERIFICATION INTERFACE WITH BAS RX SOLUTION RX SOLUTION PMPU MEDSAS BAS

ENSURING ALIGNMENT IN PHARMACEUTICAL SYSTEMS RX solution and Stock Visibility Systems These are computer based or mobile based systems that are used for monitoring medicines stock levels at hospitals and PHC’s. These systems provides information to all who has access, irrespective of whether they are at National or Provincial level.

ENSURING ALIGNMENT IN PATIENT ADMINISTRATION Currently FSDOH has the following systems that addresses patient information and revenue collection: Sourced system which provides patient information, clinical information and billing of patients, and integrates with systems like NHLS for blood results, EDI for vetting of patient legible for payment. RIS/PACS for imaging technology PADS - is used for admission and billing of patients These systems are however PDoH specific

ENSURING ICT CAPABILITY SITA provides the infrastructure network for the department Currently the department is experiencing WAN bandwidth problems and alternative solutions have been sought particularly to achieve the Ideal Clinic Realization and Maintenance (ICRM) system. The ICRM is being implemented in line with the national department of health.

DELEGATED POWERS IN THE DEPARTMENT OF HEALTH

DELEGATED POWERS IN THE DEPARTMENT OF HEALTH The Accounting Officer of the PDoH was appointed by Provincial Treasury under section 36 (3) of the PFMA since 2014. Effectively this implies that all powers vested in the Accounting Officer have been removed from the Head of the Department and the Accounting Officer has devolved powers as he deemed fit. The above was intended to balance service delivery and financial conformance. Nevertheless, the PDoH is operating on a decentralised basis. These delegations are applied by all Health facilities situated in five districts. The following Delegations are applied in this department: Supply Chain Management Delegations Financial Management Delegations Human Resource Management Delegations

SCM DELEGATED POWERS

SCM DELEGATED POWERS

FINANCE DELEGATED POWERS

HRM DELEGATED POWERS

HRM DELEGATED POWERS

DELEGATED POWERS IN THE DEPARTMENT OF HEALTH The Department has also developed and implemented the system related delegations, viz; BAS Delegations PERSAL Delegations LOGIS Delegations, however; these delegations are incorporated in the Supply Chain Management delegations.

DELEGATED POWERS IN THE DEPARTMENT OF HEALTH The Delegations are reviewed annually and the department is currently in a process of reviewing the Delegations with the implementation date of the 1st of April. The control measure put in place to ensure that delegated powers are devolved to the relevant level of authority is done through taking all the Delegations to the Internal Control Unit to conduct Risk Assessment on each Delegated power. Finance and SCM delegated powers are approved by the Accounting Officer and HR Delegations are approved by the MEC: Health During the Financial Year under review, the delegations were implemented and they were found to be enhancing performance and improving efficiency and effectiveness pertaining to service delivery

Ensuring the Effective management of Personnel expenditure in the health sector (HR) Pursuant to the Provincial Treasury quest to manage financial situation of the province, management of personnel expenditure is done through Treasury Instruction Note 48 of 2016. This implies that all posts are vetted [i.t.o. funding and approved structure] before approval is granted for filling. The measures Provincial Treasury did however had impact on the filling of critical posts of both clinical and support services. Effectively there has been a net loss of personnel in the department over a period of years. This has added to the increase in the vacancy rate.

Alignment of national and provincial health infrastructure priorities and improving infrastructure budget expenditure (challenges and opportunities and improvements) The infrastructure planning is a collaboration process between the two spheres of government. The provincial department’s infrastructure is expected produce to user asset management plan (U-AMP) document by mid-year of the planning for projects to be implemented in the following financial year. This document talks to how the immovable assets of the department will be maintenance, including those new additional ones that will be introduced into the system. In the U-AMP and attempt is made to include all the key deliverables identified, such as: The non-negotiables (maintenance of infrastructure and medical equipment); FSGDS and Provincial developments needs and priorities as outlined in SOPA and MEC’s injunction; New infrastructure to replace old and dilapidated once. Out of the U-AMP the province produces the Annual Implementation Plan (AIP) which gets approved by NDOH and is aligned to the priorities that meets NDOH’s mandate. Around February of every year, once the budget has been confirmed, NDOH and the nine PDOH infrastructure units meet to assess the priorities outlined in the AIPs of the different provinces in order to align them to National Government’s strategic priorities.

Improving infrastructure budget expenditure Alignment of national and provincial health infrastructure priorities and improving infrastructure budget expenditure Improving infrastructure budget expenditure Improve infrastructure projects planning avoid changing projects in the course of the financial year; Enhance the internal controls on contract and project management including cash flows and payments to service providers; Improve turnaround times for infrastructure procurement; Implement alternative construction procurement systems.

Alignment of national and provincial health infrastructure priorities and improving infrastructure budget expenditure (challenges and opportunities and improvements) Challenges Ageing health infrastructure Inadequate budget allocation to meet the maintenance and infrastructure backlog; Inadequate infrastructure human resource capacity and lack of technical personnel for maintenance at institutions. Opportunities Explore the issue of alternative funding source to fund the capital projects, Approaching the private sector or SOEs to fund and implemented infrastructure provision and maintenance, Use of Implementing Agents for health infrastructure project implementation

ANY OTHER MATTER THAT MAY IMPROVE ALIGNMENT AND COORDINATION Patient administration system and health information management system must be transversal systems of the health sector that are similar to BAS and LOGIS for financial and procurement systems. Applicable in all 9 Provinces and NDoH. Administered at central point. Similar functionalities across the sector. SITA must be responsible for procuring and developing systems in order to ensure streamlining and integration across the health sector. This will require that SITA be capacitated both financially and in terms of Human Resources.

ANY OTHER MATTER THAT MAY IMPROVE ALIGNMENT AND COORDINATION All academic/tertiary hospitals and specialised hospitals like psychiatric hospitals must be taken over by NDoH to ensure leveraging on resources and specialisation and similar standards. NDoH will have to build support capacity across the provinces especially in infrastructure management

THANK YOU