Guided by the decisions of the National Health Council (NHC) In financial year 2010/2011, the National Department of Health rationalized and reformed its operational structure for infrastructure service delivery, also binding to all the provinces. Integration and functional rationalization of all components dealing with infrastructure service delivery and health technology within national and provincial departments of health, under one unit in those departments which are be titled, Infrastructure Unit All the provinces should establish and populate a core infrastructure unit structure headed by one Managing Engineer or Architect. Infrastructure Development Improvement Program 3(IDIP 3) was adopted by all national and provincial departments of health and as a result IDIP Technical Assistance units (Individual engineers or project managers or architects) were employed and dispatched one per province totaling to nine and two in the national department of health, to improve the techno-professional capacity of the health departments in infrastructure service delivery. Initiation and implementation of Infrastructure Unit Support Systems (IUSS) program with the help of CSIR and DBSA, supporting national and provincial health departments. Establishment of oversight and monitoring structures nationally and provincially titled Provincial Infrastructure Project Progress Review Committees and National Infrastructure Technical Committee, Under the National Health Council and its Technical Advisory Committee. Dedicated budgetary allocation for the first time to National department of health Infrastructure Unit by National Treasury to undertake its oversight, monitoring and provincial capacitating and support roles and responsibilities. Infrastructure Service Delivery Enablers 1

National Department of Health Infrastructure Unit The main objective of the Infrastructure Unit of the National Department of Health is to assist and support optimally the planning, acquisition, operation and management of South Africa’s public healthcare infrastructure through all stages of the infrastructure life cycle. The scope of the Unit covers the Infrastructure development, Health Technology and Organizational structures and systems Major functional strategies –The development of norms and standards –Capital project status reporting –Project management information system (PMIS) –Projects monitoring and oversight support –The development of cost modelling tools 2

ENHANCING THE HEALTH INFRASTRUCTURE PROJECTS DELIVERY, LEADING TO ENHANCED HEALTH SERVICE DELIVERY Delivery related barriers budget under spending, delayed delivery by process, staff and incomplete projects. Cost related barriers poor use of available funds, poor life cycle costs, poor distribution of funding Quality related barriers poor functionality, differing standards, none compliance, INFRASTRUCTURE DELIVERY ENABLERS Barriers in Infrastructure Service Delivery 3

specific objectives of the functional strategies Development of norms and standards: Development of a sustainable set of universally adopted national norms, standards, guidelines and benchmarks for all levels of health care facilities related to all stages Capital Project Status Reporting: to obtain and capture physical, contractual and financial status information on all current public sector health projects in South Africa; to identify potential progress blockages and budget shortfalls so that remedial action can be initiated timeously; and to identify areas where support and remedial action may be required by the projects monitoring and oversight support team Project management information system (PMIS) To develop an integrated national PMIS that will enhance the oversight, monitoring and reporting of health infrastructure projects in all provinces of South Africa. Projects monitoring and oversight support to foster service delivery with relation to agreed quality standards, time and budget as well as identifying deficiencies and challenges within the system; to provide an oversight role through the early identification of potential progress blockages and budget shortfalls; and to initiate remedial action with immediate effect. The development of cost modelling tools To develop a dynamic and sustainable cost modeling capability for applications during different stages of life cycle 4

Institutional arrangement for Infrastructure Unit Support Systems (IUSS). 5

Hospital Revitalization Grant, budget and expenditure 2010/2011 F/Y The total expenditure last year stands at R3.2 B constituting 80% of the allocated budget for the year while in the year before was standing at 2.68 B constituting 77% of the allocated budget. On the other hand, the amount of under expenditure decreased from R813 M in 2009/10 F/Y to R802 M in 2010/11 F/Y. Both these figures confirms that the under expenditure pattern is now stabilized and minimally improved in the year under discussion. The expenditure inquired were spent on 389 projects covering 66 hospitals in all provinces 6

Infrastructure service delivery capability of the provinces 2010/11F/Y –The total HRP budget in 2010/11 F/Y accelerated by 15% year on year while the total expenditure improved by 20% while it should have improved by 50% –EC, MP and NC decelerated their expenditure by 17, 2 and 2 percents respectively while they should have accelerated them by 77, 14 and 57 percents. This case is more serious in MP since their year on year budget was cut by 33 percent. –FS, KZN, LP and NW accelerated their expenditure by 36, 22, 36, and 27 percents respectively, while they should have accelerated by 110, 123, 88 and 29 percents. –GP and WC needed to accelerate their expenditure by 12 and 54 percent while they accelerate them by 15 and 63 percent, which deserve encouragement and congratulations. 7

Infrastructure budget and plans 2011/2012 With effect from the beginning of financial year 2011/12, the Infrastructure Unit of the National Department of health is the custodian of the both Hospital Revitalization (HRG) and Health Infrastructure (HIG) Grants. Although the focus and assistance of the Infrastructure Unit of the NDoH will be on delivery of infrastructure financed by all sources of funding, special emphasis will be on projects funded under these two grants in view of the responsibilities assigned to NDoH by DORA. 8

Summary budget and number of infrastructure projects in all provinces covering HRG and HIG sources of financing. The above table is the summary list of projects funded under HRG and HIG per province. Regular provincial visits by the Infrastructure Unit and its IDIP TAs together with the anticipated Program Management Support Unit (PMSU) as part of the IUSS program will assist the provinces to implement these projects and achieve the goal of spending a minimum of 30% of their budget in each quarter. To the above list, the list of nursing colleges that are going to be revitalized will be added, since a total amount of R 33 M has been allocated for this purpose for all provinces. As a supplementary plan, the Infrastructure Unit of the National Department of Health has initiated a supplementary program for utilization of potential under expenditure of HRP funds in favor of purchasing essential HT equipment in facilities under this program, currently and previously. This is being done in collaboration with provinces and the HT Directorate of the department. The experience gained in GP in F/Y 2010/11 was a success story in this line whereby over R145 M unspent HRP funds could be committed and utilized in favor of HT equipment, through a Special Purpose Vehicle, named Equipment Committee. 9

Expected delivery capacity of provinces for 2011/12 Financial year Figure highlights the relation between the allocated budget for HRG in 2010/11 F/Y and its associated expenditure in that year on the one hand and the allocated HRG budget in 2011/12 F/Y on the other. As it can be seen, although there is slight improvement on budget for 2011/12 in comparison with the one in 2010/11, but it is more realistic in relation with the expenditure incurred in 2010/11 Nationally the HRG budget was increased by 4% in 2011/12 F/Y in relation with 2010/11 budget, while its expenditure pattern should desirably accelerate at 30 percent to utilize the full HRG budget for 2011/12 F/Y. EC, FS, KZN, LP, MP, NC, and NW should accelerate their expenditure pattern in relation with last year’s expenditure pattern by 129, 73, 102, 60, 28, 57, and 16 percents respectively, while GP and WC should decelerate their expenditure pattern by 1 and 21 percents respectively in relation with their last year expenditure pattern. 10

Capacitating, Support and monitoring Action Plan To improve on the deficiencies in quality and quantity of spending of capital budget in most of the provinces, emanating from their delivery capacity, the infrastructure Unit of the National Department of Health initiated several support programs to enhance the capacity of the Provincial Departments, as well as enhancing its own oversight and monitoring capabilities. 11

Proposed Intervention By NDoH Infrastructure Unit 12

Programme Management Information System (PMIS)  Service Providers were invited to tender for the Programme Management Information System  Tenders closed and evaluation is scheduled to start before the end of May 2011  All data collected during Rapid Assessment of Capital Projects (Phases 1 and 2) will be loaded into PMIS  Provinces will update project data in PMIS (Web enabled)  PMIS will generate Project Progress Report & IRM Programme Management Support Unit  Service Providers were invited to tender for the Programme Management Support Unit to support the provincial and national infrastructure units based on their determined needs, as well as monitoring the quality and quantity of spending and delivery outputs  Tenders closed and initial evaluation is scheduled to start before end May 2011  Tenders include applications for inclusion on Panel of Specialists to be used as and when required for various development stages of infrastructure Rapid Assessment of Capital Projects (Phase 2)  Service Providers were invited to tender for the Rapid Assessment of the balance of the capital projects covering about 1800 projects (Phase 2)  Tenders will be closed before end May and evaluation has been completed  Short-listed service providers may be invited for presentations  Between 3 and 9 service providers are likely to be appointed through DBSA Human Resources  IDIP established HR Team  HR Team analysed legal mandates and skill requirements in Provincial DoH & DPW  Pilot project was run in WC  Next initiative scheduled for EC Capacitating, Support and monitoring Action Plan 13

“Golden Egg” monitoring  In order to ensure quality & quantity of expenditure, cash flow will be monitored in terms of specific targets:  30% in first quarter  30% in second quarter  30% in third quarter  30% in fourth quarter ( Aiming at 110% expenditure)  “Golden Eggs” are big projects with big budgets that can realise the deliverables rapidly Focused Support  A focussed Programme Management Support and monitoring package has been designed for each Province  Details of the proposed support and monitoring packages are presented in Figures below  Specific support and monitoring package proposed for WC  Specific support and monitoring package for EC & KZN  Specific support and monitoring package for FS, GP, LP, MP, NC, NW Implementing Agent Capacity Evaluation  Capacity of Provincial DoH to deliver on capital projects is dependent on the capacity of their Implementing Agents  Implementation Capacity of Implementing Agents will be assessed (similar to assessment Provincial DoH capacity)  This may lead to recommendations on appropriate workload allocations to specific Implementing Agents Capacitating, Support and monitoring Action Plan 14

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Thanks for the attention 20