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STRUCTURE OF PRESENTATION 1.Vision and Mission 2.Health Sector Response 3.Annual Performance Plan Finance Presentation 2

3 1. VISION AND MISSION VISION 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.

2. HEALTH SECTOR RESPONSE 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 4

Interrelationship across the Health Sector Negotiated Service Delivery Agreement, the 10 Point Plan and the National Health Insurance 5 Health Sector 10 point Plan NSDA A LONG & HEALTHY LIFE FOR ALL LIFE FOR ALL SOUTH AFRICANS A LONG & HEALTHY LIFE FOR ALL LIFE FOR ALL SOUTH AFRICANS Defined Targets Defined Timeframes & critical milestones NHI

INCREASED LIFE EXPECTANCY STRENGTHENING HEALTH SYSTEM EFFECTIVENESS IMPROVED ACCESS TO HUMAN RESOURCES FOR HEALTH INTER- SECTORAL ACTION FOR SOCIAL DETERMI- NANTS OF HEALTH IMPROVED QUALITY OF SERVICES NATIONAL HEALTH INSURANCE IMPACT OUTCOMES OUTPUT IMPROVED FINANCIAL MANAGE MENT INPUTS PRIMARY HEALTH CARE ORIENTED SERVICE DELIVERY HEALTH INFORMA- TION IMPROVED ACCESSS TO HEALTH FACILITIES HEALTH SECTOR NSDA 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 6

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 SCALE UP THE COMBINATION OF PREVENTION INTERVENTIONS TO REDUCE NEW HIV INFECTIONS SCALE UP THE COMBINATION OF PREVENTION INTERVENTIONS TO REDUCE NEW HIV INFECTIONS KEY STRATEGIC INTERVENTIONS DURING 2011/ /14 WILL INCLUDE: Scaling up condom distribution, with 1 billion male condoms distributed annually during 2011/ /14, and 6 million female condoms distributed annually during 2013/14 Increase the number of Medical Male Circumcisions to during 2011/12 and annually during 2012/13 and 2013/14 Increase the HCT uptake rate from 80% to 90% in 2013/14 7

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 KEY STRATEGIC INTERVENTIONS DURING 2011/ /14 WILL INCLUDE: Increasing the number of new patients initiated on Antiretroviral Therapy (ART) to between to annually during 2011/ /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 IMPROVE THE QUALITY OF LIFE OF PEOPLE LIVING WITH HIV &AIDS BY PROVIDING AN APPROPRIATE PACKAGE OF CARE, TREATMENTS AND SUPPORT 8

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 KEY STRATEGIC INTERVENTIONS DURING 2011/ /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 REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY 9

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 KEY STRATEGIC INTERVENTIONS DURING 2011/ /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; TO REDUCE MATERNAL MORTALITY 10

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVED ACCESS TO REPRODUCTIVE HEALTH KEY STRATEGIC INTERVENTIONS DURING 2011/ /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 11

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 EXPAND PMTCT COVERAGE TO PREGNANT WOMEN KEY STRATEGIC INTERVENTIONS DURING 2011/ /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 12

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/ /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 13

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 COMBATING TB AND HIV BY REDUCING THE CO-INFECTION BURDEN COMBATING TB AND HIV BY REDUCING THE CO-INFECTION BURDEN KEY STRATEGIC INTERVENTIONS DURING 2011/ /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 in 2011/12 to in 2013/14 14

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 REDUCE THE BURDEN OF DISEASE FROM COMMUNICABLE AND NON – COMMUNICABLE DISEASES REDUCE THE BURDEN OF DISEASE FROM COMMUNICABLE AND NON – COMMUNICABLE DISEASES KEY STRATEGIC INTERVENTIONS DURING 2011/ /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 15

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 RE- ENGINEERING OF PRIMARY HEALTH CARE KEY STRATEGIC INTERVENTIONS DURING 2011/ /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 16

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE KEY STRATEGIC INTERVENTIONS DURING 2011/ /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 17

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE KEY STRATEGIC INTERVENTIONS DURING 2011/ /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 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 18

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVED HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPEMNT IMPROVED HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPEMNT KEY STRATEGIC INTERVENTIONS DURING 2011/ /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 the Community Health Workers into the formal Health 19

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVED HEALTH CARE FINANCING KEY STRATEGIC INTERVENTIONS DURING 2011/ /14 WILL INCLUDE: Work in preparation for the implementation of NHI will conitnue. Specific outputs for 2011/12 include: Finalization of the NHI policy and legislative framework NHI Pilot Sites established Funding model developed 20

IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVE THE QUALITY OF HEALTH SERVICES KEY STRATEGIC INTERVENTIONS DURING 2011/ /14 WILL INCLUDE: In 2011/12 new policies related to the legislative amendment governing the establishment an 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; 21

ANNUAL PERFORMANCE PLAN - FINANCE PRESENTATION 22

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. 23

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. 24

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. 25

Additional Funds Allocated to the Baseline for the National Department. PRIORITY FOCUS AREA 11/12 R’000 12/13 R’000 13/14 R’000 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 10,000 Forensic chemistry laboratories: Equipment and filling of posts 10,000 10,000 10,000 Oversight of hospital revitalization projects 10,000 10,000 10,000 Health technology: Equipment packages and systems 5,000 7,000 9,000 Public private partnership (PPP) projects: Planning and transactional advisor costs 11,000 7,000 3,000 26

Additional Funds Allocated to Baseline PRIORITY FOCUS AREA 11/12 R’000 12/13 R’000 13/14 R’000 Nursing colleges: Planning and coordination of upgrading and recapitalization project 9,000 5,000 National Health Insurance: Ministerial advisory committee 5,000 National workgroup investigations of patient based information technology system 5,000 Revenue management: Improved hospital tariff schedules 4,000 5,000 South African Health Products Regulatory Authority: Establishment and capacity to deal with medicines registration backlogs 10, Health Systems Trust 3,000 5,000 7,000 CCOD 5,000 6,000 7,000 Unit to support provincial finance 2,000 3,000 4,000 HIV and Aids Conditional grants 60,000 1,400,000 National Tertiary Services conditional grant to support public hospitals 250, , ,000 TOTAL 442, ,000 2,276,000 27

Programme Allocations for 2011/ /14 PROGRAMMES R’ million 10/1211/1212/1313/14 Administration Health Planning and Systems Enablement HIV&AIDS, TB and Maternal, Child and Women’s Health 6,669 8,027 9,377 11,188 Primary Health Care Services Hospital Tertiary Services and Workforce Development 13,947 15,963 17,016 17,664 Regulations and Compliance Management Total Budget Allocated 22,219 25,732 27,611 30,137 28

Economic Classifications Allocations for 2012/13 to 2013/14 Economic Classification10/1111/1212/1313/14 Compensation of Employees Goods and Services Total Transfers & Subsidies 21,034 24,489 26,316 28,778 Payment of Capital Assets Payment of Financial Assets Total 22,219 25,732 27,611 30,137 29

Conditional Grants Allocations 2011/ /14 GrantSchedule 2011/12 R' /13 R' /14 R'000 Total R'000 Health Infrastructure Grant4 1,701,856 1,820,981 1,921,134 5,443,971 Health professions and Development Training4 1,977,310 2,076,176 2,190,366 6,243,852 National Tertiary Services4 8,048,878 8,688,822 9,389,207 26,126,907 Comprehensive HIV and Aids5 7,492,962 8,824,610 10,606,664 26,924,236 Forensic Pathology Services5 590, Hospital Revitalization Grant5 4,136,290 4,335,908 4,067,859 12,540,057 Total 23,947,676 25,746,497 28,175,230 77,869,403 30

Conditional Grants Allocations 2011/ /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. 31

Conditional Grants Allocations 2011/ /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. 32

Additional Priority focus areas (Earmarked Funds) Allocated directly to Provinces. R million11/1212/1313/14 Health technology Nursing colleges upgrading and maintenance32 OSD doctor Annexure A top-up OSD therapeutic top-up Maternal and child health Personnel and goods stabilization5221,0731,444 HIV: ARV 350 threshold

Additional Priority focus areas (Earmarked Funds) Allocated directly to Provinces. R million11/1212/1313/14 Registrars esp paed, obs and critical posts Family health team pilots/models Public hospital norms and standards Policy priorities subtotal1,7153,7674,823 Improvements in conditions of service1,556 Forensic pathology shift into PES Total3,2715,9437,033 34

THANK YOU 35