1

DEPARTMENT OF DEPARTMENT OF HEALTH & HEALTH & WELFAREWELFARE

Portfolio Committee on Health

16 April 2003

2

INTRODUCTION

Vision, mission and core functions Health Progress report per program 2002/3 Health priorities 2003/4 Health budget pressures 2003/4 and service

implications Concluding remarks

3

VISION AND MISSION VISION

A caring and developmental health and welfare system which promotes well-being, self-reliance and humane society in which all people in the Northern Province have access to affordable and good quality services.

 MISSIONThrough providing comprehensive, integrated and equitable Health and Welfare services which are sustainable, cost effective and focus on the development of human potential in partnership with relevant stakeholders.”

 

4

DEMOGRAPHY

LP12.1%

WC9.7%

NC8.3%

MP6.9%

FS6.5%NC

2.1%KZN

20.7%

GP18.1%

EC15.5%

TOTAL POPULATION = 5.8 Million

(DWAF, CWSS Study, 2000)

89% OF THE POPULATION LIVE IN

RURAL AREAS.

54.3% 0F THE POPULATION ARE

WOMEN

36.9% 0F THE POPULATION AGED

LITERACY RATE FOR 20 YRS &

OLDER PEOPLE WAS 63.1 % IN 1996

46% UNEMPLOYMENT RATE

GDP CONTRIBUTION = 4.2 % IN 1996

6 DISTRICTS

44 HOSPITALS & 477 CLINICS

POPULATION DISTRIBUTION

5

MORTALITY INDICATORS 2000

Indicator Limpopo National

1994 2000 2000

Infant mortality rate/1000 live births

57 37.2 45

Under 5 mortality rate/1000 live births

83 52.3 61.0

Maternal mortality ratio /100 000 live births

53 30 150

Source: SAHRS 2000

6

MAJOR CAUSES OF DEATH

Cause PercentageIll define (All natural) 23.5

Undetermined injuries 9.1

Cardiovascular disease 7.4

Stroke 5.9

Tuberculosis 5.6

Lower Respiratory Infections 4.8

Diarrhoeal Diseases 3.9

Diabetic Mellitus 3.1

Ischaemic Heart Disease 3.0

Road Accidents 1.8Source: MRC 2001

7

Core Functions· Provide Regional and Specialised hospital services & Academic Health

Services·  Render and co-ordinate Medical Emergency Services ·  Render Medico-legal services.·  Quality control of all health services and facilities.·  Formulate and implement provincial health policies, norms, standards and

legislation.·  Develop & Manage District Health Services·  Provide technical and logistical support to health districts.·  Render specific provincial services programmes, e.g. TB programme.·  Provide non-personal health services.·  Provide and maintain Health Care Technologies.• Research on, monitor and evaluate health services/programmes.

8

PROGRAMME 1PROGRAMME 1Health AdministrationHealth Administration

9

POLICIES

ACHIEVEMENTS: 11 Policies and guidelines on the following areas have been developed

Procedures for recruitment and appointment of employees Employee suspension; Subsidized motor transport Departmental cellular phone; Procurement Policy Minimum sanctions and misconduct; Managing discipline Remuneration outside Public Service Employee compensation and over time Transfer of employee; Work EnvironmentCONSTRAINTS: Policy development inherently a lengthy

process

10

STAFF ESTABLISHMENT

ACHIEVEMENTS: Reviewed, finalized and approved the following establishments: Head Office with savings of R9.521m; Polokwane/

Mankweng Tertiary hospital complex; Polokwane Place of Safety; Thohoyandou children’s home; Sekutupu old age home.

The following management structures were reviewed: district offices, district hospitals, regional hospitals and level 13 district hospitals, specialized hospitals including 4 revitalization project hospitals finalized.

11

HRM: STAFFING

ACHIEVEMENTS: 1110 vacant posts have been filled, this number also includes doctors and nurses.

Rank and leg promotions for 4400 employees arrear payment have been finalized as planned for 2002/03

A total number of 390 employees arrear payments are still outstanding Performance management and development system implementation

plan has been initiated. Advertised 3 posts of General Manager, 1 CEO, 1 Senior Manager and

reasonable number of managers posts. A further R181m is required to fully implement 2nd and 3rd notch

promotions in terms of DPSA circular which extends beyond once off payment stipulated in the Provincial circular.

There is vacancy rate of 41,2%, and 6,03% staff turnover

12

HRM: STAFFING cont’d

TRANSFORMATION AND RESTRUCTURING IN TERMS OF RESOLUTION 7 OF 2002: List of excess personnel has been compiled and employees have started with the process of placement into vacant posts.

CONSTRAINTS: Employees turnover rate=6,03%; Vacancy rate 41,2%

Staff retention strategy Total staff establishment loss of 1085 .This included 407 that

have left the Department through resignation and transfer. A number of outstanding promotion arrear payments Payment of outstanding 2nd and 3rd notches not finalized Staff establishments for institutions and district offices are not

finalized yet to enable restructuring and redeployment process to run smoothly

13

LABOUR RELATIONS AND LEGAL SERVICES

ACHIEVEMENTS: District and institutions have been delegated management and handling of disciplinary cases

186 misconduct cases were reported and 144 cases finalized of which 13 cases were dismissals, only 42 cases still pending

15 Disputes (Conciliation and Arbitration) cases were reported and 11 cases finalized, only 4 still pending

8 Appeals reported, 1 finalized and 7 still outstanding 42 grievances have been reported, 28 were finalized, 14

are still being investigated.

CONSTRAINTS: Capacity building of line managers

14

FLEET MANAGEMENT

ACHIEVEMENTS: Fleet audit is finalized Vehicle replacement plan developed A total of 93 new vehicles have been ordered,

broken down as follows :40 Ambulances, 8 response vehicles, 25 pool cars for hospital administration and 20 for mobile services.

10 Ambulances, 23 patients transport and 1LDV have been delivered.

15

FLEET MANAGEMENT cont.

CONSTRAINTS:

-Vehicles take a long time to be delivered

-355 vehicles have traveled more than

200 000-400 000kms.

-Almost 50% of vehicles (including EMS) are always in Garages for repairs

16

EMPLOYMENT EQUITYACHIEVEMENTS: Complied with the Department of

Labour with regard to submission of Equity progress reports

The Department has achieved 70/30 targets, however with regard to Provincial Demographics ratio of 56:44, the equity status is as follows:-

CONSTRAINTS: No disabled persons in management

Health Welfare Senior management 60/40 47/55 Middle management 47/53 55/45 Supervisory level 23/77 31/69 Lower level 42/58 32/68 Disabled persons 0,5%

17

BATHO PELE PRINCIPLES & SERVICE DELIVERY PLAN

ACHIEVEMENTS: 12 consultative workshops on standards development and service delivery plan conducted

Workshops conducted monthly in all districts to review, develop and implement domain specific standards

Manual on Promotion of Access to Information Act, 2000 compiled and approved

Departmental annual Merit Award Ceremony was held to recognize good performance of employees

Suggestion boxes have been installed in 95 % of the institutions, client satisfaction surveys done in all hospitals

18

Financial Planning and Budgeting

ACHIEVEMENTS: Achievability exercise, MTEC hearings, quarterly reports & IGFR all assisted to provide a credible adjustment budget that dealt with personnel under funding and inflationary pressures.

The new Chart of Accounts for 2003/04 based on the nationally agreed programme structure and Departmental restructuring has been finalised.

Strategic plans in new format have been developed.

CONSTRAINTS: Lack of staff due to resolution 7.

19

Donor Funds

ACHIEVEMENTS: R1m was donated to Shiluvana Health Centre by Flemish government for the eye centre.

R504 000 has been commited so far. Business plan for EU’s PDPHC in place.

CONSTRAINTS: Systems for administering donor funds are new and therefore there is a learning curve involved.

20

Revenue Generation

ACHIEVEMENTS: The revised fees schedule was implemented as from 1st October 2002 with a potential 10% decrease in income.

Some private wards have been established to entice private patients.

R43.2m of revised target of R56.99m(98.8% of tgt)CONSTRAINTS: Incorrect personal data provided by

patients. 92% of patients not on medical aid.

21

PROGRAMME 2PROGRAMME 2District Health ServicesDistrict Health Services

22

• 80% communities reached on community awareness +/-10 million male condoms distributed 21 sites for female condom distribution established and

+/-400 000 female condoms distributed All 8 Regional offer PMTCT services and 33 District

Hospitals offer Nevirapine 233 VCT sites established and functional PEP treatment is being provided at all hospitals

PREVENTION AND CONTROL OF HIV/AIDS

23

HIV/AIDS/STDI’S/TB cont.

ACHIEVEMENTS :ICHB CARE PROGRAMME

– 20 Community Based Organisations offering ICHBC services 25,666 (inclusive of all chronic conditions) clients were attended to.

– 636 Care-givers trained and offering ICHBC services– 3641 orphans (of which 2157 HIV/AIDS orphans) are

benefiting from ICHBC services– 2 Step-down facilities approved and started operating .

(Kgapane & St Ritas)

Constraints:– Community Home base care kits not always available

to all clients.

24

NATIONAL VS. LIMPOPO HIV TRENDS 2001

3.044.89

7.96 8.2

11.4 11.4313.2

14.5

7.57

10.44

14.1716.01

22.8 22.424.5 24.8

4.12.56

0.550.53

4.25

2.421.350.76

0

5

10

15

20

25

30

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Limpopo National

25

2000 vs. 2001 HIV PREVALENCE BY AGE GROUP

7.7 9.3

17.616.6 18.4

20.1

10.5

15.4

7.2 7.85.5

8.9

0

5

10

15

20

25

14-19 20-24 25-29 30-34 35-39 40+

2000 2001

26

TB CASE FINDING 2000-2002

90.7 90.788.5

82.7

80.2

77.7

707274767880828486889092

Per

cen

tag

e (%

)

Bacteriological Coverage Bacteriological Positivity

2000 2001 2002

27

TB CONTROL & MANAGEMENT

Achievements– TB Case detection increased from 6468 in 2000 to 7793 in 2001)

• DOT Support work • Community awareness

– Overall TB cure rate improved from 52,8 in 2000 to 53,2% 2001– MDR/TB Clinic established at Polokwane Hospital– Business plan for establishment of MDR/TB Unit F. H. Odendaal

Hospital submitted.– Establishment of mobile laboratories services

Challenges– Sputum Turn- around time of 7- 14 days which is higher than expected

National recommendation of 4 days– Collapse of mobile services in some districts affecting the

transportation of specimen

28

Integrated Mother ,Child and Women health services

ACHIEVEMENTS:– Approximately 80% PHC facilities provide IMCI

which resulted in reduction of incidences diarrheal from 16.2 in 2001 to 13.5 in 2002, and upper respiratory infections from 25.1 in 2001 to 23.4 in 2002

– 5 clinics per districts offer PAP services and the rest on demand.

– 3715 women access PAP services.– Family planning services are offered in all clinics and

mobiles – 29 hospitals offer TOP.

29

TERMINATION OF PREGNANCY 1997-2002

419

929

19242133

44294700

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Num

ber

of te

rmin

atio

ns

1997 1998 1999 2000 2001 2002

30

TOP BY AGE GROUP– 2000-2002

50.4 49.1

0.5

10.2

89.2

0.6

11.4

88.1

0.5

0

10

20

30

40

50

60

70

80

90

2000 2001 2002

Under 18yrs Above 18yrs unknown

31

TOP BY GESTATIONAL AGE– 2000-2002

56.9

42.1

1.0

79.3

19.7

1.0

84.6

14.4

1.0

0

10

20

30

40

50

60

70

80

90

2000 2001 2002

Under 12wks Above 12wks unknown

32

Prevention and Control of Communicable Diseases

ACHIEVEMENTS:

– 75% of targeted household for February 2003 are already sprayed

– 80 temporary spraying operators are appointed.– Cases fatality for Malaria reduced from 86/100 000

population in 2001 to 51/ 100 000 population for 2002

CHALLENGES– Emerging and re-emerging infectious diseases such as

Anthrax, Severe Acute Respiratory Syndrome

33

IMMUNIZATION COVERAGE (%) UNDER 1 YEAR BY DISTRICT 2000-2002

28.7

50.3

64.9

75.9

64.261.8

58

74.6

45

53.952.549.4

71.572.7

76.9

81.8 8179.8

0

10

20

30

40

50

60

70

80

90

Bohlabela Capricorn Mopani Sekhukhune Vhembe Waterberg

2000 2001 2002

34

AFP SURVEILLANCE 1997-2003

YEAR Target Detected Detection Rate

No. Adequate Stool

Stool Adequacy rate (%)

1997 19 11 0.6 0 0

1998  19 14 0.7 2 14

1999 20 14 0.8 3 19

2000 21 29 1.4 12 41

2001 24 18 0.8 9 50

2002 25 28 1.1 25 89

2003 25 15 0.54 14

35

UNDER 5 MORBIDITIES 2000-2002

INDICATOR

Limpopo National Average

2000 2001 2002 2001

Incidence

severe malnutrition under 5 years

0.84 per 1K 0.61 per 1K 0.56 per 1K

Diarrhoeal incidence

15.41

per 1K

16.20

per 1K

13.12

per 1K.

13.2 per 1K

Lower Respiratory Infections

3.87per 1K. 25.10

per 1K.

21.86

per 1K

7.1 per 1K

Source: DHIS

36

5 TOP NOTIFIABLE MEDICAL CONDITIONS 2000 -2002

86.290.6

100.6

65

213

141

5.6 3.1 1.9 2.7 1.6 1.1 1.7 3.8 1.65

0

50

100

150

200

250C

ases

per

100

000

pop

ulat

ion

TB Malaria Measles Viral Hepatitis Typhiod

2000 2001 2002

37

Environmental Health Related Conditions

ACHIEVEMENTS: 38 178 males enrolled for initiation. Of which 648 were

admitted to hospitals and one died. 465 cholera cases were reported with fatality rate of 0.4% Of the 813 villages with access to water supply, 200 of

them were monitored and found to have safe water supply (quality & quantity).

CONSTRAINTS: Poor water supply and sanitation

38

INTEGRATED NUTRITION PROGRAMME

NUTRITION PROGRAMME:– 68 of the 105 projects are sustainable.– 2747 schools are participating.– A total number of children qualifying for PSNP 1,173 million

and only 1,131 million benefiting from the programme.– 7 additional hospitals obtained BFHI status. A total of 21

hospitals obtain BFHI status.– Stunting decreased from 34.2%in 1994 to123.1% in 2001 – Wasting increased from 3.8% in 1994 to 7.5% 2001 – Underweight increased from 10.4% in 1994 to 15% in 2001

CONSTRAINTS: Logistical problems and management problem

39

Occupational Health Related Conditions

ACHIEVEMENTS:– 50% of hospitals have trained Occupational Health

Officers.

CONSTRAINTS:– Lack of training in the implementation of the

Occupational Health and Safety Act in the Workplace.

40

PHC SERVICES Accessibility & Availability of PHC

Services

ACHIEVEMENTS:– 24 hour services have increased from 183 to 233– 10 clinics increased hours of services from 8 hours to 12 hours – 142 care groups activated and 18 new care groups established.– PHC service delivery at social security paypoint has been started

in Vhembe and Mopani district.– PHC service delivery started in Prisons in the Vhembe districts.– Antenatal coverage is 77.5% and antenatal visits per client is 3.7

CONSTRAINTS: budget for security at clinics not available.

41

PHC UTILIZATION RATE BY DISTRICTS 2000 - 2002

0.68

1.43

1.71

1.28

1.531.67

2.27

2.76 2.77

1.13 1.161.12

2.612.82

3.29

1.521.67

1.9

0

0.5

1

1.5

2

2.5

3

3.5N

umbe

r of

vis

its

per

pers

on p

er y

ear

Bohlabela Capricorn Mopani Sekhukhune Vhembe Waterberg

2000 2001 2002

42

ANTENATAL VISITS PER ANTENATAL CLIENT BY DISTRICTS 2000-2002

3.9

3.73.6 3.6

43.8

3.5 3.5

3

2.7

3.83.9

4.4 4.44.2

33.2

3.4

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Bohlabela Capricorn Mopani Sekhukhune Vhembe Waterberg

2000 2001 2002

Source: DHIS

43

DHS Development & Devolution Support

Achievements; Devolution of PHC Services: Newly Demarcated District Re-alignment A Multi-Sectoral Task Team was established in July 2002 to develop a

Devolution Strategy for Limpopo Province Draft 1 of the Strategy is under consideration by Department of Health

& Welfare, Local Government & Housing and other key stakeholders. Plan A of the strategy deals with the transfer of EHS to district

Municipalities while Plan B contain measures to address delegations of PHC services to district council municipalities.

Draft services level agreements have been developed for signing with each municipality that will receive ‘devolved’ service functions.

Heads of Health district have been appointed and given delegated powers and functions

44

EMERGENCY MEDICAL SERVICES

Achievements: 3 New stations were opened Hospital Based staff have been taken over by EMS 118 posts have been filled at various stations and the 4

shift system is being implemented at stations with sufficient staff.

Constraints: Community misunderstandings of EMS Restructuring

Programme vs Community Expectations

45

PROGRAMME 3PROGRAMME 3Regional and Regional and

Specialised Hospital Specialised Hospital ServicesServices

46

Equitable access to Health Care Services

Polokwane /Mankweng complex has reduced referrals to Ga- Rankuwa by 25%.

Referrals into PMHC– 3271

Referrals out of PMHC– 418

47

HOSPITAL PERFORMANCE INDICATORS PER DISTRICT

DISTRICTS NO. BEDS

BOR ALOS NORMAL DEIVERY

RATE

LIVE BIRTH RATE

STILL BIRTH RATE

C/S RATE

Bohlabela 1061 65.9 6.6 89.4 79.6 2.3 9.8

Capricorn 2181 71.7 11.0 78.4 79.4 2.5 11.8

Mopani 1525 73.3 7.6 84.4 79.7 1.9 13.8

Sekhukhune

1171 54.5 5.7 78.7 96.8 3.1 11

Vhembe 1945 66.2 5.2 76 94.3 2.2 21.4

Waterberg

791 60.8 5.0 68.7 79.8 2.1 12.34

48

HOSPITAL PERFORMANCE INDICATORS BY LEVELS OF HOSPITALS

LEVELS NO. BEDS

BOR ALOS NORMAL DEIVERY

RATE

LIVE BIRTH RATE

STILL BIRTH RATE

C/S RATE

DISTRICT HOSPITALS

5136 60.8 5.5 86.7 79.4 2.5 12

REGIONAL HOSPITALS

1221 68.6 5.5 82.3 94.4 2 16.3

TERTIARY HOSPITALS

698 72.1 7.9 74.5 97.2 2.8 24.4

TOTAL 7055 66.6 6.9 85 96.8 2.4 13.7

49

PROGRAMME 4PROGRAMME 4Health SciencesHealth Sciences

50

HEALTH SCIENCES

AchievementsNURSING Level 1 training material for outcome based and

community based education developed. Total enrolment stand at 690.

Constraints Absence of Selection Criteria for Rural Schools

Recruitment

51

COLLEGE OF EMERGENCY CARE

Achievements: 60 of the 72 enrolled EMS Practitioners have completed

the course. 65 completed rescue technique course.

52

HR DEVELOPMENT AND PLANNING

ACHIEVEMENTS: A total of 515 new bursaries were awarded to

students in various health and medical related fields..

53

PROGRAMME 5PROGRAMME 5Health Care Support Health Care Support

ServicesServices

54

Improved access to medicine at all Health Facilities

Achievements: 90% of medicines is available at depot 85% of medicines available at Hospitals 75% medicines available at clinics 8 Hospitals have Therapeutic committees

55

PROGRAMME 6PROGRAMME 6Health Facilities Dev. Health Facilities Dev.

And Maint.And Maint.

56

PHYSICAL RESOURCES

ACHIEVEMENTS: 35 projects to the value of R139 million were completed at 20 hospitals and R2m spent on clinic water supply.

5 revitalisation hospitals: completed initial phase; Lebowakgomo 2nd phase almost completed.

Institutions have completed and already implementing their annual maintenance plans

CONSTRAINTS: Most physical facilities projects were put on hold due to budget cuts

Tendering process take too long resulting in projects not being completed in time

Clinic electrification has stopped since April 2002 due to lack of funds

57

Provisional expenditure Provisional expenditure and revenue 2002/03and revenue 2002/03

58

Expenditure 2002/03 per program

PROGRAMME BUDGET EXPEND BALANCE

R'000 R'000 R'000HEALTH ADMINISTRATION 187,098 182,808 4,290DISTRICT HEALTH SERVICES 1,680,421 1,710,523 -30,102REG & SPECIALISED HOSP SERV. 705,680 697,806 7,874HEALTH SCIENCES SERVICES 126,606 97,744 28,862HEALTH CARE SUP. SERVICES 220,376 222,872 -2,496HEALTH FACIL. DEV.& MAINT. 225,593 242,765 -17,172TOTAL 3,145,774 3,154,518 -8,744

It should be noted that all figures for 2002/03 as presented in this section should be considered provisional as the Department has had financial systems problems since the last week of March 2003.

59

CONDITIONAL GRANTSBUDGET EXPENDITURE VARIANCES BUDGET BUDGET BUDGET

FOR FOR FOR FOR FOR FORDISCRIPTIONS 2002/03 2002/03 2002/03 2003/04 2004/05 2005/06

1 5 3 4 6 7 8EXPENDITURE R'000 R'000 R'000 R'000 R'000 R'000

1. Intergrated Nutrition Prog 129,919 129,814 105 146,433 172,102 188,603

2. Nat'l Tertiary Serv. Grant 76,256 76,256 - 46,297 46,878 46,973

3. Training and Research 45,101 25,973 19,128 40,414 51,805 72,411

4. Hospital Rehabilitation Grant 126,821 126,821 - 96,239 106,463 110,722

5. HIV/AIDS 23,905 23,905 - 28,962 42,479 55,996

6. Improv. Financial Management10,451 6,145 4,306 13,337 15,388 17,457

7. Infrastructure 38,993 38,993 - 58,888 72,735 77,320

TOTAL EXPENDITURE 451,446 427,907 23,539 430,570 507,850 569,482

Note: The expenditure figures fof 02/03 are provisional as there have been financial systems problems since the last week of March 2003.

60

Revenue collected 2002/03 & MTEF budget

BUDGET COLLECTED VARIANCES BUDGET BUDGET BUDGETFOR FOR FOR FOR FOR FOR

DISCRIPTIONS 2002/03 2002/03 2002/03 2003/04 2004/05 2005/06provisional

1 2 3 4 6 7 8EXPENDITURE R'000 R'000 R'000 R'000 R'000 R'000

1. HOSPITAL FEES 45,334 45,472 138 48,054 50,937 53,993

2. OTHER SOURCES 11,656 11,963 307 13,215 14,037 14,683

TOTAL REVENUE 56,990 57,435 445 61,269 64,974 68,676

61

Financials for MTEFFinancials for MTEF

62

Equitable Share & Conditional Grants

2000/01 2001/02 2002/03 2003/04 2004/05 2005/06R' 000 Actual Actual Est.Actual Voted MTEF MTEF

Equitable share 2,255,678 2,430,365 2,694,328 2,982,002 3,276,814 3,530,876 Conditional grants 294,386 288,536 451,446 430,570 507,850 569,482 OtherTotal revenue 2,550,064 2,718,901 3,145,774 3,412,572 3,784,664 4,100,358

63

REVENUE ESTIMATES

BUDGET BUDGET BUDGET BUDGET BUDGETFOR FOR FOR FOR FOR

DISCRIPTIONS 2001/02 2002/03 2003/04 2004/05 2005/06

1 2 5 6 7 8EXPENDITURE R'000 R'000 R'000 R'000 R'000

1. HOSPITAL FEES 42,209 45,334 48,054 50,937 53,993

2. OTHER SOURCES 15,000 11,656 13,215 14,037 14,683

TOTAL REVENUE 57,209 56,990 61,269 64,974 68,676

64

Summary of Expenditure & Estimates 2000/01 - 2005/06

2000/01 2001/02 2002/03 2003/04 2004/05 2005/06R' 000 Actual Actual Est.Actual Voted MTEF MTEF

Health Administration 163,902 151,672 186,587 214,670 223,017 241,189District Health Services 1,348,946 1,412,655 1,643,634 1,826,524 2,038,227 2,210,002Emergency Medical Services 36,568 47,833 36,787 91,631 103,507 111,818Provincial Hospital Services 351,214 365,022 435,492 442,526 476,198 506,654Central Hospital Services 248,995 239,890 270,188 308,242 314,844 340,393Health Sciences and Training 73,617 77,063 126,606 126,383 143,945 173,076Health Care Support Services 158,925 176,237 220,376 254,585 309,459 328,878Health Facilities Management 141,240 192,681 225,593 200,500 234,956 254,837Statutory Payments 571 477 511 511 511 511Total 2,523,978 2,663,530 3,145,774 3,465,572 3,844,664 4,167,358

65

Summary of Expenditure & Estimates by Std Items 2000/01 – 2005/06

STD Items 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06R' 000 Actual Actual Est.Actual Voted MTEF MTEF

Personnel 1,594,931 1,737,624 1,945,218 2,086,508 2,270,434 2,442,695Administrative Expenditure 80,944 95,704 144,907 167,161 205,482 237,938Stores and Livestock 285,972 273,607 354,232 415,603 484,573 526,088Equipment Current 27,132 17,927 26,420 48,879 60,478 67,157Equipment Capital 85,204 40,271 73,794 89,017 77,484 85,240Land and Buildings: Current 0 4,466 9,991 8,640 8,975 9,705Land and Buildings: Capital 0 0 0 0 0 0Prof and Special Serv: Current 198,116 215,834 237,928 309,648 338,938 364,454Prof and Special Serv: Capital 140,891 184,603 217,574 190,210 224,668 243,823Transfer Payment Current 99,994 92,578 134,232 148,433 172,102 188,603Transfer Payment Capital 0 0 0 0 0 0Miscellaneous 10,794 916 1,478 1,473 1,531 1,655

0 0 0Total Current 2,297,883 2,438,656 2,854,406 3,186,345 3,542,513 3,838,295Total Capital 226,095 224,874 291,368 279,227 302,152 329,063

0 0 0TOTAL STANDARD ITEM CLASSIFICATION2,523,978 2,663,530 3,145,774 3,465,572 3,844,665 4,167,358

66

CONDITIONAL GRANTSBUDGET BUDGET BUDGET BUDGET BUDGET

FOR FOR FOR FOR FORDISCRIPTIONS 2001/02 2002/03 2003/04 2004/05 2005/06

1 2 3 4 5 6EXPENDITURE R'000 R'000 R'000 R'000 R'000

1. Intergrated Nutrition Prog 124,331 129,919 146,433 172,102 188,603

2. Nat'l Tertiary Serv. Grant 79,008 76,256 46,297 46,878 46,973

3. Training and Research 33,551 45,101 40,414 51,805 72,411

4. Hospital Rehabilitation Grant 88,000 126,821 96,239 106,463 110,722

5. HIV/AIDS 7,458 23,905 28,962 42,479 55,996

6. Improv. Financial Management 4,000 10,451 13,337 15,388 17,457

7. Infrastructure 38,993 58,888 72,735 77,320

TOTAL EXPENDITURE 336,348 451,446 430,570 507,850 569,482

Note: The expenditure figures fof 02/03 are provisional as there have been financial systems problems since the last week of March 2003.

67

Expend analysis 00/01 to 05/062000/01 2001/02 2002/03 2003/04 2004/05 2005/06

R' 000 Actual Actual Est.Actual Voted MTEF MTEFPers. Exp. 1,626,285 1,737,624 1,945,218 2,086,508 2,270,434 2,442,696% of budget: 64.43% 65.24% 61.84% 60.21% 59.05% 58.61%growth rate 6.85% 11.95% 7.26% 8.82% 7.59%Non-PE 897,693 925,906 1,200,556 1,379,064 1,574,230 1,724,662% of budget: 35.57% 34.76% 38.16% 39.79% 40.95% 41.39%growth rate 3.14% 29.66% 14.87% 14.15% 9.56%Cond. Grants 294,386 288,536 451,446 430,570 507,850 569,482

11.66% 10.83% 14.35% 12.42% 13.21% 13.67%Total 2,523,978 2,663,530 3,145,774 3,465,572 3,844,664 4,167,358growth rate 5.53% 18.11% 10.17% 10.94% 8.39%

The personnel expenditure as a % of the budget has been declining since 2000 (64.43% to 61.84% in 2002/3). The personnel numbers have declined over this period from 23,607 to 23,569.

68

Fiscal Equity IssuesThe Budget for DHS: increased from 49.2 % in 1996/97 to

52.3 % in 2002/03 (excl pharmac. & capex). With pharmac. & capex included this figure moves to 63.0%.

Population served by Public Sector:• By 1999, LP had 92.4 % people without Medical Aid Cover.

Per capita Health Expenditure:• LP is the lowest. In 2002/03 LP spent R586 per uninsured person, which was 27%

below the national average and about 1/3 of Gauteng’s R1580. (IGFR 2003) • Using constant 2002 prices the LP showed a decline from 1997/98

(R611/uninsured) to 2002/03(R586/uninsured) of 4.1%. • By 1997, LP was spending R24/person on medicines compared to the

National average of R42/person & currently LP spends R37.14/person which = 3 times less than that of Gauteng.

69

Fiscal Equity Issues

Percentage Growth of the Health Budget:• Has been consistently lower than national and provincial norm.

• In 02/03 the growth was 18.11% compared to the Provincial budget growth of 22.26%.

• The comparative figures for 03/04 budget growth are 10.17% for Health and 11.66% for the Province.

• The national average growth in Health budgets is 10.87% for 2003/04

• The department got 16,43 % of the provincial budget compared to Education’s 41,55 % in 02/03. In 03/04 the comparative figures are 16,21% vs 39,83%. The national averages for % of education budget are 36,7% (02/03) and 35,6% (03/04).

• 16.21% is less than the 19% national guideline and less than the national average of 22.3% (03/04) and 16.43% is less than the national average of 22.9% (02/03).

• Equity within the LP still needs to improve as demonstrated by the above Tables & notes.

70

HEALTH PRIORITIES HEALTH PRIORITIES 2003/042003/04

71

HEALTH PRIORITIES 2003/04

HIV/AIDS/STI CONTROL & MANAGEMENT: Introduction of VCT sites in private sectors Rollout of the PMTCT services in all remaining 319 clinics in

the province by end of 2003 To reach and train more of commercial sex workers. To establish Youth Information, Education and Counselling in all

border gates. Health Promotion Strategies

TB CONTROL & MANAGEMENT: Decreasing number of patients infected with both TB and HIV. Consider Stipends for DOTS supporters Accessibility of Laboratory services Capacity for Management MDR TB Strengthening & Consolidation of Care Groups

72

HEALTH PRIORITIES 2003/04

COMMUNICABLE DISEASE CONTROL: Polio Eradication by 2004 Strategy Expanded Programme on Immunisation Laboratory Services & Malaria Control

PHC SERVICES & DHS DEVELOPMENT: Devolution of Environmental Health & other PHC Services to District Municipalities Improve 24 Hour Services at Clinics Security at Clinics and Total Risk Management Capacity for Disaster Management Integrated Nutrition Programme Integrated Management of Childhood Illnesses (IMCI) Referral System Non- personal Health Programmes

73

HEALTH PRIORITIES 2003/04

EMERGENCY MEDICAL SERVICES: Decentralisation of EMS & Patients transport to rural settings

LOGISTICAL SUPPORT SERVICES: Adequate Medicines at Facilities. Better Mx. of Health Technologies & Assistive Devices Roll out Cost Centres Capacity for Strategic Planning & Policy Analysis Capacity for Financial & General Management Consolidation of Procurement policies Capacity for in-house Fleet Management Labour Relations, Litigations & Legislative Reforms Implementation of the remaining Health information system modules

74

HEALTH PRIORITIES 2003/04

INFRASTRUCTURE DEVELOPMENT: Focus on 5 revitalization hospitals Upgrading of 21 clinics Improve water, sanitation & electricity at clinics

75

FINANCIALS 2003/04 FINANCIALS 2003/04

WITH SERVICE IMPLICATIONS

76

HEALTH PRIORITIES 2003/04

HUMAN RESOURCE DEVELOPMENT: Consolidate Health Districts Organograms Consolidate a Departmental HR Plan Management of Bursaries Nursing and EMS Training Colleges PHC Nurse Training & Community Rehabilitation Workers

Training Professional Training & Development

HUMAN RESOURCE MANAGEMENT: Filling of Critical Posts & Retention of Staff Rural Staff Incentives Strategy Conditions of Service for Staff (2nd & 3rd Notch, etc.)

77

HEALTH PRIORITIES 2003/04

COMMUNICATION, COLLABORATION AND PARTICIPATION: The following PPP projects are envisaged - Phalaborwa hospital, Duiwelskloof hospital, Laundry & Boiler services and Renal Dialysis unit.        To conduct feasibility studies for possible Expansion of PPP

Initiatives. Quality Improvement & Management Corporate Communication & Media Liaison Transformation & Inter-governmental Relations & Gender Issues Health Promotion

TERTIARY SERVICES:REVENUE GENERATION:

78

PRIORITY BUDGET2002/03 2003/04

R’ 000 R’ 000HIV/AIDS/TB/STI & other communicable diseases 37,783 43,095       HIV/AIDS and TB 34,783 40,095       Communicable diseases 3,000 3,000District Health Services – Primary Health Care 1,638,741 1,852,524Emergency Medical Services 41,680 41,631Logistical support services (including pharmaceuticals,ambulances, Hospital Information Systems (HIS)

264,765 264,848

       Pharmaceuticals 220,376 220,459       Ambulance 15,000 15,000       HIS 29,389 29,389Infrastructure development (including hospital revitalisation, clinicupgrading and maintenance)

228,593 195,912

       Hospital Rehabilitation 126,821 96,140       Clinics 42,000 40,000       New Head Office and other 21,000 21,000       Maintenance 38,772 38,772Human Resources Management issues 3,957 3,957Human Resources Development 138,426 130,928       Training 11,820 11,820       Nursing Training Colleges 47,072 46,828       Ambulance Training Colleges 5,328 2,771       Bursaries 29,105 29,105       Professional Training and Research 45,101 40,404Communication, Collaboration and participation 1,814 1,814Tertiary Service Development 309,229 353,339Revenue generation 56,990 60,409

79

BUDGET ANALYSIS FOR 2003/04 - VOTE 7: HEALTH

Table 1: SUMMARY OF EXPENDITURE AND ESTIMATES

1999/00 2000/01 2001/02 2002/03 2003/04 DEVIATION DEVIATIONProgramme Actual Actual Actual Est. Actual Voted 02/03 vs 03/04 NOMINAL

R'000 R'000 R'000 R'000 R'000 R'000 %1. Health Administration 127,810 164,473 152,149 187,098 215,181 28,083 15.01%2. District Health services 1,220,434 1,348,946 1,412,655 1,643,634 1,826,524 182,890 11.13%3. Emergency Medical Services 29,029 36,568 47,833 36,787 91,631 54,844 149.08%4. Provincial Hospital Services 309,021 351,214 365,022 435,492 442,526 7,034 1.62%5. Central Hospital Services 205,131 248,995 239,890 270,188 308,242 38,054 14.08%6.Health Sciences and Training 58,896 73,617 77,063 126,606 126,383 -223 -0.18%7. Health Care Support Services 141,273 158,925 176,237 220,376 254,585 34,209 15.52%8.Health Facilities Management - 141,240 192,681 225,593 200,500 -25,093 -11.12%

- TOTAL 2,091,594 2,523,978 2,663,530 3,145,774 3,465,572 319,798 10.17%

80

BUDGET ANALYSIS FOR 2003/04 - VOTE 7: HEALTH

Table 2: SUMMARY OF ECONOMIC CLASSIFICATION1999/00 2000/01 2001/02 2002/03 2003/04 DEVIATION DEVIATIONActual Actual Actual Est. Actual Voted 02/03 vs 03/04 NOMINALR'000 R'000 R'000 R'000 R'000 R'000 %

CurrentPersonnel 1,505,003 1,626,285 1,737,624 1,845,779 2,086,508 240,729 13.04%Transfers 54,294 91,549 92,578 134,232 148,433 14,201 10.58%Other Current Expenditure 521,607 580,049 608,454 874,395 951,404 77,009 8.81%Sub-total: Current 2,080,904 2,297,883 2,438,656 2,854,406 3,186,345 331,939 11.63%Capital - - Acquisition of capital assets 138,426 226,095 224,874 291,368 279,227 -12,141 -4.17%Transfers Payments 1,208 - - - - 0Other Capital - - - - - 0Sub-total: Capital 139,634 226,095 224,874 291,368 279,227 -12,141

- 0Total : Economic Classification 2,091,594 2,523,978 2,663,530 3,145,774 3,465,572 319,798 10.17%

81

OVERVIEW OF BUDGET 2003/04

As can be seen the nominal increase between 2002/03 adjusted estimates and 2003/04 is R319,8m. This equates to a 10% increase in the budget. The inflation for 2002 was also 10%. (CPIX figure provided by Statistics SA) There is therefore no growth in Health’s budget.

Besides the problem of no growth it should be remembered that health inflation(pharmaceuticals, surgical supplies, medical equipment, etc.) is always more than general inflation, resulting in less services to the community. The main reason why health inflation is so high is due to the fact that most of these items are imported.

The per capita expenditure on Health in this Province is the lowest in the country (IGFR 2001). With a no growth budget this situation is unlikely to change. The implications of this are that the people of this Province will not be able to have the standard of Health care that they should have. The budget pressures section will expound on this issue.

82

Table 3: EVOLUTION OF EXPENDITURE OF BUDGET IN CONSTANT 2002/03 PRICES (R MILLION)

Expenditure 1995/96 (actual)

1997/98 (actual)

1998/99 (actual)

1999/00 (actual)

2000/01 (actual)

2001/02 (actual)

2002/03 (estimate)

Average annual change

2003/04 (budget

estimate)

Total 2,841 2,827 2,578 2,939 2,931 3,145 61 3,251

% growth -0.49% -8.80% 13.98% -0.25% 7.29% 2.05% 3.38%

Total per person in rands 564.14 544.90 482.42 533.80 516.85 538.29 -5.17 540.19

Total per uninsured person

in rands 610.54 589.72 528.39 584.67 566.11 589.59 -4.19 591.67

As can be seen from the table there has been a slight real growth of 2% over the years. This has been due to the above inflation increase of personnel expenditure. This is less than the population growth. As a result the provincial per capita health expenditure has decreased annually by about R5. This again is an indicator that despite the province being the lowest funded per capita in the country the situation is unlikely to improve unless the funding situation improves.

83

BUDGET PRESSURES FOR 2003/04

  The indicative budget for 2003/04 according to GFS 2002/03

was R3,109,083,000. The final budget allocated for 2003/04 is R3,465,572,000. The increase is R356,489,000.

The following table shows the allocation of this additional money.

Following the table there will be some more detailed explanations of the service implications of the lack of sufficient budget.

84

Table 4: ALLOCATION OF FUNDS FOR BUDGET PRESSURES 2003/04

  

REQUESTALLOCATEDEVIATIONPRIORITY 2003/04 2003/04 2003/04

R'000 R'000 R'000HR MANAGEMENT PERSONNEL 285,038 146,921 -138,117

& ALL PRIORITIES Leg & rank ; 48,000 19,000 -29,000(PR 1-7) 2nd & 3rd notches 33,306 -33,306

Rural incentives/critical posts 10,000 12,000 2,000Critical Posts 98,000 20,189 -77,811ICS 02/03 carry through 57,443 57,443 0Under budgeting(inflation adjustment) 38,289 38,289 0

NONPERSONNEL 286,000 209,568 -76,432

DHS (PR 2) Security serv. at clinics 69,000 32,000 -37,000DHS/RHS (PR 2, 4) Equipment 15,000 10,000 -5,000DHS/RHS ( PR 2, 4) Maintenance & repair 5,000 4,568 -432LOG SUPPORT (PR 7) Pharmaceuticals 66,000 82,000 16,000

R41m carry through 41,000 41,000 0 Increase per capita by R5 each year 25,000 41,000 16,000

DHS/TERTIARY (PR 1-8) Inflationary pressures(R22m carry through) 22,000 22,000 0EMS (PR 3) Vehicles-ambulances(full maintenance lease) 35,000 35,000 0EMS (PR 3) EMS 10,000 4,000 -6,000

New metro 4,000 4,000 0 EMS equipment 6,000 -6,000

INFRASTRUCTURE (PR 8) Capex clinics 40,000 20,000 -20,000INFRASTRUCTURE (PR 8) Capex hospitals(tertiary hospital) 24,000 -24,000

GRAND TOTAL: 571,038 356,489 -214,549

Note: DHS=District Health Services; RHS=Regional Hospital Services; EMS=Emergency Medical Services

85

BUDGET PRESSURES FOR 2003/04 (continued)

Human resource service implications (shortage of R138m) 

Health is a human resource intensive service. Due to the budget shortage there is inadequate money for filling most of the vacant critical posts. This will make it difficult to improve service delivery at the clinics. As a result the best scenario will be the maintenance of existing services.

Security service implications at clinics (shortage of R37m)

Security at the clinics can not be improved everywhere. Clinics with no adequate security will not be able to provide 24 hour services. The lack of security will also have a detrimental effect on retention and recruitment of staff.

86

BUDGET PRESSURES FOR 2003/04 (continued)

EMS service implications (shortage of R6m & HR portion) 

Emergency Medical Services can not be expanded. The response time to very rural areas will therefore not be able to be improved. This will most likely result in some unnecessary deaths due to the fact that there is a golden hour in which to get emergency patients to a hospital for them to have a good prognosis.

Infrastructure service implications (shortage of R44m)

Infrastructure development cannot be fast tracked. It is well known that there are a large number of clinics with no water, no electricity, insufficient equipment and inadequate facilities. The development of the tertiary facilities will also be delayed. Maintenance of medical equipment will still be inadequate though better than 02/03.

87

Thank YouThank You