1. North West Province Department of Health
Budget Hearing presentation Portfolio Committee Parliament
13 May 2001

2. Presenters Mrs R Hlabatau – Chief Financial Officer
Dr T G K Oosthuizen – Acting Chief
Director Health Service Delivery
and Strategic Health Programs
Mr P Netshipale – Director Primary
Health Care Programs and
Communicable Diseases

3. STRATEGY
The Department reviewed its strategic plan during October 2001
New focused strategic goals, objectives and high level activities were developed as discussed in attached strategic plan

4. The Vision
Optimum health for all individuals and communities in the North West Province.

5. The Mission
  To ensure access to affordable, equitable, quality, caring health services for all in the North West Province through       

6. Value statement Community involvement and partnerships
Batho Pele Principles and the Patients’ Rights Charter
Innovation and performance driven,
And by valuing our people and their diversity.

7. Strategic Goals 1. Providing quality health services
2.  Providing accessible, equitable and
affordable comprehensive primary health
services
3.  Well functioning and competitive hospital
4.  Improving the health status of
communities through implementation of
integrated health programs
5.  Well managed and effective district
health system

8. Strategic Goals 6. Competent, empowered and
performance focused employees
7. Appropriate and effective
organisational systems
8. Effective management of the department’s finance and assets

9. ACHIEVEMENTS (DISCUSSED AS PART OF VARIOUS HEADINGS)

10. EXPENDITURE PATTERNS

11. STD ITEM
BUDGET
EXP.
VAR.
PERSONNEL
ADMIN
48 822
52 455
-3 633
STORES
6 161
EQUIPMENT
47 634
46 634
1 000
LAND & BUIL.
5 477
6 440
963
PROF. SERV.
33 201
TRANSFERS
54 894
40 278
14 616
MISC.
10 830
1 669
9 161
TOTALS
34 812

12. EXPENDITURE PATTERNS

13. Expenditure patterns
Personnel budget comprises 65% of the total budget
This is consistent with prior years
The national average personnel budget is 68%
The personnel budget was overspend by 2% due to the insufficient budget of ICS, backlog in rank and leg promotions

14. Expenditure patterns
Transfers were under spent by 26% as a result of delays by institutions in complying with the PFMA e.g.
Non submission of invoices by local Authorities
Non submission of Audited Financial Statements
Under expenditure in professional services relates to capital projects
Over 98% of the budget was utilized

15. MECHANISMS TO IMPROVE CAPACITY
The Department uses various mechanisms to improve its Human Resource, Financial, Procurement and Service Delivery Capacity

16. Human Resource
General Managers appointments with Heads of Admin, Clinical, and Nursing
Job descriptions for staff with Personal Performance Management Agreements levels 13 and higher
Key performance areas and key performance indicators built in, into job descriptions of all levels of staff in one Complex as a pilot for all other health facilities

17. Human Resource
Organisational Performance Management Frameworks implemented for the biggest Complex with a roll out empowerment process started to other two regional Hospital Complex’s

18. Human Resource
During the year under review, the department developed its first Work Place Skills Plan, and will build on this during the current year and in years to come.
In an effort to improve our ability to deliver quality PHC services to our communities, the department has prioritized the training of primary health care nurses. In the year under review, 118 were trained as PHC practitioners.
The issue of proper deployment of these nurses will continue to receive attention in the current year.

19. Human Resource
The post basic training of nurses in the following fields also continued to be a priority: IMCI (10), psychiatry (10), and midwifery (45).
The department sees discipline of employees as being central to capacity to deliver services.
Therefore, the training of managers and employees as investigating officers and presiding officers. A total of 40 were trained as investigating and presiding officers.

20. Financial
Establishment of a functional Internal Control Unit, filling 97% of vacant posts
Improved co-ordination and co-operation of Finance Committees
UPFS implemented at all hospitals
Developed the transaction flow process
Trained 70% of HO finance staff on the following courses:

21. Financial Project Management Cash Flow Management
Policy making and Budgeting
Provisioning and Administration System
Computer Training and Writing skills

22. Procurement
Took charge of our own maintenance of own buildings and patients transport due to poor performance experienced from Department of Transport, Roads and Public Works
Provincialisation of Emergency medical services
Outsourcing of procurement of pharmaceuticals with efforts to decentralise the process started via Vuna Health Care logistics

23. Procurement Rolling out of a computerised asset management system
Outsourcing initiatives for garden services, catering- and security services

24. Service Delivery Capacity
PPP’s:
Coordinator for the Provincial Council on Aids plus 18 Coordinators for the Local Aids Councils were appointed
Lichtenburg health district (Environmental Health Officers) in partnership with Agriculture improved the quality of their dairy products to the extent that it is now adhering to the criteria set by the EU and permission for export was granted
Joint appointments with Universities
Alpha cement/licthenburg DHS initiatives

25. Service Delivery Capacity
Through empowerment:
Primary school nutrition program was decentralised with empowerment of local women groups, etc
90 Primary Health care nurses underwent training in sign language
240 donated wheelchairs were distributed and 1130 bought out of own funds were distributed
Five multi purpose youth centres established to enhance the reproductive health of the youth, to protect themselves against HIV and teenage pregnancy was a joint effort between DFID and PPASA now fully funded by the Department

26. Service Delivery Capacity
Through empowerment:
141 VCT sites
33 funded NGO as part of the system

27. Service Delivery Capacity
Optimising resource utilisation:
100 patients were de-institutionalised
EMS – Provincialisation 1 December 2001
Forensic Medical Services – Started the process of taking over from the SAPS – Vryburg region will be first
Quality Assurance – Tender document out to get COHSASSA accreditation for all Institutions with capacity development management to sustain quality assurance program

28. Service Delivery Capacity
Networking and linking with tertiary institutions:
Attracting and retaining specialised personnel – A process started looking mainly at linking Regional Complex’s with tertiary institutions like MEDUNSA / WITS and UP to enable registrar training at and rotation of specialists through regional hospitals

29. Service Delivery Capacity
Through stakeholder involvement:
Farm worker summit held with a definite project plan to implement the outputs received from the summit which included new mobile services to be established
Governance summit held with outputs taken forward

30. COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND ANY SHORTCOMINGS
PROVINCIAL PROCESS:
Each department submits inputs to Treasury
The provincial Budget Lekgotla is held where trade offs between departments are considered to try and stay within the provincial allocation
Process of avoiding duplications by cluster approach
CFO’s meet to discuss approaches to minimise administrative expenditures

31. COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND ANY SHORTCOMINGS
PROVINCIAL PROCESS:
85% National target to be spent on Social Cluster not reached due to:
North West Star
NWDC
Agric
SABC
Public Works
Ring fencing of National Allocations could assist

32. COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND ANY SHORTCOMINGS DEPARTMENTAL PROCESS
MTEF PROCESS & SHORTCOMINGS:
Individual cost center managers prepare and submit their inputs through regional structures, hospital CEOs, College principals and program managers.
These are consolidated, compared to previous allocations, expenditure and priority program plans for the department and forwarded to the Equity/Budget Committee for further attention.

33. MTEF PROCESS cont.
The Equity/Budget committee analyses the inputs and aligns them to current and new priorities and or objectives for the next MTEF cycle and makes recommendations to the Departmental Management Committee(DMC) for discussion, verification and further recommendations to the Departmental Executive Committee.

34. MTEF PROCESS cont.
The DEC makes decisions based on the strategic priorities of the department as well as the provincial budget memorandum and strategies, and directs further adjustment where necessary.
Consultation is then done with relevant stake holders for further attention, buy-in and finalization of proposed allocations.

35. SHORTCOMMINGS-MTEF
The time frames are not realistic in terms of adequate involvement of all stake holders.
Due to limited availability of resources, it is sometimes difficult to address Equity issues.
Allocation of funds for personnel is based on previous expenditure patterns.
The financial impact of Strategic challenges is higher than the budget growth

36. CONDITIONAL GRANTS
The Department received the following conditional Grants:
Redistribution of Specialised Hospital Services conditional Grant
Training of Health Professionals Grant
Hospital Revitalisation and Rehabilitation Grant
Primary School Nutrition Grant
HIV / AIDS

42. OUTCOMES REDISTRIBTION SPECIALISED HOSPITAL SERVICES CONDITIONAL GRANT

45. Total patients treated for the year
Renal Unit
4852
Oncology Unit
1989
MDR Unit : Out
: In
638
258
EMS/ICU AMBULANCE
231
BURNS UNIT
117
JOINT SURGERY 58
IN PATIENT ONCOLOGY
747
PSYCHIATRIC UNIT
307

46. SUCCESS IN ACHIEVING EQUITY
The Equity committee has made attempts to address gaps related to resource allocation per district and region (health districts).
The difficulty of shifting of funds from one area to another is still a challenge due to 65% of expenditure being allocated to personnel

47. SUCCESS IN ACHIEVING EQUITY
Progress made to date relates to a decentralized system, which reflects fully fledged District Management structures, independent Hospital managers for level 1, and CEOs for level 2 hospitals.
Financial, Human Resource and Procurement delegations are in place to enable managers to make appropriate decisions and manage their allocated resources.

48. COMMENTS REGARDING EQUITY ON INTERPROVINCIAL ALLOCATIONS-SHORTCOMINGS
Facilitation of the devolution of primary health care to Local Authorities by creation of equal conditions of service between Provincial Health Authority staff and those appointed by Local Authorities with the end result of “One Public Service” with equal conditions of service / pay packages / progression irrespective of what tier of Governance

49. COMMENTS REGARDING EQUITY ON INTERPROVINCIAL ALLOCATIONS
The Department experience difficulty in attracting various categories of Health Care workers to rural areas. Rural allowance exists for Doctors only. Assistance regarding possible incentives to attract other categories of Health workers to rural areas equally across the country will help

50. COMMENTS REGARDING EQUITY ON INTERPROVINCIAL ALLOCATIONS
Equity regarding budget allocations between various Provincial Departments of Health is still not achieved due to the fact that money allocated by the National Department of Health is not ring fenced and within Provincial Treasuries Departments then start to compete for funding which lead to National Department of Health funding ending up being used for other Departments, i.e. Education, etc

51. PUBLIC PRIVATE PARTNERSHIPS
The Department is actively involved in both public – public and public private partnerships. Some examples:
Outsourcing of various services
Private specialists responsible for a major part of specialist services in the Province
Lichtenburg District and Department of Agriculture joint venture
University links

52. HIV / AIDS

53. HIV ACHIEVEMENTS AND PLAN FOR 2002/3
OBJECTIVES
ACHIEVEMENTS
Functionalise PCA
Assist in funding all LAC
Expand VCT sites in the Province
Establish PMTCT pilot sites
Expand female condoms distribution
Reduce incidence of STI by 30%
Provide effective HBC in all 18 districts
PCA act in place, all staff appointed in all 18 Districts
All 18 LAC funded
141 sites established & 970 Nurses trained in counseling with 8909 clients tested(2392 positive,26.8%)
Two sites established July 2001
Expanded female condoms sites from 4 to 18 and distributed female & 23 million male condoms
Reduced Syphilis form 17% to 3,6%
New form implemented in the Province
Funded 33 NGO for R1,06M in the Province and 14 National funded for R1,5M

54. HIV/AIDS ACHIEVEMENTS
OBJEC TIVES
ACHIEVEMENTS
HBC (cont..)
To involve Tertiary institutions in HIV/AIDS management in the Province
Intergovernmental committee on HIV/AIDS
Conduct Door to door campaign in the Province
To celebrate all HIV/AIDS calendar days
101 HBC district trainers trained
467 Caregivers trained including LAC’s
Develop a framework for participation of Tertiary Institutions in the HIV/AIDS programmes e.g. Research & Training
Health Act as secretariat for IDC in the Province
Facilitate all operations of the Interdepartmental Committee on HIV/AIDS
All 18 Districts conducted door to door campaigns during December 2001with
1 950 houses visited and persons reached and Condoms distributed in one week(5days)
All HIV/AIDS calendar days celebrated

55. HIV/AIDS ACHIEVEMENTS
OBJEC TIVES
ACHIEVEMENTS
Conduct a survey for the Health promotion in the Province
Organize a workshop for all Private practitioners
To organize workshops for Traditional healers
To coordinate with DEPT of Education on life skills education at school
Health promotion survey conducted on the availability of Health promoters in all districts to establish health promotion activities in the Province
Workshop organized through ROCHE in the Province with good attendances from All GP( Private Medical Officers)to standardize syndromic management of STI’s
Organized traditional healers workshop took place to address HIV/AIDS
Close collaboration with education established

56. Rustenburg TOTALS 172 141 NO OF VCT SITES IN THE PROVINCE District
Number of sites
Number operational
Mafikeng 18 14
Zeerust 21
Lichtenburg 13 9
Delareyville 10 4
Klerksdorp 12
Potchefstroom 11
Ventersdorp
Wolmaranstad 5
Vryburg 6
Ganyesa
Taung
Schweizer-Reneke 1
Kudumane 3
Odi 8
Moretele 7
Brits
Mogwase
Rustenburg
TOTALS
172
141

59. PMTCT SITES SRVICES Thlabane (U): Jul-March 2001/2 ANC - 2797
VC = 7%
Tested = 7%
HIV =44%
NVP - 38
Babies - 38
EBF - 9 =23%
EFF - 29=77%
Lehurutshe (R): Jul-March 2001/2
ANC
VC = 42%
Tested = 37%
HIV = 25%
NVP - 65
Babies - 65
EBF - 1= 2%
EFF = 98%

60. DISTRICT ORGANISATION VISITS CLIENTS TOTAL 1999 clients MORETELE
MORETELE
SUNRISE
780
193
ZEERUST
GIVE A HAND & HOPE
386 81
KLERKSDORP
NW HOSPICE
726
141
KOSH
147
DELARYVILLE
TSHWARAGANANG
716
104
DELAREYVILLE
BRIGHT FUTURE
698
112
ODI
GARANKUWA SUNSHINE
140 32
MERCY AIDS PROJECT
382
105
BRITS
MABOLOKA AIDS PROJECT
475 78
KUDUMANE
RETLATHUSA 89 23
RUSTENBURG
VISION FOR NATION
357 70
MAFIKENG
LEMOGANG
102 42
NAPWA
626
210
OPERATION BLANKET
410
185
OPERATION H8UNGER 80 38
HELPING HAND
863
490
POTCHEFSTROOM
TSHEPONG
258 47
TOTAL
7238 Home visits
1999 clients

61. LEGISLATION
We the process of passing the Provincial Council on Aids Act during the 2001/2 financial year
Drafted the Provincial Health Bill

62. THANK YOU