REPORT ON MATTERS IDENTIFIED BY THE COMMITTEE LIMPOPO DEPARTMENT OF HEALTH REPORT ON MATTERS IDENTIFIED BY THE COMMITTEE STANDING COMMITTEE ON APPROPRIATIONS AND PORTFOLIO COMMITTEE ON HEALTH MEETING 22-24 March 2017 Presented by: Dr N. Kgaphole Head of Department

Presentation Outline Alignment Between the National Budget Processes and Provincial Budget Processes (Challenges and Measures to Strengthen The Alignment). Alignment in health information systems (including revenue and billing, patient, pharmaceutical application, network infrastructure, et.) between the province and other national ICT systems for effective coordination in the health sector Devolvement of Critical Functions to Designated Levels for Service Delivery Efficiencies and Better Performance. Ensuring the effective management of personnel expenditure in the health sector Alignment of national and provincial health infrastructure priorities and improving infrastructure budget expenditure (challenges and opportunities for improvement).

1. ALIGNMENT BETWEEN THE NATIONAL BUDGET PROCESSES AND PROVINCIAL BUDGET PROCESSES (CHALLENGES AND MEASURES TO STRENGTHEN THE ALIGNMENT) Provincial Budget Processes are Aligned to the National Budget Processes This alignment is mainly achieved through the MTEC/Budget Bilaterals that the Limpopo Provincial Treasury conducts with all the Departments within the province. These MTEC/Budget Bilaterals improve provincial budget planning and implementation and a credible provincial budget. Alignment Challenges Insufficient budget of the Limpopo health budget poses a risk in the provincial budget planning processes and this might compromise the credibility of the provincial budget. The National Department of Health had however indicated that they would want to have inputs to the Department’s budget before they are finalised with the Limpopo Provincial Treasury.

ALIGNMENT BETWEEN THE NATIONAL BUDGET PROCESSES AND PROVINCIAL BUDGET PROCESSES (CHALLENGES AND MEASURES TO STRENGTHEN THE ALIGNMENT) Alignment Challenges Unfunded Mandates According to the Primary Healthcare Re-engineering, which is a national strategy, every clinic should reach Ideal clinic status. However, there is lack of funding for this project thereby making a national priority not to be fully realised. Policy changes e.g. Universal test and treat of HIV/AIDS introduced in the middle of the financial year DCST; NHI; initially funded from NDoH but the department is expected to absorb without funds

ALIGNMENT BETWEEN THE NATIONAL BUDGET PROCESSES AND PROVINCIAL BUDGET PROCESSES (CHALLENGES AND MEASURES TO STRENGTHEN THE ALIGNMENT) cont… Strengthening of the Alignment From now onwards, the Limpopo Department of Health and National Department of Health will hold a Provincial Budget benchmark exercise before finalisation of the budget to give inputs to the budgeting process. The purpose of this benchmark exercise, among others, is to: Evaluate budget alignment to national and provincial priorities; Ensure rational budget for Programmes, Hospitals, Districts and PHC Facilities; and Evaluate the credibility of the budget allocations.

2. ALIGNMENT IN HEALTH INFORMATION SYSTEMS BETWEEN THE PROVINCE AND OTHER NATIONAL ICT SYSTEMS FOR EFFECTIVE COORDINATION IN THE HEALTH SECTOR The National Health Normative Standards Framework (HNSF) for Interoperability in eHealth in South Africa has been developed to ensure interoperability of Health Information Systems in the country. The Limpopo Department of Health has deployed its system as the Hospital Information System which introduces duplication of patient file and the opportunity for people to collect medicine more than once for the same problem. The department is in the process of improving its system from a Hospital Information System to a centralised Health Information System and will ensure compliance with the HNSF minimum interoperability requirements. The current Information and Communication Technology (ICT) infrastructure is obsolete and poses a service delivery risk due to untimely system downtimes. A project to upgrade the ICT infrastructure is planned to start in the new financial year (2017/18) and will be done in a phased approach due to budget constraints.

Delegations of Authority have different levels of approval. 3. DEVOLVEMENT OF CRITICAL FUNCTIONS TO DESIGNATED LEVELS FOR SERVICE DELIVERY EFFICIENCIES AND BETTER PERFORMANCE All the support functions such as HR, Financial Management which includes Procurement and Assets Management have been devolved up to the district hospital level. Delegations of Authority have different levels of approval. Few functions are centralised at Head Office level, e.g. advertisement of vacancies and tenders, bank reconciliations, contract management, bursary management and appointment of staff

Workload Indicators Staffing Needs (WISN) 4. ENSURING THE EFFECTIVE MANAGEMENT OF PERSONNEL EXPENDITURE IN THE HEALTH SECTOR Human Resource Planning assesses and determines cost of the existing and required personnel in the department. Workload Indicators Staffing Needs (WISN) Normative guidelines for Primary Healthcare have been determined and await implementation following the completion of engagements with different stakeholders. The District Hospitals are at the data collection phase.

5. INFRASTRUCTURE

2016/17 Budget and Expenditure (as at 10 March 2017) FUNDING SOURCE ADJUSTED BUDGET ALLOCATION EXPENDITURE EXPENDITURE % BAS COMMITMENTS HFRG 379 089 338 633 89% 29 205 VOTED 357 072 258 729 72% 36 539 TOTAL 736 161 597 362 81% 65 744 The department is anticipating to break-even as at the end of the financial year. The provincial infrastructure budget is aligned to the National Health Infrastructure priorities Note: HFRG budget will be fully expended by end of the 2016/17 financial year Equitable Share budget will be fully expended by end of the 2016/17 financial year On the basis of current commitments, there is an over expenditure of R 128m projected. The projected over expenditure has been compounded by the re-allocation of R150m from capital projects to maintenance; and later some of this money had to be surrendered to offset critical budget pressures within the Department. The Department is set to start the 2017/18 financial year with a projected accrual of R 128m; Steps will have to be taken to postpone certain expenditure and commitments within the limits of the budget.

Infrastructure Challenges & Planned Interventions Ageing and inappropriate “not fit for purpose” infrastructure and equipment Resuscitation of Capital Works Planning Committee Limited capital and maintenance budgets versus the needs To revisit the work undertaken by the Task Team on health care funding, update data and cost estimates; and submit to Provincial Treasury, National Department of Health and National Treasury

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