2. 1 MPUMALANGA PROVINCE DEPARTMENT OF HEALTH AND SOCIAL SERVICES BUDGET HEARING 5 APRIL 2005

3. 2 Mpumalanga Provincial team  MEC PE PashaMember of Executive Council  Mr. HE Verachia Head of Department  Mr. R MnisiChief Financial Officer  Dr. K MichaelChief Director: Hospital Services  Ms. G MathebulaChief Director: Primary Health Care

4. 3 Mpumalanga Provincial team  Mr. R MasilelaPA to the MEC  Ms. P RousseauPA to the HOD  Mr. J MlangeniDeputy Director: Communications

5. 4 Strategic Priorities for the National Health System (2004 -2009) identified the following major elements:  Improve governance and management of the NHS  Promote healthy lifestyles  Contribute toward to human dignity by improving quality of care  Improve management of Communicable diseases and non-communicable illness

6. 5  Strengthen Primary Health Care, EMS and Hospital Services delivery systems  Strengthen support services  Human Resource planning, development and management  Planning, budgeting, monitoring and evaluation  Prepare and implement legislation  Strengthen international relations

7. 6 Key achievements for the Provincial Health Department 2004/2005 See handout

8. 7 Vision A developed society in which all people have equitable access to quality, humane and integrated health and social services

9. 8 Mission To provide and promote integrated quality health and social services in partnership with all stakeholders to ensure healthy lifestyles and reduce poverty in all communities in Mpumalanga.

10. 9 Values EquityHonesty DignityTransparency HonestyIntegrity AccessibilityValue of money InformationHuman Rights Collective Accountability Efficiency and Effectiveness

11. 10 Provincial Priorities 1. Addressing Communicable Diseases including HIV and AIDS, TB and childhood illness such as pneumonia and other diarrhoea related diseases. Also to reaffirm the commitment to rollout the comprehensive HIV and AIDS plan. 2. Addressing Non-communicable Diseases including malnutrition, diseases of lifestyle, trauma and violence with special emphasis on strengthening of emergency medical services. 3. Developing human resources: the department is commited to put in place mechanisms to attract and retain scarce skills.

12. 11 Provincial Priorities 4. Infrastructure Improvement: this is in addition to the ongoing hospital revitalization programme. 5. Strengthen the Primary Health Care services as well as the development of the District Health System by ensuring funding shifts to PHC services. 6. Creating Partnerships and strengthening collaboration with all our stakeholders.

13. 12 Key priorities for the next 3 years

14. 13 Improve governance and management of the Provincial Health System

15. 14  Establishment of Hospital Boards and Clinic Committees according to the National Health Act, Act no 61 of 2003.  Training of Hospital Board and Clinic Committee members.  Appointment of CEO’s at all provincial hospitals.  Strengthen training for Hospital managers.  Implement Departmental Communication strategy

16. 15 Promote healthy lifestyles

17. 16  Community mobilisation to adopt healthy lifestyle practices through healthy eating habits and exercise.  Strengthen Health Promoting schools.  Strengthen Diabetes Awareness through expanding the Diabetes Support groups.  Strengthen the Household and Community component of IMCI.

18. 17 Contribute towards human dignity by improving quality of care

19. 18  Strengthen community participation through Imbizo’s, community meetings and community structures e.g. DOTS and HBC groups.  Support multi-sectoral Victim Empowerment Programme.  Conduct patient satisfaction surveys at health facilities.  Establish adverse event reporting systems at all hospitals.  Ongoing clinical audits in line with National benchmarks.

20. 19 Improve management of communicable diseases and non-communicable illness

21. 20  Empower Communicable Disease Control response teams.  Monitor immunization coverage for children under 1 year of age.  Empower health workers on the Integrated Management of Childhood Illnesses for children under 5 years.  Training of PHC nurses on early diagnosis and treatment of Malaria cases.  Accelerate the implementation of the Comprehensive plan for HIV and AIDS.

22. 21  Implement TB review recommendations including management of MDR TB  Strengthening of programmes on women and maternal health including screening for breast and cervical cancer.

23. 22 Strengthen Primary Health Care, EMS and Hospital Services delivery systems

24. 23  Improve access to PHC by constructing additional facilities and providing additional mobile services in prioritised areas.  Increase delivery of PHC package at all service delivery points.  Reduce response times for EMS in urban and rural areas.  Prepare business cases for one additional revitalisation project per annum, including a business case for a provincial tertiary facility.

25. 24 Strenghten Support services

26. 25  Implement a Health Technology Management System.  Monitor and strengthen radiation control in hospitals.  Monitor compliance with EDL guidelines.  Provision of a central Pharmaceutical Depot that complies with legislation.

27. 26 Human resource planning, development and management

28. 27  Strengthen and develop a fully functional Health Sciences College.  Monitor implementation of the Departmental Human Resource Plan.  Monitor implementation and impact of Departmental Retention strategy.  Engage responsibility managers on PMDS compliance.

29. 28 Planning, budgeting, monitoring and evaluation

30. 29  Monitor compliance with PFMA and supply chain management system.  Improve and strengthen the health information system and empower managers to utilise quality health information.  Establishment of monitoring and evaluation teams to monitor performance against set objectives and standards.

31. 30 Prepare and implement legislation

32. 31  Develop and promulgate a Provincial Health Act  Monitor compliance with the Mental Health Care Act, Pharmacy Act and National Health Act.

33. 32 Strenthen international relations

34. 33  Further develop the Lebombo Spatial Development Initiative, which is a collaborative programme between Swaziland, Mozambique and Mpumalanga in addressing communicable diseases in the region.  Jointly expand the collaborative project on health information systems with the Italian Corporation.  Develop and implement a doctor and specialist rotation system with the United Kingdom and Germany.

35. 34 Brief description of the Budget with Trends 2002/03 – 2007/08

36. 35 Department of Health and Social Services Health Component Expenditure R’000 Medium Term Estimates R’000 Sources of revenue 2001/ 2002 2002/20032003/20042004/ 20052005/ 20062006/ 200720072008 Equitable share 1 285 5111 489 4331 821 4742 035 4072 183 5652 466 9322 655 194 Conditional Grants 174 050198 713320 352338 975296 893365 035399 777 Own Revenue 10 37010 54046 000 Total Revenue 1 456 5611 688 1462 152 1962 384 9222 480 4582 877 9673 054 971

37. 36 Department of Health and Social Services Health Component Budget 2004/2005 R’000 Preliminary Expenditure 2004/2005 R’000 Under/over R’000 Expenditure as % allocation Equitable share2 045 9472 011 10034 84798,3% Conditional Grants338 975255 11983 85675,3% Total2 384 9222 266 219118 70395,1%

38. 37 Department of Health and Social Services Health Component Expenditure R’000 Medium Term Estimates R’000 Programmes 2001/ 20022002/20032003/20042004/ 20052005/ 20062006/ 20072007/2008 1. Administra- tion 111 015120 729176 035216 141155 022160 723204 783 2. District Health Services 885 8551 021 2661 092 5511 109 7841 231 0861 397 7711 465 557 3. Emergency Medical Services 46 72990 62592 549120 393130 024 4. Provincial Hospital Services 224 546232 951269 611353 125382 764456 759464 439 5. Central Hospital 156 080176 775302 377365 088358 013399 982410 215 6. Health Sciences and Training 32 63839 32845 16058 91984 29293 342101 475 7. Health care Support services 12 66424 69615 42722 76533 59440 84043 229 8. Health Facilities Management 63 76372 40181 148168 475143 198208 157235 249 Total Revenue 1 456 5611 688 4782 006 3932 384 9222 480 5182 877 9673 054 971

39. 38 Department of Health and Social Services Health Component Expenditure R’000 Medium Term Estimates R’000 Conditional Grant2003/20042004/20052005/ 20062006/ 20072007/ 2008 Health Financial Management Grant2 8442 008 Provincial Infrastructure Grant29 17140 55339 97544 32352 042 Flood Construction Grant11 0166 677 National Tertiary Services Grant41 79648 52742 22444 75746 995 Health Professional Training and Development Grant 46 57542 08354 363 57 081 Hospital Revitalisation Grant65 94488 42357 018101 032117 071 Coroner Services Grant1 000 Hospital Management and Quality Improvement Grant 20 27328 99012 34013 08113 735 Integrated Nutrition Programme Grant 67 18315 0539 581 HIV and AIDS Grant34 55065 66181 392107 479112 853 Medico Legal Services1 000 Total320 352338 975296 893356 665399 777

40. 39 Department of Health and Social Services Health Component Budget 2004/2005 R’000 Preliminary Expenditure 2004/2005 R’000 Under/(over) R’000 Health Financial Management Grant2 0081 676332 Provincial Infrastructure Grant40 55318 12922 424 Flood Construction Grant6 6776 286391 National Tertiary Services Grant48 52746 4672 060 Health Professional Training and Development Grant 42 083 0 Hospital Revitalisation Grant88 42351 69936 724 Coroner Services Grant1 000728272 Hospital Management and Quality Improvement Grant 28 99021 5387 452 Integrated Nutrition Programme Grant15 05313 4021 651 HIV and AIDS Grant65 66153 11112 550 Total338 975255 11983 856

41. 40 Budgetary Trends The Mpumalanga Province had a budget of 2002/3 the budget was R1,688 billion and for 2003/4 the budget was R2,152 billion. For 2004/2005 the budget allocated was R2,385 billion The department provides in addition to the population of the province, health care services to patients from neighboring countries of Swaziland and Mozambique

42. 41 Budgetary Trends  The Departmental expenditure per capita for 2004/2005 was R64,87  The allocation for the health component represents 21,5% of the Provincial equitable share budget