INTRODUCTION List of Conditional Grants HOSPITAL GRANTS OPERATIONAL GRANTS Central Hospitals Health professionals training and research

List of Conditional Grants (cont) CAPITAL GRANTS Redistribution of specialised services Hospital reconstruction and rehabilitation (R&R) Construction Pretoria Durban Umtata

List of Conditional Grants (cont) PSNP & INP Primary school nutrition programme (PSNP) and Integrated nutrition programme (INP) HIV/AIDS National integrated plan for children and youth infected and affected by HIV/AIDS

General Notes Conditions Business plans developed and approved Expenditure in accordance with business plan Monthly financial reports Quarterly financial reports Quarterly progress reports Certificate signed by provincial Accounting Officer at the end of the financial year

General Notes (continue) Monitoring Provincial heads of health submit monthly financial reports Statistical formats to be completed on quarterly basis: List of indicators pertaining to expenditure vs cash flow Progress against action plan RDP indicators and INP indicators

General Notes (continue) Monitoring (continue) Provincial liaison and technical support visits Regular meetings per financial year between national department and provinces

Administrative costs There are no material administrative costs. The cost of planning and monitoring is material These costs are carried by the national Department and have not not been quantified

Payment schedules Central hospitals and Health Professionals Training and Research - On a monthly basis All other grants – On a quarterly basis in advance

Capacity and preparedness of national transferring department Officials in the national office are designated to monitor the grants Supported by existing administrative staff Additional staff to be appointed where existing staff cannot cope with the work load Performance of the national Department to be assessed in terms of: Regular visits to provinces Timeous reporting to Department of Finance Compliance with agreed transfer schedules

Central Hospitals PURPOSE To ensure collective planning of highly specialised services To ensure that long term strategic planning is not disrupted by budgetary problems To ensure that all citizens have equity of access to services and that there is reasonable distribution of services To eliminate the need for one province to charge another for these services

Criteria for division Based upon meeting 75% of operating expenditure of ten central hospitals: Free State - Universitas Gauteng - Chris Hani-Baragwanath, Johannesburg, Pretoria Academic & Garankuwa KZN - King Edward & Wentworth Western Cape- Groote Schuur, Tygerberg & Red Cross

Criteria for division An allocation to Eastern Cape for Grahamstown high security psychiatry facility has been included for 2000/01

Rationale for funding through conditional grant These Central Hospitals are national assets because of the types of services they deliver Because of the nature of these services it can only be offered at certain institutions Services must be accessible across provinces Cannot be funded through equitable share

Past Performance

Actual Allocation

Health Professionals Training and Research PURPOSE To support the training of all categories of health professionals and to support research To compensate provinces for the additional service costs To pursue the policy objective of shifting most teaching from central hospitals

Criteria for division During 1998/99 the allocation was made on the basis of the number of final year medical students 10% of the grant was divided equally between provinces without a medical school In following financial years, it was adjusted for inflation

Rationale for funding through conditional grant Recruitment and selection of is not limited to geographical boundaries The research component is not limited by provincial boundaries

Past Performance

Actual Allocation

Redistribution of specialised services PURPOSE To improve equity of access to tertiary care To reduce the number of people who have to be transferred To build expertise, specialist training, clinical standards and morale To build up facilities, resources and tertiary services in at least one hospital per province

Criteria for division Owing to inequalities in provinces, the need for the service and the cost of establishing it is considered primarily in allocating funds The population of the five provinces is used broadly to guide provincial allocations

Past Performance

Actual Allocation

Hospital Reconstruction and Rehabilitation(R&R) Purpose To fund a major hospital R&R project in all provinces

Criteria for division A major hospital facilities audit doen in 1995 indicated the need An index was calculated which reflected the study as a backlog index for each province This index forms the base for the division of funds Restructure hospital sector

Rationale for funding through conditional grant To achieve specific national objective of transformation of hospital sector requires national based funding The equitable share distribution does not match the required fund distribution to achieve an equitable base in the health infrastructure To develop and monitor infrastructure planning require conditionality on processes

Past Performance

Actual Allocation

Construction Durban Academic Hospital Pretoria Academic Hospital Umtata Academic Hospital PURPOSE To fund the construction and equipment of the Durban, Pretoria and the Umtata Academic Hospitals

Rationale for funding through conditional grant These are some of the designated central hospitals which will deliver mostly tertiary and quaternary services

Past Performance

Actual Allocation

Primary School Nutrition Programme (PSNP) & Integrated Nutrition Programme (INP) PURPOSE Implemented in 1994 Focus include school feeding, nutrition education and health promotion RDP allocation replaced by PSNP Conditional Grant in 1998/99 financial year

PURPOSE (cont) On 30 April 1999 approval from DSE was obtained to use PSNP Conditional Grant allocation to create infrastructure for and fund recurrent expenditures of the INP.

Criteria for division The INP/PSNP Conditional Grant Allocation replaced the RDP Allocation Methodology for distribution to provinces was maintained Projected population Poverty gap figures

Rationale for funding through conditional grant SA become signatory to the Rights of the Child in 1995 Government pledged itself to prioritise children’s issues Initiated as a Presidential Lead Project of the RDP Provided to ensure and facilitate the nutrition and social development of children Funding through equitable share would not guarantee funding for this priority

Past Performance

Actual Allocation

National integrated plan for children and youth infected and affected by HIV/AIDS PURPOSE Ensure access to appropriate and effective integrated system of prevention, care and support services for children infected and affected by HIV/AIDS

Criteria for division Principles Areas (provinces) of highest prevalence Priority provinces identified by Cabinet Areas where poverty alleviation programmes are being implemented Areas where the Integrated Nutrition Programme is implemented Areas in need of social upliftment

Criteria for division At the end of 1999 an audit was done on the readiness of the health & NGO sector to deliver home- community based care and support. This was used as basis for allocations as well as business plans submitted by provinces

Rationale for funding through conditional grant HIV/AIDS is a Government priority. Should this become part of the equitable share, there is no guarantee that it will be used for the intended purpose The National Department is not in a position to fund the Integrated Plan out of its annual budget.

Past Performance

Actual Allocation