Limpopo - Health1 Report to the Select Committee on Finance on the Provincial Budgets and Expenditure Review 2001/ /08 and Conditional Grants and Capital Expenditure Presented by the Accounting Officer of the Department of Health and Social Development Dr. HN Manzini

Limpopo - Health2 Capital Budget – Expenditure trends

Limpopo - Health3 Capital Budget – Expenditure trends

Limpopo - Health4 Capital Expenditure 2001/02 – 2004/05 Capital Expenditure Capital expenditure over the period has been utilised for: 4 x Revitalisation of Hospitals Upgrading of 75 clinics Provision of water to 112 and electricity to 38 clinics is planned Acquisition of Medical and related equipment Replacement of the motor vehicle fleet by more than 728 vehicles The provision of a fully functional oncology unit with two of the latest technology radiation units Increase in the number of EMS stations to 11 More than 140 additional Ambulances including replacements 120 Patient transport vehicles were procured Purchase of Furniture, Equipment and Computers Replacement and additional of 126 Mobile Clinics Building of a Head Office Complex Purchase of a District office and EMS building previously rented

Limpopo - Health5 Capital Budget - MTEF allocation

Limpopo - Health6 Capital Expenditure The conditional grants have been the major source of the capital expenditure of the department with an average of 53% of the funds used being provided from the conditional grants. The equitable share has provided only 20% of the funds for buildings with 80% being sourced from the conditional grants. The Hospital Revitalization grant together with the Provincial Infrastructure Grant has provided the bulk of the capital used for facilities upgrades and provision of new clinics. This trend is continued over the MTEF.

Limpopo - Health7 Conditional Grants /02 & 2002/03

Limpopo - Health8 Conditional Grants /0 & 2004/05

Limpopo - Health9 Conditional Grants Allocations The conditional grants has shown a steady increase over the past four years to grow by 68% or R242.7 million between 2001/02 and 2004/05, excluding the grant for Primary Schools Nutrition Programme that has been transferred to Education as from April 2004 onwards. The allocation again showed a sharp increase from the R407 million in 2005/06 to R614.7 million for the current financial year. This is mainly due to the increase for HIV & AIDS (R48m) as well as Hospital Revitalization (R106m) with all other grants also growing. A roll over of R million was also received in the current year to make a total of R 649 million available. The MTEF sees a total of R564 million for 2006/07 and R616 million for 2007/08 being available to the department. The reduction is in Hospital Revitalization that reduces to R124m from the current R213 m that equals double the amount from the previous year. This was allocated due to the departments ability to utilise the grant in the past

Limpopo - Health10 Conditional Grants Transfers A full transfer was received for the budgeted amount available for the period 2001/03 to 2003/04. In the 2004/05 year the department did not receive R million of the R407.4 million allocated by receiving only R392.7 million or 96.2% from National Health via the Provincial Treasury. The transfers were stopped when expenditure for the third quarter was not according to the expected level. This resulted in the department surrendering an amount of R million less than the actual under expenditure at year end, as these funds were not received and could thus not be paid back. The Provincial Treasury did roll over the funds to 2005/06

Limpopo - Health11 Conditional Grants Expenditure The department did spend an average of 88.6% of the available budget on conditional grants over the past four financial years This includes the MTEF allocation as per DORA as well as Adjustment Estimates and Roll-overs The expenditure of the total available budget for the period was as follows:01/02 = 78.1% 02/03 = 95.5% 03/04 = 86.8% and 04/05 = 91.6% The expenditure achieved demonstrates the departments ability to utilise the conditional grants despite the challenges of : –procurement issues regarding items on tender, –journalization of expenditure that is captured on the equitable share –development and implementation of approved Business plans –limiting conditions imposed on the use of the funds

Limpopo - Health12 Conditional Grants - MTEF

Limpopo - Health13 Conditional Grants Actual expenditure 2005/06

Limpopo - Health14 Conditional Grants Expenditure2005 / 06 The department has managed to increase expenditure from 6.27% = R40.67m in the first quarter to 22.1% = R m at the half year mark. The inability of the department to secure Tenders for the purchase of Medical Equipment has also resulted in limited expenditure to date on the following grants: –Hospital Management and Quality Improvement at 20.2%, –National Tertiary Services at 19.7% –Health Professional Training and Development at 49.9 % The tenders for Equipment are now being finalised and expenditure is expected to substantially increase in the second half of the year as the business plans include the assets required

Limpopo - Health15 Conditional Grants Expenditure2005 / 06 continued The business plans for HIV & AIDS has been adjusted in an attempt to ensure that service delivery is speeded up over the next six months. Some R20 million will be transferred to NGO’s during October 2005, after proper screening the NGO’s ability to deliver on the part of the Comprehensive HIV&AIDS programme that they are expected to deliver service on. Personnel Expenditure is not expected to increase as health professional posts catered for are not being filled as anticipated, some journals will be done to capture the PE related to the grant from the Equitable Share.

Limpopo - Health16 Conditional Grants Expenditure2005 / 06 continued Additional expenditure will also take place in the third quarter with the establishment of Sub-Acute wards at 20 new approved sites where the Comprehensive HIV&AIDS programme will be rolled out to. Expenditure for NHLS and Pharmaceuticals is captured on the Equitable Share and once identified is transferred to the conditional grants by means of a journal entry. Commitments for expenditure was at 37% of the budget at the end of September 2005 for the HIV & AIDS grant. The Expenditure on the Provincial Infrastructure and Hospital Revitalisation grant normally picks up in the second half of the year due to the fact that sites are only handed over in the first quarter of the year.

Limpopo - Health17 Conditional Grants Expenditure2005 / 06 continued The department anticipates to under spend by R 15 million on the Hospital Revitalisation These funds will be surrendered back to National Health with a request to increase the allocation for the 2006/07 year with the same amount due to the projects being completed in the following financial year.

Limpopo - Health18 Reporting 1.The department does not have any institutions that have to report to it on a monthly basis. 2.Certified business plans for conditional grants have been submitted to and approved by National Health as required in DORA, for the current financial year. The end