1. NCOP PRESENTATION ON CONDITIONAL GRANTS AND CAPITAL EXPENDITURE – NORTH WEST. FOURTH QUARTER ENDING 31 MARCH 2006 2006-05-03

2. PURPOSE To provide information to the NCOP on data on trends in allocations, transfers and actual expenditure of all conditional grants and capital expenditure managed by the Department. A brief assessment of the monitoring capacity for 2005/06. Over / under spending and the capacity constraints. 2006/07 Service Level Agreements and business plans progress.

3. OVERVIEW 8 CONDITIONAL GRANTS MANAGED BY DOH NW. CONSTITUTES 14% OF TOTAL BUDGET. THERE HAS BEEN A MARKED INCREASE IN THE ALLOCATIONS FOR THE PROVINCE WITH A VIEW OF CLOSING THE EQUITY GAP WITH OTHER PROVINCES. SIGNIFICANT IMPROVEMENT IN SPENDING HAS BEEN REALISED FOR THE YEAR UNDER REVIEW (2005/06) STRENGTHENING OF PROJECT MANAGEMENT IN RELATION TO CONDITIONAL GRANTS HAS IMPROVED THE MONITORING CAPACITY. % OF OVERALL UNDER EXPENDITURE REDUCED TO 9%.

4. TRENDS IN EXP. & ALLOCATIONS YEAR 01/0202/0303/0404/05 05/06 06/0707/08 NTSG 38,52032,89135,00038,606 71,889 69,38070,509 HPT&D 24,37752,82437,11244,903 64,012 62,56465,692 HOSP. REVT. 44,707 6,51337,98181,930 70,142 125,493106,495 HIV/ AIDS 2,253 21,30331,26064,619 100,92 1 142,316149,432 HM&QI 014,19312,1969,407 17,849 13,40014,070 INP 28,31436,44663,699 9,336 10,890 0 0 INFRSTRC. FORENSIC SERV. Malaria 8,58743,97126,41922,722,734 2,432 42,174 2,230,968 58,000 29,000 70,900 29,000

5. TRENDS IN EXP, TRANSFERS. & ALLOCATIONS TRANFERS FROM NATIONAL HEALTH HAS BEEN RECEIVED IN ALL FINANCIAL YEARS AND GRANTS WITH THE EXCEPTION OF THE FOLLOWING: AN AMOUNT OF R5.915m WAS WITH HELD FOR HIV&AIDS – 2004/05. AN AMOUNT OF R40m WAS WHITHHELD FOR REVITILIZATION – 2005/06 AS PER AGREEMENT.

6. GRANTBUDGETROLL- OVER TOTAL AVAILAB LE AMT RECEIVE D AMT. SPENT %SPE NT COMPREHENSIVE HIV & AIDS 100,921- 100 INTEGRATED NUTRITION PROGRAME 10,981- 10,89199.18 HOSPITAL REVITALISATION 58,05644,343102,39957,20177,04975.24 HOSPITAL MANAGEMENT & QUALITY IMPROVEMENT 12,6425,66118,30312,64217,85697.56 HEALTH PROFESSION TRAINING & DEVELOPMENT 62,5641,44864,01262,56464,012100 NATIONAL TERTIARY SERVICES GRANT 67,8883,39471,28267,88871,283100 FORENSIC PATHOLOGY SERVICES 11,116- 2,23020.06 INFRASTRUCTURE GRANT 43,723- 43,49042,17496.46 TOTAL 356,91054,846422,738366,803386,41691.41

7. EXPENDITURE FOR 2005/06 FOURTH QUARTER GRANTADJ.ALLOCEXPENDT.VARIANCE HIV/ AIDS 100,921 0 NTSG 71,283 0 HPT&D 64,012 0 HM&QI 18,303 17,849 454

8. EXPENDITURE FOR 2005/06 FOURTH QUARTER GRANT.ADJ.ALLOCEXPENDT.VARIANCE INP 10,981 10,891,090 INFRSTRU CTURE 43,723 42,174 1,549 HOSP. REVT. 102,399 77, 049 25,350 FORENSIC SERVICES. 11,116 2,230 8,886

9. OVER/UNDER EXPENDITURE Total allocation for the year under review was : R422,738m Total amount unspent : R36,322 which is 8.59% of the overall allocation. The 05/06 conditional grants expenditure performance is the best in years.

10. HOSPITAL REVITALIZATION 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.

11. HOSPITAL REVITALIZATION Sub- Programmes Budget R’000 EXPENDITUREBALANCE New Facilities (H3E) 3 869 3 489 380 Upgrading (H3F) 67 300 43 184 24 116 Other Facilities (H3G) 29 199 29 072 127 Rehabilitation (AA1) 2 031 1 303 728 TOTAL 102 399 77 049 25 350

12. HOSPITAL REVITALIZATION (cont) The balance of the allocation against expenditure amounts to 25%. An amount of R25m has been processed for payment to the implementing agent already. The expenditure will be incurred as soon as transfers from NDoH is received. The full amount of R25,350m has been requested for a roll over from the provincial Treasury.

13. HOSPITAL REVITALIZATION (cont) Capacity challenges :  Human Resource capacity both within and with implementing agents.  Incapacity of some consultants and small emerging contractors to handle projects with the required competencies.

14. 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.

15. Medico Legal Mortuaries Challenges:  The funds from the conditional grant of the Programme were only received in December 2005. Achievements:  Commitments for equipment.  Posts advertised already.  Approved business plan.

16. SERVICE LEVEL AGREEMENTS/ BUSINESS PLANS. A Service Level Agreement is in place between the Departments of Health and Public Works. Business plans have been forwarded to NDoH for all the conditional grants and awaiting approval. Transfers from NDoH have been received of all Conditional Grants during the month of April 2006.

17. EQUIPMENT BUDGET V/S EXPENDITURE FOR FIN. YEAR 05/06 CODEADJ.ALLOCEXPENDT.VARIANCE MOTOR TRANSPORT (AMBULANCE) 14,297 9,809 4,487 OFFICE FURNITURE 1,018 0 MEDICAL EQUIPMENT 39,000 49,919 -10,919 FORENSIC PATHOLOGY SERVICES 7,200 189 7,010 OTHER EQUIPMENT (Computers, printers etc.) 28,048 11,979 8,069 HEALTH FACILITIES AND MAINTENANCE 8,500 5,661 2,838 TOTAL FOR EQUIPMENT 98,06378,57519,487

18. VARIENCE REPORT The ratio 70/30 was used to purchase ambulances and patient transport. The variance of R4,487 was earmarked for mobile clinics which could not be delivered before the end of the financial year. The procurement will therefore have to be made in the new financial year.

19. VARIENCE REPORT cont… The R9.8 million was used to purchase the 18 ambulances and 14 planned patient transport. The budget for Office furniture was transferred to Public Works however, Public Works could not supply the Department due to insufficient allocation. Medical equipment were purchased for programs 2 – District Health Services and Program 4 – Provincial Hospital Services.

20. VARIENCE REPORT cont… The variance of R7 million will be rolled over into the current financial year to enable the Forensic Pathology Services to purchase mortuary vehicles. Also the variance of R2.8 million for conditional grants under program 8 - equipment for clinics would be rolled over into the current budget. The variance on other equipment is due to committed orders which had to be cancelled due to delivery after March 31 st.

21. CONCLUSION The Department is confident that systems are now in place to monitor the performance of conditional grants in line with DORA hence the improved outcome for the 2005/06 financial year.

22. CONCLUSION CONT!! We will work closely with the CIDB (Construction Industry Development Board) to use their classification of contractor competence, in appointment of contractors.

23. CLOSURE Thank you for listening