1. FREE STATE PROVINCIAL GOVERNMENT DEPARTMENT OF HEALTH PORTFOLIO COMMITTEE ON HEALTH BUDGET HEARINGS APRIL 2001

2. VISION STATEMENT n A healthy and self reliant Free State community n MISSION STATEMENT The Free State Department of Health n provides a quality comprehensive health care services to the Free State community n optimally utilises health care resources to provide a caring and compassionate service n endeavours to empower and develop all personnel to the best of their potential

3. STRATEGIC THEMES n THEME 1: PROMOTING THE WELL BEING OF ALL THE PEOPLE n THEME 2: MEETING COMMUNITY DEMANDS n THEME 3: RENDER QUALITY COMPREHENSIVE AND AFFORDABLE HEALTH SERVICES AT ALL LEVELS OF CARE n THEME 4: EMPOWERING AND DEVELOPING ALL PERSONNEL AND THE RELEVANT STAKEHOLDERS n THEME 5: TRANSFORMING HEALTH SERVICES TOWARDS PRIMARY HEALTH CARE FOUNDED ON DISTRICT HEALTH SYSTEM n THEME 6: IMPROVING THE MANAGEMENT OF HEALTH SERVICES

4. KEY STRATEGIC OBJECTIVES FROM THE STRATEGIC PLAN STRATEGIC THEME 1 PROMOTING THE WELL BEING OF ALL THE PEOPLE n Implement an integrated health promotion strategy through an inter- sectoral approach n Increased interventions in HIV/AIDS – Voluntary Counseling and Testing – Mother to child transmission – Home-based care n Ensure improved management of Tuberculosis n Implement and maintain a system for improved rural health n Ensure the development and rendering of Environmental Health Services n Ensure the implementation of an Integrated Nutrition Programme n Ensure services are accessible to people with disabilities n Ensure services are accessible to personnel

5. STRATEGIC THEME 2 MEETING COMMUNITY DEMANDS n Cultivate an Organisational Culture that is characterised by staff that are: – Proud of being health workers – Enjoy working for the department – Caring for colleagues and the clients n Improve Customer Satisfaction at all levels of service

6. STRATEGIC THEME 3 RENDER QUALITY COMPREHENSIVE AND AFFORDABLE HEALTH SERVICES AT ALL LEVELS OF CARE n Render comprehensive health care services at the most appropriate level n Improve quality and efficiency of services rendered n Render affordable and equitable services

7. STRATEGIC THEME 4 EMPOWERING AND DEVELOPING ALL PERSONNEL AND THE RELEVANT STAKEHOLDERS n Training in line with service needs n Implement Interactive Distance Education and Learning n Implement,review, maintain and monitor the induction programme n Ensure availability of health professionals n Develop and implement intervention strategies to address the impact of HIV/AIDS on health personnel n Empower the community (Hospital Boards and College Councils)

8. STRATEGIC THEME 5 TRANSFORMING HEALTH SERVICES TOWARDS PRIMARY HEALTH CARE FOUNDED ON DISTRICT HEALTH SYSTEM n Implement District Health Authorities in line with the Provincial Health Act (Act 8 of 1999) n Implement District Health System in line with District Health Plan per district n Ensure an extended access to 24 hour health services in all districts n Ensure and render comprehensive maternal services to rural communities n Restructure and re-organise integrated psychiatric and mental health services according to the Mental Health Bill

9. STRATEGIC THEME 6 IMPROVING THE MANAGEMENT OF HEALTH SERVICES n Access to and use of management information n Effective Financial Management n Develop and maintain Human Resource Plan n Public Private Partnership n Strategic Planning n Ensure sensitivity for gender issues n International co-operation n Implementation of the PFMA n Service Level Agreements (Municipalities) n Loss of cohesion in Top Management n Rationalisation of services

10. FINANCIAL RESULTS n 1997/1998 - R 141 MILLION OVER EXP - 9.28% (BUDGET R 1,518 BILLION) n 1998/1999 - R 98 MILLION OVER EXP - 5.95% (BUDGET R 1,646 BILLION) n 1999/2000 - R 135 MILLION UNDER EXP - 7.83% (BUDGET R 1,724 BILLION) n 2000/2001 - R 60,3 MILLION UNDER EXP - 3.28% BUDGET R 1,833 BILLION

11. BUDGET AND MTEF BUDGET 2001/2002 - R 1,880 BILLION MTEF 2002/2003 - R 1,985 BILLION MTEF 2003/2004 - R2,099 BILLION

12. REVENUE

13. HOSPITAL AND OTHER CLINICAL SERVICES n Policy decisions that will be implemented this year – Implementation of EDL – Strategic Physical Facilities Plan n Policy decisions intended for the MTEF period – Performance Agreements with Hospitals – Implement District Health System together with local government in line with management plan and legislation n Significant problems and constraints faced in achieving key objectives – Improve staff morale and attitudes – Lack of specific skills - Bio-Engineering n The impact and usefulness of conditional grants – Support Outreach Programme n Issues relevant from National policy perspective – Quality Assurance and Accreditation for all hospitals using COHSASA Programme n Recommendations – Improved equity and access

14. PRIMARY HEALTH CARE PROGRAMMES n Policy decisions that will be implemented this year – High dose of Vit. A to woman after delivery – Feeding of learners at identified schools n Policy decisions intended for the MTEF period – Develop and implement provincial guidelines, capacity building strategies,monitoring tools and Health Promotion Programs for all Primary Health Care programs n Significant problems and constraints faced in achieving key objectives – The burden of HIV/AIDS and TB epidemics divert funds and other resources needed for transformation n The impact and usefulness of conditional grants – Grants for Integrated Nutrition Program utilised appropriately – Squezze of Central Hospital Grant. n Issues relevant from National policy perspective n Develop and implement Primary Health Care packages for clinics n Estimated HIV/AIDS impact n Prevalence of HIV remained the same as 1999 survey - plateau phase has been reached n Recommendations – Funding need to reflect the impact of the twin epidemics of HIV/AIDS and TB

15. TEACHING AND TRAINING Policy decisions that will be implemented this year n Strategic areas of training – Adult Basic Education and Training programmes – Pharmaceutical services: Assistant Pharmacists – Radiographic services:Supplementary Radiographers – Nursing services: Assistant nurses on supernumerary to be trained as professional nurses n Bursaries – Education and training of all health professional – Award bursaries to meet the needs of the Department n Training in line with Skills Development Act – Development of skills according to the needs of the Department

16. PSYCHIATRIC AND MENTAL HEALTH SERVICES n Policy decisions that will be implemented this year – District Psychiatric services – bed capacity at specific levels of care n Policy decisions intended for the MTEF period – Restructure District Psychiatric Services n Significant problems and constraints faced in achieving key objectives – To appoint and retain Psychiatrists at Regional complexes n Recommendations – Restructure psychiatric services

17. TB SERVICES n Policy decisions that will be implemented this year – Improve management of TB statistics – Improve DOTS to decrease defaulter rate n Policy decisions intended for the MTEF period – Training of community doctors to manage TB – Hospitalisation of TB patients in district hospitals n Significant problems and constraints faced in achieving key objectives – Financial and personnel constraints where additional beds need to be established n Issues relevant from National policy perspective – Coordination with HIV/AIDS program to decrease the impact on the TB program

18. EMERGENCY MEDICAL SERVICE n Policy decisions that will be implemented this year – Maintain a quality Provincial Emergency Medical Service – Establish a Provincial Commuter Service (patient transport) n Policy decisions intended for the MTEF period – All patient transport to be accommodated within EMS sub-directorate – Training of 20% of staff to an advanced level n Significant problems and constraints faced in achieving key objectives – Severe staff shortage if Conditions of Employment Act is implemented and the total staff establishment is not filled n Issues relevant from National policy perspective – Provincialisation of Emergency Medical Service (EMS) n Recommendations – Guidelines for EMS regarding personnel, equipment and vehicles to be developed and implemented

19. SUPPORT SERVICES n Policy decisions that will be implemented this year – Implement Antifraud and Corruption system – Implement Monitoring and Evaluation system n Policy decisions intended for the MTEF period – Implement Transport and Fleet management policy – Unlocking resources within private sector for public sector delivery n Issues relevant from National policy perspective – Implement Antifraud and Corruption system – Implement PFMA – Implement Administrative Justice and Promotion of Access to Information legislation as well as Employment Equity Plan – Ensure Batho Pele culture and attitude change

20. PERSONNEL n Shortage of key staff – All health and related professions and specialists n Development and implementation of staffing norms consistent with a strategic plan – Provincial Human Resource Plan n Critical problem areas involving Human Resource issues requiring urgent attention from government as a whole – Implement Departmental Performance Management System – Current rewards and incentives system is still protected by collective agreements. – Training staff in new performance management system

21. KEY HEALTH PROBLEMS n Trends – HIV/ AIDS is stabilising n Health service interventions – Establishment of Health Promotion strategies – Promotion of advanced midwifery training – Establishment of Disease Outbreak Response Teams in every district – Implementation of Step-down facilities and Home-based care – Establishment of Victim support Centres and training – Implementation of Cervical Screening Programs in collaboration with CANSA – Building capacity to manage HIV/AIDS patients at Primary Health Care level – Dissemination of information to the community using the media