1. FREE STATE DEPARTMENT OF HEALTH Presentation on the Status of Conditional Grants Public Hearings on Conditional Grants 03 May 2006

2. 1. Overview of Presentation Introduction Background Monitoring Mechanisms Implemented Current Status on Business Plans 2005/2006 Actual Expenditure on Conditional Grants Projected Expenditure on Conditional Grants Capacity constraints and measures to overcome it Approved Business Plans Conclusion

3. The Free State Department of Health represented by Mr Sakhiwo Belot, the MEC for Health, supported by the following members:  Dr RD Chapman: Acting Head: Health  Dr AJ Schoonwinkel: Chief Financial Officer  Mrs M Khokho: Acting Executive Manager: Clinical Health Services 2. Free State Department of Health Team

4. 3. Introduction The Free State Department of Health has been invited to Public Hearings on Conditional Grants and Capital Expenditure and to address the Parliamentary Committee on the following: a) Data on trends in allocations, transfers & actual expenditure of conditional grants and capital expenditure of the department; b) Brief assessment on the department’s monitoring capacity thus far, for 2005/06 by indicating the following:  under/over expenditure,  capacity constraints that impacted on these events &  approved Business Plans

5. The FSDoH implemented the following mechanisms to monitor Conditional Grants: Expenditure on Conditional Grants, were based on approved Business Plans. (Business Plans have been approved) Allocation of Programme Manager to manage each Conditional Grant with the support of a Managerial Accountant to support the monitoring of spending trends. (Programme Managers have been appointed in writing per conditional grant) Monthly progress report to MEC for Health, by Executive Management. (Regular reports submitted to MEC. MEC health has also facilitated two joint formal meetings with MEC : PWR&T) Monthly Provincial Steering Committee meetings to monitor implementation, especially on Capital Projects. (Monthly meetings held) Presentation of full report at Quarterly Review Meetings. Done Close collaboration with National Department of Health and DPWR&T. Done 4. Monitoring Mechanisms

6. 5. Conditional Grants & Capital expenditure administered by FSDoH The following conditional grants are being administered by the Free State Department of Health: 5.1 National Tertiary Services 5.2 Comprehensive HIV and Aids (Health) 5.3 Hospital Revitalisation 5.4 Integrated Nutrition Programme 5.5 Hospital Management & Quality Improvement 5.6 Health Professions Training & Development 5.7 Infrastructure Grant

7. 6. Expenditure Trends over past 2 years

8. 7. Actual Expenditure on Conditional Grants – 31 March 2006 Conditional GrantBudgetActual Expenditure % Spent – 31 March 2006 National Tertiary Services432,018,000 100% Comprehensive HIV and AIDS (Health)100,874,000100,479,06999% Hospital Revitalisation106,082,00087,415,12582% Integrated Nutrition Programme7,296,001 100% Hospital Management & Quality Improvement 13,393,000 100% Health Prof Training & Development92,517,001 100% Forensic & Pathology Services2,366,000317,37413% Infrastructure Grant46,817,06840,641,89687% Total801,363,070774,077,46697%

9. 8. Projected Expenditure on Conditional Grants – Oct 2005 to March 2006 Conditional GrantActual Expenditure 31 March 2006 Budget 2005/2006 Actual (over)/under spending National Tertiary Services432,018,000 - Comprehensive HIV and AIDS (Health)100,479,069100,874,000R394,391 Hospital Revitalisation87,415,125106,082,000R18,666,875 Integrated Nutrition Programme7,296,001 - Hospital Management & Quality Improvement 13,393,000 - Health Prof Training & Development92,517,001 - Forensic & Pathology Services317,3742,366,000R2,048,626 Infrastructure Grant40,641,89646,817,068R6,175,172 Total437,042,097783,920,811R27,285,064

10. 9. Current Status on Conditional Grants 9.1National Tertiary Services Purpose To fund national tertiary services delivered in hospitals as identified by the Free State Department of Health, in order to ensure equitable access to basic tertiary health services by all South Africans. Funds appointments of Chief, Principal and Specialists; Equipment; Goods and Services Current Status according to Business Plan Expenditure to date on this grant, is 100%. The expenditure was according to the service level agreement as signed with National Department of Health.

11. 9.2 Comprehensive HIV and AIDS (Health) Purpose To enable the health sector to develop an effective response to the HIV and Aids epidemic, by supporting the following: approved interventions including voluntary counselling and testing, prevention of mother to child transmission programmes, strengthening of provincial management, establishment of Regional Training Centres, post exposure prophylaxis, home based care and step down care to provide a comprehensive treatment package, and the implementation of the National Operational Plan for HIV and Aids treatment and care. Current Status according to Business Plan Expenditure to date on this grant, is at 99%. The service is also being rendered as part of an integrated service at district level. Capacity Constraints Created cost centres at district level, to ensure expenditure from the beginning of the financial year.

12. 9.3 Hospital Revitalization Grant Purpose To transform and modernise infrastructure and equipment in hospitals in line with national policy and to achieve a sustainable infrastructure from which modern equitable and sustainable services can be delivered. Current Status according to Business Plan The expenditure to date on this grant, is 82%. See attached Excel document for details on project status. Capacity Constraints Development of a Working Agreement with Public Works, Roads & Transport to reach consensus on agreed-upon targets. Lack of funding to complete existing projects in the new financial year.

13. 9.4 Integrated Nutrition Grant Purpose To implement integrated nutrition activities aimed at improving the nutritional status of all South Africans. Current Status according to Business Plan The expenditure to date on this grant, is 100%. The expenditure was in line with the Business Plan.

14. 9.5 Hospital Management & Quality Improvement Purpose To transform hospital management and improve quality care in line with national policy. Current Status according to Business Plan The expenditure to date on this grant, is 100%. Expenditure was in line with the Business Plan.

15. 9.6 Health Professional Training & Development Grant Purpose To support the Free State Department of Health to fund service costs associated with training of health professionals; To enable shifting of teaching activities from central hospitals to regional- and district facilities; To develop and recruit medical specialists in under-served provinces; To expand specialists and teaching infrastructure in the province. Current Status according to Business Plan Expenditure to date on the grant, is 100%. Expenditure was in line with the Business Plan. The allocation on this grant is far less than the true provincial needs and allocations for training & development of professionals.

16. 9.7 Infrastructure Grant Purpose To transform and modernise infrastructure and equipment in hospitals in line with national policy and to achieve a sustainable infrastructure from which modern equitable and sustainable services can be delivered. Current Status according to Business Plan See attached Excel Document. Capacity Constraints Development of a Service Level Agreement with Public Works, Roads and Transport and to reach consensus on agreed-upon targets. Lack of funding to complete existing projects.

17. 10. Capacity Constraints The ability to monitor projects and to have an experienced project manager on site. The joint planning and monitoring of projects with DPR&T in order to have same targets for delivery. Determining the size of the projects so that smaller projects can be given to Health to project manage as minor works.

18. 12. Approved Business Plans Business PlanDate Approved Facilities Planning Infrastructure Plan05/09/2005 Hospital Management & Quality Improvement Grant28/04/2006 Health Professional Training & Development Grant21/04/2006 Comprehensive HIV and AIDS Integrated Business Plan19/04/2006 Revitalisation Grant28/04/2006 The following Business Plans have been approved:

19. 12. Conclusion The corrective measures that have been put in place, have been effective and will assist to ensure spending of the conditional grant budget according to the Business Plans.

20. Thank You Re a Leboha Contact Dr RD Chapman Free State Department of Health P O Box 227 Bloemfontein Email – Chapmard@fshealth.gov.zaChapmard@fshealth.gov.za Tel: 051 408 1107