1. NATIONAL DEPARTMENT OF HEALTH
BRIEFING FOR THE STANDING COMMITTEE ON APPROPRIATIONS ON THE FOURTH QUARTER EXPENDITURE FOR THE 2015/16 AND FIRST QUARTER EXPENDITURE 2016/17 FINANCIAL YEAR
NATIONAL DEPARTMENT OF HEALTH
14 SEPTEMBER 2016 1

2. Overall Expenditure per Grant Quarter 4 2015/16
(Schedule 4 and 5 grants) 2

3. Variance Explanation per Grant Quarter 4 2015/16
(Schedule 4 and 5 grants)
Total CG spending is at 99.1% or R31.9 bn against total adjusted
budget of R32.3 bn.
The major contributor to a 0.9% under spending is:
HFRG spending 96.4 %
Challenges with Implementing Agents and delays in payment of
invoices received in March.
RA: WC, as major contributor to under spending, is in process of
sourcing an implementing agent.
NHI spending 90.2%
Supply Chain Management difficulties and late delivery of
Ward Based Outreach Teams uniforms and other equipment.
RA: Various projects in process to reform SCM. Established
National SCM Forum for consolidation and effective implementation.
HPTDG spent 100%
NTSG and HIV/AIDS spent 99.6% and 99.9% respectively. 3

4. National Health Grant Quarter 4 2015/16 (Schedule 6 – Indirect Grant)

5. Variance Explanation National Health Grant Quarter 4 2015/16
(Schedule 6 – Indirect Grant)
Total indirect grant spending is at 95.3% or R1.0 bn against total adjusted
budget of R1.1 bn.
The major contributor to a 4.7% under spending is:
HPV component spending 79.4 %
Delays in submission of invoices by Provinces.
NHI component spending 96.3%
Most of the Pharmacy Assistants, contracted during 3rd quarter.
Health Facility Revitalisation component spent 100% 5

6. Summary per Economical Classification NDOH Quarter 4 2015/16
Subprogramme
Actual Expenditure as on 31 March 2016
Funds Available
% Spent
Adjusted Budget
Final Allocation
R'000
Compensation of Employees
774,278
750,097 -
100.00%
Goods and Services
1,495,819
1,377,821
1,183,893
193,928
85.93%
Transfers
33,519,141
33,553,890
33,536,117
17,773
99.95%
Capital
464,687
571,217
567,817
3,400
99.40%
Losses
900
100.00% 
TOTAL
36,253,925
36,038,825
215,100
99.41% 6

7. Summary per Economical Classification NDOH
Quarter /16 – Variance Explanation
Goods and Services
HPV expenditure slower than expected;
Condom supply had contractual difficulties;
Demographic Health Survey in progress and will be completed during 2016/17; DRG service level agreements finalized during later part of 2015 and claims i.r.o. GP contracts not all received before 31 March 2016.
Transfers
Progress reports from funded NGO’s received during last week of March 2016 and payments could not be processed before 31 March 2016.
Capital
Laboratory equipment ordered but not delivered before 31 March 2016. 7

8. Overall Expenditure per Grant Quarter 1 2016/17
(Schedule 4 and 5 grants) 8

9. Variance Explanation per Grant Quarter 1 2016/17
(Schedule 4 and 5 grants)
Total CG spending is at 22.6% or R7.7 bn against total original
budget of R33.9 bn.
The major contributor to a 2.4% under spending is:
HFRG spending 20.4 %
Slow progress by contractors as most project expenditure captured in May.
RA: Strengthen monitoring and oversight (site visits)
NHI spending 12.7%
Delays in implementation of business plans.
RA: Development of acceleration plans for all underspending Prov.
NTSG spending 22.7%
Delays in recruitment processes (specialists posts).
RA: Review implementation of Stringency measures.
HPTDG and HIV/AIDS spent 23.5% and 23.3% respectively. 9

10. National Health Grant Quarter 1 2016/17 (Schedule 6 – Indirect Grant)10

11. Variance Explanation NHI Indirect Grant (Schedule 6 – Indirect Grant)
Quarter /17
(Schedule 6 – Indirect Grant)
Total indirect grant spending is at 18.8% or R0.237 bn against total
original budget of R1.3 bn.
The major contributor to a 6.2% under spending is:
HPV component spending 1.4 %
1st campaign taking place during August & September. Expenditure
will only be realised in October 2016.
RA: NDoH to assist Provinces in reconciling and preparing claims for
refund immediately after the campaign.
HFR component spending 17.3%
Delays in procurement of machinery and equipment (HT). SCM
challenges with regards to sourcing of suppliers for maintenance
projects (G&S).
RA: NDoH together with NT in process of arranging Transversal
Contracts for all Health Technology and other equipment.

12. Variance Explanation NHI Indirect Grant (Schedule 6 – Indirect Grant)
Quarter /17
(Schedule 6 – Indirect Grant)
1/24/2018
GP Contracting component is under pressure and at risk of over expending
Ideal Clinic component spending 13.6%
Significant portion of the grant allocated for peer reviews which will
only start during September (Phase 1) and January (Phase 2).
Expenditure to be realised in 3rd and 4th quarter.
RA: NDoH has an invoice tracking system to ensure invoices are
processed speedily.
RA = Remedial Action 12

13. Summary per Economical Classification NDOH Quarter 1 2016/17
Economic Classification
Actual Expenditure as on 30 June 2016
Funds Available
% Spent
Original Budget
R'000
Compensation of Employees
23.47%
Goods and Services
20.09%
Transfers
23.36%
Capital
19.38%
Losses - 51
(51)
TOTAL
23.17% 13

14. Summary per Economical Classification NDOH
Quarter /17 – Variance Explanation
Compensation of Employees
SMS salary adjustment and performance bonusses will be implemented and processed during second quarter.
Goods and Services
Vaccines and medical supplies to administer 1st dosage of HPV ordered but not received;
WHO membership fees to be paid during second quarter;
Condoms ordered but invoices not received during first quarter and will be processed;
Full account from consultancy services managing the infrastructure projects still to be received.
Transfer payments
Outstanding audit reports and SLA’s from NGO’s caused a delay in processing transfer payments (PFMA requirements).
Capital
Accounts from implementing agents i.r.o Infrastructure Projects expected to increase in subsequent quarters of the financial year. 14

15. Target Achievement: 2015/16 Quarter 4 Highlights
Almost all targets were achieved for 2015/16; and the following are the highlights:
Continued health status improvements:
Total life expectancy in South Africa increased from an estimate of 62.2 years in 2013 to 62.9 in Under-five mortality declined from 41 per 1000 live births in 2013 to 39 deaths per 1000 live births in 2014.
infant mortality rate declined from 29 deaths per 1000 live births in 2013 to 28 deaths per 1000 live births in 2014.
Neonatal mortality rates remained stable at 11 deaths per 1000 live births between 2013 and 2014.
The maternal mortality ratio decreased from an estimate of 166 deaths per 100,000 live births in 2012 to 155 deaths per 100,000 live (Rapid Mortality Surveillance Report 2014 released December 2015, Medical Research Council)
Publishing of NHI White paper
11 millions clients aged were tested for HIV against the annual target of 10 million

16. Target Achievement: 2016/17 Quarter 1 Highlights
NDoH did well on the following child indicators:
The child under 5 years diarrhoea case fatality rate was 2.6% compared to the quarter target of 3.30%;
The child under 5 years pneumonia case fatality rate was 1.7%, against the quarter target of 2.6%; and
63.7% of pregnant women visited health facilities before 20 weeks exceeding the quarter target of 60%.
93.7% antenatal clients were initiated on ART against the first quarter target of 94%.
The couple year protection (CYP) rate was estimated at 65.7%, against the quarter target of 58%.
. Cervical cancer screening coverage was at 56.2%, which is above the quarter four target of 49%.
male condoms were distributed and female condoms against first quarter targets of male and female condoms respectively.

17. Main Challenges in 2015/16 & Interventions in 2016/17
1/24/2018
Main Challenges
Mechanisms to address challenges
Medical male circumcision ( MMCs performed vs a target of )
Based on the 2015/16 performance on medical male circumcision, the target for the 2016/17 financial year has been realistically determined
TB MDR
Loss to follow up rate 22.3% (target = 16%)
Client death rate 20.7% (target =15%)
Implementation of the adherence strategy will aim to assist in retention of patients on TB treatment
The country operational plan and district-level micro-plans include a demand creation strategy to address social mobilisation at local level by employing social mobilisation teams
Introduced a new effective MDR treatment drug called bedaquiline, as recommended by WHO
Quality of Care
PHC patient experience of care
100% in compliance with National Core Standards in in central & tertiary hospitals (target = 8 for central hospitals and 5 for tertiary hospitals)
Review the National Core Standards assessment criteria and scoring
Fast-track patient experience of care survey, tools and policies 17

18. Progress on NHI Pilot Project implementation
Under NHI Phase I the Health System Strengthening pilots have yielded a range of positive results:
District clinical specialist teams (DCSTs):Recruitment of the DCSTs started in 2011 to improve quality of care for mothers, newborns and children and achieve the Millennium Development Goals through providing direct specialist support to districts. In 2016/17, 200 specialised doctors and nurses are now providing support to primary health care and district hospitals services, with most districts in the country now having at least one specialised doctor. They have made a significant contribution in prioritising clinical care for these critical target groups and in improving skills levels of staff. Research into skills training shows a decline in maternal mortality; and ongoing review of all maternal deaths through the NCCEMD shows a significant drop in MMR at district hospitals.
School Health: 77 school health mobile clinics were purchased for the 11 NHI districts which made possible to deliver integrated school health programme. For the 2015/16 financial year, learners were screened in all provinces across all grades, and learners were screened during the first quarter of 2016/17. Over 3 million learners in Grades R to 7 were reached with deworming campaign, in the Feb/March 2016 campaign that was synchronized with HPV vaccination campaign
CCMD: A total of 644,892 patients have been enrolled on the chronic medicines supply programme.
This has significantly reduced the need for patients to wait in long queues in facilities for the collection of their chronic medicines.
The collection of a medicine package close to a patients home/work has also reduced the cost of travel and time off work.

19. GP/ Health Practitioner Contracting
Number of contracted Health Practitioners by district, as of June 2016
District
Number of contracted GPs
Doctor-PHC facility % coverage
Number of contracted PAs
Dr Kenneth Kaunda 31 89 16
Gert Sibande 25 92 30
OR Tambo 49 42 59
Pixley Ka Seme 21 93 15
Thabo Mofutsanyana 26
100 3
Tshwane 77 99
UMgungundlovu 34 96
UMzinyathi 24 95 39
Vhembe 41 28
Eden 14 98 -
Amajuba 8
New , not yet calculated 13
TOTAL
350
90.%
326
To address the challenge of poor uptake of GPs in the NHI pilot districts, the department engaged with GPs in all the NHI pilot districts and addressed concerns, with more GPs being attracted (included covering travel costs, orientation workshops on departmental policies and guidelines, providing additional consultation space in clinics and ensuring the availability of medicines and equipment).
Through the Ideal clinic programme, consultation space in clinics and the availability of essential equipments was improved.
There are currently 676 HPs (350 GPs and 326 Pharmacist Assistants) on the contract. The national contract has brought much stability to the issue of access to doctors at PHC level, boosting the morale of facility staff and increasing the satisfaction of communities. 19

20. The comment period on the White Paper has ended
NHI Workstreams
The comment period on the White Paper has ended
NHI work streams designing recommendations for implementation. 20

21. Types of Issues that the Work Streams are addressing
Work Streams will develop recommendations on implementation and phasing, focussing on, but not limited to, issues relating to:
What Financing is feasible?
Legal and Regulatory Environment
Governance
Standards for Providers
Building Capacity
Operational requirements
Beneficiary identification and enrolment.
How providers are organised (individual, networks, institutional, referral systems)?
Determine the provider payment methods for the different levels of care.
Determine if there are performance based payments how will this be monitored.
How are performance be monitored and quality determined?
Draft a statement of the benefits package, including criteria that should guide the design of the benefits package. 21

22. Thank You!