Presentation to Health Portfolio Committee 02July 2014 Strategic Focus – 2014 to 2019

Alignment between NDP 2030 MTSF and NDoH Strategic Plan

National Development Plan 2030 The Health Sector derives its vision and mandate from NDP By 2030, South Africa should have: Raised the life expectancy of South Africans to at least 70 years; Progressively improve TB prevention and cure Reduce maternal, infant and child mortality Significantly reduce prevalence of non-communicable diseases Reduce injury, accidents and violence by 50 percent from 2010 levels Complete Health system reforms Primary healthcare teams provide care to families and communities Universal health coverage Fill posts with skilled, committed and competent individuals

National Development Plan 2030 The NDP also identifies a set of nine (9) priorities that highlight the key interventions required to achieve a more effective health system, which will contribute to the achievement of the desired outcomes. The priorities are as follows: – Address the social determinants that affect health and diseases – Strengthen the health system – Improve health information systems – Prevent and reduce the disease burden and promote health – Financing universal healthcare coverage – Improve human resources in the health sector – Review management positions and appointments and strengthen accountability mechanisms – Improve quality by using evidence – Meaningful public-private partnerships 4

National DoH Strategic Plan VISION Outcome 2: 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. 5

National DoH Strategic Plan The Department’s five year strategic goals are to: 1.Make progress towards universal health coverage through the development of the National Health Insurance scheme, and improve the readiness of health facilities for its implementation; 2.Re-engineer primary healthcare by: increasing the number of ward based outreach teams, contracting general practitioners, and district specialist teams; and expanding school health services; 3. Improve the quality of care by setting and monitoring national norms and standards, improving system for user feedback, increasing safety in health care, and by improving clinical governance; 4.Improve health facility planning by implementing norms and standards; 5.Improve financial management by improving capacity, contract management, revenue collection and supply chain management reforms; 6.Improve human resources for health by ensuring appropriate appointments, adequate training and accountability measures. 7.Prevent disease and reduce its burden, and promote health through a multi stakeholder National Health Commission 8.Develop an efficient health management information system for improved decision making; 6

GOAL 1: Make progress towards universal health coverage through the development of the National Health Insurance scheme, and improve the readiness of health facilities for its implementation Achieve Universal Health Coverage through the phased implementation of the National Health Insurance(NHI) – National Health Insurance law passed by 2015/16 – National Health Insurance Fund created by 2016/17 Regulate health care in the private sector by establishing National Pricing Commission and legislating methodologies for calculating fees. – Functional National Pricing Commission to regulate health care in the private sector established – Revise and legislate methodology for the determination of the dispensing fee. NATIONAL HEALTH INSURANCE 7

Goal 2: Re-engineer primary healthcare by: increasing the number of ward based outreach teams, contracting health care providers, and district specialist teams; and expanding school health services Contribute to health and wellbeing of learners by screening for health barriers to learning – Grade 1 learners and Grade 8 learners receiving health screening Improve access to community based PHC services and quality of services at primary health care facilities – 3500 functional Ward based Primary Health Care Outreach Teams by 2018/19 Improve access to disability and rehabilitation services through the implementation of the framework and model for rehabilitation and disability services – 52 Districts implementing the framework and model for rehabilitation services by 2018/19 RE-ENGINEERING OF PHC 8

Goal 3: Improve the quality of care by setting and monitoring national norms and standards, improving system for user feedback, increasing safety in health care, and by improving clinical governance; Improve district governance and strengthen management and leadership of the district health system – 3760 primary health care facilities with functional clinic committees/ district hospital boards by 2018/19 Improve access to quality PHC services – 2325 (75%) primary health care clinics in the 52 districts qualify as Ideal Clinics by 2018/19 Ensure that the Port Health services are rendered in line with the International Health Regulations – 75 ports of entry compliant with the International Health Regulations by 2018/19 IMPROVE QUALITY OF CARE 9

Goal 3: Improve the quality of care by setting and monitoring national norms and standards, improving system for user feedback, increasing safety in health care, and by improving clinical governance; Ensure quality health care by improving compliance with National Core Standards at all levels of care – 100% compliance with the National Core Standards in 10 Central Hospitals – 100% compliance the National Core Standards in 17 Tertiary, 46 Regional and 63 Specialized Hospitals by 2018/19 IMPROVE QUALITY OF CARE 10

Goal 4: Improve health facility planning by implementing norms and standards; Improve quality of health infrastructure in South Africa by ensuring all new health facilities are compliant with health facility norms and standards -Ensure that Provinces comply with Norms & Standards for health Infrastructure -Link norms and standards to the Conditional Grant -30% budget allocation for the maintenance of existing infrastructure -Implement health facility planning ACCELERATE DELIVERY AND IMPROVE QUALITY OF INFRASTRUCTURE ACCELERATE DELIVERY AND IMPROVE QUALITY OF INFRASTRUCTURE 11

Goal 5: Improve financial management by improving capacity, contract management, revenue collection and supply chain management reforms; Monitor budgets and expenditure of Provinces for Non- Negotiable Items Develop and implement a Revenue Retention Model to strengthen revenue collection by incentivizing central hospitals to increase their revenue collection by 2016/17 Health Care Finances 12

Goal 6: Improve human resources for health by ensuring adequate training and accountability measures. Improve Turn around time of recruitment at NDoH – 3 months by 2018/19 Develop health workforce staffing norms and standards. – Guidelines for HR Norms and standards published for all levels of care by 2018/19 Improve quality of Nursing training and practice by ensuring that all Nursing colleges are accredited to offer the new Nursing qualification – 220 Public Nursing colleges accredited to offer the new nursing qualification by 2018/19 Establish the Health Leadership and Management Academy in order to – Develop training programme for Hospital CEOs and District Health Managers IMPROVE HUMAN RESOURCES FOR HEALTH 13

Goal 7: Prevent disease and reduce its burden, and promote health; To reduce the maternal mortality ratio to under 100 per live births by 2018/19 To reduce the neonatal mortality rate to under 6 per 1000 live births To improve access to sexual and reproductive health services – 55% of women have access to a combination of contraceptives by 2018/19 – Ensure that more than 70% % of females are screened for cancer of the cervix at least once every 10 years by 2018/19 – Provide Human Papiloma Virus Vaccine to at least 80% of grade 4 girls to protect them from cancer of the cervix by 2018/19 In 2015/16 the programme will include Grade 5 Girls Expand the PMTCT coverage to pregnant women by ensuring all HIV positive Antenatal clients are placed on ARVs and reducing the positivity rate to below 1% by 2018/19 – Ensure 100% of HIV positive pregnant mothers receive ARVs by 2014/15 increasing to 100% by 2018/19. – Reach a < 1% PCR test positive rate for infant at 6 weeks of age Maternal Health 14

Goal 7: Prevent disease and reduce its burden, and promote health To reduce under-five mortality rate to less than 23 per 1,000 live births by promoting early childhood development – Child under 5 years diarrhoea case fatality rate at 2% in 2018/19 – Child under 5 years severe acute malnutrition case fatality rate of 5% in 2018/19 – Immunization coverage under 1 year of 93% in 2018/19 – Confirmed measles case incidence per million total population of <1 per – Measles 2 nd Dose immunization coverage of 95% Child Health 15

Goal 7: Prevent disease and reduce its burden, and promote health; To scale up combination of prevention interventions to reduce new infections – HIV test conducted among the populations 15 to 49 years targeted at 10 million annually – 50 million over the 5 years – Targeted 1 Million Medical Male circumcisions conducted annually – 5 million cumulative in 2018/19 – Total number of people remaining on ARVs is targeted at 5.1 million at the end of 2018/19 HIV and AIDS 16

Goal 7: Prevent disease and reduce its burden, and promote health; Improve the effectiveness and efficiency of the routine TB control programme to increase the identification of TB patients; to ensure that these take and complete their treatment – TB new client treatment success rate of 85% by 2018/19 – TB defaulter rate of 5% or less in 2018/19 – TB MDR Treatment success rate improved to 65% in 2018/19 Ensure that all correctional services facilities have appropriate services and that inmates all have access to TB and HIV Diagnosis and treatments services – 48 Correctional Services Management Areas that undertake risk assessments for TB and HIV - by 2018/19 – Percentage of correctional services centers conducting routine TB Screening targeted at 95% by 2018/19 TB 17

Goal 7: Prevent disease and reduce its burden, and promote health; Ensure access for more than 500,000 miners to regular TB prevention, screening and treatment through: ▫ Strengthened regulatory framework (review current legislation & close gaps) ▫ Increased capacity to enforce compliance by mines using multi-disciplinary inspections that comprise officials from Departments of Health, Mineral Resources & Labour ▫ Effective surveillance & reporting system Increase TB/HIV awareness in peri-mining in 6 districts with high concentrations of mines Increase access to TB/HIV prevention, diagnosis, and treatment in peri- mining communities in 6 districts with high concentration of mines by screening, counselling, testing for TB & HIV using mobile units TB 18

Goal 7: Prevent disease and reduce its burden, and promote health; Establish the National Health Commission by 2016/17 Reduce risk factors and improve the management of NCDs – Reduction in obesity to 55% for women and 21% for men by 2018/19 – Counsel and screen people for high blood pressure – 5 million people cumulative by 2018/19 – Counsel and screen people for raised blood glucose levels – 5 million people cumulative by 2018/19 Improve access to and quality of mental health services – Increase that percentage of people screened for mental disorders – Increased the percentage of prevalent population access to mental health treatment from 28% to 35 % over the five year term Non Communicable Diseases 19

Goal 8 : Develop an efficient health management information system for improved decision making; Systems design for a National Integrated Patient Based Information System Appointment of the Ministerial Advisory Committee on E-Health by September 2014 Implementation of the Health Information Normative Standards Framework Health Facility IT Infrastructure – Project First phase 700 PHC facilities in NHI Pilot Districts, next phase to be extended to other Districts o Implement Health Patient Registration System o Implement Patient Administration to improve efficiency and reduce waiting times o Implement integrated electronic Health Data Collection System Finalization of mHealth Strategy and policy guidelines o Mom Connect project – mobile messages to pregnant woman o Mobile Phone Data Collection and Communication for Community Health Workers Implementation of recommendation on PHC Patient Information Systems assessment Implementation of eHealth strategy 20