1. 5/18/2018
Presentation to Standing Committee on Appropriation on 1st Quarter Expenditure for 2014/15 FY
10 September 2014 1

2. Table of Content Departmental expenditure
Conditional Grants expenditure
Plans for improving expenditure performance in Infrastructure Programmes
Plans for improving expenditure performance in the National Health Insurance pilot programme
Report on implementation of cost containment measures

3. Departmental Expenditure for 1st Quarter Expenditure for 2014/15 FY

4. Departmental Summary Expenditure

5. Departmental Summary Expenditure
All Programmes Compensation of Employees are showing a degree of pressure mainly due to the implementation of the grading of Assistant and Deputy Directors. This matter has been raised with National Treasury and will most likely be addressed during the Adjustment Budget

6. Programme 1: Administration

7. Programme 1: Administration
Invoices for property payments (water, electricity, and rent) for the last quarter of 2013/14 were processed during 2014/15 after it was received from Public Works. 7

8. Programme 2: National Health Insurance, Health Planning and System Enablement8

9. Programme 2: Reasons for Variances
The budget for compensation of employees is exceeded due to the appointment of a Health Attaché in Cuba
Slow spending on the indirect National Health Insurance grant. To this end a service provider was appointed in July 2014 to assist with the recruitment of GPs and test the Purchaser Provider split
WHO membership fees will be processed during third quarter of the financial year.
The SA Demographic Health Survey has started and still awaiting invoices from StatsSA and MRC 9

10. Programme 3: HIV and AIDS, Tuberculosis, Maternal and Child Health 10

11. Programme 3: HIV and AIDS, Tuberculosis, Maternal and Child Health
The vaccinations for the Human Papilloma Virus is scheduled for September - October 2014 and February – March For this reason no expenditure is reflecting yet on the budget of R200 million.
The printing of the general TB pamphlets in Braille was delayed at the Government Printing Works. 11

12. Programme 4: Primary Health Care Services:12

13. Programme 4: Primary Health Care Services:
The transfers to the NGO’s are scheduled for the third quarter of the financial year.
Invoices are awaited from the GCIS for the No Tobacco Campaign.
Expenditure on Environmental Health Services is expected to increase with the transfer of Port Health Services to the National Department 13

14. Programme 5: Hospital, Tertiary Services and Human Resource Development14

15. Programme 5: Hospital, Tertiary Services and Human Resource Development
Payments amounting to R11,5 million or 1.1% of the budget of R807 million for the indirect grant for Health Facilities Infrastructure were processed. Invoices are awaited from the DBSA in this regard. Indications are DBSA will claim R83 million for work done to date.
The Forensic Chemistry Laboratories advertised in the first quarter several tenders for the procurement of specialized laboratory equipment. Expenditure is expected during the 2nd and 3rd quarter 15

16. Programme 6: Health Regulation and Compliance Management16

17. Programme 6: Health Regulation and Compliance Management
The transfer payment to the Compensation Fund is scheduled to be paid in the latter half of the year.
No invoices were received from the Auditor-General to be paid yet.
The Board for the Office of Health Standards Compliance was established on 4 June The recruitment of staff as well as the expected lease of a building should increase expenditure. The office will function independent and occupy premises outside of the NDOH. This is expected to be finalised in October 2014. 17

18. Conditional Grants Expenditure for 1st Quarter Expenditure for 2014/15 FY

19. Conditional Grants Overall provincial CG spending was 21.2% or R6.4
billion against total budget of R30.1 billion
Major contributors to under spending are:
Comprehensive HIV/AIDS Grant- spent 20.2%
Health Facility Revitalization Grant – spent17.0%
National Health Insurance – spent 12.6%
Health Professions and Training Grant at 24.4% and National Tertiary Services Grant at 23.9% spent within the acceptable norm 19

20. Summary Expenditure Per Grant
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
2,321,788
583,243
100.0%
566,844
24.4%
541,718
92.9%
National Tertiary Services Grant
10,168,235
2,542,062
2,428,525
23.9%
2,207,645
86.8%
Comprehensive HIV and AIDS Grant
12,311,322
3,008,904
2,491,939
20.2%
2,601,154
86.4%
Health Facility Revitalisation Grant
5,239,981
1,310,001
892,553
17.0%
937,261
71.5%
National Health Insurance Grant
70,000
7,000
8,806
12.6%
9,865
140.9%
TOTAL
30,111,326
7,451,210
6,388,667
21.2%
6,297,643
84.5% 20

21. Summary Expenditure Per Province
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Eastern Cape
3,041,349
748,426
100.0%
506,528
16.7%
67.7%
Free State
2,343,498
588,151
518,493
22.1%
457,194
77.7%
Gauteng
7,615,616
1,918,428
1,695,171
22.3%
88.4%
Kwazulu-Natal
6,223,725
1,511,204
1,369,666
22.0%
1,386,502
91.7%
Limpopo
1,891,938
483,669
280,955
14.9%
147,414
30.5%
Mpumalanga
1,361,749
343,144
291,832
21.4%
320,173
93.3%
Northern Cape
1,146,641
282,154
277,775
24.2%
North West
1,771,909
441,947
387,687
21.9%
Western Cape
4,714,901
1,134,087
1,060,560
22.5%
93.5%
TOTAL
30,111,326
7,451,210
6,388,667
21.2%
6,297,643
84.5% 21

22. Eastern Cape Expenditure
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
199,874
49,959
100.0%
35,025
17.5%
70.1%
National Tertiary Services Grant
786,007
196,503
151,450
19.3%
77.1%
Comprehensive HIV and AIDS Grant
1,449,237
351,456
254,374
17.6%
72.4%
Health Facility Revitalisation Grant
599,231
149,808
64,582
10.8%
43.1%
National Health Insurance Grant
7,000
700
1,097
15.7%
156.7%
TOTAL
3,041,349
748,426
506,528
16.7%
67.7% 22

23. Eastern Cape Variance Explanations
5/18/2018 23

24. Free State Expenditure
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
146,419
39,931
100.0%
35,731
24.4%
26,308
65.9%
National Tertiary Services Grant
898,091
224,523
262,658
29.2%
Comprehensive HIV and AIDS Grant
843,026
210,756
118,254
14.0%
103,891
49.3%
Health Facility Revitalisation Grant
448,962
112,241
101,848
22.7%
101,772
90.7%
National Health Insurance Grant
7,000
700 2
0.0%
TOTAL
2,343,498
588,151
518,493
22.1%
457,194
77.7% 24

25. Free State Variance Explanations
5/18/2018 25

26. Transfers per % of Payment Schedule % of Transfers Received
Gauteng Expenditure
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
811,114
202,779
100.0%
223,558
27.6%
110.2%
National Tertiary Services Grant
3,493,891
873,474
755,732
21.6%
86.5%
Comprehensive HIV and AIDS Grant
2,632,578
673,716
654,926
24.9%
97.2%
Health Facility Revitalisation Grant
671,033
167,759
57,781
8.6%
34.4%
National Health Insurance Grant
7,000
700
3,174
45.3%
453.4%
TOTAL
7,615,616
1,918,428
1,695,171
22.3%
88.4% 26

27. Gauteng Variance Explanations
5/18/2018
Gauteng Variance Explanations 27

28. KwaZulu Natal Expenditure
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
292,837
73,209
100.0%
25.0%
National Tertiary Services Grant
1,496,427
374,106
394,573
26.4%
249,404
66.7%
Comprehensive HIV and AIDS Grant
3,257,992
771,870
668,277
20.5%
Health Facility Revitalisation Grant
1,162,469
290,619
233,015
20.0%
National Health Insurance Grant
14,000
1,400
592
4.2%
TOTAL
6,223,725
1,511,204
1,369,666
22.0%
1,386,502
91.7% 28

29. Kwazulu-Natal Variance Explanations
5/18/2018
Kwazulu-Natal Variance Explanations 29

30. Transfers per % of Payment Schedule % of Transfers Received
Limpopo Expenditure
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
116,206
29,052
100.0%
14,907
12.8%
9,305
32.0%
National Tertiary Services Grant
323,158
80,790
70,010
21.7%
38,189
47.3%
Comprehensive HIV and AIDS Grant
978,132
256,266
126,387
12.9%
94,584
36.9%
Health Facility Revitalisation Grant
467,442
116,861
69,202
14.8%
5,242
4.5%
National Health Insurance Grant
7,000
700
449
6.4% 94
13.4%
TOTAL
1,891,938
483,669
280,955
14.9%
147,414
30.5% 30

31. Limpopo Variance Explanations (1)
5/18/2018
Limpopo Variance Explanations (1) 31

32. Limpopo Variance Explanations (2)
5/18/2018
Limpopo Variance Explanations (2) 32

33. Mpumalanga Expenditure
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
95,288
21,000
100.0%
16,097
16.9%
7,000
33.3%
National Tertiary Services Grant
97,116
24,279
22,888
23.6%
16,186
66.7%
Comprehensive HIV and AIDS Grant
818,836
211,287
216,808
26.5%
Health Facility Revitalisation Grant
343,509
85,878
34,926
10.2%
85,000
99.0%
National Health Insurance Grant
700
1,113
15.9%
TOTAL
1,361,749
343,144
291,832
21.4%
320,173
93.3% 33

34. Mpumalanga Variance Explanations
5/18/2018
Mpumalanga Variance Explanations 34

35. Northern Cape Expenditure
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
76,697
21,474
100.0%
21,128
27.5%
National Tertiary Services Grant
298,727
74,682
88,304
29.6%
Comprehensive HIV and AIDS Grant
342,789
79,941
83,339
24.3%
Health Facility Revitalisation Grant
421,428
105,357
84,306
20.0%
National Health Insurance Grant
7,000
700
698
10.0%
TOTAL
1,146,641
282,154
277,775
24.2% 35

36. Northern Cape Variance Explanations
5/18/2018
Northern Cape Variance Explanations 36

37. North West Expenditure
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
104,586
26,148
100.0%
27,498
26.3%
National Tertiary Services Grant
237,264
59,316
44,747
18.9%
Comprehensive HIV and AIDS Grant
936,938
234,252
173,545
18.5%
Health Facility Revitalisation Grant
486,121
121,531
141,516
29.1%
National Health Insurance Grant
7,000
700
381
5.4%
TOTAL
1,771,909
441,947
387,687
21.9% 37

38. North West Variance Explanations
5/18/2018
North West Variance Explanations 38

39. Western Cape Expenditure
BUDGET
NATIONAL TRANSFERS
EXPENDITURE
PROVINCIAL TRANSFERS
Grant Name
Original Budget
Actual Transfers
Transfers per % of Payment Schedule
Expenditure
% Spent of Budget
Transfers Received
% of Transfers Received
R'000 %
Health Professions Training and Development Grant
478,767
119,691
100.0%
25.0%
National Tertiary Services Grant
2,537,554
634,389
638,163
25.1%
100.6%
Comprehensive HIV and AIDS Grant
1,051,794
219,360
196,029
18.6%
89.4%
Health Facility Revitalisation Grant
639,786
159,947
105,377
16.5%
65.9%
National Health Insurance Grant
7,000
700
1,300
185.7%
TOTAL
4,714,901
1,134,087
1,060,560
22.5%
93.5% 39

40. Western Cape Variance Explanations (1)
5/18/2018
Western Cape Variance Explanations (1) 40

41. Western Cape Variance Explanations (2)
5/18/2018
Western Cape Variance Explanations (2) 41

42. Schedule 6 (Indirect Grants)
SCHEDULE 6A GRANT PERFORMANCE REPORT AS AT 30 JUNE 2014
Grants
Original Budget (R'000) 2014/15
Total Quarter 1 Expenditure
Commitments
Budget Available (R'000)
% Spent of Budget
Health Facility Revitalisation Grant - In Direct
979,862
11,470
26,423
968,392 1%
Human Papillomavirus
200,000 0%
National Health Insurance - In Direct
395,000
5,983
13,070
389,017 2%
Total National Health Grant
1,574,862
17,453
39,493
1,557,409 . 42

43. HFRG Indirect- Variance Explanations
Delay by the Implementing Agent in awarding the contracts on time resulting in the projects starting later than anticipated. Interventions by the NDOH have resumed and the matter was taken up with the National Health Council
Industrial strike action by the staff members, particularly in the Eastern Cape and Northern Cape Provinces 43

44. HPV – Variance Explanations
Only two doses are planned for the 2014/15 financial year. The first dose will take place during October month (2nd quarter). The expenditure will therefore reflect during 2nd and 3rd quarter reporting
Orders are in the process of being issued for vaccines worth R47m ,transportation and medical supplies
Anticipate to spend entire budget allocation by end financial year 44

45. NHI Indirect – Variance Explanations
Under spending caused by challenges in attracting GPs
Appointment of a Service Provider was finalised in July 2014 to assist with the recruitment and to test the Purchaser Provider split 45

46. Plans for improving expenditure performance in Infrastructure Programmes

47. Infrastructure
Situation analysis done on the Health Infrastructure service delivery in 2010, introduction of IUSS and achievement on improvising of infrastructure expenditure
Expenditure in the first quarter of F/Y and magnitude of the task ahead and focus area of infrastructure maintenance.
Capacitation Program at national and provincial levels for alignment with Infrastructure Delivery Management System (IDMS)
State of Readiness of provinces in relation to implementation of IDMS capacitation program
Restructuring of the Infrastructure Unit of the NDoH and establishment of Infrastructure Program Office. 47

48. Infrastructure Delivery Management System [IDMS]
The IDMS has been developed through the Infrastructure Delivery Improvement Programme.
It is the Government Management System for planning, budgeting, procurement, delivery, maintenance, operations, monitoring and evaluation of infrastructure.
It comprises a set of interrelating or interacting service delivery processes which transform inputs into outputs.
IDMS focuses on infrastructure planning, decision making points through the gateway system, construction procurement, portfolio management, project management, maintenance and operations.

50. IDMS Capacitating Strategy
National Treasury and National Department of Health have embarked upon implementation of the “Capacitation Framework for the Infrastructure Development Management System” in all nine Provincial Health Departments as well as in the NDoH.
All Nine Provincial EXCOs agreed on how the IDMS will be implemented in their respective provinces with clarity on the roles of Health Departments and the roles of Public Works Departments. It also clarified the Governance Principles and Service Delivery Principles applicable for Infrastructure Delivery in each Province.

51. IDMS Capacitating Strategy
This “Framework” included the alignment of the organisational structures to the core business roles of the Infrastructure Units in each Provincial Department of Health and the Provincial Department of Public Works and the creation & appointment of personnel that matches the competency profiles to be responsible for the planning, management and maintenance of infrastructure and health technology at all Health Facilities.
The framework was adopted by the government and for Health Departments funding is provided for the appointment of public servants in these units under DORA funding. There is no funding for Public Works.

52. Agreed Provincial Head Office Structure for Health
Main Purpose: Develop –U-AMPs, Norms, Standards, Business Cases, Designs, Condition Assessments, Post Project/Occupation Evaluations
Main Purpose:
Finalise procurement strategy, budget, IPMP, sign off on IPIP, oversee procurement, oversee implementation, manage funding, reporting, monitoring and evaluation
Main Purpose :
Plan, budget, procure, commission and maintain medical equipment
Main Purpose :
Plan, budget, procure and implement ongoing maintenance of all buildings [including laundries] implement OHS

53. DORA Funded Posts: Provincial Health Offices : Minimum Staffing Norms
44 posts – R 29 million – Average salary scales.
Chief Director
IDMS Strategic and Technical Advisor [contract]
Planning
Delivery
Health Technology
Engineering & Technical Support
Director
Chief Architect
Chief Architect [2]
Deputy Director Projects [2]
Chief Engineer [2]
Health Facility Planner
Chief Quantity Surveyor [2]
Deputy Director Maintenance
Electrical Engineer
Architect
Chief Engineer
Deputy Director Policy and Systems
Mechanical Engineer
Chief Civil Structural Engineer
Architect [2]
Deputy Director OHS
Quantity Surveyor [2]
Control Engineering Technician
Deputy Director M &E
Engineer
Engineering Technician [2]
Deputy Director Institutional Improvement
Chief Works Inspector
Quantity Surveyor
Deputy Director Finance
Works Inspector [2]
Assistant Director Finance
Deputy Director Maintenance Operations
Deputy Director Contracts

54. 54 Dealing with issues at Portfolio level
Program Management Office (PMO)
Dealing with issues at Portfolio level
Dealing with contractual Institutional arrangements
Dealing with issues at admin and coordination level
Dealing with issues at project level
Dealing with issues at Program level 54

55. Plans for improving expenditure performance in the National Health Insurance pilot programme

56. Interventions – NHI (Districts)
Assist the NHI pilot districts in improving their SCM systems and processes
Engage the PDoHs on improving delegations for managers i.e. District Managers
Ensure that all PDoHs have formally appointed Provincial NHI Coordinator
Streamline role of Prov. NHI Coordinators
Strengthen district performance and oversight
Improve expenditure levels through strengthening M&E
Ensure that all existing and future commitments are processed and captured as expenditure

57. National GP Contracting
NHI Indirect Grant:
National GP Contracting
5/18/2018
From 2014/15 financial onward NDoH will pilot the purchaser-provider split with regard to contracting for additional health services starting with GPs:
Tender for contracting with service provider to recruit, contract, orient and manage GPs service to clinics
NDoH (purchaser) about to enter into an agreement with service provider (provider)
New way already proving more effective since about 70 additional GPs have are lined up to sign on
Existing contracts will be transferred to the service provider

58. Number of Contracted GPs per District
TSHWANE
THABO MOFUTSANYANA
VHEMBE
GERT SIBANDE
UMGUNGUNDLOVU
UMZINYATHI
DR KENNETH KAUNDA
PIXLEY KA SEME
EDEN
OR Tambo still to start
NATIONAL 151

59. Programme Support Activities
5/18/2018
GP/HP Contracting National Technical Task Team (NTTT), meets quarterly
Roll out of the PHC-HP Support Programme
Induction sessions (2 national and 10 district sessions, 1 left)
Objectives
Sensitise team to the most recent clinical guidelines & protocols
Familiarise new team members with District specific administrative, referral and other procedures
Clarify contractual and administrative issues, Identify training needs and areas of support
District specific training programme
Orientation to integration with clinic personnel, DCST, School Health, WBOTs
GP/HP special interest sessions
Mentoring and support
Establishing GP/HP Research Forum
Developed the Information Pamphlet on GP/HP Contracting
Developed the Query Process Flows to assist GPs with problems encountered by them

60. Spending Projections 2014/15
Item
Estimates/ month
Months remaining
Total
151 current Nationally contracted GPs R 7 R
635 additional GPs for sessions R 6 R
Courier / logistics
R50 000 R
Recruitment fees R R
Payroll administrator (2.5%) R R
Contract and performance management fees (10%) R R
Training & workshops, NTTT coordination
Communications and marketing R
Total projection Sept 14 to March 15 R
Total spent Apr to Aug 2014 R
Total 2014/15 R

61. Report on implementation of cost containment measures

62. Implementation of cost containment measures
5/18/2018
Cost containment measures were initially implemented on 23 October 2013 after the Medium Term Budget Policy Statement ( MTBPS) on the following:
Downgrading of all staff members from using business class to economy
class when using air traveling with exception of Minister, Deputy Minister
and Director- General
Hiring of luxury cars was limited  to Minister, Deputy MINISTER and
Director General and the rest of officials use B class vehicles only
Accommodation expenditure was limited to R1  including bed and
breakfast irrespective of the grading of accommodation
Transport optimization measures were also introduced by encouraging
officials to consolidate their trips
Subsequent to this National Treasury issued Instruction Note 01 of 2013 on 19 December 2013 indicating mandatory cost containment measures to be
implemented by departments. The mentioned circular was implemented in
National Department of Health on 28 February 2014 after the circular being
thoroughly analyzed. 62

63. Impact of implementation of cost containment measures63