PRESENTATION TO NCOP SELECT COMMITTEE ON FINANCE SECOND QUARTER ENDING 30 SEPTEMBER

PURPOSE To provide information to the NCOP on performance of all conditional grants managed by the Department, and the details on achievements, challenges and remedial actions for the Quarter ending 30 th September 2005.

OVERVIEW 6 CONDITIONAL GRANTS MANAGED BY DOH NW. CONSTITUTES 14% OF TOTAL BUDGET. NEEDS TO IMPROVE QUALITY OF BUSINESS PLANS FOR CONDITIONAL GRANTS. STRENGTHENING OF PROJECT MANAGEMENT IN RELATION TO CONDITIONAL GRANTS. IMPROVE CAPACITY FOR MONITORING AND EVALUATION. INFRASTRUCTURE DELIVERY MODEL AND POSSIBLE IMPACT. INTERVENTIONS IN RELATION TO THE ABOVE ARE BEEN PUT IN PLACE.

HIV and AIDS GRANT PURPOSE: To enable the health sector to develop an effective response to HIV and AIDS as well as supporting the implementation of the National Operational Plan for Comprehensive HIV and AIDS Treatment and Care.

COPREHENSIVE HIV/AIDS Sub- Programmes Budge t R’000 Expend iture for Sep. 05 R’000 Expenditu re: 1 st Quarter R’000 Expendit ure: 2 nd Quarter R’000 Budget Balance. R’000 PERCENT AGE Prevention (AB4) Care & Support (H89) Programme Mx. (H90) ARV (H51; H65 - H68) TOTAL EXPENDITURE

COMPREHENSIVE HIV/AIDS (CONT) Expenditure grown by 40% from last month. Actual expenditure is at 43.26% as at 30 September.

COMPREHENSIVE HIV/AIDS (CONT) Progress:  The adjustment for the budget of the Comprehensive Plan (ARV) sites has been done by the Budget section.  The funds to the tune of R6, 815m from National Treasury were transferred and the cash flow made available was spent.  There is availability of pharmaceuticals (ARV) and a growing number of professionals trained in CCMT.  We have in the Province accredited six additional sites for provision of the comprehensive plan.

COMPREHENSIVE HIV/AIDS (CONT) Challenges:  The cash flow constraints especially with the payment of NGOs where we have to effect the quarterly payment but we only getting monthly cash.  Cash flow constraints also makes it difficult for the Department of fast rack certain activities which could be done earlier than the planned. This matter will be resolved with National.

COMPREHENSIVE HIV/AIDS (CONT) Remedial Action:  Interaction between Province and NDoH to review the transfer schedule for HIV/AIDS Grants (Possible DORA implications).

HOSPITAL MANAGEMENT & QUALITY IMPROVEMENT. PURPOSE : To transform hospital management and improve quality of care in line with national policy.

HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT Sub- Programmes Bud get R’0 00 Expendi ture for Sep. 05 R’000 Expendit ure: 1 st Quarter R’000 Expenditure : 2 nd Quarter R’000 Budget Balance. R’000 PERCEN TAGE Hospital Development (AE1) Klerksdorp (J80) Mafikeng (J81) Rustenburg (J82) AE TOTAL EXPENDITURE

HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont) Expenditure has grown by 109 % from last month(August). Actual expenditure is % of the budget as at 30 September.

HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont) Progress:  Staff has been appointed and maintained in Swartruggens hospital, in line with the business plan.  Upgrading of Patient Administration And Billing System (PAAB) is going well.  Governance structures (hospital boards etc) have been relaunched and are now been trained, (service provider has been appointed).  A partnership with Cohsasa on Quality Improvement and hospital accreditation is ongoing. Two hospitals have already been accredited.  There have been two training sessions in the implementation of the Clinic Supervision Manual.  The final draft of the Hospital supervision manual is ready for submission for adoption by the Management Committee.

HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont) Challenges:  The training of governance structures is continuing and expenditure will reflect in the next quarter.  Initial problems experienced in relation to a contract for the PAAB system with one of the service providers, now resolved.  Strengthen Quality Assurance unit in terms human resource.  Expenditure for Swartruggens hospital (Revitalisation site) benefiting from this grant is currently incurred under Equitable Share.  The Cost Centre Accounting project plan is being revised for faster implementation.

HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont) Remedial Action:  The Business Plan is being amended to sufficiently cover for activities which have been under allocated or delayed.  A team of three appointed to support areas that are showing poor spending.  Journals are being passed to correct expenditure.

HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT. PURPOSE : Support services to fund costs associated with training of health professionals and the development and recruitment of medical specialists in under-served provinces. To support and strengthen under & postgraduate teaching and training processes in health facilities, and to enable shifting of teaching activities from central hospitals to regional and district hospitals.

HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT Sub- Programme s Bud get R’0 00 Expend iture for ep. 05R’00 0 Expendi ture: 1 st Quarter R’000 Expendi ture: 2 nd Quarte R’000 Budget Balance. R’000 Percenta ge MMACON (AA0) EXCELSIUS (AB8) Klerksdorp (J90) Mafikeng (J91) Rustenburg (J92) Prof. Training (J69) TOTAL EXPENDITURE

HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT (cont) 53.98% has been spent to date. This grant is on target in terms of planned activities and ideal expenditure.

HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT (cont) Progress:  The fund has been used to increase the intake of nursing trainees from 100 to 180.  Community based education and problem based learning is unfolding well under this grant.  Nurses, Doctors, Community Service Personnel, Interns and Healalth Support Staff have been trained in Emergency Courses, e.g. Advanced Trauma Life Support, Paediatric Advanced Life Support and Advanced Cardiac Life Support, Advanced Medical Life Support, and Advanced Orthopaedic and Basis Surgical Skills Courses.

HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT (cont) Challenges:  The grant is on target.

INTEGRATED NUTRION PROGRAMME GRANT To implement integrated nutrition activities aimed at improving the nutritional status of South Africans, based on disease-specific nutrition support, treatment and counselling focus areas, which are dependant on information, human resources and financial and administrative systems.

INTEGRATED NUTRITION PROGRAMME Sub- Programm es Bud get R’0 00 Expend iture for Sep. 05 R’000 Expendi ture: 1 st Quarter R’000 Expendi ture: 2 nd Quarter R’000 Budget Balance. R’000 PERCEN TAGE INP (HX7) TOTAL EXPENDITURE

INTEGRATED NUTRITION PROGRAMME (cont) Expenditure has increased by 34 % from August. Performance is at 30.22% as at 30 September.

INTEGRATED NUTRITION PROGRAMME (cont) Progress:  There is adequate supply of road to health charts.  The inputs for the budget adjustment have been finalised to re-align the budget to the Programme needs.  One extra hospital declared baby friendly.

INTEGRATED NUTRITION PROGRAMME (cont) Challenges:  The funds for the second quarter from the National Treasury were only received on the 22 nd August instead of 18 th July.

INTEGRATED NUTRITION PROGRAMME (cont) Remedial Action:  The programme is showing potential to spend its entire budget. There is R2 M already that is being processed this week which will take expenditure to 45.3 % to compared to a half year target of 50%.  Transfer schedule needs to be reviewed in consultation with National Department of Health.

HOSPITAL REVITILIZATION GRANT. To provide funding to enable provinces to plan, manage, modernise, rationalise and transform the infrastructure, health technology, organizational management & development and monitoring and evaluation of hospitals in line with national policy objectives.

HOSPITAL REVITALIZATION Sub- Programmes Bud get R’0 00 Expend iture for Sep. 05 R’000 Expendi ture: 1 st Quarter R’000 Expendi ture: 2 nd Quarter R’000 Budget Balance. R’000 PERCENT AGE New Facilities (H3E) Upgrading (H3F) Other Facilities (H3G) Rehabilitation (AA1) TOTAL EXPENDITURE

HOSPITAL REVITALIZATION (cont) Expenditure has grown by 15%. Although there’s a 15% growth, actual expenditure as a percentage of the budget is still at 22.53%.

HOSPITAL REVITALIZATION (cont) Challenges :  Human Resource capacity both within and with implementing agents.  Inadequate response by experienced contractors and empowered joint ventures.  Incapacity of some consultants and small emerging contractors to handle projects with the required competencies.  Tendering and procurement processes both internally and externally takes longer than expected.  Infrastructure delivery model require review.

HOSPITAL REVITALIZATION (cont) Remedial Action:  Intervene on Tshwaragano business case (cross border municipality).  Complete business cases for the entire province.  Commence planning for priority areas.  Review the implementing strategy and process thoroughly. e.g. MEC for Education is convinced a task team between Health, Education and Public Works.  Discussion are underway with the Provincial Treasury for the amount to only be transferred to the Department during 2006/07 financial year.  Review of the bottom structure to address human resource challenges.

NATIONAL TERTIARY SERVICES. To compensate provinces for the supra- provincial nature of tertiary services provision and spill over effects as well as providing strategic funding to enable provinces to plan, modernise, rationalise and transform the tertiary hospital service delivery platform in line with national policy objectives including improving access and equity.

National Tertiary Services Sub- Programme s Budge t R’000 Expend iture for Sep. 05 R’000 Expenditur e: 1 st Quarter R’000 Expenditur e: 2 nd Quarter R’000 Budget Balance. R’000 PERCENTAGE Mafikeng (H61) Klerksdorp (H62) Rustenburg (H63) TOTAL EXPENDITURE

National Tertiary Services (cont) Expenditure on this grant has grown by 34% from end of August. It stands 31.06% of the budget.

National Tertiary Services (cont) Progress:  The Programme has shown an improvement in its expenditure compared to the previous months, however this still needs more attention.  Previously, only Klerksdorp hospital complex provided a wider range of tertiary services; now Rustenburg and Mafikeng are expanding services.

National Tertiary Services (cont) Challenges:  Concluding the procurement process and receiving tertiary equipments for all the tertiary hospitals.  Amending the specifications for CT Scans due to market demands led to the delay. Price of 16 Slice CT scans came down, and we responded accordingly. NB: For this year CT scans accounts for more than 29% of the NTSG budget.

National Tertiary Services (cont) Remedial Action:  Follow up on the finalisation of the contract of procuring hospital medical equipments expected to be concluded during October  Once delivery of this equipment takes place, this will bring the expenditure to the expected level.

Malaria & Cholera Prevention Grant PURPOSE : For the sustenance of the programmes related with pushing back the frontiers of poverty and hunger among women, Aids victims and especially to provide equipment for the food gardens and in some instances provide stipend to volunteer garden workers.

Malaria & Cholera Prevention Grant Progress :  A business plan has been developed and approved for the utilisation of the rollover amounting to R1,111,460. The funds are currently under the provincial contingency reserve fund. Treasury will be transferring the money to the Department the 10 th October 2005.

Malaria & Cholera Prevention Grant Challenges:  This is a once off conditional grant resulting from the drought of  The Programme has to ensure that the roll-out of the activities is expedited to ensure spending of funds only in relation to time affected largely by a rural Bophirima district.

Malaria & Cholera Prevention Grant Remedial Action :  All line expenditure items to benefit from this grant have been identified e.g. pharmaceuticals, water tanks for clinics, food gardens and fencing for food gardens.

Medico Legal Mortuaries PURPOSE: To facilitate the transfer of forensic pathology services from the South African Police Services (SAPS) to the Department of Health and provinces.

Medico Legal Mortuaries Progress:  The Programme has the costed operational plan for the year and the necessary staff structure has been finalised.  All facilities have been audited and are in the process of being upgraded.

Medico Legal Mortuaries Challenges:  The funds from the conditional grant of the Programme are not available yet.  The programme is presently having at its disposal its equitable share which is being used for the programme.

Medico Legal Mortuaries Remedial Action:  Funds will be transferred with effect from the 1 st October However, the actual transfer will be with effect from April 2006 into provincial coffers.

Expenditure on Equitable Share in relation to pressures points  Personnel – we are at 51%, and project over expenditure of R69m.( being addressed with provincial Treasury).  Administration (Indicates pool vehicles transport costs including ambulances) – we are at 65%. ( will review funding during Adjustment Estimates process).

Current Pressure Points (Economic Classifications)  Professional services (expected to be a pressure point as service expand waste management).  Equipment (Expected to be a pressure point as we implement health technology audit recommendations).  Uniform for nurses ( based on new agreement ).

Closure Thank you for listening