PRESENTATION TO THE SELECT COMMITTEE ON SOCIAL SERVICES ANNUAL PERFORMANCE PLAN AND BUDGET 2011/12-2013/14

1. VISION AND MISSION VISION MISSION Long and healthy life for all South Africans MISSION To improve health status through the prevention of illnesses and the promotion of healthy lifestyles and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

HEALTH SECTORS PLAN 2011/12 TO 2013/14 Government adopted an outcome-based approach to service delivery The Health sector is responsible for the achievement of Outcome 2 : A long and healthy life for all South Africans Four Identified outputs: Output 1 : Increasing Life Expectancy Output 2 : Decreasing Maternal and Child mortality Output 3 : Combating HIV and AIDS and decreasing the burden of disease from Tuberculosis Output 4 : Strengthening Health System Effectiveness

Health Sector 10 point Plan Interrelationship across the Health Sector Negotiated Service Delivery Agreement, the 10 Point Plan and the National Health Insurance Health Sector 10 point Plan A LONG & HEALTHY LIFE FOR ALL SOUTH AFRICANS NSDA NHI Defined Targets Defined Timeframes & critical milestones Secret

INCREASED LIFE EXPECTANCY STRENGTHENING HEALTH SYSTEM EFFECTIVENESS IMPROVED ACCESS TO HUMAN RESOURCES FOR HEALTH INTER - SECTORAL ACTION SOCIAL DETERMI NANTS OF QUALITY OF SERVICES NATIONAL INSURANCE IMPACT OUTCOMES OUTPUT FINANCIAL MANAGE MENT INPUTS PRIMARY CARE ORIENTED SERVICE DELIVERY INFORMA TION ACCESSS TO FACILITIES HEALTH SECTOR NSDA 2010 - 2014 Reduced Maternal and Child mortality rates Reduce burden from HIV&AIDS and TB (Mortality and Morbidity) Reduce burden from non-communicable diseases Reduce burden from violence and injury Primary Health Care Oriented Service Delivery Improved quality of services Improved Human Resources for Health Improved access to Health Facilities Improved financial manage-ment National Health Insurance Health Informa - tion Inter -sectoral action for social de -terminants of Health

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 SCALE UP THE COMBINATION OF PREVENTION INTERVENTIONS TO REDUCE NEW HIV INFECTIONS KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Scaling up condom distribution, with 1 billion male condoms distributed annually during 2011/12-2013/14, and 6 million female condoms distributed annually during 2013/14 Increase the number of Medical Male Circumcisions to 500 000 during 2011/12 and 600 000 annually during 2012/13 and 2013/14 Increase the HCT uptake rate from 80% to 90% in 2013/14

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVE THE QUALITY OF LIFE OF PEOPLE LIVING WITH HIV &AIDS BY PROVIDING AN APPROPRIATE PACKAGE OF CARE, TREATMENTS AND SUPPORT KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Increasing the number of new patients initiated on Antiretroviral Therapy (ART) to between 625 000 to 675 000 annually during 2011/12-2013/14 Increasing the proportion of PHC facilities implementing nutritional intervention for People living with HIV and AIDS and TB from 77% in 2010/11 to 88% in 2013/14

REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Maintain the percentage of children under 1-year of age fully immunised at 95% throughout the MTEF period Maintain the measles immunisation coverage rate of 95 % throughout the MTEF period Increasing the number of sub-districts implementing school health services from 100 to 150 in 2011/12 , 200 in 2012/13 and 232 in 2013/14 Implementing programmes in secondary schools to address youth risk behaviour with a focus on life skill based HIV and AIDS education in 60 Sub Districts during 2011/12 and 100 Sub Districts during 2012/13 Increasing the Vitamin Supplementation coverage among children 12 to 59 Months from 38% in 2010/11 to 45% in 2013/14

TO REDUCE MATERNAL MORTALITY IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 TO REDUCE MATERNAL MORTALITY KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Maintain ante – natal coverage rate of 100 % throughout the MTEF period Increasing the antenatal coverage before 20 weeks from 37% in 2010/11 to 60% in 2013/14 Increasing the proportion of deliveries taking place in health facilities under the supervision of trained personnel from 88% in 2010/11 to 95% in 2013/14 Increasing the proportion of designated health facilities providing Choice on Termination of Pregnancy (CTOP) from 40% in 2010/11 to 55% in 2013/14; Increasing the percentage of mothers and babies who receive post-natal care within 6 days of delivery from 40% in 2010/11 to 80% in 2013/14;

IMPROVED ACCESS TO REPRODUCTIVE HEALTH IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVED ACCESS TO REPRODUCTIVE HEALTH KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Increasing the cervical cancer screening coverage from 50% in 2010/11 to 56% by 2013/14 Increasing the couple year protection rate from 32% in 2010/11 to 37 % by 2013/14

EXPAND PMTCT COVERAGE TO PREGNANT WOMEN IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 EXPAND PMTCT COVERAGE TO PREGNANT WOMEN KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: 100% of pregnant woman to be tested for HIV Increasing the antenatal clients initiated on HAART rate from 87% in 2011/12 to 100% in 2013/14 Decreasing the percentage of babies testing PCR positive 6 weeks after birth from 10% in 2011/12 to 6.5% in 2013/14 Increasing the uptake rate for HIV Positive antenatal clients on AZT for any period before labour from 86% in 2011/12 to 100% in 2013/14

TO REDUCE THE BURDEN OF DISEASE OF TUBERCULOSIS IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 TO REDUCE THE BURDEN OF DISEASE OF TUBERCULOSIS KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Increasing the TB cure rate from 70 % in 2009 to 85% in 2013/14. Reducing the TB treatment defaulter rate from 7% in 2010/11 to 5% (or less) in 2013/14

COMBATING TB AND HIV BY REDUCING THE CO-INFECTION BURDEN IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 COMBATING TB AND HIV BY REDUCING THE CO-INFECTION BURDEN KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Increasing the percentage of HIV positive patients screened for TB from 70% in 2011/12 to 100% in 2013/14 Increasing the percentage of TB patients tested for HIV from 80% in 2011/12 to 100% in 2013/14 Increasing the percentage of TB/HIV co-infected patients receiving Cotrimoxazole Prophylaxis Therapy from 90% in 2011/12 to 100% in 2013/14 Increasing the number of HIV positive patients receiving Isoniazid Preventative Therapy (IPT) from 45 000 in 2011/12 to 80 000 in 2013/14

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 REDUCE THE BURDEN OF DISEASE FROM COMMUNICABLE AND NON – COMMUNICABLE DISEASES KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Decreasing the incidence of malaria from 0,62 per 1000 population at risk in 2010/11 to 0.54 per 1000 population at risk in 2013/14; Chronic care whether from communicable or non-communicable causes will be aligned and a single chronic care model will be rolled out to 3 districts in 2011/12 The number of districts implementing the long term care model for diabetes and hypertension will be increased to 52 by 2013/14 The integrated Health Promotion Policy and Strategy with an implementation plan will be finalised during 2011/12 To strengthen the quality of Environmental Health Services , norms and Standards will be developed during 2011/12

RE- ENGINEERING OF PRIMARY HEALTH CARE IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 RE- ENGINEERING OF PRIMARY HEALTH CARE KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Implementation of community based services in each district by establishing Family Health Teams ; 54 in 2011/12, 100 in 2012/13 and 250 in 2013/14 Complete the comprehensive audit of Primary Level Services inclusive of District Hospitals by March 2011/12 Improve community participation to strengthen the governance of the District Health System, Increase number of District Health Councils established from 43 in 2010/11 to 52 in 2012/13 Increase the percentage of functional committees established for PHC facilities to 60 % in 2013/14 Improve access to primary health care services, with an increased utilisation rate of 3 visits by 2013/14 Improve health outcomes through ensuring that 52 Districts Health Plans are used for planning, budgeting, monitoring ,reporting and improved programme implementation by providing more direct support to the District Management Teams

ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Develop and implement a national infrastructure plan in conjunction with provincial infrastructure units Develop a set of Health Infrastructure norms and standards for all levels of care Establish an Infrastructure Project Management information system Finalisation of the Health Care Technology strategy Finalisation of the essential equipment lists for primary health care in 2011/12 and for secondary and tertiary health care in 2012/13

ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Accelerating the delivery of health infrastructure through Public Private Partnerships (PPPs) All five tertiary hospitals should complete the feasibility study by March 2012. These are: Nelson Mandela Academic (Eastern Cape); Chris Hani Baragwanath (Gauteng); Dr. George Mukhari (Gauteng); Limpopo Academic (Limpopo); King Edward VIII (KwaZulu-Natal); Funding will be provided to hospitals through the hospital revitalization grant : 41 Hospitals will be under construction 25 Hospitals will be in the planning phase

IMPROVED HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPEMNT IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVED HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPEMNT KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Finalising the revised Health Workforce Plan responsive to service delivery platforms by the end of 2011/12 Strategy for Rural Health workforce developed by the end of 2011/12 Norms and Standards for Health Workforce for Primary and Secondary Health Care developed Integrate Community Health Workers into the formal Health System

IMPROVED HEALTH CARE FINANCING IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVED HEALTH CARE FINANCING KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: Work in preparation for the implementation of NHI will continue. Specific outputs for 2011/12 include: Finalization of the NHI policy and legislative framework NHI Pilot Sites established Funding model developed

IMPROVE THE QUALITY OF HEALTH SERVICES IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVE THE QUALITY OF HEALTH SERVICES KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: In 2011/12 new policies related to the legislative amendment governing the establishment and functioning of the Office of Health Standards Compliance and relevant regulation will be finalised The Office of Health Standards Compliance as a national certification body will be established by March 2012 Patient satisfaction will be monitored and a patient satisfaction surveys will be conducted in 60 % of public hospitals during 2011/12 , in 90% during 2012/13 and 100% during 2013/14 20% (800) of the 4,333 public health facilities will be assessed for compliance with the 6 priorities of the core standards. This figure grows to 40% in 2012/13 and to 70% by 2013/14;

RESOURCE ENVELOPE FOR IMPLEMENTING OF THE NATIONAL DOH PLANS FOR 2010/11-2012/13

INTRODUCTION During the Medium Term Framework ( MTEF) budget process, the Health Department requested additional funding for both National and Provincial departments for the amount of R19,9 billion for the three year MTEF period. Cabinet and National Treasury approved an amount of R18,1 billion made up of R3,4billion for National Health and R14,6 billion for the provincial health departments for earmarked funds additional to the equitable share baseline.

EXPENDITURE TRENDS The Department’s expenditure grew from R13.6 billion in 2007/08 to R23.1 billion in 2010/11 at an average annual rate of 19.4 percent. Over the Medium Term period, expenditure is expected to grow to R30.1 billion, at an average annual rate of 9.2 percent. The increase in both periods is driven largely by transfers to provinces for the conditional grants, with the main increase being on the HIV and AIDS and the Revitalization of Hospitals grants, while the National Tertiary Services grant (NTSG) increased significantly in the MTEF period. The Forensic Pathology Services grant will be phased out in the 2012/13 financial year and has therefore been included in the provincial equitable share allocations.

MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 The Budget includes new allocations of R442 million for 2011/12, R692 million for 2012/13 and R2.2 billion for 2013/14.

MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 R3 million, R5 million and R7 million for the Health Systems Trust to support health systems research activities including the annual health review and district health barometer R2 million per year to publish standardised annual health statistics in the new annual health statistics publication to facilitate performance auditing and better inform the public and health service providers R5 million, R6 million and R7 million for the Compensation Commissioner for Occupational Diseases to address backlogs in compensation, improve systems and address problems identified in audit reports R60 million in 2011/12 and 2012/13, R60 million and R1.4 billion for the HIV and AIDS conditional grant for the rapidly growing treatment programme and to strengthen prevention programmes including R60 million per annum for male circumcision

MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 R10 million per year to forensic chemistry laboratories to purchase equipment and appoint staff to address backlogs R10 million to the South Africa Health Products and Regulatory Authority to establish itself and to deal with the medicine registration backlogs. This is a once off payment, based on the understanding that SAHPRA will generate and retain its own revenue going forward. R30 million in 2011/12, and R30 million in 2012/13 and 2013/14 to progressively increase the distribution of condoms R9 million, R5 million and R5 million to nursing colleges to plan and coordinate the second phase of upgrading, recapitalising and maintaining nursing colleges following the infrastructure audit

MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 The expenditure below is towards preparatory work for NHI. R10 million, R20 million and R10 million to Office of Standards Compliance and Quality Assurance to establish itself and to support its inspectorate, certificate of compliance and ombudsman functions R21 million, R17 million and R13 million for infrastructure management and private public partnerships to build up capacity in the department to oversee the hospital revitalisation projects and to support planning and transaction advisor cost for large private public partnership projects R5 million, R7 million, and R9 million for health technology to support provincial upgrading of engineering workshops and equipment audits and to develop equipment packages and systems for health technology R5 million per year for National Health Insurance to support development work and projects including the ministerial advisory committee

MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 Expenditure towards preparatory work for NHI continue ..... R4 million in 2011/12 and 2012/13 and R5 million in 2013/14 to develop improved hospital tariff schedules for use by provinces and the Road Accident Fund, including improved uniform patient fee structure, Road Accident Fund reimbursement and tariff structure, and developing diagnosis related groups system. R5 million per year for health information systems to support national workgroup investigations of new patient based IT system and to propose next steps in IT infrastructure to support the district health information system R2 million, R3 million and R4 million to monitor and support provinces in order to stabilise provincial finances and improve audit outcomes R250 million, R500 million and R750 million for the national tertiary services conditional grant to support public hospitals to achieve norms and standards partly in preparation for the National Health Insurance and to implement standards and guidelines of the Office of Standards Compliance and Quality Assurance, as well as to address differential costs of doctor occupation specific dispensation

ADDITIONAL FUNDS ALLOCATED TO THE BASELINE FOR THE NATIONAL DEPARTMENT PRIORITY FOCUS AREA 11/12 R’000 12/13 13/14 Increased distribution of condoms 30,000 Improved conditions of service 13,000 15,000 16,000 Quality Office of Standards Compliance: Support for inspectorate and accreditation function 10,000 20,000 Forensic chemistry laboratories: Equipment and filling of posts Oversight of hospital revitalization projects Health technology: Equipment packages and systems 5,000 7,000 9,000 Public private partnership (PPP) projects: Planning and transactional advisor costs 11,000 3,000

ADDITIONAL FUNDS ALLOCATED TO BASELINE PRIORITY FOCUS AREA 11/12 R’000 12/13 13/14 Nursing colleges: Planning and coordination of upgrading and recapitalization project 9,000 5,000 National Health Insurance: Ministerial advisory committee National workgroup investigations of patient based information technology system Revenue management: Improved hospital tariff schedules 4,000 South African Health Products Regulatory Authority: Establishment and capacity to deal with medicines registration backlogs 10,000 - Health Systems Trust 3,000 7,000 CCOD 6,000 Unit to support provincial finance 2,000 HIV and Aids Conditional grants 60,000 1,400,000 National Tertiary Services conditional grant to support public hospitals 250,000 500,000 750,000  TOTAL 442,000 692,000 2,276,000

PROGRAMME ALLOCATIONS FOR 2011/12-2013/14 PROGRAMMES R’ million 10/11 11/12 12/13 13/14 Administration 282 326 325 344 Health Planning and Systems Enablement 125 161 178 190 HIV&AIDS, TB and Maternal, Child and Women’s Health 6,669 8,027 9,377 11,188 Primary Health Care Services 700 730 143 150 Hospital Tertiary Services and Workforce Development 13,947 15,963 17,016 17,664 Regulations and Compliance Management 496 525 572 601 Total Budget Allocated 22,219 25,732 27,611 30,137

ECONOMIC CLASSIFICATIONS ALLOCATIONS FOR 2012/13 TO 2013/14 10/11 11/12 12/13 13/14 Compensation of Employees 385 424 465 492 Goods and Services 755 785 795 830 Total Transfers & Subsidies 21,034 24,489 26,316 28,778 Payment of Capital Assets 45 33 35 37 Payment of Financial Assets - Total 22,219 25,732 27,611 30,137

CONDITIONAL GRANTS ALLOCATIONS 2011/12-2013/14 Schedule 2011/12 R'000 2012/13 2013/14 Health Infrastructure Grant 4 1,701,856 1,820,981 1,921,134 Health professions and Development Training 1,977,310 2,076,176 2,190,366 National Tertiary Services 8,048,878 8,688,822 9,389,207 Comprehensive HIV and Aids 5 7,492,962 8,824,610 10,606,664 Forensic Pathology Services 590,380 - Hospital Revitalization Grant 4,136,290 4,335,908 4,067,859 Total 23,947,676 25,746,497 28,175,230

CONDITIONAL GRANTS ALLOCATIONS 2011/12-2013/14 Schedule 4 grants: specifying allocations to provinces to supplement the funding of programmes or functions funded from provincial budgets; Transfer payments cannot be withheld based on non performance or compliance, however, the new Division of Revenue Grant allows a 5% withholding while interventions are put in place. Grants included are: - National Tertiary Services, - Health Professions Training and Development - Forensic Pathology Services.

CONDITIONAL GRANTS ALLOCATIONS 2011/12 - 2013/14 Schedule 5 : specifying specific-purpose allocations to provinces. Grants included are: - HIV and AIDS grant and the Revitalization of Hospital grant. Schedule 5 grants may be withheld for non performance and or compliance. Interventions must also be put in place for compliance.

ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) SUMMARY PROV ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) SUMMARY PROV. ALLOCATED. Provinces 2011/12 2012/13 2013/14 Total   R'000 Eastern Cape 522,450 675,521 702,753 1,900,724 Free State 106,872 178,564 202,144 487,580 Gauteng 745,872 1,035,179 1,158,860 2,939,911 KwaZulu-Natal 299,766 494,481 534,869 1,329,116 Limpopo 258,841 470,219 594,336 1,323,396 Mpumalanga 239,498 455,859 502,401 1,197,758 Northern Cape 88,317 160,461 189,891 438,669 North West 196,090 373,169 450,116 1,019,375 Western Cape 228,820 350,550 452,977 1,032,347 2,686,526 4,194,003 4,788,347 11,668,876

CONDITIONAL GRANTS COMPREHENSIVE HIV & AIDS Province 2010/11 Budget 2011/12 Allocation 2012/13 Forward Estimates 2013/14 Forward Estimates   R'000 Eastern Cape 691,940 864,173 1,014,134 1,222,480 Free State 437,583 530,440 621,824 750,788 Gauteng 1,281,683 1,620,673 1,934,057 2,294,326 KwaZulu-Natal 1,518,811 1,889,427 2,246,099 2,675,081 Limpopo 515,896 624,909 733,963 884,146 Mpumalanga 387,646 490,366 578,087 694,264 Northern Cape 186,306 212,923 247,228 301,557 North West 476,838 599,437 705,969 848,533 Western Cape 555,054 660,614 743,249 935,489 TOTALS 6,051,757 7,492,962 8,824,610 10,606,664

CONDITIONAL GRANTS FORENSIC PATHOLOGY SERVICES Province 2010/11 Budget 2011/12 Allocation 2012/13 Forward Estimates 2013/14 Forward Estimates   R'000 Eastern Cape 69,345 73,506 - Free State 37,218 39,451 Gauteng 92,421 97,966 KwaZulu-Natal 152,406 161,550 Limpopo 39,913 42,308 Mpumalanga 50,107 53,114 Northern Cape 22,868 24,240 North West 26,433 28,019 Western Cape 66,251 70,226 TOTALS 556,962 590,380

CONDITIONAL GRANTS HEALTH PROFESSIONS TRAINING AND DEVELOPMENT Province 2010/11 Budget 2011/12 Allocation 2012/13 Forward Estimates 2013/14 Forward Estimates   R'000 Eastern Cape 160,444 170,071 178,730 188,560 Free State 117,400 124,444 130,930 138,131 Gauteng 651,701 690,803 725,310 765,202 KwaZulu-Natal 235,771 249,917 261,860 276,262 Limpopo 94,085 99,730 103,913 109,628 Mpumalanga 76,149 80,718 85,208 89,894 Northern Cape 61,802 65,510 68,583 72,356 North West 83,324 88,323 93,522 98,666 Western Cape 384,711 407,794 428,120 451,667 TOTALS 1,865,387 1,977,310 2,076,176 2,190,366

CONDITIONAL GRANTS HOSPITAL REVITALIZATION Province 2010/11 Budget 2011/12 Allocation 2012/13 Forward Estimates 2013/14 Forward Estimates   R'000 Eastern Cape 360,660 382,048 402,678 387,104 Free State 378,426 417,883 438,140 412,172 Gauteng 798,609 801,965 828,552 760,206 KwaZulu-Natal 500,815 547,698 566,605 533,432 Limpopo 323,425 371,672 392,410 369,152 Mpumalanga 331,657 356,557 378,014 355,081 Northern Cape 420,218 406,892 427,263 401,940 North West 326,303 370,074 401,150 377,375 Western Cape 580,554 481,501 501,096 471,397 TOTALS 4,020,667 4,136,290 4,335,908 4,067,859

CONDITIONAL GRANTS NATIONAL TERTIARY SERVICES Province 2010/11 Budget 2011/12 Allocation 2012/13 Forward Estimates 2013/14 Forward Estimates   R'000 Eastern Cape 557,137 609,327 660,693 698,110 Free State 659,469 715,204 769,964 800,000 Gauteng 2,561,154 2,759,968 2,933,361 3,100,895 KwaZulu-Natal 1,102,585 1,201,831 1,303,824 1,408,053 Limpopo 257,316 267,314 277,314 287,314 Mpumalanga 91,879 105,970 120,270 Northern Cape 225,948 235,948 245,948 255,948 North West 179,280 194,280 209,280 224,280 Western Cape 1,763,232 1,973,127 2,182,468 2,494,337 TOTALS 7,398,000 8,048,878 8,688,822 9,389,207

CONDITIONAL GRANTS HEALTH INFRASTRUCTURE GRANT Province 2010/11 Budget 2011/12 Allocation 2012/13 Forward Estimates 2013/14 Forward Estimates   R'000 Eastern Cape - 299,754 327,673 345,695 Free State 129,621 141,911 149,716 Gauteng 142,694 157,434 166,093 KwaZulu-Natal 358,471 393,367 415,002 Limpopo 270,802 267,888 282,622 Mpumalanga 146,368 143,383 151,269 Northern Cape 89,501 98,258 103,662 North West 145,466 159,656 168,437 Western Cape 119,179 131,411 138,638 TOTALS 1,701,856 1,820,981 1,921,134

ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) ALLOCATED DIRECTLY TO PROVINCES. R million 11/12 12/13 13/14 Health technology 20 30 40 Nursing colleges upgrading and maintenance 32 OSD doctor Annexure A top-up 110 119 126 OSD therapeutic top-up 363 426 449 Maternal and child health 228 501 700 Personnel and goods stabilization 522 1,073 1,444 HIV: ARV 350 threshold  - 500

ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) ALLOCATED DIRECTLY TO PROVINCES. R million 11/12 12/13 13/14 Registrars esp paed, obs and critical posts 100 200 300 Family health team pilots/models 400 700 Public hospital norms and standards 240 486 532 Policy priorities subtotal 1,715 3,767 4,823 Improvements in conditions of service 1,556  1,556 Forensic pathology shift into PES   620 654 Total 3,271 5,943 7,033

COMMENTS ON ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) EC: Allocated only for: Allocated funds for OSD for doctors and health therapeutics and medical registrars in obstetrics and pediatrics. Recapitalizing nursing college; etc. Improvements in Conditions of Service FS: Allocated only for: All priorities have combine amount which is R20,6m ,R53,4m and R73,5 for three years R 86,2 m, R87,7 & R89,4 m for Improvement in condition of service (ICS) GP: Allocated only for: all OSD and recapitalization of nursing colleges Improvements in Conditions of Service for Housing allowance carry through costs Policy adjustment: includes family health teams and PHC re-engineering and public hospital norms and standards.

COMMENTS ON ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) KZN, MP, NC, NW and WC :Allocated funding for all priorities identified Total Allocated Funds Earmarked are R3,2 billion, R5,9 billion,& R7 billion for 2011/12,2012/13 &2013/14 respectively. Provinces allocated R2,6 billion, R4,1 billion & R2,3 billion. Not ALL the earmarked funds have been allocated to the Health Departments. An amount of R4,7 billion remains unallocated. It is assumed that National Treasury allocated the funds to the provincial Treasuries.

CONCLUSION National DoH Annual Performance Plan 2011/12-2013/14 reflects interventions to improve health service delivery and improve health outcomes for all South Africans. A sector wide plan will be produced by end of May 2011, which will reflect the contribution of the entire sector - National and 9 Provincial DoHs - to the achievement of the Health Sector NSDA outcomes